Psychologists should make an effort to "individualize clients without stereotyping them," Nolan Zane, PhD, told psychologists at a March 13-14 meeting in Bethesda, Md. The meeting, a collaboration of APA and several mental health organizations, examined topics such as cultural differences in therapy expectation and psychological measurement issues. The goal was to encourage researchers and practitioners to work together to make evidence-based practices relevant to all cultures, not just a few.
Zane, a psychologist at the University of California, Davis, and the meeting's co-chair, stressed that culturally informed treatments can be far more effective than "one-size-fits-all" methods. The first step, he said, is articulating how specific aspects of a client's culture might affect treatment.
For example, avoiding "face loss," the loss of respect and social credibility in front of one's peers, is an important component of Chinese social interaction, he said. If psychologists know how face loss influences a client's motivations, they can be better prepared to interpret that person's behavior. For instance, face loss is a major source of stress for many Chinese and Chinese Americans, but less so for Westerners, so stress management approaches will be different for these groups. Recognizing face loss gives therapists a specific tool as opposed to just chalking up the different approaches to divergent cultures.
"If you identify face loss, then you can talk about face loss, not just 'Chinese values,'" which lets therapists zero in on the best treatment options, said Zane.
Cultural expectations also color treatment itself. In some cultures, Zane explained, suppressing one's emotions is an adaptive strategy for getting along in society. But psychotherapy often tries to get people to emote more, which can be counterproductive.
One way to help bridge the cultural gap is to empower clients in their treatment, said Margarita Alegria, PhD, a psychologist at Harvard Medical School.
"People need to be able to access information on their own, to develop their own solutions and solve their own problems," she said.
To that end, Alegria is working on the Right Question Project, which aims to teach clients to develop their own sets of questions they would like answered during treatment. Topics can include insecurities about mental health treatment through questions such as "Does mental illness ever really go away?" and even such basic questions as "What is my diagnosis?"
"Believe it or not, some people had never actually heard their diagnosis before participating in the program," Alegria said.
She found that Latino clients in the program's pilot study were three times more likely to keep going to sessions and were four times more likely to feel engaged in their treatment.
Incorporating cultural identity into treatments is also important, said Stanford University's Teresa LaFramboise, PhD. She's developing American Indian Life Skills (AILS), an intervention curriculum that ties modern theoretical practices with traditional cultural values. For example, the AILS program explains how centuries of cultural, spiritual and economic loss in American Indian communities have contributed to high levels of domestic violence, child abuse and neglect on many reservations. Growing up seeing widespread poverty and unemployment breeds stress in many young people. Using traditional American Indian notions, such as "sanctuary" and "purification," and emphasizing the importance of family and tribe role models, LaFramboise's program aims to incorporate "cultural ways of knowing" into modern intervention practices.
The program has already demonstrated success in reducing suicidal thoughts among American Indian youth, who are the most at risk for suicide in the nation. The program also fosters problem-solving skills and suicide-intervention techniques. LaFramboise sees the program's early success as validation for the idea that traditional cultural knowledge can be just as evidence-based as modern treatments.
Psychologists need to publicize such culturally informed treatments, said keynote speaker Westley Clark, MD, JD, who directs the Center for Substance Abuse Treatment at the U.S. Department of Health and Human Services. Without the demand for such services, insurance agencies won't cover culturally informed treatments, he said.
Clark also asked researchers and clinicians to develop effective treatments together. Too often, he said, the translation of research into treatment is seen as a one-way street. Instead, clinicians can and should alert researchers if they notice trends in their practices.
"If clinicians wait for researchers to get around to it, they do their clients a disservice," he said, noting that the average time between research being published and its widespread clinical application is 17 years. "A [client's] family isn't going to care about theory. They're going to ask, 'Did you help them?'"
This meeting was sponsored by the Substance Abuse and Mental Health Services Administration, National Institute of Mental Health, Asian American Center on Disparities Research and Alliant International University.