Intercultural psychotherapy

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  1. 1. Intercultural psychotherapy:the guidelines of Wen-Shing TsengHans Rohlof, M.D.
  2. 2. 04/19/13Intercultural Psychotherapy Hans Rohlof2Content lecture Case vignettes Tsengs guidelines Possible tools in assessment phase Take home messages
  3. 3. Three case vignettes In which of the three cases would youthink cognitive behaviour therapy has themost success?04/19/13Intercultural Psychotherapy Hans Rohlof3
  4. 4. Case vignette 1 35 years old Moroccan woman, married, two children Diagnosed with depressive disorder with psychoticfeatures Fear for jnun Bad relationship with husband (disappeared husband)but no possibilities for marriage counseling Social support, but with restrictions: constant discussionwith family about good and bad. Demand for medication for somatic complaints, andsleep medication04/19/13Intercultural Psychotherapy Hans Rohlof4
  5. 5. Case vignette 2 25 years old university student of Turkish background Diagnosed with depression with suicide ideation Lower class family: no respect from her parents for hereducation Identity problems: not Dutch, not Turkish, not a realMuslim. Guilt feelings about secret relationship with teacher.04/19/13Intercultural Psychotherapy Hans Rohlof5
  6. 6. Case vignette 3 40 years old man from Congo-Brazzaville Diagnosed with PTSD and depressive disorderwith psychotic features Hears voices of grandfather which make himanxious He tries to find healer to help him.04/19/13Intercultural Psychotherapy Hans Rohlof6
  7. 7. Tseng and Streltzer, 200104/19/13Intercultural Psychotherapy Hans Rohlof7
  8. 8. Motivation for therapy Differences Stimulating curiosity, exerting authority,enlisting family support. Pre-therapy groups with muchpsychoeducation04/19/13Intercultural Psychotherapy Hans Rohlof8
  9. 9. Presentation of problem Supernatural, natural, biophysical,medical, psychological explanation ofillness Dynamically understanding: descriptivediagnosis of the problem.04/19/13Intercultural Psychotherapy Hans Rohlof9
  10. 10. Goals of therapy Cultural meaning of healthy, mature oradaptive behaviour. For instance: in the West individualfreedom and independence, in someother cultures adaptation on parentswishes.04/19/13Intercultural Psychotherapy Hans Rohlof10
  11. 11. Therapist-client relationship Therapist maybe has to take an active andauthorative role in therapy. Or has to beequal. Level of expected intimacy can differ. Ethnic matching: sometimes too close.04/19/13Intercultural Psychotherapy Hans Rohlof11
  12. 12. Transference andcountertransference Intercultural and intracultural processes Diffrent roles: the anthropologist, theracist, the uncle Tom.04/19/13Intercultural Psychotherapy Hans Rohlof12
  13. 13. Impact of Therapists ValueSystem Regarding interdependence, the status ofwomen, the place of children, the attitudetowards authority.04/19/13Intercultural Psychotherapy Hans Rohlof13
  14. 14. Language andcommunication Common language? Interpreter? Level of understanding?04/19/13Intercultural Psychotherapy Hans Rohlof14
  15. 15. General issues Family participation Precription of medication04/19/13Intercultural Psychotherapy Hans Rohlof15
  16. 16. Culturally specific issues Ethnic or cultural identity Therapy with intercultural couples andgroups Supernatural beliefs, based on folk religion Somatization04/19/13Intercultural Psychotherapy Hans Rohlof16
  17. 17. Necessary competences Cultural sensitivity Cultural knowledge Cultural empathy Cultural insight04/19/13Intercultural Psychotherapy Hans Rohlof17
  18. 18. Assessment phase Cultural interviews (Rohlof, Groen, LewisFernandez) Supplementary modules04/19/13Intercultural Psychotherapy Hans Rohlof18
  19. 19. 19 april 2013Hans Rohlof19Netherlands: book about theory andcases (2002)
  20. 20. Cultural interview-Rohlof 40 open questions in a structured interview,duration: 90 minutes Following the topics of the CF At the end: questions about cultural distancefilled in by assessing person Followed by recommendations for generalassessment and treatment Written report04/19/13Intercultural Psychotherapy Hans Rohlof20
  21. 21. Cultural Interview-RohlofExamples of questions Which aspects from your own cultural backgroundhinder you? What is the explanation your family gives for yourcomplaints? Which kind of help did you get for your complaints tillnow (regular as well as alternative)? Could you tell something about you position in thefamily? In case you had emotional problems in your country oforigin what did you do? Do you have the feeling that prayer helps you? How do you think about having treatment in anotherlanguage than your mother language?04/19/13Intercultural Psychotherapy Hans Rohlof21
  22. 22. Cultural Interview Groen 25 questions, duration: 45 minutes Better understood, better evaluated.04/19/13Intercultural Psychotherapy Hans Rohlof22
  23. 23. Cultural Interview - Groen A. Cultural identity of the individual Language1. Which language did you speak when you were growing up? Did youalso speak another language?2. Which language do you speak at home now? [If applicable: with your wife? With your children? With your friends?]1. How well do you think you speak Dutch? [If this is unclear: how would you grade yourself on a scale of 1 to10?] 4. Can you explain exactly what you mean in Dutch?04/19/13Intercultural Psychotherapy Hans Rohlof23
  24. 24. Cultural Interview-Groen Ethnicity and culture5. Do you belong to a group in your country that is different from other (ethnic)groups? Are your parents from the same group?5. What makes this group different from other groups? Which customs, opinions,position in society?6. How important is belonging to this group to you?7. Are you still in contact with people from this group or your culture? If so: how important to you is this? If not: would you like to?5. What do you feel is the most important thing about your culture?04/19/13Intercultural Psychotherapy Hans Rohlof24
  25. 25. Cultural Formulation Interview(Lewis Fernandez) 12 questions, duration: 7-20 minutes Supplementary modules on CulturalIdentity, Clinician-Patient relationship,Migration etc.04/19/13Intercultural Psychotherapy Hans Rohlof25
  26. 26. Cultural Formulation Interview-Cultural Identity module1. Could you please tell me, where were you born? [If the patient was born in another country,ask the following questions] Could you please explain to me why you left that that country,and how you came to live in this country?2. What kind of community did you grow up in?3. What did your parents do?4. Please tell me your full name. Does your name have a certain meaning, liked being thename of someone else or some place?5. Could you please tell me what languages you speak? [If the patient does not speak fluentlythe language of the (predominant) local culture, inquire about fluency in the spoken andwritten forms of the predominant culture.]6. Do you practice or follow any religion or have a spiritual practice? If so, please describe.7. Do you consider yourself a member of a particular cultural (e.g., Latino in a non-Latinocontext) group? Please tell me more about that, and how it affects you. In which situationsdo you feel most part of that cultural group?8. [If the person immigrated from another country, ask the following] How do you feel aboutbeing in the host country? Are there any difficulties or challenges with your legal status forbeing in this country?04/19/13Intercultural Psychotherapy Hans Rohlof26
  27. 27. Take home messages Intercultural psychotherapy is feasible, but needscultural competences Ethnic matching is not always necessary, orneeded. Cultural interview in assessment phase is of use,but does not take away cultural sensitivity lateron in therapy.04/19/13Intercultural Psychotherapy Hans Rohlof27
  28. 28. Rijnzichtweg 352342 AX OegstgeestThe Netherlands0031715191500Sites of Centrum 45Nienoord 51112 XE DiemenThe Netherlands0031206274974
  29. 29. 04/19/13Intercultural Psychotherapy Hans