Cultural Psychotherapy: Working With Culture in the Clinical Encounter

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As a member of the Fisher River Cree Nation, his research interest focus is on Indigenous perspectives on nonviolence, human rights, mental health, peace-building, and restorative justice. Austin Johnson is a doctoral student in the clinical psychology program at the Fuller School of Psychology. He hails from Texas, which he claims is a culture of its own. Christin Fort is a completing her clinical internship as a doctoral candidate in the Fuller School of Psychology.

Her research interests emerge from her African American heritage and are focused on the intersection of attachment theory, intersubjective systems theory, and divine passability. Seeley , Pastoral Psychology, 51 1 , 41— For more information about Professor Belzen, see Prof. Belzen does not offer his own definition of religion; he is probably wise to avoid this particular ongoing debate. Psychologists of religion, however, would profit from definitional discussions about religions.

One of the best books on this topic is religion scholar Thomas A. See the special issue of the journal Mental Health, Religion and Culture — 13 4 , —, published in —which contains ten articles by a wide range of psychologists of religion. These papers provide a fascinating look at the predicament of contemporary psychology of religion through the lens of culture. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Article First Online: 17 March Furthermore, Belzen b states that.

Belzen, J. To read and to be read—The problematic nature of communication: Comment on comments. CrossRef Google Scholar. Towards cultural psychology of religion: Principles, approaches, applications.

Western Psychotherapy

New York: Springer. Bulkeley, K. Religious Studies Review, 31 , — Kim, U. Indigenous and cultural psychology: Understanding people in context. Google Scholar. Laird, J. Theorizing culture: Narrative ideas and practice principles. McGoldrick Ed. New York: Guilford Press. Riesebrodt, M. The promise of salvation: A theory of religion trans: Rendall, S. Chicago: University of Chicago Press.

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For Pablo, however, the story is complicated by the fact that he is working class, illiterate and unable to communicate in English. While he aims to communicate effectively with health providers, for example, there are circumstances beyond Pablo's control i. Pablo described an incident where he ate steak at a Christmas party and became violently ill, vomiting blood. There were people speaking Spanish. As Pablo draws heavily on the cultural schemas of personal responsibility, honest communication, and a general deference to institutional procedures, he appears to be a motivated and highly compliant patient.

Specifically, Pablo will not discuss his use of herbal remedies with doctors.

Employing Psychotherapy Across Cultures and Contexts

Viewing the two forms of medicine as complementary, he talks in great detail of when to resort to traditional measures and when to see the doctor. For Pablo, the belief in alternative and herbal remedies is grounded in a sense of community and ethnic heritage:.


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Those are things that you have with you thanks to your grandparents, from your parents. I remember the medicinal herbs and I know a lot of them because my mom used them. She was a woman that had learned it from her mother, and her grandmother, her great grandmother. Urbanites in Mexico, for example, wouldn't understand herbal remedies, since they don't know the plants. Why, then, won't Pablo discuss his use of herbs with his doctor? Unlike other situations his children's expulsion from high school, his hospitalisation , Pablo is unwilling to defer to those in authority.

Pablo knows others dismiss his use of herbs, but he insists that these plants are part of his heritage and he has experienced them as authentic. He neither wishes to abandon his village roots nor feels empowered to directly challenge the doctors. Overall, Pablo's clinical orientation is composed of an emphasis on personal responsibility and efforts as well as a readiness to defer to both the scientific and the bureaucratic authorities of the clinic, qualified by his intimate feelings for the heritage of folk medicine.

Clearly, Pablo's ethnicity is but one of many structural realities informing his hybrid habitus. His immigration experience, education status, work history, and community ties intersect with his ethnicity in shaping his cultural repertoire. He draws on different elements in this repertoire creatively and somewhat unpredictably during clinical encounters.

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To reduce his culture either to his Mexican background or his assimilation into an American culture of individualism would be dangerously misleading. Pablo's case is illustrative of the multiple structural realities that shape the habitus of immigrant patients, at the same time it highlights how patients mix and match schemas when interacting with healthcare providers.

In this paper, we have argued that adequately to address issues of cultural competency, we first have to develop a more robust understanding of patient culture. Which subset of their cultural schemas do they draw upon in specific clinical contexts? How do patients mix and match these cultural schemas?

Beyond cultural competency: Bourdieu, patients and clinical encounters

How do patient cultures shape, and are potentially shaped by, multiple steps in clinical interaction itself? The theoretical reformulation of culture has several practical implications. Furthermore, this set of conceptual lenses allows doctors to recognise the multiple and even contradictory cultural themes in a patient's clinical orientation, acknowledging for example, that a highly compliant and motivated patient may at times choose to withhold crucial information.

While current efforts of cultural competent healthcare recognise that medical practice in the US has been standardised at the expense of cultural considerations and that the medical profession needs to bring culture back in, the irony is that there is a requirement that cultural competency if it is to be taken seriously be defined in terms of standardisation and algorisms — exactly what renders medical practice culturally in sensitive in the first place.

To break away from the reproduction of simplistic understandings of culture, our paper offers a theoretical foundation for new inquiries. We suggest that professional education around issues of cultural competency must happen early in training, and must be integral to physician education. Enhanced support for cultural competency curriculum in medical schools, for example, will help doctors understand, recognise, and apply the abstract notion of hybrid habitus empirically.

The call for curriculum reform, in turn, suggests new research questions and agendas for medical sociologists and other social scientists of medicine. To offer useful case studies for cultural competency courses, we need more, and more systematic, documentations and analyses of stories like Pablo's.

Furthermore, it will be useful to observe if and how patients mix and match their schemas differently when interacting with different healthcare professionals, such as nurses, medical assistants, or medical interpreters. Indeed, it is our hope that the theory of hybrid habitus motivates and informs active research and curriculum development to advance current cultural competency efforts.


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  • The authors would like to thank Carole Joffe, Drew Halfmann, Susan Roxburgh and the anonymous reviewers for their insightful comments and suggestions. This paper is part of a larger project on cultural competency funded by the Robert Wood Johnson Foundation. Volume 30 , Issue 5. The full text of this article hosted at iucr. If you do not receive an email within 10 minutes, your email address may not be registered, and you may need to create a new Wiley Online Library account. If the address matches an existing account you will receive an email with instructions to retrieve your username.

    Cultural Competence in Healthcare

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    Share Give access Share full text access. Share full text access. Please review our Terms and Conditions of Use and check box below to share full-text version of article. Acknowledgements The authors would like to thank Carole Joffe, Drew Halfmann, Susan Roxburgh and the anonymous reviewers for their insightful comments and suggestions. Baker, D.