Abnormal behavior and psychotherapy from cultural perspectives.

The guiding values of psychology are found in the therapeutic helping relationship and the search for scientific truth. We have observed in this chapter the importance of culture in defining what is normal and abnormal and the need for culturally sensitive approaches to assessment of mental disorder. Psychotherapy for mental illness emerged also out of Western psychologies, but can these treatment approaches be applied and be useful in other cultures? Can we incorporate cultural understandings in developing therapies that are empirically validated (Sue & Sue, 2008; Tanaka-Matsumi, 2008)? Empirically supported psychological interventions that are culturally sound have increased as another consequence of globalization (Bernal, Jimenez-Chafey, & Rodriquez, 2009). The confrontation of divergent cultural values is ubiquitous in the world. This fluid situation requires not only greater cultural sensitivity in the helping relationship, but also more training in developing culturally competent therapies and therapists (Marsella, 2009).

Many cultural groups live within the U.S., however the Latinos is the largest ethnic minority, and among these Mexican-Americans constitute about 64 % (United States Census Bureau, 2009). Mexican American children are exposed to many social stressors that are reflected in mental ill health including high rates of depression. Not surprisingly drug use and suicide rates are also comparatively high among Mexican Americans (Grunbaum, Kann, Kinche, Ross, Lowry, Harris, &Collins, 2004). Collectively the statistics point to a significant need for more mental health resources and facilities for the Mexican American community. However, despite the greater need Mexican-American patients are more likely to receive poor quality care and less likely to participate in evidence based treatment and programs (Villalba, 2007). The negative mental health outcomes for this ethnic group suggest that “one standard fits all” mental health treatment is not supported by cross-cultural research and that accepted practices offering evidence based care may require culture specific changes to be ultimately effective with this minority group (Hall, 2001).

The unique cultural values of Mexican-Americans encourage a culturally sensitive approach to treatment. The social norms of the community place a high value on the family, is more hierarchical compared to other American ethnic groups, tend to be more traditional in the relationships between the genders and is more collectivistic (Rogler & Cooney, 1984; Shapiro & Simenson, 1994). Further, the Mexican-American culture places great value on personal relationships that in turn motivate individuals with mental disorders to seek out family members for advice (Parra-Cardona, Cordova, Holtrop, Villarruel, & Wieling, 2008). Consequently, fewer Mexican Americans seek professional assistance for mental problems. When evaluating the reasons for mental illness, Mexican-Americans are less likely to believe in the causes described Western diagnostic categories, but look to forms of folk medicine for answers (Yeh, McCabe, Hough, Lau, Fakhry, & Garland, 2005). Mexican cultural values create syndromes of mental illness that validate psychosomatic problems as more central to complaints and unique diagnoses not be linked to other commonly accepted diagnostic categories (Pina & Silverman, 2004).

Globalization has produced new possibilities for delivering therapeutic services across borders and cultural boundaries. Psychotherapeutic systems are multiplying and validated in varying cultural contexts (Nathan & Gorman, 2006; La Roche & Christophe, 2008). Most psychotherapeutic treatments being offered today are based on cognitive behavioral traditions that emerged in the 1960’s in Western clinical psychology (e.g. Ellis, 1962). Cognitive therapies seek to help the patient evaluate the rationality of beliefs, however that is an approach not particularly helpful if the beliefs systems of culture are irrational. On the other hand cognitive-behavioral interventions seek to teach cognitive skills. The main emphasis in cognitive-behavioral strategies is to motivate the patient to change his thinking so he can modify his behavior, and the reverse is also possible when behavior is changed it can alter dysfunctional thinking processes (Hollon & Beck, 1994). As a result of globalization and information transfer new international therapeutic organizations have emerged with a transcultural reach like the World Congress of Behavioral and Cognitive Therapy. The use of these therapies is found now in the formerly very divergent cultures in Asia as well as all over Europe and North America (Qian & Wang, 2005).

Some researchers have suggested that there is still a great need for developing more culturally sensitive psychotherapies, particularly at local levels (Snowden & Yamada, 2005). The presence of culturally competent therapists appears to be a precondition for successful outcomes of psychotherapy in many ethnic and cultural groups. In particular a therapist needs to respect the cultural values of the client and be able to overcome biases from his or her own perspectives in the process of evaluating mental disorder since any form of therapy or counseling occur within the context of cultural values (Gerstein, Heppner, Stockton, Leung, & Aegisdottir, 2009).

Treatment is adapted to each culture in a process that takes into account the patient’s cultural meanings. Culturally sensitive approaches would identify what is maladaptive and appropriate behavior within the cultural context, people traditionally provides assistance for mental disorder, and the client’s expectations for outcomes (Van de Vijver & Tanaka-Matsumi, 2008). A meta-analysis of the literature (Griner & Smith, 2006) showed that cultural adaptation of psychotherapy benefitted the client regardless of which treatment approach was used. Cultural sensitivity appears to be an essential consideration in order to produce positive outcomes for the patient.

Date: 2015-01-11; view: 748