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CROSS- CULTURAL THERAPY.
Term Paper ID:29930
Essay Subject:
Discusses issues involved in counseling & the therapeutic process for the cross-cultural population.... More...
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Paper Abstract:
Discusses issues involved in counseling & the therpeutic process for the cross-cultural population. General issues, individual race issues & issues related to the therapeutic process. Need for mental health professionals to have complete understanding of the issues invoolved to achieve effective counseling. Cultural attributes of Asian-Americans, Native Americans, African-Ameicans, Hispanic population. How to improve cross-cultural therapy.
Paper Introduction:
Salient Issues in Cross-Cultural Therapy
Cultural competency in psychotherapy and counseling grew in importance in the last two decades, until the American Psychological Association (APA) accreditation criteria and Ethical mandates were established to ensure the comprehensive training in this area for all students in applied psychology (Neville, Heppner, Louie, Thompson, Brooks, & Baker, 1996).
This paper presents the issues that have been found to be salient in the therapeutic process for the cross-cultural population, including general issues, individual race issues, and issues related to the therapeutic relationship.
The mental health professional must have a comprehensive understanding of socio-cultural, biological, and psychological factors invo
Text of the Paper:
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It was concluded that for cross-cultural therapyto be successful, the therapist needs scientific mindedness, the skillsrequired to understand dynamics, and culture-specific expertise. In search of cultural competence in psychotherapyand counseling. For example, the issue of hostile racerelations is a salient issue that needs further understanding. However,practical application of all that is learned by the practitioner, andfurther exploration of cultural strengths, are issues that need furtherexamination to improve cross-cultural therapy in the 21st century. Thus for psychotherapy to bebeneficial, the therapist must help the family define their realityaccording to their own perspective and avoid anything less. The only differences found werethat Filipinos rated spiritual and supernatural treatments more thanCaucasians (p. (1999). The Hispanic population is reported by Ho to present a tendency to besomatic as a response style. Somebelieve that the problem must be experienced before it can be trulyunderstood. Cross-cultural counseling requires knowledge of salient interpersonalissues. Skin color can result in a sensitive issueresulting from discrimination or it may be highly valued within theculture. Relocation also presentssalient issues for this group, with language problems, loss of family andfriends, economic victimization, and cultural differences leading toincreased mental illness (pp. Ho describes salient issues found for the Asian child and adolescent. Studies show that the AsianAmerican tends to express their psychological problems through somaticconcerns, which may be due to discouragement of emotional expression andself-disclosure and negative views of mental problems (pp. Thus the future of cross-cultural therapy will be improved by training that allows for the therapistto experience concept application prior to practice (Stevenson & Renard,pp. Professional Psychology:Research and Practice, 27(1), 83-89. Gangs are a problemfor this group and psychological symptoms include depression, anxiety,phobias, school refusal and social disturbances. Treatment issues include behaviors that may beemotionally expressive or passive-aggressive or aggressive (pp. American Psychologist, 53(4), 44 -448. 8 -83). Numbers of psychological and behavioralproblems for children are less, which may indicate the tendency for parentsof this group to deny or minimize problems. These factors lead to the following issues salient inthe therapy for the minority: distrust of therapy and therapists,therapist-client differences, a lack of bicultural professionals, overuseof a physician for psychological problems, language barriers, inability torecognize the need for help or its existence, and confusion about theprocess (Ho, pp. Sue (1998) reports the outcome of a study regarding thistopic. 8-14). Death due to substance use is high among Indian adults andadolescents indulge in alcohol and drug use more than other groups. Stevenson, H. Moncayo, R. Ethnicity and ethnic identity shape the child's and theindividual's belief system about mental health, mental illness, symptomsmanifestation, defense and coping mechanisms, help-seeking behaviors, andresponses to treatment (Ho, pp. In addition, the therapist must examine the issues of culture,immigration history, tradition, rituals, family organization and lifestyle, gender-role structure, labor divisions, affective styles, and stressmanagement styles. 