Title: Multicultural%20Theories%20of%20Psychotherapies
1Multicultural Theories of Psychotherapies
- Slides created by
- Barbara A. Cubic, Ph.D.Professor
- Eastern Virginia Medical School
- To accompany
- Current Psychotherapies 10
2Learning Objectives
- This presentation will focus on
- Overview of multicultural issues related to
psychotherapies - History of multicultural approaches
- Ways to integrate multicultural issues into
therapies - Research on multiculturalism
3Are Prevailing Therapies Relevant to the
Culturally Diverse?
- Most therapeutic orientations recognize
individual differences must be respected. - However, dominant models of psychotherapy tend to
be grounded in a monocultural perspective. - As such, they support mainstream cultural values
that neglect multicultural worldviews.
4Dominant Models of Psychotherapy
- May unintentionally promote ethnocentrism.
- The belief that ones worldview is inherently
superior and desirable to others.
5Terminology
- Culture is defined as an individuals total
environment. - Worldview refers to peoples systemized ideas and
beliefs about the universe. - Multicultural refers to the interaction between
people across a culture.
6Multicultural Psychotherapies
- Promote cultural sensitivity.
- Awareness, respect, and appreciation for cultural
diversity. - Believe definitions of health, illness, healing,
normality, and abnormality are culturally
embedded. - Promote empowerment and social justice and affirm
strengths.
7Multicultural Psychotherapies
Consider power differentials based on
- Race
- Gender
- Social class
- Sexual orientation
- Age
- Religion
- National origin
- Ability/disability
- Language
- Place of residence
- Ideology
- Membership in other marginalized groups
8Unity through diversity is a multicultural maxim.
9Basic Concepts
10Multiculturalism
- Acknowledges the presence of diverse worldviews.
- Views each culture as unique and dynamic, to be
understood within its own context. - Embodies cultural constructionism.
- A process whereby individuals construct their
world through social processes that contain
cultural symbols and metaphors.
11Worldviews
- Harry Triandis (1995)
- Classified worldviews according to how
individuals define themselves and relate to
others across an individualist-collective
spectrum. - Collectivistic Identity is associated with
relationships to others. - Denominated View themselves independently from
others.
12Multicultural Psychotherapists
- Work towards cultural competence, an individual.
- Becomes aware of their worldview.
- Examines their attitude towards cultural
differences. - Learns about different worldviews.
- Develops multicultural skills.
- Learns about ones position in relation to
societal power and privilege.
13Multicultural Guidelines
- Guidelines for Providers of Psychological
Services to Ethnic, Linguistic, and Culturally
Diverse Clients - Exhorted practitioners to
- Recognize cultural diversity.
- Understand central role culture, ethnicity, and
race play in culturally diverse individuals. - Appreciate the significant impact of
socioeconomic and political factors on mental
health. - Help clients understand their cultural
identification.
14Multicultural Guidelines
- Guidelines on Multicultural Education, Training,
Research, Practice, and Organizational Change - We are cultural beings.
- Value cultural sensitivity and awareness.
- Use multicultural constructs in education.
- Conduct culture-centered and ethical
psychological research with culturally diverse
individuals. - Use culturally appropriate skills.
- Implement organizational change process.
15Cultural Competence is a Lifelong Process
- Cross and colleagues (1989) identified a cultural
spectrum from - Destructiveness
- Incapability
- Blindness
- Pre-competence
- Competence
16Cultural Competence is a Lifelong Process
Destructiveness Incapability Blindness Pr
e-competence Competence
17Destructiveness
- Attitudes, policies, and practices are
destructive to cultures and individuals.
18Incapacity
- Racial superiority of the dominant group.
- Cultural blindness Belief that culture makes no
difference.
19Blindness
- Individuals believe that culture makes no
difference. - The values of the dominant culture are
universally applicable and beneficial.
20Cultural Pre-Competence
- Do not know exactly how to proceed.
21 Cultural Competence
- Possessing a set of knowledge, behaviors,
attitudes, skills, and policies needed to work
effectively in multicultural situations.
22Cultural Competence Guidelines for Organizations
- Therapists should
- Evaluate institutions mission statement to
include diversity. - Assess diversity policies.
