Tenzin Chokey
Psychotherapy is a form of medical treatment, which includes talking with a person (therapist) about an individual’s mental distress. For example, when we feel helpless and overwhelmed by mundane situations like marriage and moving places, we go for therapy. But this motivation for therapy can be different for each individual, for everyone reacts differently to the stimulus present in the environment. Making the approach to psychotherapy subjective and personal, which manifests therapy into a vulnerable space for them. In the usual setting, psychotherapy consists of a therapist who converses with the clients, who are there for the treatment through therapy. As much as psychotherapy is talk-oriented, it demands therapists to know the background information of the clients to efficiently diagnose them. Biological and psychological aspect plays a huge role in efficient diagnoses of the client. But we exist in the social community, where societal influence takes much bigger parts of our life than our own. In a way, society’s norms and individual opinions and perspectives maintain each other. Marsella and Yamada(2010) defined ‘culture’ while deconstructing the link between human behavior and society as “a learned behavior and meanings that are socially transmitted for the purposes of adjustment and adaptation” (p. 105). So, the differences in our reactions to a stimulus depend on our ‘culture’ which constitutes the foundation for categorizing normative or abnormative behavior. Then ‘culture’ becomes an integral part of therapy, since it plays a significant role in controlling the behavior of the client. And culture is a multidimensional concept, as Arredondo (1996) refers to ‘culture’ as a dynamic environment where we all are multicultural individuals living in a multicultural setting. To understand the dynamics of the multi-culture effect on behavior, the therapist needs to be multi-culturally competent and the therapy needs to be multi-cultural oriented. ‘Multicultural competence’ is the quality of being able to work efficiently across diverse cultural groups and the expertise in treating individuals from multiple cultures(Sue et al.,1992).
Most dominant and accessible psychotherapies are based on and sampled from the white Western community(Orlinsky et al.,1999). Similarly, it has been shown that some therapist underperforms when they are with clients belonging to a minority group relative to white clients(Hayes et al.,2014). The inability to provide inclusive therapy contributes to the inefficiency of psychotherapy. While not taking the cultural differences into account it neglects the possible confounding threats to efficient therapy. The efficacy of psychotherapy depends on the relationship that is being set between the client and the therapist. From the therapist's side, the most important features are being emotionally receptive, non-judgmental, empathetic, and most importantly the ability of the therapist to form a good working alliance with the client (Butcher et al.,2012). Where the studies have shown how well the clients perform well during psychotherapy is predicted by the therapist’s ability to form a good alliance with them(Baldwin et al.,2007 as cited in Butcher et al,2012). Although the definition of this therapeutic alliance can be very subjective, it portrays the nature of the relationship between the client and therapist, setting the expected goals from therapy through collaboration(Butcher et al.,2012). To set the goals and the bond, coherent communication and listening are also very important. Communication can be only achieved when the client is willing to share and feels comfortable with the therapist. This poses a huge challenge when the therapist is not conscious of the cultural background of the client. That would lead to serious misunderstandings or mistranslations of information that clients want to convey. For example in some parts of the Native American tribe, hearing the voices of dead family members is considered normal in their culture(Butcher et al.,2012). If a client approaches us saying they have been hearing the voices of their dead relative, what would happen if we diagnosed them with a disorder rather than acknowledging their beliefs first? Is diagnosing the only important part of the therapy? Where not knowing the persistent belief of such things in culture is not taken into account it does more harm than good through when clients are misdiagnosed. It has been reported that children belonging to minority tends to show psychological distress in the form of physical or somatic symptoms as compared with Caucasians(Alizadeh &Chavan,2019). But these children are getting overly misdiagnosed with psychosis, overlooking the difference in emotional reactivity across cultures(Alizadeh &Chavan,2019).
We all are from different cultural backgrounds and how could you expect all of us to categorize based on one culture? It neglects and violates the very foundation of building up the bond between therapist and clients. As much as we give importance to the bonding between the therapist and client for efficient therapy, being aware of your own client's cultural background adds extra credibility to the therapy as well as their motivation to commit to the therapy. The multicultural competence of the therapist has been shown to be affirming credibility and creating more extent of comfort during therapy(Koc&Kafa, 2019). We need more multicultural competent therapists right now. While training the therapist, multicultural competency should be addressed and taken seriously. We can incorporate these competencies in the ethics of therapy. So, it becomes more visible and prominent as their responsibility in understanding the invisible grasp of culture on people’s behavioral aspects. In that way, they can diagnose the clients through a multicultural lens than the biological aspect. Through this negotiation access to the treatment can become more adaptable and approachable. Only then we will be able to acknowledge the access to psychotherapy as a treatment and assistance rather than a nuisance.
References
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Alizadeh, S., & Chavan, M. (2019). Perceived Cultural Distance in Healthcare in Immigrant Intercultural Medical Encounters. International Migration, 58(4), 231–254. https://doi.org/10.1111/imig.12680
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Kumaraswamy, N. (2007). Psychotherapy in Brunei Darussalam. Journal of Clinical Psychology, 63(8), 735–744. https://doi.org/10.1002/jclp.20388
Marsella, A. J., & Yamada, A. M. (2010). Culture and Psychopathology: Foundations, Issues, Directions. Journal of Pacific Rim Psychology, 4(2), 103–115. https://doi.org/10.1375/prp.4.2.103
Orlinsky D., Rønnestad M. H., Ambühl H., Willutzki U., Botersman J.-F., Cierpka M., .Davis M. (1999). Psychotherapists’ assessments of their development at different career levels. Psychotherapy: Theory, Research, Practice, Training, 36, 203-215.
Volkan Koç, Gülnihal Kafa. (2019). Cross-Cultural Research on Psychotherapy: The Need for a Change - Volkan Koç, Gülnihal Kafa, 2019. Journal of Cross-Cultural Psychology. https://journals.sagepub.com/doi/full/10.1177/0022022118806577
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