Have you ever noticed that the most famous psychologists come from a Western background? Freud, who introduced the ego theory (id, ego and supergeo), Pavlov, who discovered classical conditioning or Carl Jung, the psychoanalyst who introduced the concept of the collective unconscious all share a Western culture. In the recent couple of decades, psychologists have realized that mainstream psychotherapeutic interventions are not inclusive enough to be applied to non-Western individuals without at least some considerations specific to their cultures. This led to the birth of a new approach, called the cross-cultural approach. It’s also known by other terms such as transcultural or multicultural, among others. The need for this approach was also amplified by the rapid and ongoing growth of diversity in our societies.

The foundational psychological theories are rooted in the Western culture. Moreover, in a lot of cases, the therapist and the client are influenced by different cultures. This could create further issues in the client-therapist relationship, therapeutic outcome or cause early or prompt termination of therapy.

Cross-cultural psychotherapy refers to therapy that stresses on cultural awareness and sensitivity, including ideals of feelings, psychodynamics and actions that are socially defined and constructed. Also, it tries to bridge the gap between the Western culture’s values and attitudes and those of the Eastern culture. Such factors strongly affect the therapist’s assessment and conceptualization of presenting problems as well as facilitation of goals in therapy.

Importance of cross cultural psychotherapy:

A lot of the foundations in psychotherapy are Eurocentric, meaning that they merely consider European culture, excluding the cultural assumptions of the rest of the world. In particular, assumptions related to the nature of concepts such as self-control or honor, the way a person relates to others and the universe as well as the nature of illness and cure. Further, conventional psychotherapeutic theories and interventions are usually established using the ideas and concepts of the self pertaining to the Western culture. In that sense, the self is thought to be socialized with the worldview of individuality and interiorized identity and control. As opposed to our Arab culture, for instance, where we tend to be socialized to have a collectivist identity as well as adopting an externalized identity and self-control.

For example, Arab individuals including Egyptians are more likely to feel shame as it’s related to how society perceives you if you engage in socially unacceptable acts. On the other hand, Westerns would be more likely to feel guilt, which results from an internal conflict between a person’s self and behavior. 

Consequently, the psychology community recognized a great need for the inclusion of cross-cultural psychotherapy. This involves modifying traditional forms of therapy slightly to offset the bias towards mainstream Americans and Europeans. Moreover, mental health professionals are starting to incorporate specific standards and training that reflect the diversity that exists in our society in a more accurate way. 

Dangers of ignoring cultural differences: 

Applying intervention models from the Western culture on people who are culturally diverse without any adjustments could actually do more harm than good as it could be culturally insensitive. For instance, it could invalidate their life experiences as certain cultural values could be falsely recognized as deviant or pathological. Also, it could deny them care that is culturally appropriate as well as enforce values belonging to a dominant culture upon them.

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Furthermore, non-verbal communication is extremely important in therapy, however, they are greatly influenced by culture. Non-verbal communication that proved to be important in cross-cultural psychotherapy include bodily movements such as facial expressions and eye contact, the use of personal space and vocal cues such as volume and intensity of speech. For instance, in some cultures such as our Egyptian culture, speaking in a loud voice does not necessarily imply anger or hostility. Likewise, in other cultures speaking softly does not, by default, equate to shyness or indicate depression. In addition, a therapist should be aware of how a culture constructs core beliefs, ethics and family relationships. Also, there should be an avoidance of potentially triggering terms and figures of speech for certain cultures.

What to expect when receiving cross-cultural psychotherapy and how do I know if a therapist is culturally competent?

• Modifies traditional types of treatment according to the client’s cultural needs.
• Self-awareness: Therapists should have a heightened awareness of their own assumptions, biases and values related to different races, ethnicities and cultures.
• Communicates a strong openness to understand the unique experiences of the client (as opposed to merely considering the stereotypes), while also taking into consideration their cultural perspectives without any negative judgements. 
• Has done research on general multicultural knowledge and has an understanding of various experiences that different cultural groups might go through.
• Develops and includes interventions that are culturally sensitive in their practice.
• Has the ability to establish an effective client-therapist relationship.
• Has an awareness that the client may use a different style of information procession, communication or thinking.
• Due to barriers in communication that might result from cultural differences, they should know how to determine effective ways of communication with a client.
• Asks the client for clarification if something is unclear by saying things like “What do you mean by that?”

Cross cultural psychotherapy can be applied to different forms of therapy such as cognitive behavior therapy (CBT), family therapy and couples counselling. In case of eclectic therapy, which involves combining psychological theories or approach or the use of various concepts and techniques from different sources, the influence of the client’s culture should always be taken into consideration with every step in the therapeutic process. 

To know more about cross cultural psychotherapy:

If you want to know more about cross cultural psychotherapy, a webinar is coming up on cross-cultural psychiatry on the 3rd of September at 5 pm by Meryam Schouler-Ocak, a professor for intercultural psychiatry and psychotherapy at Charité-Universitätsmedizin Berlin. She’s the chair of Ethical Issues Committee of the EPA, board member of the European Psychiatric Association (EPA), chair of Section on Transcultural Psychiatry of World Psychiatric Association (WPA-TPS) and chair of Working Group on Providing Mental Health Care for Migrants and Refugees of WPA. 

For more information regarding the presenter, please check the bio at Shezlong’s linkedin profile: https://www.linkedin.com/events/transculturalpsychiatrywebinarw6834113908190535680/

To sign up: https://bit.ly/3fPpSfY 

References:

1. APA Dictionary of Psychology. (n.d.). Retrieved from https://dictionary.apa.org/eclectic-psychotherapy#:~:text=any psychotherapy that is based,professional experiences of the therapist.
2.  Baruth, L., & Manning, M. L. (2006). Multicultural counseling and psychotherapy: A lifespan perspective. Upper Saddle River, NJ: Prentice Hall
3. Cesko, E. (2018). Transcultural Psychotherapy: New perspectives in clinical application. World Association for Positive and Transcultural Psychotherapy. https://www.positum.org/ppt-publications/transcultural-psychotherapy-new-perspectives-in-clinical-application/
4. Dwairy, M., & Sickle, T. D. V. (2001, July 26). Western psychotherapy in traditional Arabic societies. Clinical Psychology Review. https://www.sciencedirect.com/science/article/abs/pii/S0272735896000116.
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6.  Multicultural Therapy. (n.d.). Retrieved from https://www.psychologytoday.com/us/therapy-types/multicultural-therapy
7. Nugent, Pam M. S. (2013). Transcultural Psychotherapy. https://psycho logydictionary.org/transcultural-psychotherapy/ (April 29. 2013)
8. Pope-Davis, D. B., Coleman, H. L. K., Liu, W. M., Toporek, R. L., & Toporek, R. L. (2003). Handbook of multicultural competencies in counseling and psychology. ProQuest Ebook Central https://ebookcentral.proquest.com
9. Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42(1), 37–45. https://doi-org.libproxy.aucegypt.edu/10.1037/0003-066X.42.1.37
10.  Sue, D. W., & Sue, D. (2008). Counseling the culturally diverse: Theory and practice (5th ed.). New York: Wiley.
11. Team, G. E. (2019). Multicultural Concerns. Retrieved from https://www.goodtherapy.org/learn-about-therapy/issues/multicultural-concerns
12.   Wendt, D. C., Gone, J. P., & Nagata, D. K. (2015, April). Potentially Harmful Therapy and Multicultural Counseling: Bridging Two Disciplinary Discourses. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4556361/