- Evaluate how people of color perceive specific
policies. - Acknowledge within group diversity.
- Be aware that diversity requires examination.
- Recognize that multicultural sensitivity may mean
advocating.
23Multicultural Practitioners Can Help
Organizations Achieve Cultural Competence
- Include community representation and input at all
stages of implementation. - Integrate all organizational systems.
- Ensure changes made are manageable, measurable,
and sustainable. - Make the business case for cultural competency
polices. - Require commitment from leadership.
- Help establish staff training on an ongoing basis.
24Empowerment
- Racial micro-aggressions refer to assaults
individuals experience because of race, color,
and ethnicity. - Cultural trauma refers to a legacy of adversity,
pain, and suffering among many minority group
members. - Research has identified a human tendency to
categorize individuals into in- and out-group
members leading to unconscious biases.
25Empowerment Multicultural Psychotherapists
Subscribe To
- Reality is constructed into a context.
- Experience is valuable knowledge.
- Learning/healing results from sharing multiple
perspectives. - Learning/healing is anchored in meaningful and
relevant contexts.
26Empowerment
- Emphasis on empowerment frequently leads
psychotherapists to commit to social justice. - Psychotherapy will be unsuccessful if clients
feel that their therapist is unconsciously
racist, ethnocentric, sexist, elitist,
xenophobic, homophobic, etc.
27Multicultural Psychotherapies Underlying
Assumptions
- Culture is complex and dynamic.
- Every encounter is multicultural.
- Reality is constructed and embedded in context.
28Western Worldviews Dominanceof Mainstream
Psychotherapy
- Multicultural psychotherapies are relevant to all
individuals. - Cultural competence is crucial for effective
psychotherapy. - Multicultural psychotherapists engage in
self-awareness. - Healing
- Empowers individuals and groups.
- Involves multiple perspectives.
- Holistic and liberatory.
29Comparing Multicultural Approaches to Other
Therapy Systems
30Impact of Culture on Treatment Outcomes
- In contrast to European-Americans, African
Americans - Tend to drop out of CBT at a higher rate.
- Found treatment less positive after receiving
services even when they expressed positive
expectations initially.
31Culture Affects Psychotherapeutic Process
- Cultures impact is greater on therapy process
than outcome. - Personal/collective history is important in
people of colors lives. - Transcultural psychiatry and psychology advocate
for the use of community/indigenous resources. - Minority empowerment movements further the
development of multicultural psychotherapies.
32History of Multicultural Psychotherapies
33Multicultural Psychotherapies Interdisciplinary
Origins
- Early theoretical influences include
- Psychological anthropology
- Ethnopsychology
- Cultural anthropology
- Psychoanalytic anthropology
- Folk healing
34Evidenced Based Practices (EBP)
- EBP appear effective for a number of culturally
diverse populations.
35Paulo Freire (1973)
- Identified dominant models of education as
instruments of oppression. - Conscientization Critical consciousness as a
process of person and social liberation. - Involves questions of What? Why? How? For whom?
Against whom? By whom? In favor of whom? In favor
of what? To what end? - Helps oppressed individuals to author their own
reality.
36 Types of Therapy/Counseling Re-evaluation
Counseling (RC)
- An empowering co-counseling approach where two or
more individuals take turns listening to each
other without interruption. - Counselor encourages the client to discharge
emotions (catharsis). - Next, client becomes the counselor and
listens.
37Types of Therapy/CounselingFeminist Therapy
- Attempts to empower all people and promote
equality at individual, interpersonal,
institutional, national, and international
levels. - Women of Color feminist therapists address the
interactions between racism, sexism, classism,
heterosexism, ethnocentrism, ableism, and other
forms of oppression.
38Types of Therapy/CounselingEthnic Family Therapy
- Know their own culture.
- Avoid ethnocentric attitudes and behaviors.
- Achieve an insider status.
- Use intermediaries.
- Have selective disclosure.
- Often use cultural genograms.
39Current Status of Multicultural Psychotherapies
40Current Status Three Models
- Multicultural psychotherapists practice following
three models (or a combination thereof). - Cultural adaptation of dominant psychotherapy
41Current Status Three Models
- Ethnic psychotherapies
- Integrates cultural variables in treatment
through the examination of worldviews, cultural
transitions, relationships and context. - Based on a philosophical spiritual foundation
that promotes connective, ancestral and sacred
affiliations in healing.
