Psychotherapy with Members of Diverse Populations

Question 1

African Americans

Answer 1

• emphasize group welfare over individual needs
• extended kinship network that includes both nuclear and extended family members as well as individuals outside the biological family (church)
• roles are flexible; relationships between men and women tend to be egalitarian and adults and children may adopt multiple roles
• may exhibit signs of healthy cultural paranoia
• use time-limited, directive, goal-oriented, problem solving approach and fostering empowerment by promoting egalitarianism in the therapeutic relationship

Question 2

Multisystems model

Answer 2

Boyd-Franklin (1989)
addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths

recommended for African American clients

Question 3

American Indians and Alaskan Natives

Answer 3

• exhibit a spiritual and holistic orientation to life that emphasizes harmony with nature and regards illness as a result of disharmony
• place greater emphasis on the extended family and tribe than on the individual and adhere to a consensual collateral form of social organization and decision making
• more present than future oriented
• listening more important than talking

Question 4

Network therapy (LaFromboise et al. 1990)

Answer 4

incorporates family and community members into the treatment process and situates an individual’s psychological problems within the context of his/her family, workplace, community, and other social systems

Question 5

Asian Americans

Answer 5

• place greater emphasis on the group (family, community) than individual
• adhere to a hierarchical family structure and traditional gender roles
• emphasize harmony, interdependence, and mutual loyalty and obligation in interpersonal relationships
• value restraint of strong emotions that might otherwise disrupt peace and harmony and/or bring shame to the family

Question 6

Therapy guidelines for Asian Americans

Answer 6

A. emphasizing formalism in therapy
B. being aware that the functions of shame and obligation in Asian cultures is to reinforce adherence to prescribed roles and responsibilities
C. recognizing that modesty and self-deprecation are not necessarily signs of low-self-esteem
D. establishing credibility and competence early in therapy
E. preventing premature termination by providing the client with an immediate and meaningful benefit
F. being aware that Asian clients may express their mental health problems as somatic complaints
G. focusing more on behaviors than emotions

CBT, solution-focused, and other brief therapies are often effective but need to be modified to focus more on family than individual

Question 7

Hispanic/Latino Americans

Answer 7

• emphasize family welfare over individual welfare and stress allegiance to family over other concerns
• view interdependence as both healthy and necessary and highly value connectedness and sharing
• consider discussing intimate personal details with strangers as highly unacceptable and belief that problems should be handled within the family or other natural support system
• adopt a concrete, tangible approach to life
• often attribute the control of life events to luck, supernatural forces, acts of God, or other external factors

Question 8

Guidelines for Hispanic/Latino Clients

Answer 8

A. emphasizing personalismo
B. being aware that Hispanic/Latino families are basically patriarchal, that sex roles tend to be relatively inflexible, and that the parent-child bond is often stronger than the husband-wife and other family relationships
C. recognizing that differences in degree of acculturation within a family are often a source of individual and family problems
D. considering the impact of religious/spiritual factors
E. being aware that may express mental health problems as somatic complaints

Question 9

Internalized homophobia

Answer 9

occurs when LGBT individuals accept heterosexual society’s negative evaluations of them and incorporate these into their self-concepts; consequences include low self-esteem, self-doubt or self-hatred, a sense of powerlessness, denial of one’s sexual orientation, and self-destructive behavior

Treatment includes identifying and correcting cognitive distortions, providing training in assertiveness and coping skills, and activating social support systems

Question 10

Coming out

Answer 10

• Can have beneficial effects
• higher “outness” was associated with lower levels of psychological distress
• no gender related age difference in coming out to others
  adolescent males have earlier firsts except coming out

Question 11

Cultural Competence

Answer 11

Awareness- aware of own assumptions, values, and beliefs that may be detrimental to others

Knowledge- attempt to understand the worldviews of culturally diverse clients; have an understanding of the history, experiences, and values of various groups including knowledge about the impact of oppression

Skills- use therapeutic modalities and interventions that are appropriate for culturally different clients

Question 12

Sue and Zane (1987)

Answer 12

Two processes are critical when working with culturally diverse clients

1. credibility- client’s perception that the therapist is an expert and is trustworthy
2. giving- the client’s perception that he/she has received something from therapy

Question 13

Curanderismo

Answer 13

holistic system of healing that is practiced in some Latin American cultures; based on assumption that illness can arise from either natural or supernatural forces that affect physical, emotional, and/or spiritual functioning; led by male or female healer and combine religious and spiritual rituals with herbal medicine, massage, and traditional methods of healing

Question 14

Ho’oponopano (setting it right)

Answer 14

traditional Hawaiian spiritual healing ritual for restoring harmony among family members by resolving a current conflict or interpersonal problem; entails a structured process that is conducted by senior family member or other elder and begins with identifying the problem, followed by discussions that lead to confession, restitution, and forgiveness