433). The element of mistrust can take many forms. (1992). Most minorities seek symptom relief and do not considertherapy to be a solution; they consider family or extended family theirsource of support. 6 -63). The effects of these assumptions are further exemplified by Stevensonand Renard (1993) who describe the tendency to view the African-Americanfamily regarding their societal racism struggles, educational achievement,and culture, when it would be more helpful to view the cultural strengthsof the culture. Delinquency and dropping out of school is highfor this group and they tend to experience discrimination, and problemswith relocation (pp. Improving Cross-Cultural Therapy in the 21st Century The role of culture within the therapeutic process is recognized bymental health professionals. These issues must be understood by the therapist and beyondawareness, it must be known how they translate into behaviors relevant toneeds and problems. The mental health professional must have a comprehensiveunderstanding of socio-cultural, biological, and psychological factorsinvolved to assist in therapy with ethnic individuals. They must understand sociopolitical factorsand have specific techniques and strategies necessary for working withculturally different groups. Ho reports that Black children and adolescents areaffected by poverty and other risk factors and racial oppression. The problem of racism may be even more difficult to deal with whenthe client is a child. This is assumed tobe due to economic, educational, and cultural deficits. 39-43). Although this group has alower rate of alcohol and drug use, use of cocaine and heroin are higher;shared needles has led to higher rates of AIDS cases. Results of this cross-cultural counseling research demonstratedthat ethnically matching client to therapist resulted in fewer dropouts andlengthening of treatment. Studies show that Asian American patients tend to be similar to Whitepatients except that they are more likely to be diagnosed as psychoticwhich may indicate an avoidance of therapy for less severe disturbances.It has also been found that this group tends to drink less alcohol and havefewer cases of alcoholism than other groups, but drug use is just asprevalent as with other groups. Salient issues in treatment include the need for anddifficulty in obtaining a trustworthy relationship between the therapistand the client. For the American Indian child and adolescent, Ho reports theprevalence of middle ear infection which results in hearing loss and delaysin learning and cognitive and psycholinguistic development with lowereducational achievement, reading problems, and emotional problems. For example, it isassumed by many in the dominant culture that ethnic minority groups tendnot to be good candidates for mental health services. For example, the patient may not view their problems asan illness (Ho. Hypertension related to stress and asthma are leading causes of deathamong the youth and suicide rates are high. 433-436). A high dropout rate of ethnic minority clients points tothe therapist's inability to provide for the client's needs. Trusting ole' wise owlstherapeutic use of cultural strengths in African-American families.Professional Psychology: Research and Practice, 24(4), 433-442. Different races present unique salient issues thatthe therapist needs to understand. Oppression issues are taught in classesdesigned to train practitioners for psychotherapy, but what to do and whenand how to do it become more difficult when the therapist faces this typeof interaction. Again the need to uncover false assumptions isexemplified. 17). Values found in the U.S. J., Louie, C. 38 ). The impact of multicultural training on White racialidentity attitudes and therapy competencies. Cross-cultural therapy can be improved by incorporatingthe strengths of the client's ethnicity into the therapeutic structure.For example, the African-American family demonstrates strengths whichinclude their dependence on the help of extended relatives, theirtransmission of cultural child-rearing values, their religious worldview,and their family communication regarding their struggle with racial issues. Blackadults are more likely than White adults to be unemployed and children aremore likely to be raised by a single mother. In contrast,research by minorities regarding minority mental health services have foundthese services to be beneficial. Edman and Johnson (1999) report findings of a study regardingFilipino American and Caucasian American beliefs about mental problems,their causes and treatment. 