Considering Culture One Client at a Time: Maximizing the Cultural Exchange

Chu, Brian C.

doi:10.14713/pcsp.v3i3.905

Cited by 12 publications

(19 citation statements)

References 16 publications

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“…A critically reflective tension between these overlapping domains prevents the misinterpretation of a clinical issue as cultural when it is not or assuming an issue is personal and idiosyncratic when it is in fact cultural (Chu, 2007;Fields, 2010). At moments where cultural misunderstandings arise, it is imperative that the therapist disclose a lack of knowledge and invite the patient to provide corrective feedback.…”

Section: Clinical Considerations In Applying Relational Interventionsmentioning

confidence: 99%

Addressing cultural impasses with rupture resolution strategies: A proposal and recommendations.

Gaztambide¹

2012

Professional Psychology: Research and Practice

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In striving to become more culturally competent, clinicians are faced with the challenges of building and maintaining a therapeutic alliance with clients from diverse ethnic backgrounds. These challenges evoke related concerns regarding the corrosive effect of cultural misattunements, microaggressions, and impasses on the therapeutic alliance and how these lead to poorer treatment outcomes and higher dropout rates for ethnic minority clients. By emphasizing nondefensive responsiveness and validation of the patient's experience, rupture resolution strategies provide a pragmatic set of skills that, when integrated with cultural mindfulness, have the potential of addressing cultural ruptures in the here-and-now encounter with the culturally different. This article will review the theoretical foundation and evidence base for alliance repair interventions and elucidate a model of culturally conscious rupture resolution. This model posits that ruptures in psychotherapy with ethnic minorities not only point to tensions emerging in the therapeutic alliance, but also reorient the treatment dyad toward broader sociocultural realities. Successfully processing these relational-cultural enactments may lead to a "corrective cultural experience" that is transformative to both client and clinician. A case example will be presented to illusu-ate the process of becoming aware of and repairing cultural ruptures in the therapeutic relationship.

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Section: Clinical Considerations In Applying Relational Interventionsmentioning

confidence: 99%

Addressing cultural impasses with rupture resolution strategies: A proposal and recommendations.

Gaztambide¹

2012

Professional Psychology: Research and Practice

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“…Furthermore, individual diversity within a specific cultural group is likely to be large, and culture-specific information will not be invariably applicable. It is more important that clinicians be aware of their own assumptions and engage in ongoing attempts to challenge them and test cultural hypotheses, in a process that has been called ''maximizing cultural exchange'' (Chu 2007;Fields 2010). The patient and family would be essential partners in this process, ensuring that not only culture, but also individual variations applicable to the specific patient and family are incorporated as much as possible into treatment.…”

Section: Clinical Significancementioning

confidence: 99%

Treatment of Culturally Diverse Children and Adolescents with Depression

Stewart

Simmons²,

Habibpour

2012

Journal of Child and Adolescent Psychopharmacology

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This article is written for the practitioners treating depression in ethnic minority youth. It will review the context in which services are delivered to these youth: Researchers have recognized persistent ethnic differences in terms of utilization of services and unmet need. Furthermore, when ethnic minority youth do receive pediatric mental health care, the services that they receive may differ from those given to White patients. The reasons for these discrepancies have been examined in numerous studies, and have included contextual variables (economics, availability, and accessibility of services), patient variables (differences in prevalence or manifestation of the disorder, cultural beliefs and attitudes, preferential use of alternative or informal services, health literacy, and adherence), and provider variables (referral bias and patient-provider communication). Information about the differences between White and minority youth in the pharmacodynamics and pharmacokinetics of the antidepressant response is still limited. There are significant challenges for developing evidence-based guidelines that inform practice with these youth, hinging on both the underrepresentation of ethnic minority groups in clinical trials, and the great variability in biological and cultural characteristics of individuals in ethnic minority categories. Awareness on the part of the practitioner of the cultural variables that influence help-seeking and ongoing utilization of mental health services may aid in the engagement, effective treatment, and retention of ethnic minority children and adolescents with depression. However, given the great heterogeneity that exists within any cultural grouping, clinicians will need to integrate information about cultural patterns with that obtained from the individual patient and family to inform optimal practices for each patient. This article is written to enhance awareness on the part of the practitioner as to the variables that influence psychiatric care for depression in culturally diverse youth. The mental health needs of minority youth are not well served: They are treated less frequently, and when they are treated, the services they receive are less frequently adequate. The reasons that have been proposed for the disparities in their care, particularly with regard to diagnosis and treatment for depression, will be reviewed. They include contextual factors (such as economics, insurance, and other variables affecting the availability of services) patient and family factors (such as prevalence, symptom presentation, and values and beliefs that influence whether patients are referred to and avail themselves of services), and provider factors (such as referral bias and patient-provider communication, which affect whether patients engage and stay in treatment). The implications for the practitioner treating ethnic minority youth with depression will be discussed. Culture, as used in this article, refers to the common values, beliefs, and social behaviors of individuals with a shared heritage. S...

