Psychotherapy w/Members of Diverse Populations

Question 1

1.0 African-American

Answer 1

Blacks, to be emphasized:

1. interconnectedness, group over the individual
2. extended family systems that include church
3. roles in family are flexible, egalitarian for men and women and adults/children ave multiple roles.
4. healthy cultural paranoia
5. ecostructural or ecological sytemic approach in therapy

**Boyd-Franklin’s Multisystems Model: **

1. addresses multiple systems, intervenes at multiple levels and empowers families by using their strengths
2. incoporate extended family, nonblood kin, church and agencies
3. time-limited, problem-solving, goal driven approach and foster egalitarian relationship
4. cultural mismatch should be addressed in first session between therapist and client.

Question 2

2.0 American Indians and Alaskan Natives

Answer 2

Tribals

1. spiritual and holistic orientation to life emphasize harmony w/nature and illness as disharmony
2. extended family and tribe more than individual, consensual collateral form of social organization and decision-making
3. time is personal and seasonal rather than clock/calendar. more present than future
4. cooperation and generosity
5. listening is more important than talking
6. build trust and credibility, be aware of the history
7. reaffirm the client’s unique culture/history
8. collaborative, problem-solving, client centered, NOT directive or confrontational
9. incorporate elders, healers.
10. NETWORK therapy: incorporates family, community into therapy and situates the problems w/in a broad context.

Question 3

3.0 Asians

Answer 3

Asians

1. group (family, community) than on the individual
2. adhere to hierarchical family structure and traditional gender roles.
3. harmony, interdependence, loyalty, obligation
4. restraint of strong emotions, don’t shame family

In therapy:

1. directive, structured, goal-oriented, problem-solving
2. alleviating specific symptoms focus is preferred
3. give concrete advice, therapist as expert
4. but encourage participation
5. formalism in therapy
6. functions of shame/obligation to reinforce adherence to prescribed roles and responcibilities
7. modesty and self-deprecation are not always signs of low self-esteem
8. establish credibility and competence early in therapy by stressing therapist education/experience
9. prevent premature termination by providing client immediate and meaningful benefit
10. often present with somatic complaints
11. focus on behavior more than emotions
12. cbt, solution-focued and other brief therapies

Question 4

4.0 Hispanics/Latino Americans

Answer 4

Hispanic/Latino

1. family welfare over individual welfare, stress allegiance to family above all
2. interdependence both healthy and necessary and value connectedness and sharing
3. problems should be handled w/in the family, so discussing intimate personal details with stranger is unacceptable.
4. concrete, tangible approach to life rather than abstract, long-term perspective
5. attribute control of life events to luck, supernatural, god and external forces

In therapy:

1. be active and directive and have multimodal approach that focuses on behavior, affect, congitions, interpersonal relationships, and biological functioning.
2. use family therapy, familismo
3. emphasize formalismo at start and then personalismo
4. patriarchal, sex roles are often inflexible
5. parent-child bond is often stronger than husband-wife.
6. id the degree of acculturation in the family as possible source of conflict/problems
7. consider the impact of religion and spiritual factors.
8. often somatic complaints

Question 5

5.0 Sexual Minorities

Answer 5

LGBT

1. higher rates of certain psychological problems
2. teens: depression, anxiety and substance use and suicidality.
3. NOT due to sexual orientation but due to the prejudice and discrimination LGBT encounter because of sexual orientation.
4. stigmatized, social and emotional isolation
5. _Internalized Homophobia_: whtn LGBT individual accept hetersexual society’s negative evaluations of them and incorporate these into their self-concepts.
   
   1. low self-esteem, self-doubt/hatred, powerlessness, denial, self-destructive bx.
6. address in therapy by id’ing and correcting cognitive distortions, training in assertiveness and coping skills, and activating social supportive systems.
7. Coming Out: may result in rejection and other negative consequences it is also beneficial.
   
   1. research with lesbians that widely disclose: better esteem, positive affectivity, lower anxiety, healthy pro-social engagement (not slutty).
   2. more ‘outness’ associated with lower levels of psychological distress.
   3. males/females first disclose about same time
   4. no gender-related age differences in coming out to others
   5. coming out earlier now than in the past.
   6. adolescent males have earlier onset of milestones of: first same-sex attraction, self-labeling, sex contact….equal for coming out.