Psychotherapy with Members of Diverse Populations Flashcards
African Americans
- 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
Multisystems model
Boyd-Franklin (1989)
addresses multiple systems, intervenes at multiple levels, and empowers the family by utilizing its strengths
recommended for African American clients
American Indians and Alaskan Natives
- 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
Network therapy (LaFromboise et al. 1990)
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
Asian Americans
- 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
Therapy guidelines for Asian Americans
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
Hispanic/Latino Americans
- 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
Guidelines for Hispanic/Latino Clients
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
Internalized homophobia
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
Coming out
- 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
Cultural Competence
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
Sue and Zane (1987)
Two processes are critical when working with culturally diverse clients
- credibility- client’s perception that the therapist is an expert and is trustworthy
- giving- the client’s perception that he/she has received something from therapy
Curanderismo
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
Ho’oponopano (setting it right)
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
Sweat lodge ceremony
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
Acculturation- Berry and colleagues (1987)
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:
- Integration- person maintains his/her own minority culture but also incorporates many aspects of the dominant culture
- Assimilation- person accepts the majority culture while relinquishing his/her own culture
- Separation- person withdraws from the dominant culture and accepts his/her own culture
- The person does not identify with his/her own culture or with the dominant culture
Acculturation- Phinney and Devich-Navarro (1997)
six categories of acculturation: assimilated, fused, blended bicultural, alternating bicultural, separated, marginal
Worldview
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
Cultural Encapsulation
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
Emic Orientation
culture-specific theories, concepts, and research strategies; see things through eyes of the members of that culture
Etic Orientation
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
High context communication
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
Low context communication
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
Internalized oppression
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.
Conceptual incarceration
adopting a White Anglo-Saxon Protestant worldview and lifestyle
Split-self syndrome
polarizing oneself into “good” and “bad” components, with the bad components representing one’s African American identity
Survival mechanisms- Sue & Sue, 2003
- Playing it cool- concealing anger or other unacceptable feelings by acting composed and calm
- Uncle Tom syndrome- adopting a passive or “happy-go-lucky” demeanor
Cultural paranoia
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
Functional paranoia
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
Intercultural Nonparanoiac Discloser
Low functional paranoia; low cultural paranoia
- Willing to self-disclose to an African American or Anglo therapist
Functional Paranoiac
High Functional Paranoia, low cultural paranoia
- Non-disclosive to both AA and Anglo therapists; due to pathology; use interventions to alleviate pathology
Healthy Cultural Paranoiac
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
Confluent Paranoiac
High functional paranoia; high cultural paranoia
Nondisclosing to AA and Anglo therapists due to combination of pathology and racism ; need same race therapist
Sexual stigma
shared knowledge of society’s negative regard for any nonheterosexual behavior, identity, relationship, or community
Heterosexism
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
Sexual prejudice
refers to negative attitudes that are based on sexual orientation, whether the target is homosexual, bisexual, or heterosexual
