12/11/2017StudentName: Seidu BawaClass: PYS5215Assignment: Integratingmulticultural therapy with cognitive behavioral therapyProf.:Jennifer M. Karalekas, Ed.
D In recent years, there has been anincreased attention and research on the influence of multiculturalism and theneed for mental health practitioners to incorporate cultural sensitivity whenserving clients of different ethnic and diverse background. The purpose of thispaper will be to focus on the application of multicultural therapy approach(MCT) with cognitive behavioral therapy (CBT) in servicing underserved, lowincome communities, migrant families and inner city individuals with culturesthat may differ from that of the practitioner. Even though this particularapproach is in its early stages, progress is being made and more practitionersare starting to recognize its importance due to the scientific researchinvolved and the empirical evidence of data collection with cognitivebehavioral therapy. Cognitive behavioral therapy (CBT) as explained in class isa goal oriented collaborative approach based on scientific evidence whose coreprinciple is to challenge the client’s negative beliefs developed due to pastexperiences and emphasis is put on restructuring the client’s dysfunctional beliefswith homework assignments and other techniques. MCT on the other hand takesinto consideration the cultural background of the client, religious adherence,spirituality, past experiences and cultural values which the clinician couldconsider during the therapeutic process. While the convergence of these twoapproaches may provide practitioners with a wealth of information that willallow them to understand their clients a bit more, there are potentiallimitations to consider when merging the two approaches.
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I’ll discuss the advantagesof these approaches for both client and clinician and the potential limitationscritics fear it may counterproductive integrating the two and how suchlimitation could be used as opportunities to improve the effectiveness ofmerging MCT and CBT. The purpose of this paper and thereason I focused my research on this topic is because of my interest to workwith migrants and minority families in underserved and low income communitieswho are finding it difficult transitioning in their new found home. As aminority with a different cultural background and upbringing from that of thedominant culture, I’ve noticed the lack of diversity in mainstream mentalhealth practitioners and sometimes the imposition of the dominant culturalawareness of self on the minority culture without even realizing it. Suchbiases could lead to misdiagnoses by the clinician during the diagnostic andassessment phase because certain cultural aspects were not factored in therebyprolonging treatment. I’m alsofascinated by the cognitive abilities of individuals and I’m on the belief thata person’s mental faculty is the single most important tool he/she possess andif he/she can alter his/her thoughts and outlook about self, he/her can discovernew potentials in defeating their self-doubt and are capable of reinventingthemselves and accomplishing greater things. It is important for me, as aclinician or mental health practitioner to reconcile the two in order to be abetter practitioner with less implicit biases due to the wealth of informationI’ll be exposed to from evidence based scientific research in CBT.MulticulturalTherapy Culture is asensitive topic for most people especially among minority and migrantcommunities. Culture goes beyond self-identity: its social support,self-awareness and a sense of belonging, so when a client can’t connect withthe clinician; little to nothing would be achieved during therapeutic treatment.
There is the need to establish trust, empathy and understanding while renderingservice to individuals of such demography. Considering the cultural beliefs andbackground of the client could provide an in-depth understanding regarding theclient’s genuine concerns. But often times due to the sensitive surroundingpeople’s culture on their outlook on life, it’s been found that mainstreampsychologies either avoid discussing it or viewing it as a separate entity fromthe individual’s experience. Factoring in the client’s experience, culture lossdue to migrating willingly or for political unrest and culture grievance couldbe keys to unraveling the client’s state awareness. Cultural grievance couldmanifest in the form of depression, increased anxiety, low self-esteem,self-doubt, isolation and the feeling of rejection by the dominant culture.
Ican attest to such feeling because I was a teen migrant myself a certain pointin my life and while I was grieving a cultural loss, a school councilorreported that I was just being uncooperative. The stress of acculturation wasnot accounted for: it was rather a disengaged evaluation and a quick assessmentto caste me as the other. Marginalizationof such cultural bereavement especially among minority group is wide spread inthe psychology world.
Mainstream psychological research still ignores thecentrality of culture and separates studies that include cultural minorities(or that simply address cultural influences) into the separate domain ofcross-cultural or multicultural psychology (Clark, 1987). MCT encourages the clinician to consider theindividual’s environment, lifestyle, social support and belief system duringthe assessment period. Contextualizing all these aspects could provide theclinician a glimpse of the client’s cognitive function and how they perceivethemselves and the world at large.