42Current Status Three Models
- Ethnic psychotherapies (continued)
- Include approaches based on Eastern philosophical
traditions and narratives as a collectivistic way
of relating. - Testimonio Chronicles traumatic experiences in
Latin America. - Cuento therapy Empirically proven to be an
effective treatment for Puerto Rican children. - Dichos (sayings) Form of flash psychotherapy
that consists of Spanish proverbs or idiomatic
expressions capturing folk wisdom.
43Current Status Three Models
- Holistic approaches
- Folk healing is form of indigenous psychotherapy.
- Fosters empowerment, encourages liberation, and
promotes spiritual development.
44Current Status
- Several professional and academic organizations
have supported the development of multicultural
psychotherapies. - Publications on the topic include
- Cultural Diversity and Ethnic Minority Psychology
- Journal of Multicultural Counseling and
Development - Psychology of Women Quarterly
- Women and Therapy
458 Cultural Dimensions
Bernal, Bonilla and Bellido Eight Cultural Dimensions
Language Fits clients worldview. Persons Therapeutic relationship. Metaphors Shared concepts of a cultural group. Content Therapists cultural knowledge. Concepts Treatment concepts culturally consonant with clients context. Goals Objectives congruent with clients adaptive cultural values. Method Cultural adaptation and validation of methods and instruments. Context Clients environment, including history and sociopolitical circumstances. Language Fits clients worldview. Persons Therapeutic relationship. Metaphors Shared concepts of a cultural group. Content Therapists cultural knowledge. Concepts Treatment concepts culturally consonant with clients context. Goals Objectives congruent with clients adaptive cultural values. Method Cultural adaptation and validation of methods and instruments. Context Clients environment, including history and sociopolitical circumstances.
46Ricardo Munozs Suggestions for Culturally
Adapting CBT
- Involvement of culturally diverse people in the
development of interventions. - Inclusion of collectivisitic values.
- Attention to religion/spirituality.
- Relevance of acculturation.
- Acknowledgement of the effects of oppression.
47Pamela Hays (2001) Framework
A Age
D Developmental
D Disabilities (acquired)
R Religion
E Ethnicity
S Socioeconomic status
S Sexual orientation
I Indigenous heritage
N National origin
G Gender
48Culturally Sensitive Psychotherapy (CSP)
- Targets specific ethnocultural groups.
- A group may benefit from a specific intervention
more than from interventions designed for others.
49APA Multicultural Guidelines No. 5
- Encourages psychologists to strive to learn about
non-Western healing traditions and to acknowledge
and enlist the assistance of recognized helpers
and traditional healers in treatment.
50Other Approaches
- Carolyn Attneaves Network Therapy
- Community-based approach.
- Recreates the social context clans network to
mobilize a persons family and social support. - Ignacio Martin-Baros Psychology of Liberation
- Collaborative approach focused on assisting
oppressed clients in developing critical analysis
and engaging in transformative actions. - Resonates with African-American psychology as it
is based on Black liberation theology and
Africanist traditions.
51Theory of Personality
52Multicultural Clinicians Adhere to Diverse
Theories of Personality
- A unique contribution of multicultural
psychotherapy is the formulation of cultural
identity development theories. - View the self as an internal representation of
culture. - Ethnic and racial identity stage affects beliefs,
emotions, behaviors, attitudes, expectations, and
interpersonal style.
53Diverse Models of Identity Development Propose
Members of Groups Move Through Stages
Value Dominant Group/De-Value Own Group Value
Own Group/De-Value Dominant Group Integrate
Appreciation for Multiple Groups
54Ethnic Minority Groups (Atkinson, Morten Sue,
1998)
- Conformity
- Internalize racism.
- Choose dominant groups values, lifestyles, role
models. - Dissonance
- Question and suspect dominant groups values.
- Resistance-immersion
- Endorse minority-held values, reject dominant
cultures values.
55Ethnic Minority Groups (Atkinson, Morten Sue,
1998)
- Introspection
- Establish their own racial ethnic identity.
- Synergistic
- Experience self-fulfillment without categorically
accepting minority values.
