Theory of Psychotherapy chapters 13, 14, 16, & 17
Social Liberation -Feminist Therapy
The change process known as social liberation entails increasing alternatives for social behaviors. These include advocating for the rights of oppressed populations, empowering clients to change their lives, and making policy interventions
Glass Ceiling -Feminist Therapy
Also hindering advancement is the glass ceiling-the subtle barrier that women and minorities face in their climb up the corporate or power ladder. Although women can see the top of the hierarchy and are informed that with patience and persistence they can reach the apex, they rarely do. The glass ceiling frequently prevents women from moving into top positions: only 17% of the U.S. Congress member and only 16% of Fortune 500 board members are women. If you need any more evidence, simply count the number of U.S. presidents of Catholic popes who were women!
Liberation Psychotherapy -Multicultural Therapy
An inspirational template for active intervention is liberation psychotherapy. It challenges the traditional notion of marginality and provides means to eliminate the subordinate status of minority cultures. Awareness of the social context promotes concrete change; working toward freedom forms the base of liberation psychotherapy. We need to actively intervene in order to transform the society in which we live
Gender Role Strain Paradigm -Male-Sensitive Therapy
Another and newer way at looking at Marc's life is through the lens of the gender role strain paradigm. Here, gender roles are seen as socially constructed and frequently problematic. According to the gender role strain paradigm, gender role norms are often inconsistent and contradictory. Social condemnation and stressful consequences commonly follow role violations, and many behaviors prescribed by gender role norms are dysfunctional
Heterosexism -LGBT Therapy
Heterosexism is founded upon the initial assumption that the client is heterosexual. It can manifest itself in something as simple as the intake form, where questions about the relational dominations often exclude LGBT experiences. Most heterosexual therapists are unaware of the power and privilege inherent in being the majority sexual orientation. The experiences of an LGBT individual are nearly unknowable to them. Thus, therapists must keep their sense of privilege from reducing their empathy, by becoming more aware of how heterosexist norms pervade our society. Using the term marital therapy (instead of couple therapy), for example, can offend those not granted the legal right of marriage
Internalized Homophobic -LGBT Therapy
Homophobia is not restricted to heterosexuals, however. Being raised in a heterosexist world that continually tells LGBTs that they are wrong or sick, many experience internalized homophobia. This refers to a set of negative attitudes toward homosexual features in oneself. LGBT individuals with internalized homophobia receive harsh criticisms from others and from within themselves simultaneously
4 Major Therapeutic Factors -Integrative Therapy
Hubble, Duncan, & Miller: -Client factors >Harnessing client competence, tapping client's resources -Relationship factors >Fostering therapeutic alliance, embracing client's theory -Hope and expectancy >Facilitating hope -Models and techniques >Selecting methods that provide structure and fit client
Lesbian, Gay, Bisexual, and Transgendered (LGBT) -LGBT Therapy
Lesbian, gay, bisexual, and transgendered (LGBT) clients constitute a group within themselves. Despite their heterogeneity, however, shared experiences of discrimination and stigma connect LGBT clients with other minority group clients. LGBT clients, like racial/ethnic minority clients, are an oppressed group in society. They have been subjected to detrimental stereotypes, have been slighted and marginalized in psychotherapy research, and have often been underserved or inappropriately served in the mental health system. No matter where we stand, we see similar problems-exclusion, invisibility, and the absence of cultural competence among practitioners. Thus, LGBT, clients require psychotherapists who are culturally competent in all sexual orientations
A Sketch of Paul Wachtel -Integrative Therapy
-1940-present -Ushered in sophisticated attempts at theoretical integration -Trained in psychoanalytic therapy and then incorporated behavioral and systemic -His system began as effort to portray behavior therapy as foolish, superficial, and possible immoral
Therapeutic Processes -Multicultural Therapy
-3 perspectives: >Cultural relativism >Cultural universality >Cultural adaptation -Consciousness raising: Understanding how culture has oppressed and shaped self-views -Catharsis: Expressing healthy anger and recognizing that anger is normal and justified -Choosing: Channeling new-found liberation and pride
100 Person World Village -Multicultural Therapy
-57 Asians -21 Europeans -14 from Western Hemisphere -8 Africans -70 non-white -70 non-Christian -50% of world wealth would be in the hands of 6 Americans
Culture-Bound Syndromes -Multicultural Therapy
-Amok: In Malayan culture, sudden, wild homicidal aggression -Anorexia nervosa: In Western cultures, preoccupation with thinness and refusal to eat -Ataques de nervios: In Caribbean cultures, impulsivity, dissociation, and anxiety -Susto: In Central American cultures, loss of soul causing depression and somatic symptoms -TKS: In Japanese culture, intense fear of offending other people through social awkwardness -Windigo: In Algonquin Indians, anxious, agitated and convinced of bewitchment
Theory of Psychopathology -Integrative Therapy
-Anxiety is core - common emphasis of both psychoanalysts and behaviorists -Views the process of therapy as a "blooming rose - an unfolding and self-creating process" -Cyclical psychodynamics: Powerful conflicts can be understood as both cause and effect >Intrapsychic conflicts create problematic beh. >Problematic beh. create intrapsychic conflicts -Vicious self-perpetuation cycles maintain psychopathology
Reports of Superior Outcomes of Certain Treatments are Misleading -Integrative Therapy
