Taking culture into consideration during therapy!

Sep 17, 2011   //   by Richard Figueira   //   Blog, East Providence, Lincoln, Rhode Island, Mental Health, cranston  //  No Comments

Multicultural Considerations in Therapy

Clinicians face an interesting task when diagnosing and treating a minority client especially when considering the clients cultural upbringing. The clinicians at Anchor Counseling Center express cultural acuity in their dedication to assisting all people despite race, gender, socioeconomic status, or sexual orientation.  Culture may be defined as “the quality in a person or society that arises from a concern for what is regarded as excellent in arts, letters, manners, education, religion, etc. (Webster’s Heritage Dictionary). A more common definition of culture is “the behaviors and beliefs characteristic of a particular social, ethnic, or age group.” Generally, culture is not measured effectively. For the most part it is measured by broad inquiries such as “what’s your religion, what is your socioeconomic status, and what is your race/ethnicity?” Questions of culture usually go no deeper than that, rendering the assessment inaccurate.

The only way to assess another’s culture with semblance of accuracy is to dig a little deeper, or rather, ask more in-depth questions (done in person is even better).  Questions may include: “1) What were your parents like? 2) How were you raised 3) Did you grow up with a certain belief system/has it changed? 4) What would you consider your socioeconomic status? 5) What ethnicity do you most associate with/why? 6) What is traditional and/or important to you?” These questions actually allow the clinician to get a snapshot of another’s life and/or thought process.  The more specific questions give a basis for understanding the individuals culture, as some aspects of their culture may not follow “culture-specific or culture-general belief systems” (Lopez, 2006 p. 16).

The cultural competence model proposed by Steve Lopez is a “model of cultural competence derived from research and clinical practice to serve as a guide in providing culturally appropriate mental health services for culturally diverse clientele” (23). His model recognizes that clients and clinicians have their own culture-specific perspectives. A culturally competent therapist is capable of moving (and deriving meaning) between the two different perspectives to form a beneficial treatment plan.  Lopez suggests that the cultural perspective operates in four different clinical domains: engagement, assessment, theory, and method.  Regarding engagement, “a culturally competent therapist is able to understand what the client views as the problem and what the client wishes to gain from therapy.”  Basically, the therapist gains understanding as to how the client perceives his/her issue. The client perceives the therapist as understanding his/her circumstance and the therapist has the job of assessing potential theoretical issues, diagnostic formulations and historical factors ( Lopez, 1997, 576).

The assessment dimension is really just the idea that when conducting formal or informal assessment procedures, the culturally competent therapist will consider mainstream cultural-specific norms and the norms specific to the client’s culture (577). And even though the DSM-IV offers clinicians the appendix of culture-bound syndromes, the appendix is limited in its applicability in relation to the numerous cultural differences that exist in America.  This acknowledgement of existing differences between mainstream and individual cultural norms helps to eliminate over-pathologizing or minimizing causation/diagnoses.  The third domain is theory, which generally explains the clients psychological functioning and how therapy works to change the behavior (579). Culturally competent clinicians recognize that clients may hold differing theoretical models which may be rooted in his/her culture. Assessing what the client believes to be the problem and ways the problem is maintained by his/her culture is beneficial. The idea is that the therapist integrates the client’s explanations with the theoretical model in order to get some positive effect. The last domain is the Methods, or procedures by which the clinicians use to facilitate change in their client (582). This is basically means that clinicians fit the method of treatment to what the client believes is helpful, or believes can work.  For example, if I am a patient with depression but my culture forbids drug therapy the therapist would direct me to alternative methods of treatment such as an exercise plan or maybe meditation etc., something I think is acceptable and will work.  Also, it is important that clinicians learn about culturally syntonic treatment methods for their clients in order to influence, or persuade them to try a method different than what they “know” (582).

There are several ways students and professionals can further their own degree of cultural competence.  The main idea that I came up with is to embark on a mission of self-discovery.  By this I mean an in-depth study of your life, perceptions and how others and how you think others may perceive you. Research your likes and dislikes about how you were raised and if you still hold similar beliefs or if they have changed. Only once we can somewhat understand our own cultures can we begin to try and see things form another perspective. It’s hard to imagine that we can try and know someone else if we don’t sort-of know ourselves.  Also understanding our own privileges can help put into perspective others who don’t have those privileges. Keep an open-mind and be aware of our own biases and stereotypes. Making the assumption that every client you meet is different from you helps eliminate biases and other assumptions you might make based on what you think you know.  I am also a firm believer in just getting out there and experiencing a different culture, being uncomfortable for five minutes won’t necessarily kill you.  Another means to become competent is to ask questions, if you truly don’t know, just ask. Most people would rather that you ask ‘with foot in mouth,’ as opposed to you operating on assumption.  It seems humiliating, but I have been on the receiving end of some ‘foot in mouth’ comments and most of the time it is a humorous experience as you know that the other person knows that he/she just said something really off the wall. I would recommend that we just try and remain humble beings and learn from one another. So whatever your race, gender, belief, background, or sexual orientation, we are here to assist you and your needs.  In helping individuals, children and families, the Anchor Counseling Center is always open to learning new things from the people we serve.

References

* Lopez, S. R. (1991).  Cultural sensitivity in clinical practice:  A process model.  California Psychologist, 24, pp. 14;23.

* Lopez, S. R. (1997). Cultural competence in psychotherapy: A guide for clinicians and their supervisors. In C. E. Watkins, (Ed.), Handbook of psychotherapy supervision, (pp. 570–588). New York: Wiley.

* Lopez, S. R., & GUARNACCIA, P. J. (2000). Cultural psychopathology: Uncovering the social world

of mental illness. Annual Review of Psychology, 51, 571–598.

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