Culture and TreatmentCulture and Treatment

PsychotherapyPsychotherapy

Traditional Psychotherapy Sigmund Freud Centered on unconscious (repressed) memories

of traumatic experiences, usually from early childhood.

Contemporary Psychotherapy Cognitive and Cognitive-Behavioral Therapies

(CBT) Cognitive therapy focus: examining the rationality

or validity of one’s beliefs

Psychotherapy (cont.)Psychotherapy (cont.)

CBT (cont.) What a person believes is more important than

what the person thinks or sees. Cognitive “behavioral”: the development of

strategies for changing behavioral routines and teaching cognitive skills.

Challenges Few studies include minorities, one cannot

say that psychotherapy is effective across groups

Political correctness drove early approaches Treatments should be modified to include

worldviews and experiences of culturally diverse clients (Sue et al). For instance, psychoanalytic approaches

indicate that problems are derived from unconscious conflicts, whereas other cultures may view the problem as stemming from physical problems or being out of harmony with the environment.

Culturally Competent TherapyCulturally Competent Therapy

Culturally Competent TherapyCulturally Competent Therapy(cont.)(cont.)

Blending Traditional and Non-Traditional A patient may need individual counseling but also

involving a culturally sanctioned treatment i.e. a Shaman (a healer linked to spiritual world) may be more beneficial.

Culturally Based TherapiesCulturally Based Therapies

Mexico and Latin AmericaCuranderism (Latino folk healing) is prevalent in

Mexico and through Latin American and South Western region of the U.S.

Therapies practiced by Curanderos start with herbs and culminate in spiritualism.

The blending of religion and treatment is common, and at the level of spiritualism, the forces of Good or Evil are brought in as well.

Culturally Based TherapiesCulturally Based Therapies(cont.)(cont.)

Malaysia Prayer and religion has been incorporated

China Using Taoist and Confucian principles, which

are embedded in psychotherapy (restricting self desires, learning how to be content, etc.)

Europe Group therapy has been incorporated

Beyond PsychotherapyBeyond Psychotherapy

Psychotherapy focuses on the individual Community Psychologists

Beyond traditional focus of the individual, to include an analysis at the community level Which requires a recognition of the

relationship between the individual and his or her daily interactions within diverse social settings.

Involving the community in treatment. Beneficial for immigrants and refugees.

CULTURE AND CULTURE AND PSYCHOTHERAPYPSYCHOTHERAPY

Traditional PsychotherapyTraditional Psychotherapy

Freud’s psychoanalytic model: through individual therapy sessions, therapists encourage patients to explore their memories and unconscious thoughts

Roger’s client-centered (Humanistic) approach to psychotherapy: emphasized client’s self-propelled growth. All about taking control

Obviously, traditional psychotherapy stems from and is bound by a uniquely Western cultural perspective

Cultural Limitations of Contemporary Cultural Limitations of Contemporary PsychotherapyPsychotherapy

Cognitive therapy: focused on examining rationality or validity of one’s beliefs

Cognitive-behavioral therapies:emphasize development of strategies for teaching cognitive skills

Psychotherapy a is a distinctively Western approach in all respects, from the 50-minute hour to the fee structure.

Cultural Limitations of PsychotherapyCultural Limitations of Psychotherapy

Approaches to treatment are bound to cultural norms, values, and beliefs

Traditional and contemporary psychotherapy focuses on the individual

Other cultures might find this focus on self uncomfortable and believe dwelling on unpleasant thoughts should be avoided

Psychotherapy in Cultures Psychotherapy in Cultures Outside the United StatesOutside the United States

Like other Western concepts, psychotherapy has been exported to other parts of the world; incorporated essential elements of their culture to make psychotherapy useful

ex) In Malaysia, religion incorporated into psychotherapy

ex) In China, Taoists and Confucian principles incorporated into psychotherapy

Psychotherapy in Cultures Psychotherapy in Cultures Outside the United StatesOutside the United States

Group psychotherapy has also been exported to countries outside the US and Europe, including the Middle East but not without difficulties.

