CULTURAL ADAPTATION OF PSYCHOTHERAPY . Guillermo Bernal, Ph.D. University of Puerto Rico. Race, Ethnicity, and Mental Health : Treatment Innovations and Cultural Adaptations of Evidence-based Interventions- 13 th Annual Conference: Miami, Florida May 1, 2009.
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Guillermo Bernal, Ph.D.
University of Puerto Rico
Race, Ethnicity, and Mental Health : Treatment Innovations and Cultural Adaptations of Evidence-based Interventions- 13th Annual Conference: Miami, Florida May 1, 2009.
Work on this presentation was supported in part by NIH Research Grant R01-MH67893 funded by the NIMH, Division of Service & Intervention Research.
Procrustean Fit – Early example (fitting person to the model)
The systematic modification of an EBT or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meanings, and values.
(Bernal, Jiménez-Chafey, & Domenech Rodríguez, in press)
(Kendall & Beidas, 2007)
(Hall, 2001; Sue, Bingham, Porche-Burke, & Vásquez, 1999; Trimble & Mohatt, 2002)
(Bernal & Scharrón-del Río, 2001)
(Alegría & McGuire, 2003)
PRINCIPLE E: RESPECT FOR PEOPLE’S
RIGHTS AND DIGNITY
… Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.
(d = .44)
(d = .51) versus treatment as usual (d = .22)
Adaptation systematically guided by two types of evidence:
∙ Case study
Culturally adapted CBT used to successfully treat school phobia in 12-year-old Chinese American males who experienced “drop attacks” when confronted with school situations
∙ Somatic symptoms are a more culturally appropriate expression of anxiety in Chinese culture (less stigmatizing) and serve as an escape behavior when confronted with certain stressors (i.e., teasing).
∙ Pycho-educational information was presented using a cultural bridging technique to link Asian cartoon culture with Chinese culture and the connection between emotions and somatic experiences.
(Hwang, Wood, Lin, & Cheung, 2006)
“Ethnicity should not be treated as a nuisance variable. Understanding ethnic differences is not only helpful to ethnic groups, it is good for science. The United States is one of the most diverse societies in the world. Why not take advantage of that fact by promoting external validity and by testing the generality of theories?” (Sue, 1999)
Alegria, M., & McGuire, T. (2003). Rethinking a universal framework in the psychiatric symptom-disorder relationship. Journal of Health and Social Behavior, 44(3), 257-274.
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Bernal, G., Domenech Rodriguez, M. (2009). Advances in Latino Family Research: Cultural Adaptations of Evidence-Based Interventions. Family Process, 48, 2,169-178.
Bernal,G., Jiménez-Chafey, Domenech Rodríguez, M. (in press) Cultural Adaptation of Evidence-based Treatments for Ethno-cultural Youth, Professional Psychology: Research and Practice.
Domenech-Rodríguez, M., & Weiling, E. (2004). Developing culturally appropriate, Evidence-Based Treatments for interventions with ethnic minority populations. In M. Rastogin & E. Weiling (Eds.), Voices of Color: First person accounts of ethnic minority therapists. (pp. 313-333). Thousand Oaks: Sage Publications.
Domenech Rodríguez, M. Oldham, & Baumann, (in press). Cultural adaptation of an empirically supported intervention: From theory to practice in a Latino/a community context, American Journal of Community Psychology.
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Hwang, W. (2006). The Psychotherapy Adaptation and Modification Framework: Application to Asian Americans. American Psychologist, 61, 702-715.
Hwang, W., Wood, J. J., Lin, K., & Cheung, F. (2006). Cognitive-Behavioral Therapy with Chinese Americans: Research, theory, and clinical practice. Cognitive and Behavioral Practice, 13, 293-303.
Lau, A. S. (2006). Making the case for selective and directed cultural adaptations of evidence-based treatments: Examples from parent training. Clinical Psychology: Science and Practice, 13, 295-310.
Matos, M., Torres, R., Santiago, R., Jurado, M., & Rodriguez, I. (2006). Adaptation of Parent-Child Interaction Therapy for Puerto Rican families: A preliminary study. Family Process, 45, 205-222.
Rosselló, J., & Bernal, G. (1999). The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Rican adolescents. Journal of Consulting and Clinical Psychology, 67, 734-745.
Rosselló, J., & Bernal, G. (2005). New Developments in Cognitive-Behavioral and Interpersonal Treatments for Depressed Puerto Rican Adolescents. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed.). (pp. 187-217). Washington, DC, US: American Psychological Association.
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