Cross-cultural Psychotherapy Research Articles

Microskills of broaching and bridging in cross-cultural psychotherapy: Locating therapy skills in the epistemic domain toward fostering epistemic justice.

Psychotherapy research has shown evidence of positive impacts of broaching cultural differences on the therapy process and outcomes. This increasing body of research also highlights a need to clarify clinical skills of broaching and subsequent bridging to guide therapists in cross-cultural psychotherapy. In articulating microskills to promote broaching and bridging, we critically reflect on cautions against slipping into a technocratic approach that is a mechanical prescriptive skill-based guideline. Using critical theory on epistemic injustice, we examine how to integrate cultural aspects into therapy conversations that are aligned with epistemic and social justice. Drawing from sociolinguistic and critical scholars on language and power, we interrogate epistemic domains of knowledge and power during broaching and bridging in everyday clinical talks. We focus on theorizing and illustrating "how-to-do" broaching and bridging to guide therapists in everyday cross-cultural encounters with selected microskills such as a therapist's self-disclosure, cultural immediacy, and reflective listening. Using case illustrations with detailed transcripts for each skill, we interrogate how a client's epistemic status can be managed in the moment-to-moment conversation between a client and therapist in the continuum from dismissing to deepening the client's experience. A series of detailed case illustrations are intended to guide therapists' self-reflection and/or train therapists toward meaningful cross-cultural work. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic justice in cross-cultural therapy encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Developing a model of broaching and bridging in cross-cultural psychotherapy: Toward fostering epistemic and social justice.

Epistemic and social injustice occurs when therapists implicitly and explicitly impose personal, professional, and institutional power onto clients, and dismiss client experience which is embedded in cultural identity and social location. Despite research evidence highlighting the positive impact of broaching in cross-cultural psychotherapy, questioning the rationale and barriers to broaching is paramount. Drawing from scholarship on epistemic in/justice, we argue that the very existence of marginalization of a client in the life and in the therapy exemplifies epistemic injustice. Epistemic injustice bears two types-testimonial and hermeneutic injustice. When clients' experience of marginalization is decentered or discredited, testimonial injustice occurs. By not providing clients with opportunities to share this experience in therapy, there is little shared understanding cultivated in the cross-cultural dyad, contributing to hermeneutic injustice. Thus, epistemic in/justice requires broaching not as an option but as an integral part of therapy. Synthesizing scholarship in cultural competence, humility, intersectionality, and antioppressive practice, we define broaching as the therapist's tasks for intentional understanding of the cultural aspects and systemic oppression in the client's life-in-context. A therapist who is broaching is aware of cross-cultural similarities and differences and the workings of power in the therapy dyad and makes deliberate efforts to demonstrate this understanding to the client which includes explicit discussion in sessions. We propose pathways, dimensions, foci, and timing of ongoing broaching and bridging cross-cultural encounters in therapy. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic and social justice in therapy encounters. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Knowledge Synthesis of Cross-Cultural Psychotherapy Research: A Critical Review

This article presents a current knowledge synthesis of empirical studies on cross-cultural psychotherapy since 1980. Guided by a critical review framework, our search in seven relevant databases generated 80 studies published in English. Main themes are organized into (1) therapists’ cultural competence ( n = 46); (2) therapy process in cross-cultural dyads ( n = 22); and (3) cross-cultural differences in gender, sexual orientation, or social class ( n = 12). Compared to previous reviews on cross-cultural psychotherapy, the findings of this review highlight a broad range of methodological rigor in both quantitative and qualitative studies. Most studies examined actual therapy participants rather than participants in analog studies, thus emulating more therapy-near experiences in cross-cultural psychotherapy research. Also, several studies explored cross-cultural compositions beyond racial and ethnic majority therapist-minority client dyads, and included therapists of color as the participants, exploring reverse power dynamics in therapy and giving voices to foreign-born therapists. The therapy process research provides rich and full descriptions around the dynamic and interactional therapy process in cross-cultural dyads, which can be used to foster cultural sensitivities among therapists in their practice and training. We discuss the limitations of the studies included in the review and its implications for psychotherapy practice, training, and future research.

