Systems of Psychotherapy A Transtheoretical Analysis Chapter 14

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Systems of Psychotherapy: A Transtheoretical Analysis Chapter 14. Multicultural Therapies

Systems of Psychotherapy: A Transtheoretical Analysis Chapter 14. Multicultural Therapies

A Sketch of Multicultural Therapy ♦ Psychotherapy developed by upper-class, white heterosexuals in western

A Sketch of Multicultural Therapy ♦ Psychotherapy developed by upper-class, white heterosexuals in western Europe ♦ Therapy originally and erroneously envisioned as transcultural ♦ Traditional txs increasingly inappropriate for clinical needs of minority & oppressed groups ♦ Changing demographics signal need for cultural awareness & competence

100 Person World Village ♦ ♦ ♦ ♦ 57 Asians 21 Europeans 14 from

100 Person World Village ♦ ♦ ♦ ♦ 57 Asians 21 Europeans 14 from Western Hemisphere 8 Africans 70 non-white 70 non-Christian 8 gay, lesbian, or bisexual 58% of world wealth would be in the hands of 6 Americans

3 Multicultural Pioneers ♦ Lillian Comas-Diaz ♦ Stanley Sue ♦ Beverly Greene

3 Multicultural Pioneers ♦ Lillian Comas-Diaz ♦ Stanley Sue ♦ Beverly Greene

Theory of Personality ♦ Culture is a major determinant of personality ♦ Culture is

Theory of Personality ♦ Culture is a major determinant of personality ♦ Culture is constellation of human knowledge, belief & behavior passed down from earlier generations ♦ No single theory for multicultural treatment ♦ We require multiple perspectives rooted in particular cultures

Defining Race & Ethnicity ♦ Race: category of persons related by common heredity or

Defining Race & Ethnicity ♦ Race: category of persons related by common heredity or genetics and whose features are perceived in terms of external traits ♦ Ethnicity: a shared culture with respect to lifestyles, norms, and values ♦ Racial identity: the quality of a person’s commitment to his or her socially ascribed racial group

Race & Ethnicity (cont. ) ♦ Race & ethnicity not always the same ♦

Race & Ethnicity (cont. ) ♦ Race & ethnicity not always the same ♦ No individual is a repository of a pure culture ♦ All people have multiple groups, & not all members have same characteristics ♦ Crucial to avoid the myth of uniformity (all group members have the same characteristics) ♦ Culture, race, & identity overlap but not perfectly

Theory of Psychopathology ♦ Expression and manifestation of pathology are often culturally determined ♦

Theory of Psychopathology ♦ Expression and manifestation of pathology are often culturally determined ♦ Pathology is behavior that predominant culture consensually deems unusual or maladaptive ♦ Etiology is mix of biology, culture, & psychology ♦ Impact of race/ethnicity usually due less to biological vulnerability and more to social inequality

Social Causes of Psychopathology ♦ Social, political, & economic oppression ♦ Stress resulting from

Social Causes of Psychopathology ♦ Social, political, & economic oppression ♦ Stress resulting from prejudice & discrimination ♦ Internalized racism: low self-esteem & selfhatred caused by discrimination ♦ Problems with acculturation ♦ Failure to be accepted by dominant culture

Culture-Bound Syndromes ♦ In Malayan culture, Amok – sudden, wild homicidal aggression ♦ In

Culture-Bound Syndromes ♦ In Malayan culture, Amok – sudden, wild homicidal aggression ♦ In Western cultures, Anorexia nervosa – preoccupyation with thinness & refusal to eat ♦ In Caribbean cultures, Ataques de nervios – impulsivity, dissociation, & anxiety ♦ In central American cultures, Susto – loss of soul causing depression & somatic symptoms ♦ In Japanese culture, TKS – intense fear of offending other people through social awkwardness

Therapeutic Processes ♦ 3 perspectives: Cultural relativism, cultural universality, cultural adaptation ♦ Consciousness raising:

Therapeutic Processes ♦ 3 perspectives: Cultural relativism, cultural universality, cultural adaptation ♦ Consciousness raising: understanding how dominant culture has oppressed & shaped self-views ♦ Catharsis: expressing healthy anger & recognizing that anger is normal & justified ♦ Choosing: channeling new-found liberation & pride

Social Liberation ♦ Liberation psychotherapy ♦ Founded by Ignacio Martin-Baro ♦ Challenged notion of

Social Liberation ♦ Liberation psychotherapy ♦ Founded by Ignacio Martin-Baro ♦ Challenged notion of marginality & fosters action to eliminate subordinate status in minority cultures ♦ Action is required to secure freedom ♦ Psychotherapists advocate for their clients to take action to transform society