-Bruce Wampold notes 3 reasons: 1. Comparative therapy studies ignore therapist effects and overestimate treatment effects 2. Comparison treatments are often not bona fide; lack of structural equivalence 3. Purported outcome differences are often due to allegiance effect (researcher's favorite)
Therapeutic Relationship -Gender-Sensitive Therapy
-Characterized by 2 Es: empowerment and egalitarianism -Empowerment: Therapist helps instill power, both social and individual, in client -Egalitarianism: Comparatively equal relationship between therapist and client -Treatment goals are mutually generated
Types of Integration -Integrative Therapy
-Common factors >Determining core ingredients -Technical eclecticism >Selecting best treatment for person/problem -Theoretical integration >Two or more theories are combined
Stages of Gay and Lesbian Identity Formation -Multicultural Therapy
-Confusion - questioning sexuality -Comparison - accepts possibility -Tolerance - accepts that he/she is gay/lesbian -Acceptance - increased contact with gays/lesbians -Pride - person finds peace with and prefers sexual orientation
Feminist Therapeutic Processes -Gender-Sensitive Therapy
-Consciousness raising: one's suffering due to gender restrictions and discrimination -Choosing: can be achieved even within a patriarch society -Counterconditioning: healthy opposites applied to gender-linked, culture-induced distress -Social liberation: increasing alternatives for equality; "the personal is political"
Practicalities of Feminist Therapy -Gender-Sensitive Therapy
-Consumer-oriented: clients encouraged to shop around for therapist -Lower-cost sessions common -Empowered consent regarding risks and benefits of psychotherapy -Non-hierarchical leadership to group treatment and community organization -Mostly, but not always, women therapists -Length of treatment determined by patient -Treatment length increases when client decides to pursue more ambitious goals -Feminist consciousness takes considerable time -Successful feminist action takes even longer
Theory of Personality -Multicultural Therapy
-Culture is a major determinant of personality -Culture is constellation of human knowledge, belief and behavior passed down from earlier generations -No single theory of personality for multicultural treatment -We require multiple perspectives rooted in particular cultures
Future Directions -Multicultural Therapy
-Demographic changes and pluralistic society make multiculturalism inevitable -Pluralism: More inclusive, less ethnocentric models of human behavior and treatment -Meaning of culture broadened to multiple dimensions of identity (age, disability, social status, etc.) -Practitioners must secure multicultural competence
Common Factors -Integrative Therapy
-Determine the core ingredients that different therapies share -Goal: Create more parsimonious and efficacious treatments based on commonalities -Commonalities account for more outcome than unique factors that divide the therapies -Occupy an intermediate level of abstraction, between concrete technique and global theories
Eclecticism vs. Integration -Integrative Therapy
-E: Technical; I: Theoretical -E: Divergent; I: Convergent -E: Collection; I: Blend -E: More empirical; I: More theoretical -E: Realistic; I: Idealistic -E: Lazarus; I: Wachtel -E: Multimodel tx: I: Integrative therapy
Therapeutic Relationship -Multicultural Therapy
-Empathy, regard, and collaboration are foundation -Relationship can be challenging if therapist is of different race and ethnicity -Meaning of "therapist" varies by culture -Racial/ethnic meaning of therapist and patient may be preferred -Therapist adapts to cultural preferences -Therapist is advocate: Empowers clients for social change
Theory of Psychopathology -Multicultural Therapy
-Expression and manifestation of pathology are often culturally determined -Psychopathology is behavior that predominant cultural consensually deems unusual or maladaptive -Etiology is mix of biology, culture, and psychology -Impact of race/ethnicity usually due less to biological vulnerability and more to social inequality
Criticisms of Gender-Sensitive Therapies -Gender-Sensitive Therapy
-From a psychoanalytic perspective -From a cognitive-behavioral perspective -From a humanistic perspective -From an integrative perspective
Criticisms of Multicultural Therapy -Multicultural Therapy
-From a psychoanalytic perspective -From a cognitive-behavioral perspective -From a humanistic perspective -From an integrative perspective
Future Directions -Gender-Sensitive Therapy
-Future demands culturally competent, gender-sensitive therapies -Feminist therapy needs a central, organizing theory of human behavior -Will more fully address inclusiveness (e.g., age, SES, disabilities) -More gender-sensitive training in graduate programs and continued education
Practicalities of Multicultural Therapy -Multicultural Therapy
-Goal: Develop network of change agents that will reverberate throughout client's life -Frequently involves contact with families, communities and indigenous healers -Use of translators is controversial and often contraindicated -Pre-treatment preparation clarifies expectations and defines comfortable role for client, typically leading to lower dropouts and better outcomes
Feminist Theory of Personality -Gender-Sensitive Therapy
-Identity influenced by prevailing environment, including social learning and gender roles -Gender roles and discrimination influence cognitive structures and behavior patterns -Differences between gender due in part to women primarily raising children (Chodorow) -Children bombarded with messages of gender expectations -Gender roles deeply ingrained in personality
Therapeutic Content -Multicultural Therapy
-Intrapersonal Conflicts >Anxieties and defenses >Self-esteem -Interpersonal Conflicts >Intimacy and sexuality >Communication >Hostility >Control -Indivduo-Social Conflicts >Adjustment versus transcendence >Impulse control -Beyong Conflict to Fulfillment >Meaning of life >Ideal individual
Therapeutic Content -Gender-Sensitive Therapy
-Intrapersonal conflicts >Anxieties and defenses >Self-esteem >Responsibility -Interpersonal conflicts >Intimacy and sexuality >Communication >Hostility >Control -Indivduo-Social conflicts >Adjustment versus transcendence -Beyond conflict to fulfillment >Meaning of life >Ideal individual
