Academic journal article American Journal of Psychotherapy

The Practice of Cognitive-Behavior Therapy in Roozbeh Hospital: Some Cultural and Clinical Implications of Psychological Treatment in Iran

Academic journal article American Journal of Psychotherapy

The Practice of Cognitive-Behavior Therapy in Roozbeh Hospital: Some Cultural and Clinical Implications of Psychological Treatment in Iran

Article excerpt

Contemporary cognitive-behavior therapy underscores the importance of the culture-specific variables in the treatment of psychological problems. The flexibility and strengths of cognitive-behavior therapy provide us with an excellent opportunity to build a cultural model of cognitive-behavior therapy based on the clinical, as well as theoretical, knowledge of the practitioners and researchers working in different cultural settings. As a first step, we need to share our experiences with the other colleagues working in different cultures.


Despite wide acknowledgment of the role of culture in human behavior, the study of culture on the practice of psychotherapy in general, and cognitive-behavior therapy (CBT) in particular, has been largely ignored in mainstream psychology. Up until the 1980s, most psychotherapy practice, including CBT, was guided by assumptions that the constructs and principles developed in the United States with European-Americans applied to individuals everywhere (Vera, Vila, & Alegría, 2003, p. 521). There was a belief that CBT was based on universal assumptions, sustaining the use of similar methods, constructs, measures, and therapies across cultural groups. Different voices from different sources, however, changed the picture. For example, Sue and Zane (1987) claimed that traditional forms of treatment should be modified for individual clients because these were geared primarily for mainstream America. They believed diat treatment should match, or fit, me cultural lifestyle or experiences of die client (p. 38). The relevance of culture, according to their view, can be studied in three areas of psychotherapeutic intervention: 1) problem conceptualization, 2) means for problem resolution, and 3) treatment goal.

Within social psychology, there has been a dramatic increase in the study of social cognition - how individuals perceive and interpret their social world. One of subset of social cognition that has become important in clinical psychology and psychopathology is the concept and process of attribution, which grew from research on locus of control (Rotter, 1966). The observed performance for attributions to internal dispositions, especially when it comes to the behavior of others, has become known as the "fundamental attribution error". For a long time psychologists thought this type of error was present in all cultures. But studies raised doubts about this assumption of universality (see Choi, Nisbett, & Norenzayan, 1999 for a review). Berry et al. (2003), reviewing the literature, concluded "it seems the basic psychological process of attribution is present across cultures, but it is developed and used differently, according to some features of the cultural context" (p. 73).

In the area of culture, ethnicity, and mental illness, many relevant studies appeared with the basic assertion that the practice of psychiatry and clinical psychology - no matter where it is practiced - is significandy influenced by its setting (Al-Issa, 1977; Bhugra & Bhui, 1998; Castillo, 1997; Engel, 1977, 1980; Kleinman, 1980; Organitsa, 1998; Organitsa et al. 1998; Renfrey, 1998; Sue & Sue, 1987). The researchers generally look at culture as a construct that captures a socially transmitted system of ideas tbat specify, in highly diverse ways, "normal" behavioral patterns for a great variety of daily needs (Hughes, 1993, p.8). Kazarian & Evans' (1998) book, Cultural Clinical Psychology, can be considered a very promising breakthrough in this regard. They proposed the term "cultural clinical psychology" as a viable integration of culture into the science and practice of clinical psychology (p.3).

In spite of these advances in general mental health practice, the impact of cultural studies on CBT has not been highlighted sufficiendy. Not is only culture missing from nearly all the textbooks on CBT, it has not been included in the body of knowledge in some state-of-the-art papers (e. …

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