Cultural Barriers in Multicultural Psychotherapy -A.W.

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CULTURAL BARRIERS IN MULTICULTURAL PSYCHOTHERAPY

ultural barriers are sources of bias that can play a significant role in the effectiveness of multicultural psychotherapy. Culture-related, class-related, and language-related barriers are three major (and over-lapping) sources of potential bias identified in the seminal writings of Derztld W. Sue and David Sue. Each source of bias can produce problems that may affect the initiation, continuation, and success of psychotherapy. Among the problems that may arise are the misinterpretation of a client's cultural norms as symptoms of a disorder: misunderstanding of culture-bound syndromes and socio-political reasons for client behavior: and the misuse of interpreters.

Culture comprises the values, beliefs, and norms that are shared by a group of people. such as a racial on ethnic minority. Culture influences how people think about, act on, and see the world. Traditional psychotherapy theories and the mainstream European American/Caucasian culture in the United States (referred to as "Caucasian culture") share common values and beliefs that can be barriers in multicultural psychotherapy. Examples of these commonalities are the emphasis placed on the use of standard English. direct verbal expression, and long-term goals: the distinction between physical and mental well-being: and the determination of cause—effect relationships.

CULTURE-RELATED BARRIERS

Culture-related barriers in psychotherapy stem from cultural differences between therapists (who are predominantly Caucasian in the United States) and their clients. Common differences arise in the areas of (1) the value of individualism versus collectivism; (2) verbal, emotional, and behavioural expressions; (3) preferred therapeutic approaches; and (4) views regarding the separation of the mind and body.

Individualism is associated with the Caucasian culture and collectivism with non-Caucasian cultures. The Caucasian culture tends to stress the importance of having a single identity that is not defined by any-thing or anyone else, whereas in non-Caucasian cultures, a person’s identity is often defined by his or her family or cultural group. Consequently, a Caucasian therapist may misinterpret a client’s need to consider family needs ahead of his or her own as unhealthy, overly dependent, and lacking maturity.

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Tied to views regarding individualism and collectivism are the verbal, emotional, and behavioural expressions of different cultures. In the Caucasian culture, for example, when someone engages in wrongful behaviour, he or she often feels guilt, but in many non-Caucasian cultures, the person is more likely to feel shame. Guilt is seen as an individual emotion and shame as a group emotion. Additionally, the importance of verbalizing emotions and emotional reactions is stressed in the Caucasian culture. Self-revelation requires the client to communicate his or her feelings about any topic the therapist probes, even if it involves the most intimate details of the client’s life. If a client is not forthcoming, he or she may be viewed as paranoid, guarded, or inhibited. Non-Caucasian cultures are more likely to view such verbal expressions as a sign of disrespect and immaturity and tend to value remaining quiet and listening. Furthermore, culture is reflected in behavioural expressions such as assertive-ness, which is valued to a greater extent in the Caucasian culture than in many non-Caucasian cultures.

There are also cultural differences in preferred therapeutic approaches. Traditional psychotherapy theories are generally analytical, linear, and logical, with the primary goal of searching for a cause–effect relationship that is responsible for the individual’s problem(s). This contrasts with the more holistic, creative, and nonlinear worldview of many cultures. Additionally, traditional psychotherapy relies on the scientific method and its method of asking and answering questions, including completing quantitative evaluations. Direct and some-times confrontational techniques are evident in traditional psychotherapy, whereas some cultures (e.g., Asian) value indirectness and subtlety in communication. Many cultures prefer not to be so straightforward in questioning and responding, and this may lead the therapist to a negative interpretation of the client’s behaviour (e.g., the client is nonresponsive and withdrawn).

Distinctions between mental and physical health are generally more clearly marked for Caucasians than for non-Caucasians. Non-Caucasian cultures are less likely to separate the mind and body and may be confused by the distinction in traditional psychotherapy. These clients may expect to receive the kind of treatment typically provided by physicians and the clergy. This includes immediate and tangible solutions such as advice and medication. Traditional therapies are more ambiguous and long term and tend to be less consistent with the expectations of non-Caucasian cultures.

Culture-bound syndromes can also play a role in creating cultural barriers in therapy. Some syndromes seem to exist only in certain cultures, and they may be mistakenly viewed as indicative of pathology. For example, many Latinos believe in the evil eye, a syndrome of distress also known as ‘mal de ojo’). Patients with this syndrome believe that when a person is given the evil eye by another, he or she will experience misfortunes in his or her career, love, and family life. In this case, the therapist may incorrectly conclude that the client is paranoid because of the client’s perceived preoccupation with people causing him or her harm. Moreover, therapists must understand that many people do not seek help for certain symptoms of distress because those symptoms may be considered normal in their culture.

CLASS-RELATED BARRIERS

Class-related barriers include socioeconomic status (SES) and how others perceive this status. Although therapists are largely members of the middle to upper class, ethnic minority groups are disproportionately represented in lower SES classes. These groups may see themselves and be seen as inferior to the upper classes. It may be difficult for therapists to understand and relate to these clients (and vice versa), and class-related characteristics may be wrongly attributed to an individual’s cultural group.

In traditional psychotherapy theories, clients are expected to gain insight into the causes of their so-called abnormal behaviour. Usually, when this insight is gained, clients take the time necessary to think about their motivations and behaviours. Gaining insight may not be valued by some cultures, and the process is likely to be time-consuming. Many low-SES clients do not have the luxury of this kind of time. They may only think of the here and now and do not perceive insight as an appropriate goal for their life situation. They may instead be concerned with immediate questions such as, “How can I take care of my family when my job pays minimum wage?” Transportation and funds to attend therapy sessions (especially when they take place over the long term) are additional concerns.

LANGUAGE-RELATED BARRIERS

In the United States, the language of therapy is usually monolingual, standard English. However, for culturally diverse clients, this can be a significant barrier. Clients may become frustrated during therapy when attempting to communicate in a second language. The effort required to speak grammatically correct English may come at the cost of expressing the content that the therapist is seeking. Speaking in a second language may also cause clients to express their emotions differently. Some emotion-related words that are learned in a first language may have adeeper level of meaning than the words learned in a second language. Therefore, if the expression of feelings is made in the second language, emotions associated with experiences may not be effectively expressed.

Lack of awareness of nonverbal language and its associated cultural meanings can be a barrier in psychotherapy. Nonverbal communication differences occur in the areas of proxemics (personal space), kinesics (bodily movements), paralanguage (vocal cues, e.g., vocal inflections), and high- and low-con-text communication. High-context communication relies heavily on nonverbal messages, whereas low-context communication relies more on verbal messages. Misunderstandings can result from differences in nonverbal messages—for example, a therapist may mistakenly assume that a Latino client’s lack of eye contact is indicative of unassertiveness or depression, although the behaviour may be a culturally related sign of respect.

When a therapist uses an interpreter, several problems may occur. For example, the interpreter may not translate accurately, especially when it comes to mental health concepts that vary in meaning across cultures, and there may be concerns about dual relationships and loss of confidentiality. When a family member is used as an interpreter, his or her own concerns may affect the information that is transmitted and thus the power balance. Ideally, the interpreter is trained professionally. The interpreter should be fluent in both languages and know and understand the terminology the therapist uses. Moreover, the therapist and interpreter should meet before and after a counseling session with a client to answer any questions the interpreter may have and to review the important aspects of the translation.

Important Note: This work is owed to the ‘Encyclopedia of Multicultural Psychology’, published by the ‘Sage Publications’ in 2006. Please acknowledge this information if you are to use this work for any of your writings. Thank You.

-A.W.