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“…This case study presents methods by which cognitive-behavioral approaches were concretely and successfully modified to accommodate the ethnic and cultural specificities and complexities of the successful case of "TC," a mid-20s Chinese American male with Major Depressive Disorder and Generalized Anxiety Disorder. The broader implications of these specificities and complexities for general practice with such clients is well-discussed in two commentaries on the TC case by Chu (2007) and Hwang and Wood (2007). For example, Chu uses the case to illustrate the nature of cultural competence by placing it within "a general approach that clinicians can use to become oriented to a culture [with which they are not necessarily familiar], make use of evidence-based frameworks, and treat the therapy as an ongoing cultural exchange" (p. 34).…”

Section: Response To Knight and Hyer Commentariesmentioning

confidence: 99%

Balancing Between Empirically-Supported Methods and Individualized Treatment Design in the Case of Geoffrey

Mohlman

Cedeno

Price

et al. 2008

PCSP

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This is a response to the commentaries by Dr. Knight (2008) and Dr. Hyer (2008) on "The Case of Geoffrey" (Mohlman et al., 2008). The response focuses on three major themes: the notion of cultural competence in the psychotherapeutic setting; possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults; and the growing use of cognitive remediation in the treatment of psychiatric disorders. We also address some of the other excellent issues raised by Drs. Knight and Hyer regarding cohort effects in the study of older therapy clients and missing elements in the case of Geoffrey.Keywords: African American; aging; comorbidity; transdiagnostic approach; augmenting cognitive behavior therapy (CBT); baby boomers _____________________________________________________________________________________ RESPONSE TO KNIGHT AND HYER COMMENTARIESThe commentaries on Deconstructing Demons: The Case of Geoffrey (Mohlman et al., 2008) by Dr. Knight (2008) and Dr. Hyer (2008) were thoughtful and comprehensive. We appreciate Dr. Knight's observation that there are few didactic resources for psychologists whose clients have multiple diagnoses (e.g, psychiatric, cognitive, medical), which is the rule rather than the exception with aging adults. Dr. Hyer points out the usefulness and appropriateness of the transdiagnostic approach, especially with clients who have a range of symptoms and poor prognostic indicators. The empirical case study is one way to begin to amass the necessary documentation for mental health practitioners to make informed choices about treatment planning when working with older adults with multiple problems. This response will address three major themes raised in the commentaries: the notion of cultural competence in the psychotherapeutic setting, possible risks inherent in and alternatives to the medicalization of mental health treatment for older adults, and the growing use of cognitive remediation in the treatment of psychiatric disorders.

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Considering Culture One Client at a Time: Maximizing the Cultural Exchange

Cited by 12 publications

References 16 publications

Addressing cultural impasses with rupture resolution strategies: A proposal and recommendations.

Addressing cultural impasses with rupture resolution strategies: A proposal and recommendations.

Treatment of Culturally Diverse Children and Adolescents with Depression

Balancing Between Empirically-Supported Methods and Individualized Treatment Design in the Case of Geoffrey

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