56White American Groups (Helms, 1990)
- Contact
- Individuals are aware of minorities, but do not
perceive themselves as racial beings. - Disintegration
- Acknowledge prejudice and discrimination.
- Reintegration
- Engage in blaming the victim and in reverse
discrimination.
57White American Groups (Helms, 1990)
- Pseudoindependence
- Become interested in understanding cultural
differences. - Autonomy
- Accept, respect, and appreciate both minority and
majority group members.
58Model of Bi-Racial Identity Formation (Poston,
1990)
- Personal identity
- Choice of group categorization
- Enmeshment or denial
- Appreciation
- Integration
59Gay and Lesbian Groups (Cass, 2002)
- Confusion
- Questions their sexual orientation.
- Comparison
- Accepts possibility that they may be a sexual
minority. - Tolerance
- Recognition that one is gay or lesbian.
60Gay and Lesbian Groups (Cass, 2002)
- Acceptance
- Increases contact with other gays and lesbians.
- Pride
- Prefer to be gay or lesbian.
- Synthesis
- People find peace with their own sexual
orientation.
61Feministic Identity (Downing Rush, 1985)
- Passive/acceptance
- Revelations
- Embeddedness/emanation
- Synthesis
- Active commitment
62The Psychotherapy Process
63No Unifying Theory of Psychotherapy
- Focus is on how the therapist can understand the
life of a culturally different client. - Therapeutic alliance requires cultural congruence
between clients and therapists worldviews. - To begin moving towards cultural self-awareness,
the therapist identifies the dominant cultures
values in which they communicate and practice.
64Bennets (2004) Multicultural Sensitivity
Development Model
- The ethnocentric stages
- Denial Deny existence of cultural differences,
avoid culturally diverse people. - Defense Recognize other cultures but denigrate
them. - Minimization View own culture as universal.
65Bennets (2004) Multicultural Sensitivity
Development Model
- The ethnorelative stages
- Acceptance Recognize and value cultural
differences. - Adaptation Develop multicultural skills.
- Integration Sense of self expands to include
diverse worldviews.
66Multiculturalism and Therapy
- Atkinson, Thompson and Grant (1993) asserted
that - Low acculturated clients expect therapists to
behave as advisor, advocate, and or facilitator
of indigenous support systems. - More acculturated clients may expect their
clinician to act as a consultant, change agent,
counselor and or psychotherapist.
67Multiculturalism and Therapy
- Besides acculturation, clients expectations are
shaped by interpersonal needs, developmental
stages, ethnic identity, spirituality, and other
factors. - Most dominant psychotherapists ignore
transferential cultural issues. - Multicultural psychotherapists examine it through
a dialogue on cultural differences and
similarities.
68Cultural Empathy
- Empathy is an interpersonal concept referring to
a clinicians capacity to attend to the emotional
experience of clients. - Somatic aspect of empathy refers to non-verbal
communication and body language. - Cognitive aspect of empathy occurs by becoming an
empathic witness.
69Cultural Empathy
- Affective component involves emotional
connectedness. - Development of affective empathy is critical in
multicultural psychotherapy. - Learned ability to obtain understanding of the
experience of culturally diverse individuals
informed by cultural knowledge and interpretation.
70Cultural Empathy
- Cultural empathy is the ability to place self in
the others culture and is developed through
self-reflection. - Therapy promulgates the projection of conscious
and/or unconscious messages about the client and
therapists cultures. - Clients of color expect psychotherapists to
demonstrate cultural credibility.
71Comas-Diaz Jacobsen (1991)
- Intra-ethnic transference may transform the
therapist into one of several roles - Omniscient/omnipotent therapist
- Traitor
- Auto-racist
- Ambivalent
72Comas-Diaz Jacobsen (1991)
- Inter-ethnic transferential reactions may lead
the patient to - Overcompliance and friendliness.
- Denial.
- Mistrust, suspiciousness and hostility.
- Ambivalence.
73Interethnic Dyads Countertransferential Reactions
- Denial of cultural differences
- Clinical anthropologists syndrome
- Excessive curiosity about clients ethnocultural
backgrounds at the expense of their psychological
needs. - Guilt (re societal and political realities)
- Pity
- Aggression
- Ambivalence
74Intraethnic Dyads Countertransferential Reactions
- Us and them mentality
- Shared victimization.