A Major Alternative: Psychotherapy with LGBT Clients -Multicultural Therapy
-Lesbian, gay, bisexual, and transgender (LGBT) clients are oppressed minority group -Homophobic attitudes toward LGBT clients persist -Gay affirmation therapy celebrates and advocates for LGBT -Reparative/sexual conversion therapy attempts to "convert" clients to heterosexual orientation, but is largely discredited
3 Multicultural Pioneers -Multicultural Therapy
-Lillian Comas-Diaz -Stanley Sue -Beverly Greene
Integrative Therapies -Integrative Therapy
-Look beyond the confines of single-school approaches to see what can be learned and how patient can benefit -Goal: Enhance the effectiveness and efficiency of psychotherapy -Characterized by spirit of open inquiry and transtheoretical dialogue -Avoid the "dogma eat dogma" history of psychotherapy
Sexual Trauma -Gender-Sensitive Therapy
-Major contributor to psychopathology -About 1/4 of American women have experienced childhood sexual abuse -About 60% of rapes are acquaintance rapes; only 30% of rapes are reported -Rage related to sexual abuse can manifest itself in pathological symptoms
Gender-Role Expectations -Gender-Sensitive Therapy
-Men must achieve or exceed masculine standards or accept "failure" -Men hide feelings behind facade of toughness, resistance, and violence -Male problems (e.g., aggression) are often byproducts of typical socialization -Men find it difficult to seek help; seen as admission of weakness -Men often genuinely unaware of their emotions (normative male alexithymia)
A Sketch of Sociopolitical Forces -Gender-Sensitive Therapy
-Modern psychotherapy created by White men in their own image and according to their own values -Rise of feminism (commitment to equal social, economic, and political rights for men and women) in the 60s and 70s -Gilligan's In A Different Voice illuminated sexist bias in psychology research and practice -Women denied equal rights and an equal voice in mental health care -No single person responsible for feminist treatment; a collaborative effort
Therapeutic Process -Integrative Therapy
-Need for active intervention for neurotic patterns to change -Insight is one way of disrupting the destructive cycle of events -Employ behavioral methods such as assertion training -Insight and action are mutually facilitative
Effectiveness of Gender-Sensitive Therapies -Gender-Sensitive Therapy
-No randomized controlled studies on effectiveness of feminist therapy -Increased satisfaction commonly observed in same-gender therapy dyads -But no consistent benefit of patient-therapist gender matching on outcome -More difficult to test by traditional means because results are not limited to symptom remission
4 Stereotypes of "True Masculinity" -Gender-Sensitive Therapy
-No sissy stuff: avoid anything "feminine" -The big wheel: must be successful, respected breadwinners -The sturdy oak: exude confidence, strength, self-reliance -Give 'em hell: behave aggressively and daringly
Sketch of Integrative Motives -Integrative Therapy
-Proliferation of therapies -Inadequacy of single theory for all patients -External socioeconomic contingencies -Ascendancy of short-term, problem-focused treatments -Therapists observing and experimenting with various treatments -Commonalities contribute heavily to treatment outcome -Development of professional societies (e.g., SEPI) devoted to psychotherapy integration
Theory of Psychopathology -Gender-Sensitive Therapy
-Psychological distress is often environmentally induced and culturally determined -Many disorders (e.g., self-destructive behaviors) are coping effects in oppressive, inescapable environments -Disorders caused in part by: >Sex-role stereotyping >Gender-role expectations >Role strain and role conflict >Sexual trauma >Gender-related economics
A Sketch of Multicultural Therapy -Multicultural Therapy
-Psychotherapy developed by upper-class White heterosexuals in western Europe -Therapy originally and erroneously envisioned as transcultural -Traditional therapies are increasingly appropriate for addressing the problems of minority and oppressed groups -Changing demographics signal need for cultural awareness and competence
Defining Race & Ethnicity -Multicultural Therapy
-Race: Category of persons related by common heredity or genetics and whose features are perceived in terms of external trails -Ethnicity: A shared culture with respect to lifestyles, norms, and values -Race and ethnicity not always the same -All people have multiple groups and not all members have same characteristics -Thus, crucial to avoid the myth of uniformity (all group members have the same characteristics)
Effectiveness of Multicultural Therapies -Multicultural Therapy
-Reviews of multicultural treatment tend to reflect the race of the reviewer -Many racial and ethnic minorities are underserved in mental health -Most minority clients prefer same-race therapists, but no consistent differences in outcome when so matched -Meta-analyses conducted on culturally adapted therapies reveal a positive effect (d=.46)
Technical Eclecticism -Integrative Therapy
-Seeks to improve ability to select best treatment for client and problem -Guided by research and experience on others with similar problems -Technically-based rather than theoretical -Do not need to subscribe to underlying theory to use effective methods -Not to be confused with syncretism
Social Causes of Psychopathology -Multicultural Therapy
-Social, political, and economic inequality -Stress resulting from prejudice and discrimination -Internalized racism: Low self-esteem and self-hatred caused by discrimination -Problems with acculturation -Failure to be accepted by dominant culture
Role Strain & Conflict -Gender-Sensitive Therapy
-Strain: multiple demands of different roles -Conflict: clashing or conflicting roles -Women subscribing to traditional sex role have higher incidence of depression and anxiety as well as lower self-esteem -Stress created by society's antagonism toward changing roles
APA Guidelines for Therapy with Women -Gender-Sensitive Therapy
