Psychotherapy Across Cultures
Psychotherapy Across Cultures
RELIGION AND PSYCHOTHERAPY
Psychology has had a long history of being neglectful, if not outright antagonistic, to issues related to spirituality and religion, often finding those who are spiritual or religious as being deluded or at least not as psychologically healthy and advanced as they could be (e.g., Ellis, 1971; Freud, 1927/1961)
During recent years many mental health professionals, including psychologists, have become interested in spirituality and religion as part of their professional work and are seeking ways to better integrate spirituality into their psychotherapy activities (Miller, 1999; O’Hanlon, 2006).
The APA Ethics Code states
Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status and consider these factors when working with members of such groups. (p.
Section 3.01 under the Human Relations section of the 2002 APA Ethics Code further calls for us to avoid any kind of discrimination based on, among other qualities, “religion” (p. 1064). Therefore, we must be sure that we are respectful to those from all religious and spiritual traditions and beliefs without discrimination or bias.
(Carlson et al., 2002)
These findings suggest that clients in the United States and in other parts of the world are likely to have some affiliation with religion and may seek support through their religious or spiritual beliefs, practices, and experiences.
RELIGIOUSLY BASED PSYCHOTHERAPY
Smith et al., 2007
This finding provides some empirical evidence that spiritually oriented psychotherapy approaches may be beneficial to individuals with certain psychological problems (e.g., depression, anxiety, stress, eating disorders).
Azhart et al. (1994)
assessed the effectiveness of religious intervention in the treatment of Muslim patients with anxiety disorder. Sixty-two patients were randomly assigned to treatment or control groups. Both groups received medication and supportive psychotherapy for anxiety.
In addition, however, one group received a religious intervention. After three months, the religious intervention group scored significantly lower on anxiety tests than did the group without religious treatment.
PROBLEMS WORKING CROSS CULTURALLY
There are many problems in working psychotherapeutically across cultures, with numerous examples of failure to understand cultural issues. For example, the ignorance of traditional family structures can lead to major diagnostic and therapeutic errors.
These errors include potentially disastrous transference relationship interpretations, the confounding of traditional beliefs with psychiatric symptoms, and a lack of awareness of differences in presenting symptomology.
. cultural prohibition in relation to emotions (not expressing emotions to a stranger)
.need to be aware of differences in presentation of symptoms
- need to understand differetn explanatory modesl individuals from different cultures may have about their mental illness
For example, attachment theories in the West emphasise the unique relationship first between mother and child, and then father and child, and then between the child and the outside world. In extended family systems in Eastern societies, there may be less immediate reliance on the mother in the postnatal period, with a number of key figures providing care.
AFRO CARIBBEAN FAMILY STRUCTURE
The African-Caribbean family has unique mating and childrearing patterns. Some of these patterns include absent fathers, grandmother-dominated households, frequently terminated common-law unions, and child-shifting, where children are sent to live with relatives because the parents have migrated or have begun a union with another spouse. Families tend to have a matrifocal or matricentric structure.
There are four basic types of family structures that affect childrearing, values, and lifestyles. Hyacinth Evans and Rose Davies (1996) describe these as (1) the marital union; (2) the common-law union (the parents live together, but are not legally married); (3) the visiting union (the mother still lives in the parents' home); and (4) the single parent family
Relationships often start as a visiting union, change to a common-law union, and culminate in a marital union. Approximately 30 to 50 percent of African-Caribbean families are headed by a female ( Jamaica:
33.8%; Barbados: 42.9%; Grenada: 45.3%) (Massiah 1982).
SOCIOCENTRIC v INDIVIDUALISTIC SELF
A sociocentric self is experienced in social groups in which all people are connected, and the self consists of multiple compatible (and not pathological) selves (or self-states). Such theoretical differences will determine how technical aspects of the therapy are managed.
In some cultures emotional distesss not easily verbalised.
MEANING OF THERAPY
In culturally diverse societies, practitioners and services will need to adapt interventions, or deliver them with a discerning and sensitive appreciation of the way a treatment is received.
