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Psychotherapy in a multi-cultural society
- Tanvir Ahmad Rana, Shabbir Ahmad Rana, Assistant Professor in Psychology, G C University, Lahore (21 May 2007)
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Tanvir Ahmad Rana, Visiting Senior Lecturer Faculty of Health & Sciences, Staffordshire University, Shabbir Ahmad Rana, Assistant Professor in Psychology, G C University, Lahore
Send letter to journal:
tanvir_rana{at}hotmail.com Tanvir Ahmad Rana, et al.
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Bhui and Morgan (2007) have highlighted the need for psychotherapists to be aware of the sensitive role of race , culture and ethnicity. Even in general psychiatric practice these factors can influence assessment, diagnosis , treatment and prognosis. For example, the distress conveyed by a patient may not necessarily be psychopathological but may be culturally grounded (Drenan & Swarz, 2002). In African and West Indian groups ‘paranoid beliefs’ may be culturally sanctioned ( Ndetei & Vadher, 1984). It is known that people from Asian cultures are more prone to somatizing their (depressive) symptoms. Sometimes, a prolonged assessment is required to distinguish between religious beliefs and true delusions. Psychotherapy is greatly dependent upon the therapeutic relationship. Unless the therapist takes into consideration cultural and racial variations , there is a high likelihood of ineffective communication and misunderstanding , which in turn influences transference and countertransference, processes that are pivotal in psychodynamic therapy. Many Western concepts and theories , like Freud’s injunction ‘to share everything that comes to mind’, Klein’s emphasis on negative transference, and ideas like separation anxiety are not equally applicable to clients from differing ethnic backgrounds. It is also important to appreciate this problem from a different but related angle i.e. the desired need for therapists from BME backgrounds to have a clearer understanding of ‘white culture and norms’ and the awareness of the possible influence of their own beliefs and values might have in the psychotherapeutic process. Some authors have suggested the need for reconciling different explanatory models regarding communication with patients from other cultures ( Bhui & Bhugra, 2004). Ethnic matching has been suggested as one solution but apart from lacking sufficient empirical evidence, this may not always be a pragmatic option because of scarcity of therapists. It has, moreover, been reported that some therapists and patients belonging to the same ethnic background experience ‘internalised racism’ . For psychotherapy to be successful, there is a need for a common language for the subtle communication of thoughts and feelings. It has been proposed that third parties may be included in the treatment to bridge the cultural gap between the therapist and the client( Heilman & Wilztum, 1994). Not understanding the racial, cultural and religious backgrounds and differences can be one of the greatest barriers and challenges for psychotherapists. REFERENCES Bhui & Bhugra (2004) Communication with patients from other cultures: the place for explanatory models Advances in Psychiatric Treatment 10: 474-478 Bhui & Morgan (2007) Effective psychotherapy in a racially and culturally diverse society. Advances in Psychiatric Treatment , 13: 187- 193. Drenan, G. & Swarz, L. (2002) The paradoxical use of interpreting in psychiatry. Social Science and Medicine, 54, 1853–1866.[CrossRef][Medline] Heilman, S.C. & Wilztum,E. ( 1994) Patients, chaperones and healers: enlarging the therapeutic encounter. Social Science and Medicine, 39, 133-143 Ndetei, D. M. & Vadher, A. (1984) A cross-cultural study of the frequencies of Schneider's first rank symptoms of schizophrenia. Acta Psychiatrica Scandinavia, 70, 540–544. |
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