-Therapist should: >Be free of gender-defined roles and stereotypes >Recognize reality and variety of sex discrimination and facilitate options for clients >Be knowledgeable about current research >Not use derogatory labels >Inform clients about therapy practices (informed consent) >Realize that privilege belongs to client (not family or spouse) >Not reinforce stereotypic dependency of women >Respect the client's assertive behavior >Recognize that abused clients are victims of crimes >Recognize the client's right t define sexual preference
A Major Alternative: Male-Sensitive Psychotherapy -Gender-Sensitive Therapy
-Traditional therapy designed by men to treat primarily women -Psychotherapy for men based on an accurate understanding of male personality development -Men are negatively effected by gender role expectations and suffer from role strain (as do women)
Practicalities of Men-Affirming Psychotherapy -Gender-Sensitive Therapy
-Treatment formats more flexible than conventional, face-to-face therapy -Group therapy is powerful and common -Humor is frequent means to begin conversations about serious issues -Initially, therapist may avoid open-ended questions about feelings; focus on practical matters
Theoretical Integration -Integrative Therapy
-Two or more theories are integrated in hope that sum will be better than its parts -Blend both theory and technique -Hybrid examples: Psychoanalytic and behavioral; cognitive and interpersonal -Most integrated theory is cognitive therapy
Gender-Related Economics -Gender-Sensitive Therapy
-Women clustered in lower paying, sex role occupations -Divorced women and their children constitute an increasing proportion of the poor -Average women worker with same education receives 81 cents to a dollar for a man -40-90% of working women have been sexually harassed -Professional women assigned to "mommy track" or hit the "glass ceiling"
Cultural Empathy -Multicultural Therapy
A positive multicultural relationship may well demand more than ordinary therapy empathy; it may require cultural empathy. As defined in the Western culture, empathy takes on an individualistic interpretation of human desire and distress. "I understand your personal feelings." Cultural empathy takes on a more inclusive orientation by placing cultural responsiveness at the center. It is a learned ability to accurately understand the client's self-experience from another culture and then to express that understand back to the client. "I understand your personal feelings and your cultural context."
Empowerment -Feminist Therapy
A women with knowledge of gender socialization can use its power to change. The feminist therapist encourages the client to make choices that will change her life for the better-not just to settle for what others are willing to give her, but to lobby for what she is truly entitled to. The therapist and the client agree on the parameters of treatment. Ideally, the therapy is free of constrictions based on gender-defined roles, and the options explored are free of sex role stereotypes. By empowering clients, therapists help them develop greater autonomy, self-confidence, and power. To choose something, rather than just passively accept current conditions, requires power, and power is what the therapist seeks to instill in clients. The term empowerment captures the essence of this process. Choosing is ultimately the responsibility of the client, but helping the client develop the power and the skill to choose wisely is in the hands of the therapist
Cultural Competence -Gender-Sensitive Therapy
As part of the broader movement toward cultural competence in psychotherapy, gender is a critical variable and a central mediator of a client's experience. Women-and men-will be recognized as a special culture that requires tailored formulations and interventions. Psychotherapists will increasingly consider gender context when conducting assessments and devising treatments
Browning of America -Multicultural Therapy
As the population of the United States (and the world) becomes more diverse, the practice of psychotherapy must follow suit of be left by the wayside. In other words, the browning of America changes not only people of color, but also the institution of psychotherapy
Myth of Uniformity -Multicultural Therapy
Attempting to merge so much diversity under a single label may lead mental health professionals to tenuous conclusions about individuals. In doing so, they fall victim to the myth of uniformity, the naïve belief that all members of a group will have the same characteristics. There is a fine line between sensitivity to a person's membership in a particular cultural group and losing sight of that person's individuality. Thus, cultural characteristics differ across cultural groups as well as among individuals within those groups
Bibliotherapy -Feminist Therapy
Bibliotherapy involves the client's learning about herself and her environment through reading. Reading books and articles relevant to therapeutic issues educates the client and reduces the knowledge differential between the therapist and the client. Popular examples are books related to assertion, sexual abuse, women's health, codependency, workplace discrimination, relationship conflicts, and family or origin conflicts
Feminism -Gender-Sensitive Therapy
Feminism, the philosophical root of feminist therapy, is a commitment to equal social, economic, and political rights for men and women. Of late, there has been confusion and backlash over the use of the term feminist. We will use the term descriptively and accurately as defined in the dictionary: A person who believes in and/or advocates the principle that women should have political, economic, and social rights equal to those of men
Consciousness-Raising Groups
Consciousness-raising groups are an integral component of feminist therapy. These groups, initially an outgrowth of the women's movement, involve groups of women who meet regularly to discuss their lives as women. They share information about their lives and identify common threads in their experiences. A women who is being abused by her husband may become involved in a consciousness-raising group and subsequently discover that several other members of the group have also been abused. The knowledge that she is not alone in her predicament may help the women feel less isolated; moreover, group members' experiences and advice may prompt her to seek the help she desperately needs. Women come to understand that their experiences with discrimination and violence are not isolated incidents involving only themselves but are universal experiences of women
