Academic journal article American Journal of Psychotherapy

Cultural Sensitivity and Supportive Expressive Psychotherapy: An Integrative Approach to Treatment

Academic journal article American Journal of Psychotherapy

Cultural Sensitivity and Supportive Expressive Psychotherapy: An Integrative Approach to Treatment

Article excerpt

Cultural sensitivity is a concept that has become increasingly important in psychotherapy research and practice. In response to the growing ethnic minority population and the increased demand for psychological services among minority clients, many therapists and researchers have attempted to identify competencies and guidelines for providing culturally sensitive approaches to treatment. However, many cultural sensitivity concepts are theoretical and have rarely been integrated into an established psychotherapeutic framework. The purpose of this manuscript is to operationalize the concepts of cultural sensitivity into specific therapeutic techniques using a manual-guided Supportive Expressive Psychotherapy approach. Developing these strategies may serve to further assist therapists with the delivery of mental health services to ethnic minority clients.

Historically, psychotherapy treatment inadequacies among ethnic minority clients have been associated with factors such as few bilingual therapists, prejudicial and discriminatory practices, and limited knowledge and understanding of the influence of cultural variables on ethnic minority clients (S. Sue, 1993). In an evaluation of mental health services across a five-year period, Sue, Fujino, Hu, Takeuchi, and Zane (1991) found that ethnic match between client and therapist had a substantial impact on the length of treatment, yet was not predictive of treatment outcome. The authors theorized that clients may have greater interpersonal attraction to a therapist who is ethnically similar, at least during initial engagement in the treatment process. Further support for the advantage of ethnic match was provided by S. Sue (1998), who demonstrated that ethnic clients who attended ethnic-specific treatment programs remained in treatment longer than those receiving mainstream non-ethnic-specific treatment.

Although one response to improving services to ethnic minorities in the community has been to increase the number of treatment providers with similar cultural backgrounds to clients, thus facilitating development of ethnic specific services, S. Sue points out that this approach when used alone has been criticized for encouraging segregation (S. Sue, 1998). The ethnic match approach also ignores cultural differences that may exist between the ethnically similar client and therapist (Maramba, Nagayama, & Gordon, 2002). S. Sue (1998) encourages researchers and clinicians to explore the factors that account for the improvement in treatment retention when there is a client and therapist ethnic match. Sue and Zane (1987) theorize that the single most important explanation for treatment difficulties stems from the therapist's inability to provide culturally sensitive forms of treatment. Many therapists are unprepared to work with ethnic minority clients because they are unfamiliar with the cultural backgrounds and lifestyles of ethnic minority groups. Constantine (2002) states that training in cultural competence may increase the efficacy of treatment by bridging the gap between the therapist and the client. Bernai and Castro (1982) and Wyatt and Parham (1985) suggest that a barrier to cultural competence among therapists is rooted in the training that mental health professionals receive, which has been developed primarily for Anglo- or mainstream Americans. For instance, 39% of accredited clinical psychology programs still do not include minority-related coursework; 74% of these programs do not require even one course in minority client treatment for completion of doctoral training (Bernai & Castro, 1994). Forty percent of clinical psychology programs do not utilize off-site clinical settings that serve ethnic minorities for practicum placements (Bernai & Castro, 1994). Abreu, Chung, and Atkinson (2000) note that programs that do offer cultural competency training are often limited, requiring completion of one or two courses, which is simply not enough to develop an understanding of the multifaceted nature of cultural sensitivity. …

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