- Cultural myopia
- Inability to see clearly due to ethnocultural
factors that obscure therapy. - Distancing
- Survivors guilt
- Overidentification
- Ambivalence
- Anger
75Mechanisms of Psychotherapy
76Mechanisms of Psychotherapy
- Multicultural psychotherapists may
- Use contemplative practices.
- Promote spiritual development
- Foster creativity through use of art, folklore,
ethnic practices, and other creative cultural
forms. - Lead the patient to cultural consciousness.
- Example The affirmation, redemption, and
celebration of ones ethnicity and culture.
77Ethnopsychopharmacology
- Field that specializes in the relationship
between ethnicity and responses to medications. - Ethnocentrism has resulted in culturally diverse
clients mistrust of psychopharmacology. - Racial and ethnic groups may respond or use
medications differently.
78Ethnopsychopharmacology
- African Americans with affective disorders are
often misdiagnosed and thus mistreated with
antipsychotic medications. - Common for Latinos to share medications with
family members and significant others (due to
familism), self-medicate and combine medications
with herbal remedies. - Diets of some people of color contain foods that
are incompatible with certain kinds of
psychotropic medications.
79Applications of Multicultural ism
80Multiculturalism
- Multicultural psychotherapies apply to everyone
and are particularly helpful when individuals
present to treatment with identity issues,
relationship problems, cultural adaptation,
ethnic and racial stressors, and conflicts of
diverse nature.
81Multicultural Assessment Explanatory Model
- Explanatory model of distress
- A culture-centered assessment based on an
anthropological method that elicits a clients
perspectives of their illness, experience and
healing.
82Multicultural Assessment Cultural Formulation
- Cultural formulation and analysis
- Process oriented approach that places diagnosis
in cultural context examining - Individuals cultural identity.
- Cultural explanations for individual illnesses.
- Cultural factors related to the psychosocial
environment and levels of functioning. - Cultural elements of the therapist-client
relationship. - Overall cultural assessment of diagnosis and
treatment.
83Multicultural Assessment Genograms
- Cultural genogram
- Diagram of a genealogical tree highlighting
dynamics from a nuclear to an extended family
perspective. - www.genopro.com/genogram_rules/default.htm
84Multicultural AssessmentGenograms
- Cultural genogram places individuals within their
communal contexts. - Uses three or more generations of ancestors.
- Clients invited to use imagination to summon up
family information (e.g. photos). - Share the symbols used in family genograms.
85Multicultural AssessmentGenograms
- Important factors might include
- Individual and family culture(s)
- Meaning of race and ethnicity
- Sexual orientation
- Family
- Social class
- Marriage
- Gender roles
- Relations
- Migration
- Refugee experience
- Acculturation
- Stress
- Spirituality and faith
- History and politics
- Trauma (i.e., sexual and gender trauma)
- Meaning of differences
86Ethnocultural Assessment
Explores diverse stages in cultural identity development Explores diverse stages in cultural identity development
Heritage Explores ethnocultural ancestry, history, genetics, and sociopolitical contexts and cultural trauma.
Family saga Entails examining the family, clan and group story.
Niche Attends to the post-transition analysis with special emphasis on clients intellectual and emotional interpretation of family saga.
Self adjustment Cultural resilience assessed during this stage.
Relationships Explores clients significant affiliations, including exploration of the therapist-client relationship.
87Multicultural Assessment
- Multicultural assessments can be complemented
with a power differential analysis. - An analysis of the clients cultural groups
social status compared to the therapist.
88Evidence for Integrating Multicultural Issues
into Therapy
- Karlsson (2005)
- Inconclusive results and low validity for ethnic
matching. - Evidence suggests clients working with
psychotherapists of similar ethnic backgrounds
and languages tend to remain in treatment longer. - Ethnic and linguistic match does not necessarily
translate into mutual cultural identification
nor is it necessarily desirable for some clients.
89Evidence for Integrating Multicultural Issues
into Therapy
- More research is needed on multicultural
psychotherapies. - Multicultural therapists advocate for research
funding that is applicable to the lives of
culturally diverse individuals and communities.