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Multicultural Theories of Psychotherapies

Multicultural Theories of Psychotherapies. Slides created by Barbara A. Cubic, Ph.D. Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10. Learning Objectives. This presentation will focus on: Overview of multicultural issues related to psychotherapies

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Multicultural Theories of Psychotherapies

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  1. Multicultural Theories of Psychotherapies Slides created by Barbara A. Cubic, Ph.D.Professor Eastern Virginia Medical School To accompany Current Psychotherapies 10

  2. Learning Objectives • This presentation will focus on: • Overview of multicultural issues related to psychotherapies • History of multicultural approaches • Ways to integrate multicultural issues into therapies • Research on multiculturalism

  3. Are Prevailing Therapies Relevant to the Culturally Diverse? • Most therapeutic orientations recognize individual differences must be respected. • However, dominant models of psychotherapy tend to be grounded in a monocultural perspective. • As such, they support mainstream cultural values that neglect multicultural worldviews.

  4. Dominant Models of Psychotherapy • May unintentionally promote ethnocentrism. • The belief that one’s worldview is inherently superior and desirable to others.

  5. Terminology • Culture is defined as an individual’s total environment. • Worldview refers to people’s systemized ideas and beliefs about the universe. • Multicultural refers to the interaction between people across a culture.

  6. Multicultural Psychotherapies • Promote cultural sensitivity. • Awareness, respect, and appreciation for cultural diversity. • Believe definitions of health, illness, healing, normality, and abnormality are culturally embedded. • Promote empowerment and social justice and affirm strengths.

  7. Multicultural Psychotherapies National origin Ability/disability Language Place of residence Ideology Membership in other marginalized groups Consider power differentials based on: • Race • Gender • Social class • Sexual orientation • Age • Religion

  8. Unity through diversity is a multicultural maxim.

  9. Basic Concepts

  10. Multiculturalism • Acknowledges the presence of diverse worldviews. • Views each culture as unique and dynamic, to be understood within its own context. • Embodies cultural constructionism. • A process whereby individuals construct their world through social processes that contain cultural symbols and metaphors.

  11. Worldviews • Harry Triandis (1995) • Classified worldviews according to how individuals define themselves and relate to others across an individualist-collective spectrum. • Collectivistic: Identity is associated with relationships to others. • Denominated: View themselves independently from others.

  12. Multicultural Psychotherapists • Work towards cultural competence, an individual. • Becomes aware of their worldview. • Examines their attitude towards cultural differences. • Learns about different worldviews. • Develops multicultural skills. • Learns about one’s position in relation to societal power and privilege.

  13. Multicultural Guidelines • Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Clients • Exhorted practitioners to: • Recognize cultural diversity. • Understand central role culture, ethnicity, and race play in culturally diverse individuals. • Appreciate the significant impact of socioeconomic and political factors on mental health. • Help clients understand their cultural identification.

  14. Multicultural Guidelines • Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change • We are cultural beings. • Value cultural sensitivity and awareness. • Use multicultural constructs in education. • Conduct culture-centered and ethical psychological research with culturally diverse individuals. • Use culturally appropriate skills. • Implement organizational change process.

  15. Cultural Competence is a Lifelong Process • Cross and colleagues (1989) identified a cultural spectrum from: • Destructiveness • Incapability • Blindness • Pre-competence • Competence

  16. Cultural Competence is a Lifelong Process • Destructiveness • Incapability • Blindness • Pre-competence • Competence  

  17. Destructiveness • Attitudes, policies, and practices are destructive to cultures and individuals.

  18. Incapacity • Racial superiority of the dominant group. • Cultural blindness: Belief that culture makes no difference.

  19. Blindness • Individuals believe that culture makes no difference. • The values of the dominant culture are universally applicable and beneficial.

  20. Cultural Pre-Competence • Do not know exactly how to proceed.

  21. Cultural Competence • Possessing a set of knowledge, behaviors, attitudes, skills, and policies needed to work effectively in multicultural situations.

  22. Cultural Competence Guidelines for Organizations • Therapists should: • Evaluate institution’s mission statement to include diversity. • Assess diversity policies. • Evaluate how people of color perceive specific policies. • Acknowledge within group diversity. • Be aware that diversity requires examination. • Recognize that multicultural sensitivity may mean advocating.

  23. Multicultural Practitioners Can Help Organizations Achieve Cultural Competence • Include community representation and input at all stages of implementation. • Integrate all organizational systems. • Ensure changes made are manageable, measurable, and sustainable. • Make the business case for cultural competency polices. • Require commitment from leadership. • Help establish staff training on an ongoing basis.

  24. Empowerment • Racial micro-aggressions refer to assaults individuals experience because of race, color, and ethnicity. • Cultural trauma refers to a legacy of adversity, pain, and suffering among many minority group members. • Research has identified a human tendency to categorize individuals into in- and out-group members leading to unconscious biases.

  25. Empowerment: Multicultural Psychotherapists Subscribe To • Reality is constructed into a context. • Experience is valuable knowledge. • Learning/healing results from sharing multiple perspectives. • Learning/healing is anchored in meaningful and relevant contexts.