Culture -Multicultural Therapy
Culture is the major determinant of personality; each distinct culture includes events and expectations that shape both the group and the individual. Culture is an integrated constellation of human knowledge, belief, and behavior that is learned and transmitted to succeeding generations. It binds members of societies through a set of attributions, shared traditions, common beliefs, and norms for living. These characterize a particular class, community, or population. Culture is a matter of intersections-of class, race, ethnicity, gender, age, and sexual orientation-which are diverse and ever changing
Internalized Racism -Multicultural Therapy
Discrimination ripples across centuries, trapping each new generation in a web of stereotypes and self-fulfilling prophecies. How can people who, for generations have internalized messages about incompetence, be expected to emerge unscathed and psychologically sound? When minorities are constantly bombarded with messages that the dominant culture is best, they begin to accept these messages and denigrate both themselves and their own cultural group-a process known as internalized racism. Minorities often begin to idolize the dominant culture and see their own culture themselves as inferior
Empowered Consent -Feminist Therapy
Feminist therapists invite clients and their families to ask questions about the services they will receive. Going beyond the typical informed consent for treatment, feminist therapists aspire to empowered consent, meaning that the client gains access to knowledge that the clinician possesses regarding, for example, risks and benefits of psychotherapy, the right to refuse any method, the ability to seek a second opinion, and the right to terminate treatment at any time. The distinctive emphasis on women's groups and bibliotherapy contributes to the demystification of psychotherapy and the value of social liberation
Feminist Therapy -Gender-Sensitive Therapy
Feminist therapy is based on the twin convictions that women share many of the characteristics of oppressed people and that women have been denied equal rights and an equal voice. The key to a healthy individual lies in recognizing the negative effects of a male-dominated society on women's self-concept and on establishing a more egalitarian power balance with men. In Gilligan's terms, the goal is "to bring women's voices in psychological theory and to reframe the conversation between women and men."
Multicultural Psychotherapy -Multicultural Therapy
Few mental health professionals today embrace only one of these three perspective. Instead, multicultural psychotherapy constitutes a blend on culture-specific, transcultural, and adaptation components. Thus, our coverage of therapeutic processes combines aspects of all three
Gender Socialization -Feminist Therapy
Gender socialization shapes not only the prevalence, but also the expression of distress. The prevalence of various behavioral disorders differs between the sexes. Congruent with sex role stereotyping that leads women to internalize distress and men to externalize it, men show higher lifetime prevalence rates for externalizing disorders, such as alcohol and drug abuse and antisocial personality disorder. Women, on the other hand, show a higher prevalence of mood, phobic, obsessive-compulsive, and panic disorders-largely internalizing problems
Advocates -Multicultural Therapy
In empowering their clients, multicultural therapists will frequently adopt different helping roles-as advisor, mentor, change agent, facilitator, consultant, and even as advocate. As advocates, psychotherapists work to empower clients for social change. Therapists teach and encourage growth for individual clients as well as society as a whole. When the advocate's values are on the side of the client in a particular conflict, the therapy relationship is certainly strengthened. The therapist, while working with the presenting individual, is also seeking to transform society
Intersectionality of Multiple Identities -Multicultural Therapy
In the future, practitioners will indeed be "adressing" the complex intersectionality of multiple identities in their assessment and treatment of heterogeneous clients. Although the content of each category varies, there are many commonalities relating to acculturation-separateness, inclusion-exclusion, and power-oppression. Multicultural therapies will take us deeper into compassion and connection. We will increasingly recognize the existence of intolerance against members of certain disability communities, such as Islam after the 9-11 terrorist attacks. The future hope is that we will be increasingly united by tolerance and even celebration of our differences
Male-Sensitive Therapy -Male-Sensitive Therapy
Male-sensitive therapy seeks to help men understand the strong connections between gender beliefs and problematic behaviors. Through treatment, men come to recognize emotional needs, identify sources of beliefs, and recognize that these beliefs were not freely chosen but can be changed nonetheless. Men aim to change their "reality" about the meaning of masculinity to more functional and healthy ideals. For example, "real men" can express positive and vulnerable feelings, can be more openly nurturant in their relationships, acknowledge needs for interdependence and security, and learn alternatives to physical or intellectual responses
Racial Identity -Multicultural Therapy
Many people use a person's racial categorization, such as Black versus White versus Hispanic, to mean racial identity. However, racial identity is more broadly defined as the quality of a person's commitment to his or her socially ascribed racial group, based on the perception that one shares a common racial heritage with that group. The commitment to one's racial group consists of several factors: personal identity (feelings and attitudes about oneself), reference group orientation (the extent to which one uses the racial group to guide feelings, thoughts, behaviors, values) and ascribed identity (one's deliberate affiliation or commitment to a particular racial group).
