The Role of Culture in Treatment

Introduction A counselor who takes on etic perspective believes that disorders such as depression and the behaviors that come along with it occur the same way in every society and would not adapt therapeutic methods to meet the cultural needs of the patient A counselor who takes on an emic perspective believes that many factors come into play when diagnosing and treating a client and would adapt therapeutic methods to meet the cultural needs of a patient

What is the key difference between a counselor that takes an etic perspective versus a counselor that takes an emic perspective? The emic perspective believes that culture plays a significant role in both the diagnosis and treatment of a disorder The emic perspective believes that culture plays a key role in treatment but that diagnosis is universal The emic perspective believes that treatments for a disorder work regardless of culture The emic perspective believes that symptoms are universal

Kleinman (2004) Even if mental illness is universal, the way in which groups of symptoms are “confronted, discussed and managed varies among social worlds; cultural meanings and practices shape its course”

Addressing Culture and Treatment Use of Cross-Cultural Treatment (also known as intercultural counseling, multicultural counseling or culturally sensitive treatment) Use of Indigenous Psychotherapy (IP) which is embedded within a culture and carried out by someone who is sanctioned within the community to be therapist

Basic Principles To Consider When Developing Culturally Sensitive Treatment Western clinicians may need to consult with family members and local healers to recognize symptoms (Paniagua, 2013) We cannot assume that people across cultures label emotions such as anger and sadness the same way (Angel & Williams, 2013) Some groups do not value the independent view of the self that is part of western treatments (Angel & Williams, 2013) For Western psychologists, focusing on yourself, talking about yourself, talking about your feelings etc. are important; however, in other cultures, this approach may run exactly counter to what is considered constructive

Research Findings On Culturally Sensitive Treatments Mindfulness-based meditation therapy on anxiety and depression in Japanese patients undergoing anti-cancer treatment resulted in a significant decrease in both anxiety and depression (Ando et al, 2009) Chinese Taoist cognitive psychotherapy (CTCP) helped Chinese patients with GAD more than drugs or a combination of the two (Zhang et al, 2002)

Research Findings (cont) Interventions conducted in a client’s language were twice as effective as interventions conducted in English (Griner and Smith, 2006) Based on a meta-analysis of 76 studies, culturally sensitive therapy was found to be generally effective (Griner and Smith, 2006) Accommodating for culture-specific values (respect of hierarchal relationships, value of family members, importance of being polite) were particular effective with Hispanic patients (Kalibatseva and Leong, 2014)

Developing A Culturally Sensitive Treatment One of the frameworks used to develop a culturally sensitive approach to treatment is the Ecological Validity Framework developed by Bernal, Bonilla and Bellido (1995) which outlines eight areas that may adapted: Language- translation, jargon etc Ethnically similar persons- however, similarity of worldviews and attitudes between client and therapist may be important than ethnic similarity (Atkinson et al, 1984) Metaphors- expressing oneself in culturally relevant forms

Developing A Culturally Sensitive Treatment (cont) Concepts- beliefs about treatment are in line with the patient’s culture Goals- using the beliefs about treatment goals from the country of origin Method- adaptation of culturally appropriate methods of treatment Context- accounting for the changing context of patients including acculturation, country of origin and social support

Indigenous Psychotherapy IP treatments (indigenous healing) encompasses therapeutic beliefs and practices that are rooted within a given culture including, but not limited to: Reliance on family and community networks Incorporation of traditional, spiritual and/or religious beliefs (acupuncture, meditation, Yoga, burning incense, use of herbs etc) Use of shamans Indigenous Psychology (IP) may offer the best treatment for many (Sundararajan, Misra & Marsella, 2013) but are difficult to study since the practices are usually not open to outsiders

Example of Indigenous Healing Andrew Solomon: Notes on an Exorcism https://www.youtube.com/watch?v=-UBgBpFGODI&t=195s

Reflection In what ways was the therapy in Senegal similar to approaches that are used in Western society? What do you think about the comments made by the Rwandans to Andrew? What can you tell about the Rwandan culture from this conversation? About Western culture?

Barriers to Seeking Treatment Cognitive Barriers The way people think about treatment is influenced by culture. For example, African Americans may be encouraged to rely on their own willpower to confront problems, be self-reliant and to “tough-out” difficult situations (Snowden, 2001) Affective Barriers Many collectivistic cultures avoid seeking help in order to avoid the stigma and shame of being diagnosed with a mental illness. A study of Asian Americans identified stigma, suspiciousness and a lack of awareness about the availability of services as barriers to seeking treatment (Uba, 1994) Sociocultural Barriers The disclosure of personal problems or family dysfunction to strangers is highly discouraged in collectivistic cultures. A lack of awareness, financial constraints and low English proficiency are also barriers.