Experiences of psychotherapists working with refugees in Germany: a qualitative study

BackgroundDespite a high burden of mental health problems among refugees, there is limited knowledge about effective mental health care provision for this group. Although substantial efforts in understanding the complexity of cross-cultural psychotherapy – which in the context of this study we use to refer to therapy with client and therapist of different cultural backgrounds – have been made, there remains a dearth of research exploring barriers for effective cross-cultural psychotherapy. This study aimed at narrowing this gap in knowledge by exploring major challenges encountered by psychotherapists in cross-cultural psychotherapy and strategies which have proven useful in overcoming such challenges.MethodsWe employed a qualitative study design, conducting semi-structured in-depth interviews with 10 purposely selected psychotherapists working with refugees in Germany. Respondents were from varying theoretical background and had varying levels of experience. Data were analyzed using a thematic approach, following a mix of deductive and inductive coding.ResultsRespondents reported three main challenges in their cross-cultural practice: different or unrealistic expectations of clients towards what psychotherapy would offer them; challenges grounded in different illness explanatory models; and communication challenges. In dealing with these challenges, respondents recommended psychoeducation to overcome issues related to problematic expectations towards psychotherapy; “imagining the real”, identifying “counter magic” and other client-appropriate resources to deal with issues related to clients’ foreign illness attributions; and translators in dealing with communication barriers, though the latter not univocally.ConclusionsResults show that psychotherapy with refugees can be very successful, at least from the psychotherapist perspective, but also poses significant challenges. Our findings underline the importance of developing, testing, and institutionalizing structured and structural approaches to training psychotherapists in cross-cultural therapy at scale, to accommodate the rising mental health care need of refugees as a client group.

Unraveling Cultural Countertransference: The Experience of Caucasian Therapists Working with Asian-American Adults

This qualitative study explores the countertransference experiences of seven psychodynamically-trained Caucasian therapists who treated an Asian-American adult for at least a year. These seasoned clinicians were interviewed about their beliefs, feelings, and sense of connection with their American-born clients whose parents had immigrated from Mainland China, Taiwan, Korea, Vietnam and the Philippines. The article describes the Caucasian therapists’ responses as they navigated the unfamiliar terrain of their clients’ bi-cultural identities. The relevance of Western psychological theories was also explored. The findings from the interviews were grouped into six categories that comprised the participants’ cultural countertransference experiences: 1) impact of the participants’ personal cultural background on potential countertransference 2) Impact of their familiarity with and preconceptions about Asian culture 3) importance given to cultural issues in the treatment 4) degree of resonance with the client’s experiences 5) negative reactions to client's cultural content and 6) how participants navigated the cross-cultural treatment. The research found that culture was always in the room but frequently was not explored. As a result of the study, the participants grew in awareness about their cultural countertransference feelings, highlighting the importance of culturally-sensitive consultation when providing cross-cultural psychotherapy.

The ‘hostile environment’ and the therapeutic journey of an adolescent girl*

ABSTRACTThis paper is drawn from doctoral research investigating whether cross-cultural psychoanalytic psychotherapy and the transference relationship can be helpful in the development of the self of an adolescent BAME patient. I will refer to some of the findings from the doctoral research and from the material in the patient’s three-and-a-half years intensive psychotherapy, to show how her ideas of self, ‘other’, gender and sexuality were affected, in a particular way, by her experience of inhabiting family, social and political environments she experienced as hostile. This paper will describe how child psychotherapy can be crucial in supporting adolescents negotiate their identity, when the environments they inhabit act to impede this. I will pay particular attention to how the transference and countertransference can be used to understand and tend to the patient’s ideas of self and other that have been informed by the post-colonial beliefs embedded in the environments they inhabit.