Racial Disparities in Health Care -Multicultural Therapy
Many such problems can be attributed, at least in part, to social and political factors, including institutionalized racism. In health care, considerable evidence suggests racial power differentials between clinicians and their patients, as well as clinicians' implicit racial biases and ethnic stereotypes, contribute to the inequitable health care that patients of color receive across the nation. Racial disparities in health care, including mental health care, have barely improved over the years. Stated simply, to be a person of color in the United States means to receive worse health care, if one has access to health care at all
Androcentric -Gender-Sensitive Therapy
Modern psychotherapy was created by White men in their own image. Since its earliest beginnings in Europe, psychotherapy has emphasized male society's definition of healthy mental states and has largely ignored the needs of the diverse populations it professes to serve. Most psychotherapy research, practice, and training have been historically conducted by men, even though women have comprised the majority of clients. The net result was that the preponderance of psychotherapy was androcentric (male-centered)
Mother Blaming -Feminist Therapy
Mother blaming, or mother bashing, portrays mothers are responsible for virtually all the problems of their children. Psychology contains no concept of "acceptable" or praiseworthy behaviors for mothers. If the family appears to be warm and loving, it is "enmeshed," and this is invariably considered to be the mother's fault. There is also a double standard in describing mothers and fathers. Mothers are described according to how they are, whereas fathers are described by what they do; if both parents behave in the same manner, the mother's behavior is described as "cold", but the father is "just that way"
Culturally Determined -Feminist Therapy
Much of psychological distress is environmentally induced and culturally determined. Pathology occurs when the social structure is so rigidly defined that people are not permitted to grow and when relationship are unbalanced, as is the case the power inequalities between men and women. Distress is not solely the result of intra-psychic conflicts, but more likely the result of social and political factors. In fact, the term psychopathology is generally avoided in the feminist literature because it smacks of an underlying intrapsychic perspective, words such as distress, pain, or problem are preferred
Cultural Relativism; Cultural Universality -Multicultural Therapy
Multicultural psychotherapy is based on one of three perspectives on the ideal therapeutic process. The first, cultural relativism, consists on developing culture-specific psychotherapies for each patient group. This transforms psychotherapy by applying culture-specific theories and techniques to the unique sociocultural reality of each group, such as African-Americans clients, Asian-Americans clients, Latino/Hispanic-Americans clients, and Native-Americans clients. The second perspective, cultural universality, consists of developing general transcultural therapeutic skills applicable across a wide array of minority groups
Gender Identity Paradigm -Male-Sensitive Therapy
One way of looking at Marc's life is anchored in the gender identity paradigm, in which there are two distinct and opposite identities of "masculine" and "feminine". Marc incorporated the traditional characteristics of the masculine sex role: no sissy stuff, the big wheel, the sturdy oak, and give 'em hell. According to the gender identity paradigm, healthy psychological adjustment depends on achieving a secure gender identity
Traditional or Indigenous Healers -Multicultural Therapy
Part of working in minority cultures may be contact with traditional or indigenous healers. Multicultural therapists frequently collaborate with folk healers, either because the client demands it or because the therapist realizes that it is necessary. Such collaboration will probably challenge professional training and socialization that teaches folk healing is quackery. But collaboration will probably teach that folk healing and psychotherapy share much in common and that the former has much to say about spiritual and existential matters
Pluralism -Multicultural Therapy
Pluralism is likely to dominate in the evolution of multicultural therapies. Pluralism is the condition in which numerous ethnic and racial groups are present and accepted within society, accompanied by the belief that such a condition is desirable. The hope is that pluralism will become the social blueprint, infusing diversity and flexibility into psychotherapy constructs. Existing paradigms will not only be questioned, but modified by pluralistic ones that are less ethnocentric and more inclusive. Many extant "universal" principles of human behavior will be perceived as example of clinical myopia or cultural imperialism
Acculturation -Multicultural Therapy
Psychopathology may stem not only from clashes with the dominant culture, but also from family responses to that dominant culture. Conflicts in minority families frequently revolve around acculturation. Acculturation is the cultural modification of an individual or group by adapting to or borrowing traits from another culture. Put simply, individuals are torn between remaining loyal to their family of origin and cultural group, on the one hand, and desiring to experience new ways of thinking and acting, on the other
Race; Ethnicity -Multicultural Therapy
Race and ethnicity contribute heavily to how we conceptualize culture. Although the terms should not be used synonymously with culture, they constitute two of the most salient aspects of culture for many individuals. Further, it is important to note that race and ethnicity denote distinct processes. Race is a category of persons who are related by a common heredity or genetics, and who are perceived and responded to in terms of external features or traits. On the other hand, ethnicity is shared culture with respect to lifestyles, norms, and values
