Employing psychotherapy across cultures and contexts.

Abstract

Byline: K. Jacob Psychotherapy and psychological interventions are practiced across diverse cultural and health settings, for a variety of emotional distress and among very heterogeneous groups of people. Different schools of psychotherapy exist and are employed across regions, contexts, and cultures. However, they have been criticized for the failure to appreciate the ethnocentricity of their approaches. [sup][1] The apparent contradictions between the theory and methods of individual schools of psychotherapy and their use in diverse social and ethnic environments are often emphasized. Nevertheless, a diligent examination of the issues suggests that many so-called unresolvable tensions between the standard psychotherapies and their use in diverse contexts are explained by the form-content dichotomy related to psychological therapy. [sup][2] This editorial highlights some issues related to the use of psychotherapy across cultures. Imposing structure to resolve conflicts Behavior therapy with its focus on learning, classical and operant conditioning, behavioral analysis, identification of maladaptive behaviors, reinforcement schedules and exposure, and response prevention highlights the form and structure of its processes. Such structural analysis is applied across content, situations, regions, and culture. Similarly, cognitive therapies, which emphasize cognition, identify faulty schemas, dysfunctional thought patterns, cognitive biases, and distortions; and employ Socratic questioning, collaborative empiricism, and guided discovery to change beliefs, thoughts, attitude, and practice are applied across contexts and cultures to diverse problems, different stressors, and situations. Psychodynamic psychotherapies argue that intrapsychic and unconscious conflicts are causal and that resolution of such tensions and the use of mature defenses are part of treatment. Psychoanalysis has its own structure and detail. Similarly, interpersonal psychotherapies, supportive psychotherapy, client-centred approaches, and crisis intervention have their different foci, form and structure, and are used to manage diverse contents across contexts and cultures. Such structural differences in approaches are also found for non-western psychological interventions like yoga and meditation, which are employed across diverse clinical problems and are popular across cultures. The different schools of psychotherapy have different theories and techniques and yet only provide structures for psychological interventions. These are useful in a management of a range of contents in dissimilar contexts, regions, and cultures. Nevertheless, while the different schools of psychotherapy claim unique theories and argue that specific technique is responsible for improvement, others suggest that they share common approaches, which are reasons for their success. [sup][3] These common factors (also called nonspecific factors), identified across psychotherapies, are also seen in successful therapists sans background. Unconditional positive regard for the patient is cardinal to success and also used as a vehicle for identification and modeling. Patient and therapist expectancies, treatment, and culturally determined credibility have a major impact on outcome. Mobilizing disaffection for present state, loosening, and modifying contextual threats and dismantling dysfunctional patterns are found in most psychotherapies. The provision of new perspectives and concepts, redefining and reframing issues, providing an orderly account of the situation, conceptualizing change, and confronting problems differently are also universal. The arousal of hope and the provision for success are standard ingredients of most approaches. These factors are not only seen in western psychological interventions but also in oriental and non-western psychological therapies and are characteristics of good therapists irrespective of background. [sup][2] Complexity of culture Collective knowledge, shared beliefs, values, language, institutions, symbols, and images result in a shared worldview. …