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Multicultural Perspectives on Psychotherapy. Where did we leave off?. Clinical Implications Should we focus on race, class, and culture in therapy? The two “good” arguments NOT to: 1. We are all fundamentally the same.

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Multicultural Perspectives on Psychotherapy

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Multicultural perspectives on psychotherapy

Multicultural Perspectiveson Psychotherapy

Where did we leave off

Where did we leave off?

  • Clinical Implications

    Should we focus on race, class, and culture in therapy?

    The two “good” arguments NOT to:

    1. We are all fundamentally the same.

    2. Each of us is a unique person with unique life experiences.

Multicultural perspectives on psychotherapy

  • Researchers and practitioners who advocate for the opposite stance – that focusing on class, race, and culture is necessary – cite a broad range of reasons to support their claims.

  • So… let’s consider some of them…

What do we mean by culture

What do we mean by “culture”?

  • Culture is the traditions, beliefs, and values which are present in and passed down among members of a certain group.

  • Sources of culture can include:

    - race

    - ethnicity

    - sexual orientation

    - gender

Issue 1 accurate assessment diagnosis

Issue #1: Accurate Assessment& Diagnosis

  • The DSM – IV

    - Uses discrete categories to classify disorders according to the presence of certain symptoms.

    Does our classification system work across cultural groups?

    - Research/clinical observation used to produce the

    categories come from populations that were

    predominantly White.

    - Some critics will argue that the categories of the DSM are

    not directly useful for diagnosing individuals of different

    cultural backgrounds.

Issue 1 accurate assessment diagnosis1

Issue #1: Accurate Assessment& Diagnosis

  • The DSM acknowledges the existence of “culture-bound” syndromes…

    - The “culture-bound” disorders mentioned by the DSM are relegated to an appendix, and relatively little consideration is given to cultural differences throughout the rest of the book.

    - This implies that the disorders in the regular sections of the DSM are universal (i.e. not culture-bound).

Issue 1 accurate assessment diagnosis2

Issue #1: Accurate Assessment& Diagnosis

  • The same disorder, different presenting problems

    - What if the disorder really is the same, but it doesn’t look the

    same because of culture?

     Culture may influence manifestations of disorders.

    - Depression

     Dhat

     Hwa-byung

    - PTSD in Southeast Asians

Issue 1 accurate assessment diagnosis3

Issue #1: Accurate Assessment& Diagnosis

  • Completely different disorders

    - It is possible that the disorders we see in the U.S. are only

    found in the U.S. because of our social norms and

    experiences, which are specific to the “American culture.”

    - Major Depressive Disorder prevalence rates.

    - Culture may influence what disorders we have altogether.

    - The disorders mentioned previously may really be


    - On the other hand, how can we know? We might be

    misdiagnosing or failing to recognize the disorders.

Issue 2 appropriate training

Issue #2: Appropriate Training

  • APA accreditation:

    - APA requires its graduate programs to recognize the importance of diversity in the training and education they provide to their students.

     UIUC, for example…

  • Coursework and Practica:

    - As students, we want to receive training and education in the most effective therapeutic techniques and approaches.

Issue 3 treatment research applicability

Issue #3: Treatment Research& Applicability

  • RCTs and ESTs:

    - RCTs tend to be performed on homogeneous populations – mostly White, middle class populations.

    - Yet, the population of ethnic minorities (for example) in the U.S. is approximately 30%, and it is expected to increase over the next few decades.

    - We have no evidence that our current treatments work specifically with these populations.

Issue 3 treatment research applicability1

Issue #3: Treatment Research& Applicability

  • It is important to note that this is not necessarily because

    researchers are purposefully excluding members of other races or ethnicities. But, for some reason, these populations are underrepresented in these studies.

     What does this mean for the generalizability of the

    findings of RCTs? How does that limit the treatments we

    consider to be ESTs?

    - We do know that these individuals underutilize services and drop out of therapy earlier in the process.

