The direction that should be considered is the training of clinicians that are aware of cultural differences, able to communicate these issues to their patients, and work around the cultural gaps to try and comprehend the patients’ goals, environment and situation, while not taking any culturally effected variables for granted. “…it is essential that we develop training programs that produce therapists who have learned to consider appropriate cultural factors in their clinical work with culturally diverse clients”(Trull, 76). Cultural competence, the ability to treat people of any imaginable culture, should be a qualification in the training of clinicians and therapists. Gaining experience with culturally diverse patients, learning about cultural specific mental illnesses, and becoming accustomed to questioning the simplest detail in the patients’ cultural reality must be formulated items on the training schedule for clinicians. “Clinical psychologists and other mental health professionals must demonstrate cultural competence – a knowledge and appreciation of other cultural groups and the skills to be effective with members of these groups”(Trull, 76).
The APA has made huge steps in acknowledging the necessity of having clinicians become culturally competent and be able to treat patients of varied cultural origins with equal success; one of which was to add a Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations
Psychological service providers need a sociocultural framework to consider diversity ofvalues, interactional styles, and cultural expectations in a systematic fashion. They needknowledge and skills for multicultural assessment and intervention, including abilities to:
- recognize cultural diversity;
- understand the role that culture and ethnicity/race play in the sociopsychological andeconomic development of ethnic and culturally diverse populations;
- understand that socioeconomic and political factors significantly impact thepsychosocial, political and economic development of ethnic and culturally diverse groups;
- help clients to understand/maintain/resolve their own sociocultural identification; andunderstand the interaction of culture, gender, and sexual orientation on behavior and needs.
A body of research concerning culture and cultural issues has been formed, and several major studies have been made available to clinicians to broaden their understanding, and aid them in the treatment of all cultures; these appear on the APA website.
- the impact of ethnic/racial similarity in the counseling process (Acosta & Sheenan, 1976; Atkinson, 1983; Parham & Helms, 1981);
- minority utilization of mental health services (Cheung & Snowden, 1990; Everett, Proctor, & Cartmell, 1983; Rosado, 1986; Snowden & Cheung, 1990);
- relative effectiveness of directed versus nondirected styles of therapy (Acosta, Yamamomoto, & Evans, 1982: Dauphinais, Dauphinais, & Rowe, 1981; Lorion, 1974);
- the role of cultural values in treatment (Juarez, 1985; Padilla & Ruiz, 1973; Padilla, Ruiz, & Alvarez, 1975; Sue & Sue, 1987);
- appropriate counseling and therapy models (Comas-Diaz & Griffith, 1988;McGoldrick, Pearce, & Giordino, 1982; Nishio & Blimes, 1987);
- competency in skills for working with specific ethnic populations (Malgady, Rogler, & Constantino, 1987; Root, 1985; Zuniga, 1988).
In 1988, as a response to the increase in awareness to the issues at hand, the APA’s Board of Ethnic Minority Affairs or BEMA created a task force to deal with learning and educating clinicians about several ethnic minorities including “American Indians/Alaska Natives, Asian Americans, and Hispanics/Latinos. For example, the populations also include recently arrived refugee and immigrant groups and established U.S. subcultures such as Amish, Hasidic Jewish, and rural Appalachian people”(Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations). The task force of the BEMA established guidelines for mental health care givers for treating these and other populations. Guidelines include awareness and respect to cultural variables and their effect on personality, assessment, and treatment. They attempt to increase communication by stressing the importance of explaining the clinical treatment to the patient; if needed explanations will be given in writing. Where language issues exist, the clinician is to cater to the patient’s needs, or if not able to, make a satisfactory referral. Attention is also given to the cultural background of the clinician, and its possible effect on therapy.
Awareness towards differences is the first step towards overcoming the gap between people. For me as an Israeli living for the last few years in the US, being different has been a main obstacle to overcome. Only after one faces the difficulty of living in a new setting where people use a different language and different customs, can one understand the scope of the alienation and all of the subtleties of being different. Although Washington DC has many foreigners, and diplomats, and the locals are used to seeing people that look and act differently, living here has still been a challenge. From personal experience of fiends and myself I can testify that seeking psychological help in the US is no simple issue for foreigners. The language barrier may be the greatest obstacle. If one feels inapt in explaining what one feels, one may be reluctant to go and seek help. Fearing how clinicians may interpret certain emotions and situations might prevent people from approaching mental care clinics. The awareness of the APA to cultural issues is admirable, but naturally sharing this awareness with each and every clinician may be a process that will take some time to complete. Having researched the cultural competence needed for clinicians, I have newly formulated concerns about receiving mental health care in the US, if I ever need it. The fact that cultural differences may impair the clinician’s ability to assess my problems, and might cause him or her to set goals for treatment that are not consistent with my own personal goals, may cause me to seek professional help with in my own cultural group. Hopefully, the attempt of the APA to educate and train clinicians in cross-cultural therapy will create a new professional future in which the gaps between people are bridged, and where clinicians and patients of varied cultural background can work together for a healthier society, regardless of their possible differences.
References
American Psychological Association. American Psychological Association Ethical Principles of Psychologists and Code of Conduct.
American Psychological Association. APA Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations.
Ivey, A. E. (1987). The Multicultural Practice of Therapy: Ethics, Empathy, and Dialectics. Journal of Social and Clinical Psychology, 5, 195-204.
Korman, M. (Ed.) (1973). Levels and Patterns of Professional Training in Psychology. Wahington DC: American Psychological Association.
Myers, D. (1999). Social Psychology. New-York: McGrew-Hill College.
Trull. T. J. & Phares J. E. (2001). Clinical Psychology, Concepts, Methods and Profession. Stamford: Wadsworth/Thompson Learning. Sixth Ed.
Shiraev, E. & Levy, D. (2001). Introduction to Cross-Cultural Psychology. Needham Heights: Allyn & Bacon.