262-263). Social class or economic issues are aspects of thetherapeutic situation, which cannot be overlooked; they may result inunique priority structures. Ho states that salient issues found within a general context,suitable to most ethnic cases include the following: biculturalism,language, social class, skin color, belief systems, mental health symptoms,and help-seeking behavior. Alcohol use correlateswith poor academic performance as does inhalant use. Ho states that this group views psychological and physical healthwithin a holistic view, which must be acknowledged in their treatment.Additional issues found with this group includes the effects of relocationwhich may be found in the parents' anxiety level and the child's loss andfeelings of uncertainty; relocation tends to exacerbate normaldevelopmental conflicts. Salient Issues in Cross-Cultural Therapy Cultural competency in psychotherapy and counseling grew in importancein the last two decades, until the American Psychological Association (APA)accreditation criteria and Ethical mandates were established to ensure thecomprehensive training in this area for all students in applied psychology(Neville, Heppner, Louie, Thompson, Brooks, & Baker, 1996).This paper presents the issues that have been found to be salient in thetherapeutic process for the cross-cultural population, including generalissues, individual race issues, and issues related to the therapeuticrelationship. References Edman, J. 8-9). Top rated treatments for both groups included psychology, positivethinking, family time, and support groups. (1998). Black children and adolescents also present salient issues common totheir cultural group. Minority children and adolescents in therapy.Newbury Park, CA: SAGE Publications. The American Indian isreported to have a tendency to experience abandonment and neglect,discrimination and distrust, and the Black is reported to be poor andoppressed, unemployed, destructive and aggressive or overly obedient withhigh degrees of emotionality. This phenomenon may be easy to understand but less easy to remedy (pp. Theprevalence of Fetal Alcohol Syndrome and Fetal Alcohol Effects are alsoreported; with findings of one study revealing that of these children 73percent had been adopted or put in foster homes due to abandonment orneglect. Theimprovement of cross-cultural counseling lies in the therapist's ability toascertain what the cultural strengths are, including feelings, behaviors,values, and cultural expressions, rather than focusing on what may be wrongor problematic about their struggle (p. 117-163). This theoreticalknowledge base needs to be accompanied with practical applications (Ho,1992, p. C. E., Thompson, C. Poor urban children have thehighest rates of psychopathology and psychiatric impairment with behaviorsthat are destructive, aggressive, and disruptive. Segregation and victimization by the American mainstream result inidentity confusion and defenses such as strict obedience to authority ortoughness of character. For example,tendencies to avoid disclosure may be due to this sensitivity, since itmight render the client vulnerable to racism and more oppression, and yetdisclosure is needed to help with the movement of the therapeutic exchange. E., &Brooks, L. 1 1-1 3). Findingsregarding minority counseling revealed that the successful therapeuticintervention requires the therapist to understand their own worldviews aswell as those of their client. The authors conclude that to improve the therapeutic situation, thetherapist must learn to empower the client which will include therestructuring of the family to facilitate and mobilize their ability tointeract with the external environment. The Hispanic is viewed as tending to presentsomatic symptoms, depression, anxiety, and victimization. Thus again it is stipulated that effective cross-cultural counselingrequires proficiency in concept application and the issue remains regardinghow to gain this culture-specific expertise for the unmatched therapist. Different cultures present different symptoms and styles ofcoping within the same disorder and most minorities have a negative view ofmental illness. For this study, both groups reported similar ratingsregarding causes and treatment for depression and schizophrenia. (1998). Although the therapist may have studied these racial issues,when they haven't experienced them, they may find it difficult to developthe trusting relationship that is necessary for the therapeutic process.It is concluded that cultural knowledge is important but it is insufficientfor application of the concepts into practice. Language may present acommunication barrier. TheIndian adolescent reports issues of depression and anxiety, and suicide isthe second cause of death. The issue of denial as the primary defense mechanism is found anddepression is frequently reported; cultural adjustment, anxiety, maritaland intergenerational conflict are present (pp. K. Portrayals of differentminority groups are presented which include for example, the Asian'stendency to avoid emotional expression and therapy. Psychoanalytic Psychology, 15(2), 262-286. C., & Renard, G. For example, working with minority cultures may require a moreinterpersonal competence, with an active exchange and avoidance of eyecontact; repeated direct questioning can be intrusive to many minorities.Self-disclosure is viewed negatively by most minorities. Other therapeutic issues such as