Relational-Cultural Theory -Feminist Therapy
Relational-cultural theory emerged from the Stone Center at Wellesley College in the late 1970s to explain female development throughout the life span. Personality is not defined by individual construction alone; personality is also built in response to societal marginalization and power imbalances. Relational-cultural theory holds that female identity, our personhood, is in large part culturally defined by the domination and subordination of women
Reparative Therapy and Sexual Conversion Therapy -LGBT Therapy
Reparative therapy and sexual conversion therapy constitute the opposite of affirming the LGBT identity; instead, they are designed to change or "convert" LGBT clients "back" to a heterosexual orientation or at least gain control over same-sex behavior. Such treatments might include structured aversive fantasy, psychodynamic methods, group therapy, and religion-based programs. Although reparative therapy is still practiced, it is considered in professional circles to be discredited. The evidence for the efficacy of sexual conversion programs is less than compelling. Several studies have found that the use of reparative therapy negatively predicts beneficial outcomes. Because same-sex desire is no longer considered pathological, efforts to change sexual orientation are unwarranted and may even prove harmful
Role Conflict -Feminist Therapy
Role conflict involves roles clashing with each other, as when the priorities of being a good mother conflict with the priorities of being a good student. The pressures of one role can take over and inhibit performance in other roles. Conflicted over "abandoning" children to day care settings, many women feel that they are forced to choose between being a good mother and a good worker. The fire fueling this guilt is associated with the messages society sends to women about proper child-rearing practices
Role Strain -Feminist Therapy
Role strain involves conflicting demands from different roles. For example, a women may work during the day, come home and care for her family in the evening, and then attend school at night. She has four distinct roles to perform (worker, mother, wife, and student). The strain of performing adequately in all these roles can be overwhelming
Culturally Adapted Therapies -Multicultural Therapies
Several meta-analyses have now been conducted on the burgeoning number of controlled studies on culturally adapted therapies-traditional therapies tailored to improve the treatment utilization and outcomes of ethnic minority clients. A meta-analysis of 65 studies, encompassing 8,620 clients, evaluated the effectiveness of culturally adapted therapies versus traditional, nonadapted therapies. The results revealed a positive effect (d = 0.46) in favor of clients receiving culturally adapted treatments. Cultural "fit" works, not only as an ethical commitment but also as an evidence-based practice
Alexithymia -Male-Sensitive Therapy
Socialization also begets difficulty in identifying and expressing emotions, a condition known as alexithymia. Men are often genuinely unaware of their emotions. In the absence of such awareness, men tend to rely on their cognition and try to logically deduce how they should feel. If they are aware of their emotion, many men are also slow to express them. A clinical tale tells of a farmer who asked his son on Sunday afternoon how we was feeling. On Tuesday morning, the son grunted "fine"
Androgyny
Some feminist theorist have suggested that the ideal individual would represent an Aristotelian mean, an equal balance of stereotypically male and female characteristics, a concept known as androgyny. An androgynous individual possess a large and flexible behavioral repertoire and exhibits a range of psychological characteristics depending on the situation Androgyny has been prescribed by many as a way for women to become liberated from traditional gender-role traits and lead more fulfilling lives. Androgynous individuals tend to be more independent, flexible, and higher in self-esteem than stereotypically "feminine" women
The Personal Is Political -Feminist Therapy
The interconnectedness of clients' "inner" world and their "outer" world is often ignored in traditional psychotherapy. But through feminist therapy, clients come to realize the significance of the statement The personal is political. This feminist motto essentially means using understanding about oneself as a basis for understanding the oppression of all women. This motto expresses the feminist position that the source of psychopathology is not intrapsychic, but rather sociopolitical in nature. The intrapsychic influences on distress pale in comparison to the broader social and political forces that hold women captive in stereotyped expectancies and gender discrimination. Therapy, therefore, targets women's unhealthy external situations as well as internalized messages
Feminization of Poverty -Feminist Therapy
The lower economic status of women adds to the formation and maintenance of distress. Women continue to be clustered in lower paying, sex role occupations; there is a distinct economic disadvantage to being female. The feminization of poverty is a pithy phrase that captures the realization that single and divorced women and their children constitute an increasingly proportion of poor people, especially in the United States. Gender gaps in wages at work and in child care at home conspire to keep women in economically fragile, and thus less powerful and more distressed, positions
Egalitarianism -Feminist Therapy