Cognitive Behavior TherapyCBT as explained in class puts an emphasis on theindividual’s abilities to self-improve through cognitive restructuring, coping skillsand homework assignments in a collaborative effort to change the client’s thoughtsand beliefs, and their maladaptive behaviors. CBT is becoming more appealing tomost clinicians because of its reliable scientific data and the empiricalevidence it provides. Its adaptation by clinicians demonstrates the importanceof tangible information and results oriented approach that clinicians mayreference to incorporate in their practices. It’s been reported that there hasbeen countless researches and publications of CBT in the past decade alone. Asurvey of over 2000 councilors, social workers and psychologist found that approximately69% using CBT (Psychotherapy Networker 2007). Another poll of practicingpsychologist found that 89% of the 470 respondents used CBT (Meyers 2006).These statistics shows how quickly mental health practitioners are embracing CBTbecause of its widely researched evidenced based approaches.
The uniqueness ofthe client is the central focus of the therapist in CBT and its core principleis to work collaboratively with the client to make them realize their uniqueness.Another aspect of CBT mentioned in class is that it is time limited unlikeother psychotherapy techniques so clinicians utilizes the various approaches ofCBT that best fit the client situation. Some of these different approaches of CBTare rational emotive behavioral technique or REBT and cognitive therapy. CBTclinicians’ assumptions are that our emotions drive our feelings and thoughts andthose emotions develop into rational or irrational thoughts that fuel our perceptionof ourselves and the world. Albert Ellis, one of the pioneers of CBT laterdeveloped the REBT approach explained it as “an action-oriented psychotherapythat teaches individuals to identify, challenge, and replace theirself-defeating beliefs with healthier ones that promote emotional well-beingand goal achievement.
” The goal is to undo the “victimhood” mind set of theclient and help them modify their thoughts on the outlook of life. The secondmost significant form of CBT is cognitive therapy developed by Aaron T. Beck inthe 1960’s is used in the treatment of depression. According to Beck, people’sview of certain life events contributes to their cognitive distortion.
Both CBTapproaches put an emphasis on modifying the client’s thoughts and internaldialogue in combating self-doubt and victimhood. CBT and MCT shared similarities There are certainsimilarities shared by both approaches and when implemented during thetherapeutic processes could be a success in achieving the therapeutic goal. A person’s culture influences their perceptionof themselves and of others; and places emphasis on the uniqueness of theirindividuality, so does CBT. Secondly, they both focus on empowering the clientin achieving better goal and realizing their potentials.
For example, CBTempowers the client through educational approach by giving the client homeworkand challenging them to try something that they normally wouldn’t because theyfear they will be rejected. On the other hand, MCT also empowers the client byreminding them on how they find meaning in and strength in their culturalidentification. Another aspects shared by both MCT and CBT is respect for theclients point of view. Their input is valued and their irrational thoughts arereplaced with rational thoughts rather than being ridiculed. And both workcollaboratively with the client in achieving an attainable end result withoutthe clinicians imposing their personal beliefs. Potential limitations Although theintegration of these two approaches provides clinicians with a wealth ofinformation to work with, there is a need for more research especially amongminority groups.
Some aspects of CBT may be in conflict with that of MCT intheir application. Firstly, CBT recommends clients to be vocal, very assertiveand independence during the therapeutic process. While with MCT, subtlecommunications are valued over assertiveness in most cultures, interdependenceover personal independence (social support) and finally listening and observinginstead of questioning and behavior areseen as spirituality rather than a world view (Jackson, Schmutzer, Wenzel & Tyler 2006). Eventhough both take into account the personal history of the client during theassessment process, however CBT gives more attention to the here and now, andthat could lead to a neglect of the past. The history of the client’s culturecould be vital into unraveling what may have caused their outlook in life.
Being aware of these potential limitations and recognizing them will only giveroom for more research on how these two could work together rather thanpreclude their integration. Integration of CBT and MCTIn a diverse and multicultural society like North America,linear approach to therapy to a migrant family going through culturalbereavement would not be understood if the whole aspect of the circumstancesurrounding their migration is not taken into consideration. Culturallycompetent clinicians would take into account the families overall history,environmental events and situations that caused them to migrate. For instance,a family that migrated due to political unrest may grieve differently from afamily that migrated willingly for the purpose of a better opportunity. Languagebarrier, economic hardship and the feeling of rejection may affect the migrantfamily’s self-esteem and self-worth. When that is the case, the culturallycompetent clinicians may teach the clients cognitive restructuring. Through cognitive structuring, the migrantfamily may learn to undo certain dysfunctional thoughts by recognizing commoncognitive errors they might have developed due to their circumstance.
