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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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.
- sexual orientation
- 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
- Some critics will argue that the categories of the DSM are
not directly useful for diagnosing individuals of different
- 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).
- What if the disorder really is the same, but it doesn’t look the
same because of culture?
Culture may influence manifestations of disorders.
- PTSD in Southeast Asians
- 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.
- APA requires its graduate programs to recognize the importance of diversity in the training and education they provide to their students.
UIUC, for example…
- As students, we want to receive training and education in the most effective therapeutic techniques and approaches.
- 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.
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.
- Many proponents of multiculturalism in psychotherapy will advocate for “ethnic matching.”
Does ethnic matching improve psychotherapy
What if ethnic matching is not possible?
It’s not easily defined, but what might it entail? What might it NOT entail?
- 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
- Don’t assume that a person’s cultural background tells you
- The behaviors displayed may not be considered maladaptive
or abnormal in the other culture.
- there may be a cultural explanation for the client’s
- 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.
- 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.
- 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).
- Be careful about what you think you know about a person
given their 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
- 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.
- If the client’s cultural background is salient, then it should
not be ignored.
- 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.).
- 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?