Culture in the therapy room
Counselling and psychotherapy can be viewed as a process of interpersonal interaction and communication. In order for the therapeutic process to occur, the client and the therapist must be able to exchange both verbal and non-verbal communications and messages.
While breakdown in communication often occurs between members who share the same culture the problem becomes exacerbated between people of different racial or ethnic background. Many mental health professionals have noted that racial or ethnic factors may act as impediments to counselling. The focus of this writing is on culture in the therapy room.
What is 'culture' in the therapy room?
Culture consists of all these things that people have learnt to do, believe value and enjoy in their history. It is the totality of ideas beliefs, skills, tools, costume into which each member of society is born. As we live in a multicultural society it is important to focus more on the presence of culture difference in therapy sessions and the effect of this on the therapeutic process.
As one of the central tasks of the counsellor is to listen and understand the other person’s experience and feelings sensitively and accurately as they are revealed at the moment to moment interaction during the counselling session, bearing in mind the client’s culture is almost essential for the therapist.
It is important for the counsellor to be aware that people from cultures other than their own may present problems in different ways. A therapist who depends entirely on their own internalized value system about what constitutes a state of well being for an individual who asks for help may come to rely on stereotypes in making decisions about their clients who are drawn from different cultural groups.
Thus, it becomes dangerous for the counsellor to ignore any perceived cultural differences among clients and proceed to define reality in terms of one set of cultural assumption values or in terms of one theoretical principle without acknowledging the importance of difference. Counsellors need to understand the client’s culture and use of language within that culture in order to maintain the importance and effectiveness of their communication.
Do ethnic similarities impact therapy?
There have been debates as to whether or not ethnic similarity has an impact on therapy outcome.
Two reviews by Atkins conclude that the research assessing counsellor client ethnic similarity on counselling outcome has produced mixed findings. However, research published subsequent to these reviews has produced much stronger evidence of an ethnic similarity effect.
The strongest support for an ethnic similarity effect on counselling outcome is provided by three studies of archival data in mental health centres. Flaskerud examined the case records of 300 clients (50 black, 50 Mexican, 50 Filipinos, 50 Vietnamese, 100 whites) in four public community mental health agencies and found that both cultural and ethnic similarities between the therapist and the client were predictive of dropout status.
Those clients matched with their therapists on the basis of ethnic or/ and culture were less likely to drop out of therapy within four sessions or less (without the therapist’s consent) than were clients mismatched for culture and/or ethnicity.
There have been some studies carried out regarding the issue of discussing cultural differences with the client. However, there is no dominant view regarding when, whether, and how the discussion about differences should take place. Analogue studies have found that making sensitive responses to client’s concern about racial and cultural issues is preferable to ignoring or avoiding client’s concern.
Some theories suggest that therapists should address differences in the first session, particularly given termination rate as high as 50% after one session for minority clients. Others assert that differences should not be brought up during crises interventions because other mental status priorities would prohibit effective dialogue.
In the most survey carried out by Aprile et al (2006) on 689 psychologists, most reported having such discussion but with less than half of their cross-cultural /racial clients. Therapists consistently described themselves a comfortable with and skilled at these discussions and reported that discussion facilitated therapy.
However whether or not the therapist decides to discuss the issue of difference, they must be aware and open to these differences and the impact it has on the therapeutic process and the relationship dynamics.
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