Multicultural Theories of Psychotherapies

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.