Issue 4 therapist characteristics

Issue #4: Therapist Characteristics

  • The majority of clinicians are White. They grew up in the U.S. And they are obviously well-educated and likely to be middle-class.

    - Many proponents of multiculturalism in psychotherapy will advocate for “ethnic matching.”

     Does ethnic matching improve psychotherapy


     What if ethnic matching is not possible?

Alright so i just gave you a bunch of problems now what do we do to fix them

Alright, so I just gave youa bunch of problems…Now, what do we do to fix them?

Cultural competency

Cultural Competency

  • What is Cultural Competency?

    It’s not easily defined, but what might it entail? What might it NOT entail?

Considerations about the therapist

Considerations about the Therapist

  • Be aware of your attitudes regarding culture.

    - S/he needs to consider the role that culture plays in his/her own


    - Consider how s/he perceives culture as an influence on

    individuals and society.

    - Be aware of a tendency to advocate for assimilation into

    American culture or maintenance of traditional cultural beliefs

    and practices.

  • Never make assumptions.

    - Don’t assume that a person’s cultural background tells you

    anything important.

Considerations about the therapist1

Considerations about the Therapist

  • Be cognizant of cultural explanations of phenomena.

    - The behaviors displayed may not be considered maladaptive

    or abnormal in the other culture.

    - there may be a cultural explanation for the client’s


  • Beware of oversimplified cultural explanations.

    - For example, the idea of collectivism vs. individualism is a broad dichotomy. In reality, these differences probably lie on a continuum…with not only variation between cultural groups but also within cultural groups.

Considerations about the therapist2

Considerations about the Therapist

  • Issues of Cultural Relativism

    - There may be times when the client’s culture seriously clashes with the values/beliefs of the therapist.

    - It is difficult to know what to do in these situations.

     Fowers & Richardson (1996) assert that the therapist can choose to reject the questionable behaviors of the other culture. However, this is contingent upon the therapist first having an accurate and complete perspective on the client’s culture.

  • How might we accomplish this?

Considerations about the client

Considerations about the Client

  • Traditional culture may only be a part of the client’s identity

    - A person’s identity is complex, and cannot be summed up

    simply by considering their culture of origin.

    - The individual may or may not be very connected with the

    traditions, beliefs, and values of the other culture.

    Acculturation: “the process of psychosocial change generated

    when a group or an individual comes into [continuous first-hand] contact w/ another culture and is, thus, affected by both adherence to traditional culture and exposure to a [new] culture” (Karlsson, 2005).

Considerations about the client1

Considerations about the Client

  • Each client is an individual, not a stereotype

    - Be careful about what you think you know about a person

    given their cultural background.

  • Be aware of the social experiences the client may have due to his/her cultural background

    - Society often places certain stigmas on people of differing

    cultures. It is important to recognize the impact that

    experiences of prejudice/discrimination may have on the


Considerations about the relationship

Considerations about the Relationship

  • Recognize that culture is there

    - Cultural differences between the therapist and the client can and do influence the relationship; however, these influences do not have to be negative.

    - Differences can be used as a catalyst for important and beneficial discussions regarding the client’s cultural experiences. They can educate both members of the relationship and breakdown stereotypes.

Considerations about the relationship1

Considerations about the Relationship

  • Address necessary cultural content

    - If the client’s cultural background is salient, then it should

    not be ignored.

  • Use culture in developing treatment

    - There may be strengths in the client’s cultural orientation that

    the client and therapist can use.

    - Alternatively, engaging others who are relevant to the person’s culture can enhance treatment (e.g. indigenous healers, church leaders, etc.).

Ok can we consider an example

Ok, can we consider an example?

  • Earlier in the course we saw Gina – an African American woman – interact with two White male therapists.

    - Would the therapists have been more effective in this particular case if they had paid more attention to Gina’s cultural identity and background?

    - If so, what might they do to display appropriate cultural competence?

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