Thetherapist long term goal is to get the client to be aware of their irrationalthoughts without undermining their experience.Also, respecting the clients personal experiences and inputduring the therapy session are emphasized by both MCT and CBT. Respect is animportant integral part a therapeutic process that could help in theestablishment of trust. And since CBT is a collaborative therapeutic approach,caution must be taken on the part of the clinician in being sensitive toclient’s external factors rather than just the internal factors. So there whenconsidering given the client therapeutic assignments, the culturally competentclinician could implement an important tool of MCT which is Social support. Consideringexternal factors with respect to the client’s culture even though CBT mainly focuseson the internal dialogue of the client could facilitate a better therapeuticrelationship. The importance of culture in the expression of grief washighlighted by a case report of bereavement in an Ethiopian female refugee.
Hersymptoms of grief were complicated by her inability to perform her culturallysanctioned purification rituals because of her relocation. Compounding herproblem, she was erroneously diagnosed at various times due to the use ofWestern derived diagnostic criteria and a lack of appreciation of the culturaldifferences in the presentation of grief by clinicians (13). Thesymptoms of cultural bereavement may be misdiagnosed due to problems withlanguage, culture and the use of Western diagnostic criteria in non- Westernpeoples. Schreiber (13) notedthat traditional healing and purification rituals as well as supportivepsychotherapy, after the correct diagnosis was made, were essential in thetreatment of this patient’s syndrome.
Additionally, to alienate the client’score cultural beliefs may be perceived as disrespectful. Individuality is encouragedwith respect to environment in MCT; however both put an emphasis on acknowledgingthe situation that created the event. And also subtleresponse, lack of eye contact and unassertiveness are a sign of respect in mostAsian and African culture. Therefore, repetitive questioning whilecommunicating may be seen as disrespect in certain cultures and societies (Weismanet l 2005). Nodding and being silent in-between questions to give the client timeto formulate their response is encouraged in cultural responsive CBT. Such caring attitude during treatment ishelpful in establishing trust when restructuring the client’s cognitivethoughts.
It shows the culturally competent clinicians validates the clientsexperiences by actively listening instead interrupting them midsentence andchallenging their personal experiences. Moreover, A loss of culture congruity can be depressive among migrantswho have been forcibly removed from their birth places due to political unrest.Therefore, homework assignments during the therapeutic process should include aculturally related strength and support system that would remind the client of copingskills. It could be a list of question that they can ask their family membersto remember pass success or repeated phrase that would remind them of how resilientthey are. A visit to religious monastery or a cultural center or a particular songcould be helpful in reminding them that you value their spirituality andcultural beliefs. The culturally responsive CBT clinician role in the therapyis to remind the clients that their irrational fears are innate and so aretheir rational ones, and together they’ll work collaborative to make themrealize their worth and to not be victims of their circumstances.
Conclusion Multiculturalism therapy values the client’s experiences andencompasses open minded on the part of the therapy and client. Culturally competentclinicians are flexible and cherish the importance of culture in shaping peopleoutlook of life so therefore they consider their every aspect of the personalhistory during the therapeutic process. Like I mentioned in the introduction,MCT provides clinicians with a wealth of information to work with because of itswell-researched and recorded technique that’s making more appealing to mostpractitioners. And with CBT, its expanded approach in considering the overallcultural aspects of the client that influences their outlook is beneficial toboth therapist and client at such. Although the integration of these twoapproaches, MCT and CBT are in their early stages with potential limitations,research has shown; they’re more promising in their relevance and effectivenessdue to the wealth of information and empirically base evidence that cliniciansare exposed to.And lastly, the reason I chose todo my research paper on the multicultural therapy approach and Cognitivebehavioral approach is to better understand and conceptualized the strugglesmigrant families like myself whose parent has been in this country for almostthree decades.
I still remember how difficult the transition process was when Ifirst migrated as a teenager; living behind everything familiar to me to a landunfamiliar to me in every aspect. I felt constraint and restricted, my head wasspinning; I was in constant thought process which later, I and other migrantkids came to find out it was depression, we just knew we’re miserable. I sawmyself and the struggles I went through as a young migrant when this topic wasdiscussed in class.
And the worth part of it was the lack of mental healthcouncilors that are well equipped with the cultural awareness to deal with achanging demographic in underserved and low income communities. I found solaceand support in other migrant families in the neighborhood. Even though someshare no cultural similarities with me, we share something in common and thatis culture grievance and with that we empowered one another and found a voice withinthat grievance. To be a trained clinician in cognitive behavioral therapy withcompetency in culture to have the necessary tools to help other minority groupin overcoming their grievance and to not experience low self-esteem and self-doubtis my hope.