Clinical Psychology: Science, Practice, and Diversity by Andrew M. Pomerantz

Author:Andrew M. Pomerantz [Pomerantz, Andrew M.]
Format: epub, pdf
Tags: Psychology, Clinical Psychology
ISBN: 9781544333625
Google: e6CgDwAAQBAJ
Published: 0101-01-01T00:00:00+00:00

Photo 11.1 Individuals from diverse cultural backgrounds come to psychotherapy with very different expectations about the behaviors of clients and therapists.

© JohnnyGreig/iStockphoto.com

As it is traditionally practiced in North America and the Western world, psychotherapy involves verbally discussing one’s problems, focusing attention on them, and gaining greater understanding of or control over them. These basic processes clash with cultural values common to some non-Western cultures whose members often prefer to “conceal” rather than “reveal” . Individuals from Eastern cultures often prefer to avoid, rather than confront, negative thoughts. Thus, the communication styles of clients with psychotherapists—in simplest terms, the extent to which they are comfortable self-disclosing about problematic behaviors, thoughts, and feelings—may depend significantly on their cultural values.

A client’s willingness to self-disclose to a psychotherapist may also depend on the individualistic versus collectivistic nature of a client’s culture. Western cultures tend to foster an individualistic way of life, emphasizing self-reliance and self-determination. In contrast, Eastern cultures tend to encourage collectivism, whereby the needs of the family/group and the relationships that bind the family/group take priority over individual goals. Thus, whereas a client of European descent may feel slightly uncomfortable discussing a personal problem or shortcoming, a client of Asian descent may feel a much stronger sense of shame about a similar problem or shortcoming because of his or her perception that the problem reflects on family members as well .

Training psychotherapists to be culturally competent is the foundation on which they can build an appreciation of clients’ expectations about psychotherapy. Like many others, Toukmanian and Brouwers recommend that training in psychotherapy emphasize the personal development of the therapist’s attitude toward diverse cultures.

This training should encompass four levels: self-understanding , listening to clients’ cultural values, accepting clients’ cultural values, and understanding clients’ cultural values.

If you were the client, how important would it be for your psychotherapist to appreciate your expectations about psychotherapy that relate to your cultural background? Specifically, which values would be most important to recognize?

Efficacy Versus Effectiveness of Psychotherapy

Empirical studies of psychotherapy outcome generally fall into two categories. The extent to which psychotherapy works in a controlled research study—that is, “in the lab”—refers to its efficacy. Most recent studies of psychotherapy outcome are efficacy studies. They maximize internal validity—that is, the ability to draw conclusions about the cause–effect relationship between therapy and outcome—by controlling as many aspects of therapy as possible. Efficacy studies typically feature well-defined groups of patients, usually meeting diagnostic criteria for a chosen disorder ; manualized treatment guidelines to minimize variability among therapists; and random assignment of participants to control and treatment groups .

In contrast, the extent to which psychotherapy works with actual clients treated by therapists in clinics, private practices, hospitals, and counseling centers—that is, “in the real world”—refers to its effectiveness. Effectiveness studies tend to include a wider range of clients, including those with complex and overlapping diagnostic profiles, or whose symptoms don’t qualify for any specific disorder; allow for greater variability between therapists’ methods than a manual would allow; and may or may not include a control group for comparison to a treatment group.

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