  26. Empowerment • Emphasis on empowerment frequently leads psychotherapists to commit to social justice. • Psychotherapy will be unsuccessful if clients feel that their therapist is unconsciously racist, ethnocentric, sexist, elitist, xenophobic, homophobic, etc.

  27. Multicultural Psychotherapies’ Underlying Assumptions • Culture is complex and dynamic. • Every encounter is multicultural. • Reality is constructed and embedded in context.

  28. Western Worldview’s Dominanceof Mainstream Psychotherapy • Multicultural psychotherapies are relevant to all individuals. • Cultural competence is crucial for effective psychotherapy. • Multicultural psychotherapists engage in self-awareness. • Healing: • Empowers individuals and groups. • Involves multiple perspectives. • Holistic and liberatory.

  29. Comparing Multicultural Approaches to Other Therapy Systems

  30. Impact of Culture on Treatment Outcomes • In contrast to European-Americans, African Americans: • Tend to drop out of CBT at a higher rate. • Found treatment less positive after receiving services even when they expressed positive expectations initially.

  31. Culture Affects Psychotherapeutic Process • Culture’s impact is greater on therapy process than outcome. • Personal/collective history is important in people of color’s lives. • Transcultural psychiatry and psychology advocate for the use of community/indigenous resources. • Minority empowerment movements further the development of multicultural psychotherapies.

  32. History of Multicultural Psychotherapies

  33. Multicultural Psychotherapies: Interdisciplinary Origins • Early theoretical influences include: • Psychological anthropology • Ethnopsychology • Cultural anthropology • Psychoanalytic anthropology • Folk healing

  34. Evidenced Based Practices (EBP) • EBP appear effective for a number of culturally diverse populations.

  35. Paulo Freire (1973) • Identified dominant models of education as instruments of oppression. • Conscientization: Critical consciousness as a process of person and social liberation. • Involves questions of What? Why? How? For whom? Against whom? By whom? In favor of whom? In favor of what? To what end? • Helps oppressed individuals to author their own reality.

  36. Types of Therapy/Counseling: Re-evaluation Counseling (RC) • An empowering co-counseling approach where two or more individuals take turns listening to each other without interruption. • “Counselor” encourages the “client” to discharge emotions (catharsis). • Next, “client” becomes the “counselor” and listens.

  37. Types of Therapy/Counseling:Feminist Therapy • Attempts to empower all people and promote equality at individual, interpersonal, institutional, national, and international levels. • Women of Color feminist therapists address the interactions between racism, sexism, classism, heterosexism, ethnocentrism, ableism, and other forms of oppression.

  38. Types of Therapy/Counseling:Ethnic Family Therapy • Know their own culture. • Avoid ethnocentric attitudes and behaviors. • Achieve an insider status. • Use intermediaries. • Have selective disclosure. • Often use cultural genograms.

  39. Current Status of Multicultural Psychotherapies

  40. Current Status: Three Models • Multicultural psychotherapists practice following three models (or a combination thereof). • Cultural adaptation of dominant psychotherapy

  41. Current Status: Three Models • Ethnic psychotherapies • Integrates cultural variables in treatment through the examination of worldviews, cultural transitions, relationships and context. • Based on a philosophical spiritual foundation that promotes connective, ancestral and sacred affiliations in healing.

  42. Current Status: Three Models • Ethnic psychotherapies (continued) • Include approaches based on Eastern philosophical traditions and narratives as a collectivistic way of relating. • Testimonio: Chronicles traumatic experiences in Latin America. • Cuento therapy: Empirically proven to be an effective treatment for Puerto Rican children. • Dichos (sayings): Form of flash psychotherapy that consists of Spanish proverbs or idiomatic expressions capturing folk wisdom.

  43. Current Status: Three Models • Holistic approaches • Folk healing is form of indigenous psychotherapy. • Fosters empowerment, encourages liberation, and promotes spiritual development.

  44. Current Status • Several professional and academic organizations have supported the development of multicultural psychotherapies. • Publications on the topic include: • Cultural Diversity and Ethnic Minority Psychology • Journal of Multicultural Counseling and Development • Psychology of Women Quarterly • Women and Therapy

  45. 8 Cultural Dimensions

  46. Ricardo Munoz’s Suggestions for Culturally Adapting CBT • Involvement of culturally diverse people in the development of interventions. • Inclusion of collectivisitic values. • Attention to religion/spirituality. • Relevance of acculturation. • Acknowledgement of the effects of oppression.

  47. Pamela Hays (2001) Framework

  48. Culturally Sensitive Psychotherapy (CSP) • Targets specific ethnocultural groups. • A group may benefit from a specific intervention more than from interventions designed for others.

  49. APA Multicultural Guidelines No. 5 • Encourages psychologists to strive to learn about non-Western healing traditions and to acknowledge and enlist the assistance of recognized helpers and traditional healers in treatment.

  50. Other Approaches • Carolyn Attneave’s Network Therapy • Community-based approach. • Recreates the social context clan’s network to mobilize a person’s family and social support. • Ignacio Martin-Baro’s Psychology of Liberation • Collaborative approach focused on assisting oppressed clients in developing critical analysis and engaging in transformative actions. • Resonates with African-American psychology as it is based on Black liberation theology and Africanist traditions.

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