goalformation and progress evaluation must include the values of the clientsuch as the salient issue of interdependence rather than independenceusually sought in the Western culture (pp. Racial socialization can result in angry childrenand this tendency may be too great for the child to understand. Neville, H. Filipino American andCaucasian American beliefs about the causes and treatment of mentalproblems. High levels ofdepression are also found and neurological symptoms often are misdiagnosed. The lack of this premise is noted as an exploration of thework by Ho (1992) reveals the many difficulties that different culturesface, with very little mention of their strengths. (1993). Stevenson and Renard (1993) report that without the understanding ofhow to put theories into action, therapy with minorities will continue tobe ineffective in some cases. Cultural diversity and the cultural andepistemological structure of psychoanalysis implications for psychotherapywith Latinos and other minorities. that are inconsistentwith traditional values result in additional stress for the child oradolescent; self-depreciation and low self-worth are found among this groupas are physiological symptoms targeted at the respiratory and digestivesystems. Some assume that most therapists are notfamiliar with cultural factors and receive only training pertaining to theAnglo American. Sue, S. This informationis helpful for the therapist to be made aware of possible problems andbarriers that need to be incorporated, for treatment to be effective.However, this skewed view lacks information regarding client strengths thatmay not only change the view of so called problems to be fixed, but wouldalso be beneficial for the empowerment of the client. p. (1996). Cultural Diversity and Ethnic Minority Psychology, 5(4), 38 -386. Hispanic adolescent boys have high rates of abstinenceregarding alcohol use; girls tend to drink more. They must have the ability to translateinterventions into strategies that work for the minority group treated (p.44 ). Ho, M. A., Heppner, M. It is also assumed that many dismiss the notion ofpsychodynamic treatment for minorities such as the Latino for example,since they tend to focus on the present and want symptom relief rather thanto disclose personal experiences (pp. The issue of effectiveness of ethnically matching the client with thetherapist, to help ensure their ability for concept application, remainsunanswered. The APA has extended accreditation criteria to include comprehensivetraining on research, theories, and practice regarding racial or minorityissues (Neville, Heppner, Louie, Thompson, & Brooks, 1996). 436-442). Early pregnancy iscommon. Moncayo (1998) further points out that it is important to examine theassumptions associated with cross-cultural counseling. 7). Verbal and non-verbal cues must be understood regarding the client's culture and thetherapist needs to act accordingly. For example, an ethnic minority is a part oftwo cultures and must learn to function in both. For example, Homentions many salient issues with regard to cross-culture counseling suchas sensitivities and anger regarding oppression and discrimination,economic hardships, language barriers, confusion and distrust, andavoidance of problems or their disclosure. This portrayal conflicts with the assumption that minorities viewmental illness and treatment as negative, and tend to deny emotions andseek cures only for somatic expression. Regardless oftherapeutic intervention (individual, group, family) the therapist must beaware of the issues for each group and put this awareness into action.Since the minority is likely to view therapy in a negative manner,establishment of the initial relationship will require capitalizing onissues related to gender, age, communication styles, family structure, anduse of empathy and authority, transference and counter-transference (PP.117-163). Although depression is noted for this groupit is not clear whether culture would offer more of an explanation.Mexican American boys are described as aggressive and acting out comparedto Anglo-American boys described as neurotic; girls are described asdepressive. The study shows that a focus thatonly includes possible "negative" cultural views presents limitedinformation.Improvement in cross-cultural counseling for the 21st century needs toinclude a more rounded and factual representation of cultural perceptions,which can begin with a portrayal of their strengths. Researchers have sought to understand theunique cultural values and behaviors that need to be comprehended in orderto insure a successful therapeutic intervention (Stevenson & Renard, 1993). Theyagreed that causes included emotion, stress, family problems, and substanceabuse. 39-43). Whetherthis hostility is played out within the therapeutic situation and how it isexpressed, needs to be addressed before a trusting therapist-clientrelationship can be established. L., & Johnson, R.
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