Are most psychotherapeutic interventions suitable for people from different cultural backgrounds? - Chapter 8

What is this chapter about?

In the sequel, the abbreviation BME will refer to people with a "black and minority ethnic" background. Most psychotherapeutic interventions are developed for and applied to (white) people with a Western culture: are such interventions equally suitable for, and effective in, people from different cultural backgrounds? In terms of accessibility and appropriateness of the services provided, many assistive institutions are well suited to Western culture, but not to the needs of BME populations.

What is cultural competence?

Cultural competence of the therapist refers to the therapist's ability to successfully involve BME children and their families in interventions. The diversity within a BME group must of course always be recognised.

What is the effectiveness of CBT in BME children and families?

CBT is often routinely used in adults from BME groups, sometimes in a culturally adapted form. These include ethnically matching the therapist with the client, transferring the therapy into the client's mother tongue, translating material and taking into account the client's cultural norms and values. Custom forms of CBT are at least as effective, sometimes more effective, than the unadjusted form. They are especially more effective with clients who have not made the (Western) culture their own and when the language of the therapist and client do not match. Certain specifically developed programs for parents from BME groups can provide benefits in terms of increased engagement and a higher percentage of people completing treatment.

How can the involvement and effectiveness of the intervention be increased?

The variations in identities and cultures within populations (based on social class, sexuality, and the like) emphasize the heterogeneity in cultural experiences. Therefore, the authors of the book argue not for a culture-specific approach of the therapist, but for a process-specific approach. Two examples of process-specific models are the model of Hays (2009) and the work of Falicov  (1995). Such models provide a  framework for the therapist to work with ethnically different target groups. For example, Hays's model (2009) called "Ten Steps to Cultural Competence" emphasizes that the therapist should know about culturally determined "respectful behavior", that he/she should use culture-related strengths, have examined the cultural environmental factors and cognitive factors, and that he/she emphasizes that the treatment is about cooperation, and not about confrontation.

Within the cultural competence, the overall competence in forming a therapeutic relationship with the client is to be able to analyse and formulate the experienced problems and the ability to convey the intervention. In addition to essential qualities such as empathy, warmth and sincerity, the importance of a respectful, non-judgmental and collaborative attitude in working with clients of BME populations cannot be overstated. Also consider the "little things", such as appropriate forms of greetings (first name or last name, handshake, eye contact?). In terms of analysing and formulating the experienced problems, the client's perspective should be the main focus and the focus should be on the current problems which are decided on together. However, the client's standards and values may differ significantly from those of the therapist, and the therapist should not try to "convince" the client to apply other standards and values. After all, everyone is unique. According to Rathod and colleagues (2010), it is therefore important to jointly determine what is functional for the client within his/her culture, given his/her standards and values.

A common problem in BME populations is that the (younger) child (through schooling and dealing with peers) adapts much more quickly to the (Western) culture than the parents. Especially during adolescence, in which Western children emphasize independence, this can clash violently. It is important that the therapist does not align himself with the adolescent (since his values are closer to the therapist's own norms and values) and thus reject the parents. Try to find safe middle  ground – make compromises, which are in the interest of the child's psychosocial development.

In a thorough analysis and formulation of the problems of children and families of BME populations, it should not be forgotten to also address protective factors. Adapting to a new culture obviously takes a lot of stress, but there are also related factors that reduce this stress:

• BME clients often have a broader and deeper social network for support.
• Bi-cultural competence is beneficial for the child: many people are afraid of a "culture clash", but it is often true that children who grow up in two worlds are better at seeing different perspectives and beliefs.
• A strong and secure ethnic identity, like certain religious beliefs, is related to a great psychosocial adaptability.

Outside the therapy room

Therapists tend to focus on interactions and events within the therapy room and not on the whole system/context. It is important to think about the structure of our health services and the obstacles in terms of engagement, effectiveness and accessibility of children and families with BME backgrounds. The Building Bridges project was set up to increase the involvement and accessibility of support for BME groups. For example, it was discovered that a non-pathologizing and solution-oriented therapy was preferred, with an emphasis on the client's own vision of the problem, his/her strengths and the way he/she thinks that change can take place. The Fathers and Sons project was set up to meet the needs of a specific group, namely the Somali, Yemeni and Black British fathers and sons whose relationship suffered greatly from the generational differences and the experiences of migration, discrimination and bi-cultural life.  

What can be concluded?

It is clear that cultural values and beliefs are an essential component of working with children and families with a BME background. In addition to working according to a process model, it is also important for therapists to think about specific approaches for specific BME groups. The following questions are important: who determines which intervention is used and how therapists are trained? What are goals? In order to arrive at answers, it is essential that this group of service users and the wider community is involved.

In the sequel, the abbreviation BME will refer to people with a "black and minority ethnic" background. Most psychotherapeutic interventions are developed for and applied to (white) people with a Western culture: are such interventions equally suitable for, and effective in, people from different cultural backgrounds? In terms of accessibility and appropriateness of the services provided, many assistive institutions are well suited to Western culture, but not to the needs of BME populations.