Dr Jaswant Singh Neki

Dr. Jaswant Singh Neki (1925–2015) is amongst the foremost psychiatrists of India. He has been variously described as a world-renowned mental health expert, a noted metaphysical poet, a teacher par excellence, and an excellent humane person of international repute. He joined his graduate course in medicine and surgery from King Edward Medical College, Lahore and completed graduation from Medical College, Amritsar.1 He passed his MA (Psychology) from Aligarh Muslim University. Later he passed DPM exam from All India Institute of Mental Health, Bangalore. He held high academic and administrative positions including Consultant - WHO, Geneva and UNDP S-E Asia. Keywords: J S Neki, Guru-Chela relationship, Kairos, Poet, Cross cultural psychotherapy.

Negotiating therapy goals and tasks in cross-cultural psychotherapy

ABSTRACTAs therapy progresses, alliances become more complex and are constantly negotiated. Analyzing transcripts from video-taped actual therapy sessions, this article examines how a client and therapist from different cultures negotiate to assert and/or compromise their goals and tasks in psychotherapy. Using the Negotiation of Therapy Agenda (NOTA), we conduct a turn-by-turn analysis to examine discursive patterns deployed by the client and therapist in cross-cultural interactions. Findings illustrate how the therapy goals and tasks (1) become ‘incompatible’ when therapist falls into enacting their own cultural values by essentialising the client’s culture; and (2) become ‘compatible’ when the therapist closely tracks and follows the client’s talk and subsequently cultural values. This analysis thus highlights the process of negotiating therapy goals and tasks as a site to reify cultural values and norms in cross-cultural dyads. We close with suggestions on how to actively attend to opportunities for cultural engagement in therapy and on future research areas.

The child's voice through drawings in cross-cultural psychotherapy

The drawing is a valuable mediation tool to encourage the active participation of the child in the cross-cultural group psychotherapeutic process. It enables the therapists and, ultimately, the family, to take into account their psychological movements.

Expanding the Horizons of Forgiveness Therapy: A Cross-Cultural Application with a Bedouin-Arab Woman

This paper highlights forgiveness therapy, a therapeutic approach that has received limited attention in the social work literature. This study represents a beginning exploration of its cross-cultural application. Theoretical and empirical perspectives on forgiveness and forgiveness promoting psychotherapy are provided, and Enright’s pioneering process model is delineated. A case study of the utilization of forgiveness therapy with an Israeli Bedouin-Arab woman who experienced a traumatic interpersonal injury within the polygamous family is presented. LaRoche and Maxie’s guidelines for conducting cross-cultural psychotherapy are utilized to examine important dynamics that emerge in the case study. These authors’ recommendations, which are consistent with a process-oriented conceptualization of culture, as well as intersectionality, appear potentially useful for informing the transcultural application of forgiveness therapy. Future research questions and directions related to the utilization of forgiveness promoting psychotherapy with diverse populations are considered.

Religion and mental health: the contribution of anthropology

Religion and mental health: the contribution of anthropology

Cross-cultural psychotherapy. M. M. Bishop and G. Winokur (1956). Reprinted from the J Nerv Ment Dis. 123:369-375

Cross-cultural psychotherapy. M. M. Bishop and G. Winokur (1956). Reprinted from the J Nerv Ment Dis. 123:369-375

Clinical significance of cross-cultural competencies (CCC) in social work practice

Although culturally competent practice is ethically sound and sociopolitically valued, the ways in which cultural competencies affect clients' change processes have been little explored in either clinical or cultural literatures. With few theoretical guidelines, social workers in their daily practice are faced with significant challenges to integrate both clinically grounded and culturally competent practice in fostering clients' changes. This article proposes a theoretical integration of clinically significant cultural practice in social work. Drawing from the therapeutic alliance research, this article proposes relationally focused cultural competencies to promote the construct of cross-cultural competencies (CCC). CCC has three roles that can promote changes in clinical social work practice. It can (1) mediate the working alliance; (2) serve as a pathway to a client's internal working model of self and other; and (3) provide corrective emotional experience. The implications for cross-cultural psychotherapy practice, training, and research are also discussed.

