Critical Aspects of psychotherapy


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Critical Aspects of psychotherapy

• Multicultural Aspects of Therapy

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This lecture will consider

• Historical perspective
• counselling/psychotherapy in society today
• western theories
• non-western helping/healing
• bereavement

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Historical perspectives

• 1554 West Africans in London
• 1770 18000 black slaves
• 1851 727326 Irish immigrants
• 1880 60000 Jewish immigrants
• 1947 120000 Polish immigrants
• Commonwealth
• Vietnamese Eastern European

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Counselling/psychotherapy today

• Listening
• empathy
• caring
• training
• professional bodies (BPS BACP)
• Relate Samaritans Drugline Childline

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Western theories

• Philosophy
• medicine
• psychiatry
• psychology
• counselling/psychotherapy
• Freud Jung Adler Klein Beck Ellis
  Meichenbaum Rogers Maslow

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Non-western helping/healing

• Religion/philosophies
• alternative/complimentary therapies
• beliefs/attitudes/practices

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Religions/philosophies

• Judeo-Christian
• Islam
• Hindu
• Buddhist
• Sikh
• Rastafarian
• Pagan

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Alternative/complimentary

• Reflexology
• osteopathy
• chiropractic
• aromatherapy
• Reiki
• Iridology
• shiatsu

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Alternative/complimentary (2)

• Chinese Traditional Medicine
• acupuncture
• herbs
• astrology
• Feng Shui

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Beliefs/attitudes/practices

• Gender
• pain
• diet/nutrition
• rituals
• normal/abnormal

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culture

• Many definitions shared social-psychological
  nexus of beliefs and values which provides
  guidelines for ones actions and gives meaning to
  their actions
• Sharma (1996)
• transcultural therapy-relationship/process in
  which therapist/client belong to different
  cultures (ibid)

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Mental illness culture

• culture implicitly and explicitly defines social
  psychological reality Sohan 1996
• therefore is behaviour acceptable/unacceptable
• Marsella 1985 states that cultures vary in their
  perceptions of reality
• non-western groups- mystical states
  depersonalisation visions deviant belief more
  tolerated

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Cultural definitions

• Unacceptable/deviant behaviours may be due to
• genetics/biochemical imbalance
• supernatural
• deficient diet
• socio-economic conditions

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Culture therapy

• Interventions may in some way be suggested by the
  culture
• immoral behaviour-church attendance
• sorcery/evil spirits-certain individuals
  responsible for therapeutic role

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stigma

• Kleumann 1977 mental illness great stigma for the
  chinese
• Rock 1982 British females emotions then
  somatic symptoms
• Indian/Pakistani females somatization

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Bereavement

• Arie 1981 death treated with indifference in
  ancient times
• emotional reactions increased in the 17th century
• control of emotional displays
• 1800 death seen as peaceful and pleasant

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Western death customs

• Death customs in the western worlds emphasize
  denial
• mourning customs no-longer upheld
• no pause to ark the death of a person
• life carries on
• efforts to deny death are not working
• hopes and miracles pursued

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Life above death

• Person who is dying is expected to be as cheerful
  as possible and involved in life
• this gets carried over into the mourning
  process-there is no set ritual
• mourn.but not for too long

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Is grief normal

• Grief Worder 1991 normal reaction to loss
• mourning process is the process grieving person
  goes through
• bereavement is adaptation to loss
• mourning is a cultural response to grief

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• 1917 Freud stated grief was not pathological
  overcome after a time interfering with it was
  useless possibly harmful
• 1940 Klein mourner goes through a transitory
  manic/depressive state and overcomes it

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How do people cope

• Lindemann 1941 normal reaction to a distressing
  situation
• symptoms waves of physical distress lasting 20
  minutes to 1 hour
• SOB sighing empty feeling in stomach weakness
  tension poor appetite feelings of unreality
  withdrawal from others preoccupations with image
  of deceased

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• Thoughts of negligence anger guilt
• restlessness
• length of grief reaction is dependant upon a
  persons success in completing grief work
• Marris 1958 Widows in London inability to
  acknowledge loss
• Gorer 1965 n80 15/never forgot never get over
  loss

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• Parkes 1972 griefprice one pays for lovegrief
  and joy are both parts of life
• Lopata 1973 20 not over husbands death did
  not expect to get over it
• Glick Weiss Parkes 1974 men women respond
  differently men lost a part of themselves.
  Women felt abandoned

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• Bell 1971 older widows more problems than
  widowers
• women more financial hardships
• less opportunity to remarry
• loss of role of wife more important to them
  than that of husband for men

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1985 Obershaw myths of grieving

• Not something people get over
• people get through it by working at it
• not wait for time to heal
• doesnt think that people go through demarcated
  stages of grief
• no steady forward movement

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stages

• Pollock 1961 x 2
• Westberg 1973 x 10
• Engel 1961 x 6 shock disbelief developing
  awareness restitution resolving the loss
  idealisation the outcome

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Stages of dying

• Kuber-Ross 1969
• denial-it cant be happening to me
• bargaining just one more chance
• anger life is unfair
• depression it is hopeless
• acceptance peace readiness to move one

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Briese Farra 1984

• Grief theory based on phases is misleading
• no-one goes through them sequentially
• proposed alternate way more acceptable to men
  less emphasis on emotions
• based on life components
• self others work community transcendence
• dependent on stresses/responsibilities/priorities
• invest more in some components

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