Therapeutic Content Intrapersonal Conflicts ♦ Anxieties & defenses ♦ Self-esteem Interpersonal Conflicts ♦ Intimacy

Therapeutic Content Intrapersonal Conflicts ♦ Anxieties & defenses ♦ Self-esteem Interpersonal Conflicts ♦ Intimacy & sexuality ♦ Communication ♦ Hostility ♦ Control

Therapeutic Content (cont. ) Indivduo-Social Conflicts ♦ Adjustment versus transcendence ♦ Impulse control Beyond

Therapeutic Content (cont. ) Indivduo-Social Conflicts ♦ Adjustment versus transcendence ♦ Impulse control Beyond Conflict to Fulfillment ♦ Meaning of life ♦ Ideal individual

Therapeutic Relationship ♦ Empathy & collaboration are foundation ♦ Can prove challenging if therapist

Therapeutic Relationship ♦ Empathy & collaboration are foundation ♦ Can prove challenging if therapist is of different race & ethnicity ♦ Meaning of “therapist” varies by culture ♦ Racial/ethnic matching of therapist & patient may be preferred ♦ Therapist adapts to cultural preferences ♦ Therapist is advocate: empowers client for social change

Practicalities of Multicultural Therapy ♦ Length of treatment is matter of individual & cultural

Practicalities of Multicultural Therapy ♦ Length of treatment is matter of individual & cultural preferences ♦ Frequently involves contact with families, communities & indigenous healers ♦ Use of translators is controversial and often contraindicated ♦ Pre-treatment preparation clarifies expectations & defines role for client, typically leading to lower dropouts and better outcomes

A Major Alternative: Psychotherapy with LGB Clients ♦ Lesbian, gay, & bisexual (LGB) clients

A Major Alternative: Psychotherapy with LGB Clients ♦ Lesbian, gay, & bisexual (LGB) clients are oppressed minority group ♦ US now recognize same-sex marriages but no federal law bans economic & housing discrimination ♦ Homophobic attitudes toward LGB clients persist ♦ Gay Affirmative Therapy celebrates and advocates ♦ Reparative/sexual conversion therapy attempts to “convert” clients back to heterosexual orientation but is discredited

Effectiveness of Multicultural Therapies ♦ Reviews of multicultural treatment tend to reflect race of

Effectiveness of Multicultural Therapies ♦ Reviews of multicultural treatment tend to reflect race of the reviewer ♦ Many racial & ethnic minorities are under-served in mental health ♦ Most minority clients prefer same-race therapists, but no consistent differences in outcome when matched ♦ Meta-analyses conducted on culturally adapted therapies reveal a positive effect (d =. 52)

Criticisms of Multicultural Therapy ♦ From a Psychoanalytic Perspective (psychology replaced with victimology, lack

Criticisms of Multicultural Therapy ♦ From a Psychoanalytic Perspective (psychology replaced with victimology, lack of individual responsibility) ♦ From a Cognitive-Behavioral Perspective (mandating diversity has negative side effects, lack of controlled research) ♦ From a Humanistic Perspective (lack of concern for value of individual) ♦ From an Integrative Perspective (psychotherapy should match needs of entire individual, not only culture)

Future Directions ♦ Demographic changes & pluralistic society make multiculturalism inevitable ♦ Pluralism: more

Future Directions ♦ Demographic changes & pluralistic society make multiculturalism inevitable ♦ Pluralism: more inclusive, less ethnocentric models of human behavior & treatment ♦ Meaning of culture broadened to multiple dimensions (age, disability, social status, etc. ) ♦ Practitioners must secure multicultural competence

Key Terms acculturation “browning of America” cultural empathy cultural relativism cultural universality culturally adapted

Key Terms acculturation “browning of America” cultural empathy cultural relativism cultural universality culturally adapted therapies culture-bound syndromes ethnicity gay affirmative therapy heterosexism internalized homophobia internalized racism intersectionality of multiple identities lesbian, gay, & bisexual (LGB) liberation psychotherapy microaggressions multicultural psychotherapy myth of uniformity pluralism pretreatment patient preparation race racial disparities in health care racial identity reparative therapy sexual conversion therapy traditional or indigenous healers unconscious racism

Recommended Websites ♦ APA Presidential Taskforce on Diversity Education: www. teachpsych. org/diversity/ptde/index. php ♦

Recommended Websites ♦ APA Presidential Taskforce on Diversity Education: www. teachpsych. org/diversity/ptde/index. php ♦ Association for Multicultural Counseling & Development: www. counseling. org/home ♦ Parents, Families & Friends of Lesbians & Gays: www. pflag. org ♦ Society for the Psychological Study of Ethnic Minority Issues: http: //division 45. org ♦ Society for the Psychological Study of Lesbian, Gay & Bisexual Issues: www. apadivision 44. org