The second hallmark of the therapeutic equal relationship between the therapist and the client. Equalizing power will be manifested in many ways: reducing the knowledge discrepancy between the participants, generating mutual goals, increasing the clinician's self-disclosure, and demystifying the process of therapy. Reducing the discrepancy includes valuing the client's perspectives and insights just as highly as the therapist's. Because therapy is a cooperative relationship, goals are mutually generated by the therapist and the client. Self-disclosure reduces the role distance and the power differential between the parties and aids in developing a trusting relationship. Because feminist therapy often focuses on sensitive women's issues-such as work discrimination, sexual harassment, and physical changes-therapist self-disclosure is a vital component in establishing a trusting and empathic alliance
Cultural Adaptation -Multicultural Therapy
The third perspective, cultural adaptation, splits the different. Research-supported therapies based on cultural universality, such as short-term psychodynamic or cognitive-behavioral therapies, are tailored to the individual cultures of the patient, as in cultural relativism. In this way, culturally adapted therapies enjoy, at one, the nomothetic support of following controlled research and the idiographic sensitivity of tailoring treatment to the patient's cultures
Pretreatment Patient Preparation -Multicultural Therapy
The upshot is for multicultural therapists and their clients to engage in mutual exploration of preference from the inception of psychotherapy. One common practice is to acquaint beginning clients with the respective roles of patient and therapist and the nature of the psychotherapy enterprise. These procedures, which fall under the heading of pretreatment patient preparation, take a variety of forms, including direct instruction, informational interviews, therapist modeling, video presentations, and role playing. Many patients hold divergent expectations about the process of psychotherapy and may be uncomfortable with the nature of mental health treatment; pretherapy orientation is designed to clarify these expectations and to mutually define a more comfortable role for the client. Evidence for the positive impact of this preparation is quite plentiful.
Power Analysis Group -Feminist Therapy
Therapists liberally refer clients to groups that endorse feminist principles and that aid in the therapeutic process. Women's groups, domestic abuse groups, assertiveness training, power analysis, and sex role analysis are just a sampling of the variety of educational groups. Power analysis groups are designed to increase women's awareness of the power differential existing between men and women and to empower women to have influence on the interpersonal and institutional externals in their lives. Similarly, sex role analysis groups are designed to increase women's awareness of how the sex role expectations of society adversely affect them and also to understand the ways in which men and women are socialized differently in society
Internalized Oppression -Feminist Therapy
These social messages are facets of internalized oppression; the external messages become a part of how we think and feel. Little girls are scolded for wanting to play with trucks and trains, the so-called "boy toys," and told that their self-worth rests primarily on being pretty and proper. Girls are rarely encouraged to pursue activities that require autonomy or skill; they are told to play "dress up" and "house," whereas little boys are encouraged to play doctor or police officer. At an early age, girls begin to devalue themselves and their true desires as they begin to conform to the expectations of the larger society. One researcher states emphatically, "No women will treasure fame or glory she can achieve at the price of being called unfeminine. This below the belt blow sends most women into despair."
Gay Affirmative Therapy -LGBT Therapy
This proactive stance is evidenced in gay affirmation therapy, which celebrates and advocates for the integrity of LGBT. Such treatment is intended to counteract the destructive effects of a homophobic society and promote positive regard for the client. Gay affirmation therapy first emerged in the 1980s and 1990s when gay and lesbian therapists started writing about their own lives, when they realized the need for empowering therapists free of heterosexist bias
Unconscious Racism -Multicultural Therapy
Those with power and privilege frequently believe that they are not discriminatory or prejudice in principle, but society is structured to preserve their privilege. In terms of race, this often leads to unconscious racisms, unknown and unintentional expressions of prejudice that lead to discriminatory behaviors. Multiple experimental studies demonstrate the subtle bias due to unconscious racism; up to 80% of Whites in the United States show this bias in their behavior
Fundamental Attribution -Feminist Therapy
Under these collective circumstances, women's problems in living are not-necessarily psychopathological. Rather, they frequently represent reasonable and creative attempts to survive oppressive conditions. Resistance may be evidence of resiliency. For therapists to erroneously attribute women's problems to their pathological dispositions, instead of correctly to their oppressive situations, is to commit the fundamental attribution error. (The error is the tendency of attributing one's own behavior to the situation, while attributing other people's behavior to their disposition)
Culture-Bound Syndromes -Multicultural Therapy:
Within individual cultures, there exist recurrent patterns of aberrant behaviors particular to that culture, known as culture-bound syndromes. These localized disorders frame coherent meanings for behaviors that might not neatly fit into DSM criteria. Some of the best-studied culture bound syndromes that one might encounter in clinical practice are outlined in Table 14.1. This incomplete listing reminds us of the influential role of culture in determining what societies deem as abnormal and how individuals express distress
