Culture and Treatment

Psychotherapy  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.) 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 Therapy

Culturally Competent Therapy (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 Therapies Mexico and Latin America Curanderism (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 Therapies (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 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 PSYCHOTHERAPY

Traditional 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 Psychotherapy  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 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 Outside 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 Outside 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

Summary  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 BEHAVIOR ACROSS DIVERSE CULTURES IN THE UNITED STATES

Psychotherapy with Diverse Cultures in 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 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 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 Treatment  Cause of mental disturbances attributed to evil spirits (for Latinos)  Mistrust and stigma (for all ethnic groups)

TREATMENT 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 SERVICES

 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 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 TO 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 CLINICAL TRAINING

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

CONCLUSION

 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