Review of Alvin Dueck and Kevin Reimer’s A Peaceable Psychology: Christian Therapy in a World of Many Cultures

If you care for, counsel or provide psychotherapy for people from cultural backgrounds different from your own, and who does not these days, A Peaceable Psychology is a must read. The authors, Alvin Dueck, the Evelyn and Frank Freed Professor of the Integration of Psychology and Theology at Fuller Theological Seminary, and Kevin Reimer, Professor of Psychology at Azusa Pacific University, have written a most compelling, challenging and at times disturbing book about the role of modern American psychology within the growing multicultural world, both overseas and here in the United States. The authors, rooted in their Anabaptist tradition, challenge us to reflect critically upon the assumptions, values and unconscious motives that drive our efforts to spread American-style psychotherapy around the world. While modern American psychologists believe that they are helping the world by exporting their knowledge, methods and psychotherapeutic delivery systems, we are in fact, in the opinion of the authors, “doing violence,” a cultural violence upon those who we seek to help. We do this violence because in exporting the basic values of the modernwestern psychotherapeutic establishment, like individualism, secularism, scientism and materialism, we are undermining the culture of nonwestern clients and nonwestern cultures in general. The best alternative, according to the authors, is a “peaceable psychology,” a psychology grounded in the radical teachings and servant model of Jesus Christ, which has as its core values assumptions that are often different from modern western psychology. The book is well written, well organized, well documented and loaded with clinical examples, gripping stories and insightful biblical passages. It takes the normal textbooks on cross-cultural psychotherapy “one step further,” suggesting that modern psychology is not the savior of the world, but a new form of cultural colonialism or what the authors call a psychological “Constantinianism,” a repetition of the 4th century merging of religion and power that, in their view, diluted and distorted the radical and healing nature of Jesus’ teachings. Some of the more intriguing points include the idea that modern American-based psychology assumes the importance of the individual, at the expense of the communal. The very fact that we treat people as individuals, in a therapist’s office, challenges the cultural assumptions and norms of many non-westernized clients. They suggest that even our Pastoral Psychol (2010) 59:525–526 DOI 10.1007/s11089-010-0277-8

Cultural accommodation as method and metaphor.

The author summarizes the cultural accommodation model (CAM) of cross-cultural psychotherapy (F. T. L. Leong & S. H. Lee, 2006). This summary is divided into 2 parts, with the 1st part describing the theoretical development of the CAM as a method of psychotherapy and the research approach underlying it. This section includes a description of the author's program of research in which the development of the CAM, as well as its precursors, is embedded. L. H. Rogler, R. G. Malgady, and O. Rodriguez's (1989) framework has served as the foundation of the author's program of research on Asian American mental health. In focusing on the 4th stage of L. H. Rogler et al.'s model, F. T. L. Leong (1996) developed an integrative and multidimensional model of cross-cultural psychotherapy based on C. Kluckhohn and H. A. Murray's (1950) tripartite model. The CAM is an extension of F. T. L. Leong's (1996) integrative multidimensional model. The 2nd part of this article provides some speculation about the development of the CAM as a metaphor for the author's development as a psychotherapist and a psychological scientist.

Oxford Textbook of Psychotherapyedited by Glen O. Gabbard, Judith S. Beck, and Jeremy Holmes; Oxford and New York, Oxford University Press, 2005, 552 pages, $98.50