Several problems arise when conducting group therapy in Arab cultures

SummarySummary

Certainly, the usefulness, let alone effectiveness, of treating with psychotherapy individuals who are not from the West has not yet been well established

Need to evaluate efficacy of treatments

TREATMENT OF ABNORMAL TREATMENT OF ABNORMAL BEHAVIOR ACROSS DIVERSE BEHAVIOR ACROSS DIVERSE

CULTURES IN THE UNITED CULTURES IN THE UNITED STATESSTATES

Psychotherapy with Diverse Cultures Psychotherapy with Diverse Cultures in the United Statesin the United States

Only few studies examining effectiveness of psychotherapy for people of diverse cultural backgrounds

Those studies report conflicting results; therefore premature to arrive at definitive conclusion

Researchers and practitioners advocate for infusion of cultural elements for successful treatment

Seeking TreatmentSeeking Treatment

Asian American and Native American adults and adolescents report lower rates of utilization of mental health services, higher dropout rates, and poorer treatment outcomes than European Americans and African Americans

Some evidence suggests the use of ethnic-specific mental health services leads to better outcomes

Barriers to Seeking TreatmentBarriers to Seeking Treatment

Reasons for underutilization of mental health services Shame, loss of face, active avoidance of morbid

thoughts, attributions of causes of mental illness to biological factors, and fear of a system not set up to deal well with cultural differences (for Asian Americans)

Individuals encouraged to rely on own willpower to confront problems (for African Americans)

Cultural belief that sickness comes from disharmony with self, community, and nature (for Native Americans)

Barriers to Seeking TreatmentBarriers to Seeking Treatment

Cause of mental disturbances attributed to evil spirits (for Latinos)

Mistrust and stigma (for all ethnic groups)

TREATMENT ISSUESTREATMENT ISSUES

Issues to consider when treating ethnic minorities Understanding culturally different ways of

thinking about illness and expressing thoughts about illness

Correct interpretation of nonverbal communication

Taking into account how cultures vary on importance of hierarchy in interpersonal relationships

Treatment expectations Recognizing role of extended families in many

cultures

CULTURALLY COMPETENT CULTURALLY COMPETENT SERVICESSERVICES

Treatment methods should be modified to improve their fit with the worldviews and experiences of culturally diverse clients

Acculturation status and ethnic identity may be important determinants of client response to treatment (more than simple ethnic similarity)

Clinicians sensitive to client’s cultural background and who take the time and effort to understand the client within his/her cultural context is beneficial

According to Sue and Sue, a culturally sensitive therapist will have acquired:

(1) Knowledge of diverse culture and lifestyles

(2) Skill and comfort in using innovative treatment methods

(3) Actual experience working with culturally diverse clients

Therapist should also be aware of his/her own cultural background and its influences on definitions and perceptions of abnormal behavior

INDIGENOUS HEALINGINDIGENOUS HEALING

Indigenous healing encompasses therapeutic beliefs and practices that are rooted within a given culture

Many indigenous treatments are rooted in religion and spirituality; they rely heavily on family and community networks

Many countries merge aspects of traditional psychotherapy with culture-specific methods and beliefs to produce unique systems of healing

Culture-specific systems of treatment all share the characteristic of mobilizing healing forces within the client, but cultures differ in the exact ways in which the mobilization of healing forces occur

AN ALTERNATIVE APPROACH AN ALTERNATIVE APPROACH TO TREATMENTTO TREATMENT

Community psychologists analyze mental health at the community level

Community-based treatments may especially relevant for helping immigrants, refugees, and those from developing countries

CULTURE AND CULTURE AND CLINICAL TRAININGCLINICAL TRAINING

All accredited clinical programs of clinical training in the US mandated to incorporate culture and diversity in their training programs

CONCLUSIONCONCLUSION

Future research needs to explore the efficacy of different treatment approaches that address both etic and emic concerns, blending traditional and culture-specific methods in a comprehensive fashion