Culture and Psychotherapy : A Guide to Clinical Practice
Contemporary’ mental health practitioners widely recognize the importance of cultural issues in psychotherapy. Knowledge of cultural factors and skill in dealing with them within the psychotherapeutic process are often necessary’ for a successful treatment outcome. The conduct of culturally appropriate and relevant psychotherapy can be quite challenging, however, particularly since cultural issues are often mystifying, misinterpreted, or even unrecognized.
Imagine, for example, doing psychotherapy with a Hispanic woman who presented problems of “losing her soul,” or a Native American woman who could not escape her “spirit song,” or an Irish patient who was concerned that he had done something not approved by his Catholic church. Dealing with psychological matters that involve supernatural or religion is an area that tends to be neglected in modem therapy, yet it is essential when treating patients from various cultural backgrounds who are oriented to supernatural beliefs.
In psychotherapy, what kind of professionally and culturally appropriate relationship should one build with a Japanese patient who was raised to respect authority figures and will not acknowiedgc feelings or opinions that he thinks will displease the therapist? To what extent, and in what way, should one encourage a Mexican patient to express his inner feelings and opinions to other members in a group session, when he culturally was taught not to reveal his intrapsychic thinking and negative feelings to others, particularly strangers?
When treating delayed grief reactions in a Vietnamese woman, a Samoan mother, or an African American woman, what kind of cultural considerations are necessary’ to help each patient resolve the trauma of loss? What differences in therapeutic strategies might be necessary’ for these patients of different cultural backgrounds? How might one understand, tolerate, and intervene in a culturally relevant way for a patient from mainland China or a Jewish patient from New’ York to resolve culturally accepted but clinically problematic dependency needs?
How would one conduct treatment with an underprivileged Native American adolescent as opposed to a socioeconomically affluent Caucasian adolescent? What determines the choice between individual psychotherapy or a group-oriented, action-based socio-occupational program to enhance ethnic identification? Should families be more involved in the therapy of Italian or Latino patients because of cultural values favoring the family system? Would one choose to conduct a more structured or more expressive family therapy for Scottish or Russian families? Would this depend on how they culturally stress the cohesiveness of family relationships?
These are questions that need to be considered and answered when conducting psychotherapy. They present challenges that modern therapists must confront daily in clinical practice in our increasingly multiethnic and culturally metropolitan society.
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