Question 15

Sweat lodge ceremony

Answer 15

traditional Native American healing practice; participants sit in a circle around a pit and water is pored on stones to create and intensify heat; sweating, combined with prayers and chanting, storytelling, and other rituals cleanses the body, mind, and spirit of impurities

Question 16

Acculturation- Berry and colleagues (1987)

Answer 16

refers to the degree to which a member of a culturally diverse group accepts and adheres to the values, attitudes, behaviors, etc. or his/her own group and the dominant (majority) group

4 categories:

1. Integration- person maintains his/her own minority culture but also incorporates many aspects of the dominant culture
2. Assimilation- person accepts the majority culture while relinquishing his/her own culture
3. Separation- person withdraws from the dominant culture and accepts his/her own culture
4. The person does not identify with his/her own culture or with the dominant culture

Question 17

Acculturation- Phinney and Devich-Navarro (1997)

Answer 17

six categories of acculturation: assimilated, fused, blended bicultural, alternating bicultural, separated, marginal

Question 18

Worldview

Answer 18

refers to how a person perceives his/her relationship to nature, other people, institutions, and so on

impacted by a person’s cultural background and experiences and is determined by two factors: the person’s locus of control and locus of responsibility

worldview of therapist and client can affect therapeutic process

members of minority groups are increasingly likely to exhibit an internal locus of control and external locus of responsibility

Question 19

Cultural Encapsulation

Answer 19

Therapists are exhibiting cultural encapsulation when:

a. define everyone’s reality according to their own cultural assumptions and sterotypes
b. disregard cultural differences
c. ignore evidence that disconfirms their beliefs
d. rely on techniques and strategies to solve problems
e. disregard their own cultural biases

Question 20

Emic Orientation

Answer 20

culture-specific theories, concepts, and research strategies; see things through eyes of the members of that culture

Question 21

Etic Orientation

Answer 21

phenomena that reflect a universal (culture general) orientation; involves viewing people from different cultures as essentially the same; traditional psychological theories and practices usually reflect an etic perspective

Question 22

High context communication

Answer 22

grounded in the situation; depends on group understanding, relies heavily on nonverbal cues, helps unify a culture, slow to change; most diverse groups use this style

Question 23

Low context communication

Answer 23

relies primarily on the explicit, verbal part of a message; less unifying than high-context communication and can change rapidly and easily; must Euro-American cultures use this style

Question 24

Internalized oppression

Answer 24

system beating (acting out against the system), system blaming, total avoidance of Whites, and/or denial of the political significance of race

ex. earning acceptance through status/wealth; escaping through use of drugs/food/etc.

Question 25

Conceptual incarceration

Answer 25

adopting a White Anglo-Saxon Protestant worldview and lifestyle

Question 26

Split-self syndrome

Answer 26

polarizing oneself into “good” and “bad” components, with the bad components representing one’s African American identity

Question 27

Survival mechanisms- Sue & Sue, 2003

Answer 27

1. Playing it cool- concealing anger or other unacceptable feelings by acting composed and calm
2. Uncle Tom syndrome- adopting a passive or “happy-go-lucky” demeanor

Question 28

Cultural paranoia

Answer 28

a healthy reaction to racism; may occur when African American client does not disclose to a white therapist due to a fear of being hurt or misunderstood

Question 29

Functional paranoia

Answer 29

an unhealthy condition that itself is an illness; unwilling to disclose to any therapist, regardless of race or ethnicity, due to general mistrust and suspicion

Question 30

Intercultural Nonparanoiac Discloser

Answer 30

Low functional paranoia; low cultural paranoia

- Willing to self-disclose to an African American or Anglo therapist

Question 31

Functional Paranoiac

Answer 31

High Functional Paranoia, low cultural paranoia

- Non-disclosive to both AA and Anglo therapists; due to pathology; use interventions to alleviate pathology

Question 32

Healthy Cultural Paranoiac

Answer 32

Low functional paranoia, high cultural paranoia
Self-disclose to an AA therapist but are reluctant to disclose to Anglo therapists due to past experiences of racism and or white therapist’s attitudes and beliefs

Need to help client develop disclosure flexibility- recognize when i is appropriate or inappropriate to self-disclose

Question 33

Confluent Paranoiac

Answer 33

High functional paranoia; high cultural paranoia

Nondisclosing to AA and Anglo therapists due to combination of pathology and racism ; need same race therapist

Question 34

Sexual stigma

Answer 34

shared knowledge of society’s negative regard for any nonheterosexual behavior, identity, relationship, or community

Question 35

Heterosexism

Answer 35

cultural ideologies, which are systems that provide the rationale and operating instructions that promote and perpetrate antipathy, hostility, and violence against homosexuals; includes beliefs about gender, morality, and sexuality that define sexual minorities as deviant or threatening and is inherent in language, laws, and other cultural instructions

Question 36

Sexual prejudice

Answer 36

refers to negative attitudes that are based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual