1 / 38

EVIDENCE BASED PSYCHOTHERAPIES for BME PATIENT GROUPS

AGENDA. 1.Do they take ethnic /cultural differences into consideration?2.Are the major Psychotherapies effective for BME patient groups?. EVIDENCE BASE. CBT Randomised Controlled Clinical Trials PSYCHODYNAMIC PSYCHOTHERAPY Case Studies

orde
Download Presentation

EVIDENCE BASED PSYCHOTHERAPIES for BME PATIENT GROUPS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. EVIDENCE BASED PSYCHOTHERAPIES for BME PATIENT GROUPS Dr BEENA RAJKUMAR

    2. AGENDA 1.Do they take ethnic /cultural differences into consideration? 2.Are the major Psychotherapies effective for BME patient groups?

    3. EVIDENCE BASE CBT Randomised Controlled Clinical Trials PSYCHODYNAMIC PSYCHOTHERAPY Case Studies & Case Series Descriptive Observational Studies; Case Studies, Case series & Qualitative Studies.

    4. COGNITIVE BEHAVIOURAL THERAPY

    5. CBT Practice oriented research on CBT has historically focused on people from European American Identities . Dearth of empirically based studies involving people of minority cultures. ( Casa 1988,Renfrey 1992,Iwamasa & Smith 1996,Hall 2001).

    6. MULTI-CULTURAL THERAPY TRANS- CULTURAL COUNSELING STUDIES When culture is ignored: - Conflict in values - Client discomfort & poor engagement - Dropout increases - Treatment failure (Dana et al 2000;Pope Davis & Coleman 1997; Sue 2001)

    7. CR- CBT BECKIAN CBT MULTI CULTURAL THERAPY

    8. CBT- the 5 components THINKING BODILY BEHAVIOUR RESPONSES EMOTION

    9. CULTURALLY RESPONSIVE CBT C ENVIRONMENTAL PROBLEMS THINKING ( Cognition ) BODILY C BEHAVIOUR RESPONSES C EMOTION

    10. CULTURALLY RESPONSIVE-CBT Making therapy more “ appropriate” for people from ethnic minority backgrounds.

    11. Cultural – Responsive CBT Consider cultural influence of the 5 components of CBT. Taking stressors associated with immigration, social isolation and language barriers. Use culturally related strengths & supports to generate helpful thoughts & images. Giving ‘culturally congruent homework’.

    12. CURRENT EVIDENCE CR-CBT Depression ( * Miranda et al 2006; n=267;) ( Lara et al 2003; Dai et al 1999;Comas Diaz et al 1999) Panic Attacks (Hinton et al 2004; Carter et al 2003) PTSD (Otto et al 2003; Zoellner 1996* ; * Kubany et al 2003) GAD (Hinton et al 2005) Substance Misuse (Carroll et al 1998;* )

    13. CURRENT EVIDENCE Depression among HIV positive patients ( Markowitz et al 2000) Schizophrenia ( Rathod et al 2004)

    14. LIMITATIONS Non- Specific effects Influence of acculturation status untested Several confounding factors Low statistical power Diverse CRT’s Applicability in Britain

    15. THE WORLD-CR- CBT Africans in Africa Anderson 2009; Tobias Lundgren2009; Chinese in China Chan & Leung 2002; Chen & Davenport 2005) Indians in India Grover 2007;Joseph Raj 2008; Kurivilla 2002 Pakistani’s in Pakistan Naeem 2009

    16. CBT - CONCLUSIONS The emerging evidence to suggest CR –CBT is effective in treating patients from BME backgrounds.

    17. PSYCHODYNAMIC PSYCHOTHERAPY

    18. PSYCHODYNAMIC PSYCHOTHERAPY Similarities and Differences in the therapeutic relationship are source material for transference and counter-transference. (Bailey 2007) The race of the therapist and patient will affect the therapy. (Thomas1992)

    20. BME PATIENT – White therapist

    21. WHITE PATIENT- BME Therapist WHITE PATIENT BME Therapist Race Based Transference- Freud’s intrapsychic instinctual conflicts or Kleinian ideas of defensive projection of undesirable aspects of self on to the therapists. (Tan 1993) Complex psycho-social phenomenon that is driven by the pragmatics of power relations in the world. (Farhad Dalal 2007)

    23. WHITE THERAPIST- BME patient WHITE THERAPIST Fear – being perceived as ‘racist’. (Davids 1992) Fear – BME patient as ‘aggressive & lacking Insight’. (Holmes 1992) Guilty- about ‘white privilege. (Yi 1998 & Tang 2006) BME Patient

    24. BME THERAPIST- white patient BME THERAPIST

    25. BME Therapist –BME Patient BME Therapist

    26. ETHNIC -MATCHING No evidence to show that ethnic matching improves outcome (Holmes 1992) Advantage: More empathy & less negative counter-transference. Disadvantage: Over-identification with patients social situation resulting in reinforcement of patient’s pathology. It is not the race of the therapist but acknowledgement of race that is crucial to therapeutic outcome.

    27. Sense of ‘SELF’ Early trauma such as racial discrimination defensive splitting to protect the self from the painful feeling of being an outsider and consequently they may struggle to form an integrated sense of self . (Lijtmaer 2006) Belonging can secure the self and this secure development of self is the foundation from which identity is formed. (Bailey 2007)

    28. The Therapist- good practice Therapist need to be aware of racial blind spots through their own personal therapy, supervision. (Holmes 2006;Holt Garner 2003).

    29. CONCLUSION-PSYCHODYNAMIC PSYCHOTHERAPY When difference is central in therapy ,the therapist may need to take the initiative in interpreting this. If these issues are not explored therapy may be unsuccessful.

    30. SYSTEMIC FAMILY THERAPY

    31. SYSTEMIC FAMILY THERAPY Culture is a key aspect of family therapy. Considerations of culture (Kluckhohn,1958;Kluckhohn & Strodbeck, 1961;Speigel,1971;) Culture Sensitive approaches & interventions (McGoldrick,1982) In USA –ethnicity focused articles –(1984-1997)- 16%

    32. STRUCTURAL FAMILY THERAPY Families of The Slums – (Salvador Minuchin et al 1967) Applications to Multicultural Family Systems. (Naverre et al 1998) - Chinese & Vietnamese families. - Hispanic families.

    33. BRIEF STRATEGIC FAMILY THERAPY (BSFT) Hispanic Adolescents – behavioural problems. (Santisteban et al 2006)

    34. POST-MODERN APPROACHES ‘Fresh start for families’ (Fraenkel,2006)

    35. CULTURE SPECIFIC MODELS African- American Families- A Multisystems Approach

    36. IN BRITAIN………………. Constructing ‘the family’ across culture. (Renee Singh 2009) Culturally sensitive therapy. (Pakes 2007) A tale of 3 cultures . (Burnham 2002) Transcultural family therapy (Lau 1984)

    37. NICE GUIDELINES….. SCHIZOPHRENIA – Culturally Informed, Family Focused Treatment for Schizophrenia (Weisman2006)

    38. SYSTEMIC FAMILY THERAPY CONCLUSION Culture sensitivity has become integral part of family therapy.

    39. COMMON THEMES & CONCLUSION Research : Increasing evidence to show that cultural adaptation of mean stream psychotherapies work for people from BME backgrounds. Therapists: It is not the colour of the therapist but the willingness to consider culture, flexibility to adapt therapy to make therapy culturally-specific & self-reflexivity about ones own cultural views .

More Related