Chapter 4 Cultural Issues in Clinical Psychology The

Chapter 4 Cultural Issues in Clinical Psychology

The U. S. Population • The U. S. population is increasingly diverse, particularly in certain areas/cities – 20% of U. S. schoolchildren speak a language other than English at home – In Miami, Detroit, and Washington DC, a single ethnic minority group represents over half of the population

Cultural Issues (cont. ) • As stated by Mc. Goldrick, Giordano, and Garcia -Preto (2005), “[we] must incorporate cultural acknowledgment into our theories and into our therapies, so that clients not of the dominant culture will not have to feel lost, displaced, or mystified”

Multiculturalism as the “Fourth Force” • Some argue that multiculturalism is the defining issue of the current generation of psychology • Defining paradigms of previous generations have included – Psychoanalysis (1 st) – Behaviorism (2 nd) – Humanism/person-centered (3 rd) • Multiculturalism can enhance any of previous “forces”

Culture and Clients • Culture shapes how clients understand their problems • Questions to assess client understanding: – What do you call your problem (illness, distress)? – What do you think your problem does to you? – What do you think the natural cause of your problem is? – How do you think this problem should be treated? – Who else (e. g. , family, religious leaders) do you turn to for help?

Recent Professional Efforts to Emphasize Issues of Culture • Journals and books on cultural topics • New APA divisions – Division 35—Society for the Psychology of Women – Division 36—Psychology of Religion – Division 44—Society for the Psychological Study of Lesbian, Gay, and Bisexual Issues – Division 45—Society for the Study of Ethnic Minority Issues – Division 51—Society for the Psychological Study of Men and Masculinity

Recent Professional Efforts to Emphasize Issues of Culture (cont. ) • Revisions to APA ethical code – Competence – Discrimination – Interpreting Assessment Results – Others • APA Accreditation Standards

Recent Professional Efforts to Emphasize Issues of Culture (cont. ) • DSM efforts toward multiculturalism – Text describing cultural variations of disorders – General guidance for cultural competence • “Outline for Cultural Formulation” • “Cultural Formulation Interview” – Cultural concepts of distress glossary • Nine terms that represent psychological problems in various cultures • Some related to DSM disorders; others unique • Exs. Taijin kyofusho, susto, maladi moun

Recent Professional Efforts to Emphasize Issues of Culture (cont. ) • Revisions of prominent assessment methods – MMPI-2 – Wechsler intelligence tests

Cultural Competence • The counselor’s acquisition of awareness, knowledge, and skills needed to function effectively in a pluralistic democratic society • 3 main components: – Awareness – Knowledge – Skills

Cultural Competence: Self-Awareness • Learning about one’s own culture – Values, assumptions, biases – By doing so, become less egocentric – Realize that differences are not deficiencies

Cultural Competence: Knowledge of Diverse Cultures • Can gain knowledge by – – Reading, especially regarding history Direct experiences Relationships with people of various cultures Asking client to explain cultural meaning (to a limited extent) • Remember that there are exceptions to cultural trends – Metaphor—Asian men tend to be relatively short, but Yao Ming is 7’ 6”

Cultural Competence: Knowledge of Diverse Cultures (cont. ) • Acculturation – Response to new cultural environment – Balance between adopting new and retaining original culture – Specific strategies: • • Assimilation (high new, low original) Separation (low new, high original) Marginalization (low new and original) Integration (high new and original)

Cultural Competence: Culturally Appropriate Clinical Skills • Techniques should be consistent with the values and life experiences of each client • “Talk therapy” may work better for some cultural groups than for others • Some cultural groups may respond more positively to “action” than “insight”

Cultural Competence: Culturally Appropriate Clinical Skills (cont. ) • Microaggressions – Comments or actions made in cultural context that (often unintentionally) convey negative beliefs – Can suggest dominance and cause marginalization or invalidation – Psychologists can avoid by examining their own beliefs

Cultural Adaptation • Modifying treatments with empirical evidence for members of a cultural group

Etic vs. Emic Perspective • Etic – Emphasizes similarities between all people – Assumes universality – Downplays culture-based differences • Emic – Emphasizes culture-specific norms – Appreciate clients in the context of their own culture

Tripartite Model of Personal Identity • Three levels of identity – Individual level • Every person is totally unique – Group level • Every person is like some others – Universal level • Every person is like all others • Clinical psychologists can recognize all three levels for any client

What Constitutes a Culture? • Narrow vs. broad definitions – Some argue that ethnicity and race are the defining characteristics of culture – Others argue that many other variables can define a culture, such as • • Socioeconomic status Religion Gender Age Geography/region Political affiliation Disability status

Interacting Cultural Variables • Multiple cultural factors can combine to create a unique culture for a particular individual – Two people of the same ethnicity can differ on many other variables, and can have very different life experiences as a result

Training Psychologists in Cultural Issues • Educational alternatives – Courses – Readings – Real-world experiences – Recruit and retain diverse students and faculty – Encourage cultural self-knowledge, curiosity, and humility

Measuring the Outcome of Culture. Based Training Efforts • Many questions remain – How can we measure a baseline of cultural competence? – How can we measure change after training? – Whose opinion should we seek? Psychologist, client, supervisor, others? – How can we infer cause?