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Culture and Treatment
Psychotherapy

Traditional Psychotherapy



Sigmund Freud
Centered on unconscious (repressed) memories
of traumatic experiences, usually from early
childhood.
Contemporary Psychotherapy

Cognitive and Cognitive-Behavioral Therapies
(CBT)

Cognitive therapy focus: examining the rationality
or validity of one’s beliefs
Psychotherapy (cont.)
CBT (cont.)
 What a person believes is more important than
what the person thinks or sees.
 Cognitive “behavioral”: the development of
strategies for changing behavioral routines
and teaching cognitive skills.

Challenges

Few studies include minorities, one cannot say
that psychotherapy is effective across groups
Culturally Competent Therapy
Political correctness drove early approaches
 Treatments should be modified to include
worldviews and experiences of culturally
diverse clients (Sue et al).

For instance, psychoanalytic approaches
indicate that problems are derived from
unconscious conflicts, whereas other cultures
may view the problem as stemming from
physical problems or being out of harmony
with the environment.
Culturally Competent Therapy
(cont.)

Blending Traditional and Non-Traditional
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A patient may need individual counseling but also
involving a culturally sanctioned treatment i.e. a
Shaman (a healer linked to spiritual world) may
be more beneficial.
Culturally Based Therapies
Mexico and Latin America
Curanderism (Latino folk healing) is prevalent in
Mexico and through Latin American and South
Western region of the U.S.
Therapies practiced by Curanderos start with
herbs and culminate in spiritualism.
The blending of religion and treatment is
common, and at the level of spiritualism, the
forces of Good or Evil are brought in as well.
Culturally Based Therapies
(cont.)
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Malaysia
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China
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Prayer and religion has been incorporated
Using Taoist and Confucian principles, which
are embedded in psychotherapy (restricting
self desires, learning how to be content, etc.)
Europe

Group therapy has been incorporated
Beyond Psychotherapy

Psychotherapy focuses on the individual
 Community Psychologists

Beyond traditional focus of the individual, to
include an analysis at the community level

Which requires a recognition of the
relationship between the individual and his
or her daily interactions within diverse
social settings.
 Involving the community in treatment.
 Beneficial for immigrants and refugees.
CULTURE AND
PSYCHOTHERAPY
Traditional Psychotherapy

Freud’s psychoanalytic model: through
individual therapy sessions, therapists
encourage patients to explore their memories
and unconscious thoughts

Roger’s client-centered (Humanistic) approach
to psychotherapy: emphasized client’s selfpropelled growth. All about taking control

Obviously, traditional psychotherapy stems
from and is bound by a uniquely Western
cultural perspective
Cultural Limitations of Contemporary
Psychotherapy

Cognitive therapy: focused on examining
rationality or validity of one’s beliefs

Cognitive-behavioral therapies:emphasize
development of strategies for teaching
cognitive skills

Psychotherapy a is a distinctively Western
approach in all respects, from the 50-minute
hour to the fee structure.
Cultural Limitations of Psychotherapy

Approaches to treatment are bound to
cultural norms, values, and beliefs

Traditional and contemporary psychotherapy
focuses on the individual

Other cultures might find this focus on self
uncomfortable and believe dwelling on
unpleasant thoughts should be avoided
Psychotherapy in Cultures
Outside the United States

Like other Western concepts, psychotherapy
has been exported to other parts of the world;
incorporated essential elements of their
culture to make psychotherapy useful

ex) In Malaysia, religion incorporated into
psychotherapy

ex) In China, Taoists and Confucian principles
incorporated into psychotherapy
Psychotherapy in Cultures
Outside the United States

Group psychotherapy has also been exported
to countries outside the US and Europe,
including the Middle East but not without
difficulties.

Several problems arise when conducting
group therapy in Arab cultures
Summary

Certainly, the usefulness, let alone
effectiveness, of treating with psychotherapy
individuals who are not from the West has not
yet been well established

Need to evaluate efficacy of treatments
TREATMENT OF ABNORMAL
BEHAVIOR ACROSS DIVERSE
CULTURES IN THE UNITED
STATES
Psychotherapy with Diverse Cultures
in the United States

Only few studies examining effectiveness of
psychotherapy for people of diverse cultural
backgrounds

Those studies report conflicting results;
therefore premature to arrive at definitive
conclusion

Researchers and practitioners advocate for
infusion of cultural elements for successful
treatment
Seeking Treatment

Asian American and Native American adults
and adolescents report lower rates of
utilization of mental health services, higher
dropout rates, and poorer treatment
outcomes than European Americans and
African Americans
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Some evidence suggests the use of ethnicspecific mental health services leads to better
outcomes
Barriers to Seeking Treatment
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Reasons for underutilization of mental health
services
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Shame, loss of face, active avoidance of morbid
thoughts, attributions of causes of mental illness to
biological factors, and fear of a system not set up
to deal well with cultural differences (for Asian
Americans)
Individuals encouraged to rely on own willpower to
confront problems (for African Americans)
Cultural belief that sickness comes from
disharmony with self, community, and nature (for
Native Americans)
Barriers to Seeking Treatment

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Cause of mental disturbances attributed to evil
spirits (for Latinos)
Mistrust and stigma (for all ethnic groups)
TREATMENT ISSUES
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Issues to consider when treating ethnic
minorities
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Understanding culturally different ways of
thinking about illness and expressing thoughts
about illness
Correct interpretation of nonverbal
communication
Taking into account how cultures vary on
importance of hierarchy in interpersonal
relationships
Treatment expectations
Recognizing role of extended families in many
cultures
CULTURALLY COMPETENT
SERVICES

Treatment methods should be modified to
improve their fit with the worldviews and
experiences of culturally diverse clients

Acculturation status and ethnic identity may
be important determinants of client response
to treatment (more than simple ethnic
similarity)

Clinicians sensitive to client’s cultural
background and who take the time and effort
to understand the client within his/her cultural
context is beneficial

According to Sue and Sue, a culturally
sensitive therapist will have acquired:
(1)
(2)
(3)

Knowledge of diverse culture and lifestyles
Skill and comfort in using innovative
treatment methods
Actual experience working with culturally
diverse clients
Therapist should also be aware of his/her
own cultural background and its influences
on definitions and perceptions of abnormal
behavior
INDIGENOUS HEALING

Indigenous healing encompasses
therapeutic beliefs and practices that are
rooted within a given culture
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Many indigenous treatments are rooted in
religion and spirituality; they rely heavily on
family and community networks
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Many countries merge aspects of traditional
psychotherapy with culture-specific methods
and beliefs to produce unique systems of
healing

Culture-specific systems of treatment all
share the characteristic of mobilizing healing
forces within the client, but cultures differ in
the exact ways in which the mobilization of
healing forces occur
AN ALTERNATIVE APPROACH
TO TREATMENT

Community psychologists analyze mental
health at the community level

Community-based treatments may
especially relevant for helping immigrants,
refugees, and those from developing
countries
CULTURE AND
CLINICAL TRAINING

All accredited clinical programs of clinical
training in the US mandated to incorporate
culture and diversity in their training
programs
CONCLUSION

Future research needs to explore the
efficacy of different treatment approaches
that address both etic and emic concerns,
blending traditional and culture-specific
methods in a comprehensive fashion