Academic journal article Journal of Cognitive Psychotherapy

Cultural Relativism in Cognitive Therapy with Disadvantaged African American Women

Academic journal article Journal of Cognitive Psychotherapy

Cultural Relativism in Cognitive Therapy with Disadvantaged African American Women

Article excerpt

Cognitive therapy is considered by many the treatment of choice for unipolar depression. Yet a number of the proven techniques of cognitive therapy depend on cultural assumptions which derive from the Western European tradition and may not be shared by ethnically diverse clients. In particular, concepts of time, and of personhood or the self, may differ considerably among minority clients. Modifications to the technique of cognitive therapy are discussed which may create a better fit between the world view of disadvantaged African American women and the cognitive model. Three case vignettes are presented including data on the use of these modifications in a practice situation using single subject design.

Cognitive therapy of depression is considered the treatment of choice for unipolar affective disorders by many clinicians. Its effectiveness has been empirically tested and is well documented (Beck, Rush, Shaw, & Emery, 1979; Norcross, Prochaska, & Gallagher, 1989). Progress also continues on the development of cognitive therapy as an effective psychotherapeutic modality in the treatment of anxiety disorders and personality disorders at a number of centers for cognitive therapy nationwide (Beck & Freeman, 1990). This research is making important strides toward increasing the diagnostic specificity with which clients may appropriately be selected for treatment with the cognitive model. Also beginning to emerge is a clearer understanding of the impact of diagnostic variables on the selection of specific techniques for use with a given client. Less well known, however, are possible modifications to the technique of cognitive therapy that may be indicated, given other client variables such as socioeconomic status, and particularly, cultural heritage.

This situation is not surprising in view of the dearth of information about cultural relativism in mental health service systems generally. Within social work education, for instance, Lum (1986) and others have decried the lack of adequate coverage of cross-cultural issues in methods and practice courses. In a review of 18 well-regarded practice texts for social work written from 1970 to 1983, Lum found that content devoted to ethnicity and minorities totaled 101 out of 7,688 pages (1.6%) among these texts combined (p. 16). In the field of psychology, research on cross-cultural issues is also in a state of neglect. In a recent review of representative APA journals, Graham (1992) found a decline from 5.2% to 3.6% of articles devoted to empirical research on African Americans from 1970 to 1989. Of these articles, less than 4% reported on treatment issues relative to the needs of African Americans.

In the present paper, I will report on several modifications to the standard technique of cognitive therapy of depression described by Beck and colleagues which I have found useful for work with a population of African American women. Three briefcase reports will be presented including data on treatment effectiveness using single subject design.


The three clients included in these reports have a number of similarities of background and history. All three have the following in common:

* They did not finish high school;

* they do not consider their neighborhood safe;

* they receive AFDC, food stamps, and Medicaid;

* their work history has been very interrupted;

* they have been victims of racial discrimination;

* they have been witnesses to violent crimes.

While these characteristics will obviously not be present in the history of all women of color who present for treatment, they are not uncommon among African American women of the underclass. Such aspects of the life experience of these clients set them apart from the cultural norms of the white middle class majority clients with whom cognitive therapy was primarily developed (Beck, Rush, Shaw, & Emery, 1979). …

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