Intercultural psychotherapy

Intercultural psychotherapy: the guidelines of Wen-Shing Tseng

Hans Rohlof, M.D.

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Intercultural Psychotherapy – Hans Rohlof2

Content lecture

• Case vignettes• Tseng’s guidelines• Possible tools in assessment phase• Take home messages

Three case vignettes

• In which of the three cases would you think cognitive behaviour therapy has the most success?

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Case vignette 1

• 35 years old Moroccan woman, married, two children• Diagnosed with depressive disorder with psychotic

features• Fear for jnun• Bad relationship with husband (‘disappeared husband’)

but no possibilities for marriage counseling• Social support, but with restrictions: constant discussion

with family about good and bad.• Demand for medication for somatic complaints, and

sleep medication

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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 her

education• Identity problems: not Dutch, not Turkish, not a real

Muslim.• Guilt feelings about secret relationship with teacher.

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Case vignette 3

• 40 years old man from Congo-Brazzaville• Diagnosed with PTSD and depressive disorder

with psychotic features• Hears voices of grandfather which make him

anxious• He tries to find healer to help him.

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Tseng and Streltzer, 2001

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Motivation for therapy

• Differences• Stimulating curiosity, exerting authority,

enlisting family support.• Pre-therapy groups with much

psychoeducation

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Presentation of problem

• Supernatural, natural, biophysical, medical, psychological explanation of illness

• Dynamically understanding: descriptive diagnosis of the problem.

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Goals of therapy

• Cultural meaning of healthy, mature or adaptive behaviour.

• For instance: in the West individual freedom and independence, in some other cultures adaptation on parents’ wishes.

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Therapist-client relationship

• Therapist maybe has to take an active and authorative role in therapy. Or has to be equal.

• Level of expected intimacy can differ. • Ethnic matching: sometimes too close.

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Transference and countertransference

• Intercultural and intracultural processes• Diffrent roles: the anthropologist, the

racist, the ‘uncle Tom’.

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Impact of Therapist’s Value System

• Regarding interdependence, the status of women, the place of children, the attitude towards authority.

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Language and communication

• Common language?• Interpreter?• Level of understanding?

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General issues

• Family participation• Precription of medication

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Culturally specific issues

• Ethnic or cultural identity• Therapy with intercultural couples and

groups• Supernatural beliefs, based on folk religion• Somatization

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Necessary competences

• Cultural sensitivity• Cultural knowledge• Cultural empathy• Cultural insight

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Assessment phase

• Cultural interviews (Rohlof, Groen, Lewis Fernandez)

• Supplementary modules

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19 april 2013

Hans Rohlof19

Netherlands: book about theory and cases (2002)

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 distance

filled in by assessing person• Followed by recommendations for general

assessment and treatment• Written report

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Cultural Interview-RohlofExamples of questions

• Which aspects from your own cultural background hinder you?

• What is the explanation your family gives for your complaints?

• Which kind of help did you get for your complaints till now (regular as well as alternative)?

• Could you tell something about you position in the family?

• In case you had emotional problems in your country of origin what did you do?

• Do you have the feeling that prayer helps you?• How do you think about having treatment in another

language than your mother language?

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Cultural Interview Groen

• 25 questions, duration: 45 minutes• Better understood, better evaluated.

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Cultural Interview - Groen

• A. Cultural identity of the individual • Language

1. Which language did you speak when you were growing up? Did you

also 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 to

10?]

• 4. Can you explain exactly what you mean in Dutch?

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Cultural Interview-Groen

• Ethnicity and culture

5. 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?

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Cultural Formulation Interview (Lewis Fernandez)

• 12 questions, duration: 7-20 minutes• Supplementary modules on Cultural

Identity, Clinician-Patient relationship, Migration etc.

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Cultural Formulation Interview-Cultural Identity module

1. 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 the name of someone else or some place?

5. Could you please tell me what languages you speak? [If the patient does not speak fluently the language of the (predominant) local culture, inquire about fluency in the spoken and written 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-Latino context) group? Please tell me more about that, and how it affects you. In which situations do you feel most part of that cultural group?

8. [If the person immigrated from another country, ask the following] How do you feel about being in the host country? Are there any difficulties or challenges with your legal status for being in this country?

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Take home messages

• Intercultural psychotherapy is feasible, but needs cultural competences

• Ethnic matching is not always necessary, or needed.

• Cultural interview in assessment phase is of use, but does not take away cultural sensitivity later on in therapy.

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Intercultural psychotherapy

Health & Medicine

Transcript of Intercultural psychotherapy