Ethnic matching has been proposed as a way of addressing cultural differences, including those of race, language and religion. Nevertheless, there is little good empirical evidence that it leads to better outcomes
RACIALLY INCLUSIVE PSYCHOTHERAPY
The therapist needs to be skilled in exploring racial and cultural identity
The therapist must understand that, for some patients, life events with racial elements are part of a social reality that can become an internal representation and that can emerge in their mental life, fantasy and beliefs
The therapist must have the capacity to perceive, apprehend and think through the primitive feelings of aggression, hatred, humiliation and shame that accompany racial encounters, conflicts and enactments (after Carter, 1995).
While individualization of therapy is generally accepted as a principle, in practice therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy. The findings of this study have practical implications for therapists and mental health practitioners using CBT with people with psychosis from BME communities.
CULTURALLY SPECIFIC PSYCHOPTHERAPIES
Psychotherapies that are unique to specific societies make use of the cultural
fabric of that society, with its associated beliefs and aspirations and ways of seeing the world. Mobilising these cultural beliefs can lead to recovery.
Naikan (Japanese: 内観, lit. “inside looking” or
“introspection”) is a structured method of self-reflection developed by Yoshimoto Ishin (1916–1988) a
businessman and devout Jodo Shinshu Buddhist who, as a young man, had engaged in an ascetic 'contrition'
(mishirabe) practice involving sensory deprivation through dwelling in a dark cave without food, water or sleep. Wishing to make such introspection available to others he developed Naikan as a less difficult method which he first introduced to young people who had been incarcerated for committing crime and social disturbances. Later the practice was introduced to the general public.
Naikan practitioners claim that Naikan helps people understand themselves and their relationships.
Naikan practice is based on three questions:
What have I received from (person x)?
What have I given to (person x)?
What troubles and difficulties have I caused to (person x)?
.honer very highly held in Japan (valuing people/family)
MEANING OF THERAPY
Mental distress is not always seen as a disease or illness: it might be thought of as an outcome of family or interpersonal dysfunction, or of adverse life events and misfortune, or a consequence of breaches in religious and cultural codes of conduct.
e.g. in india where mental illness is normally thought of as family problems
others might see it as religious problems
Identity has cultural, ethnic, religious as well as personal components. Cultural, religious and ethnic identity formation and expression are personal processes that include conscious and unconscious compromises between aspired, experienced and imposed identities. Such identities are challenged during the acculturation experience.
Littlewood (Kareem J., R. Littlewood 2000) suggests the existence of three possible approaches to intercultural work:
Maintaining traditional healing;
Imposing Western psychiatry;
Reconciling the first two approaches to produce a therapy that incorporates the possibilities of each.
Nafsiyat offers specialised therapeutic help to people from ethnic and cultural minorities and for people in mixed cultural relationships as well as for people for whom cultural matters are an issue. The centre's staff includes qualified psychotherapists, psychiatrists, social workers, psychologists and counsellors.
Therapeutic help is offered to individuals, families, children and adolescents experiencing psychiatric problems, emotional strain and sexual problems. Some of the interventions offered include domestic violence, relationship issues, childhood sexual abuse and cultural based issues.
Bronislaw Malinowski observed that young boys living in the Trobriand islands exhibited the type of hostility that Sigmund Freud had described in his formulation of the Oedipus complex, only it was directed not at their fathers but at a maternal uncle who was assigned the role of family disciplinarian.
not having the same family structure across the world, therefore the Oedipus complex does not apply
This observation posed a challenge to Freud's oedipal theory by raising the possibility that boys' tense relations with their fathers at a certain period in their lives may be a reaction to discipline rather than a manifestation of sexual jealousy
This refers to the gradual physical, biological, cultural and psychological changes that take place in individuals and groups when contact between two cultural groups takes place.
Culture Helman (2000) defines culture as a set of guidelines inherited by members of a particular society that tell them how to view the world, how to experience it emotionally and how to behave in relation to other people. Culture is transmitted by symbol, art, ritual and language.