<p><strong>Background:</strong> The problem of enhancing validity in cross-cultural psychometric-test development in the field of clinical psychology has been perpetuated by several factors. Societal biases and value judgements, a positivistic paradigm, and challenges associated with multiculturalism continually spill over into cross-cultural research methodology. An overemphasis on quantitative methods and insufficient exploration of the meaning of the concepts to be measured tend to threaten construct validity. <strong></strong></p><p><strong>Objectives and Methods:</strong> This article tracks some of the progress in the field of clinical cross-cultural psychometric-test development – prior to and since the International Test Commission Guidelines, and including the complex South African situation – to give support to the perspective that previous cross-cultural research inadequately equips contemporary researchers to develop valid tests for multicultural clinical contexts.</p><p><strong>Results:</strong> A systems-informed paradigm shift is proposed, which involves the application of systemic concepts such as circularity, relationality, neutrality, and a concern with process issues. Ideally, multidisciplinary, multicultural test-developing teams that include members of the target-cultural group should consult and collaborate with the target groups before embarking on test-adaptation or test-development activities. Such teamwork would help to ensure that the meaning of the relevant concept/s is captured in a valid way for each cultural group. Furthermore, such collaboration should form a part of using qualitative research designs more frequently in clinical cross-cultural psychometric-test development.</p><p><strong>Conclusions:</strong> The emphasis should be on building theory and generating hypotheses, in order to pursue a deeper understanding of the constructs under investigation, and to advance theoretical developments in the field of clinical cross-cultural psychometric-test development.</p>