Back to table of contents Previous article Next article Book ReviewFull AccessOxford Textbook of PsychotherapyNorman A. Clemens M.D.Norman A. Clemens M.D.Search for more papers by this authorPublished Online:1 Sep 2006https://doi.org/10.1176/ps.2006.57.9.1347aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Aiming to be a definitive, comprehensive textbook of psychotherapy, this tome covers the sweep of significant psychotherapies extant today. It contains 43 chapters by authors from both sides of the Atlantic, and many of them are prominent in their particular fields. The editors take on the challenge of doing justice to each modality of psychotherapy while integrating their perspectives in certain ways and making the presentations clinically relevant.The organization of the book is felicitous. It starts with a section on the major modalities of treatment—psychoanalytic and psychodynamic, which are regrettably not distinguished from each other; cognitive and behavioral therapies; and interpersonal individual therapies, followed by group, family, couples, and art interventions. The final chapter in the section makes a strong try at integrating the various psychotherapeutic methods while defining elements that are common to all. Every effort is made to present the evidence base, and frequent citations refer the reader to voluminous bibliographies. There is no overall index of references listed by author, and the general index is inconsistent in tracking major authors named in the text.The second section addresses psychotherapy for numerous axis I psychiatric disorders. From here on, most chapters are coauthored by proponents of multiple therapies, especially psychodynamic and cognitive-behavioral. This usually results in subsections on one school and then the other, which is followed by some effort at an integrated discussion with conclusions at the end of each chapter.Section III describes psychotherapy for personality disorders, which necessitates weaving together the therapeutic management of presenting symptoms and behavior with the long-term effort to modify the underlying personality structure. For example, the chapter on borderline personality disorder does a creditable job of portraying cognitive, behavioral, dialectic-behavioral, and psychoanalytic perspectives and then addresses general management issues that challenge all approaches.Section IV divides the field in yet another direction, psychotherapy across the life cycle. The chapters on children and adolescents fill in more of the developmental perspective. Chapters on psychotherapy during the reproductive years and psychotherapy with older adults complete the spectrum.Section V presents issues in specific populations: medical patients, issues of gender and sexual orientation, and cross-cultural psychotherapy. The final section on special topics addresses a number of important subjects. An especially provocative chapter explores the implications of research in cognitive neuroscience for cognitive behavior therapy and psychodynamic psychotherapy. A more general chapter on research is followed by discourses on psychotherapy and medication, ethics, clinical-legal issues, and supervision of psychotherapy. Brief and time-limited therapies bring this lengthy book to a close.This book is daunting to read. It crams an enormous amount of material into 552 pages of a coffee-table-sized, attractive volume by setting it in tiny type that is conducive to eye strain. Many pages of gray type are intermittently broken up by topic headings, but the occasional chart or table is a welcome break from the onslaught of words. The writing is clear and informative but variable in its liveliness and ease of flow. Fortunately, many authors make their points with brief clinical illustrations. Covering so much territory means that this is not the definitive text from which to learn any one psychotherapy, but it makes an excellent reference and overview.Dr. Clemens is clinical professor of psychiatry at Case Western Reserve University, Cleveland, Ohio. FiguresReferencesCited byDetailsCited ByNone Volume 57Issue 9 September, 2006Pages 1347-1348PSYCHIATRIC SERVICES September 2006 Volume 57 Number 9 Metrics PDF download History Published online 1 September 2006 Published in print 1 September 2006

Hidden Points of View in Cross-cultural Psychotherapy and Ethnography

This article examines the challenges posed by cross-cultural psychotherapy in a creolized world, and the way this intersects with issues faced by the ethnographer. It proposes 'the relational subject,' implicit in systemic psychotherapy and social anthropology, as a framework for an understanding of communication. In cross-cultural psychotherapy, this assumption is central to non-discriminatory and equitable treatment. Drawing on Bateson's ethnographic work, the article connects 'the relational subject' to what Bateson, following Whitehead, called 'the fallacy of misplaced concreteness' and later referred to as 'context.' The article examines the choices of 'context' first in ethnography and systemic psychotherapy and then in Bateson's own analysis of the Naven ritual. It is suggested that cross-cultural psychotherapy is psychotherapy in which the therapist keeps in mind, both her own and her client's contexts. This means an assessment of process (performative aspects) as well as content (semiotic aspects) and attention to 'moments' rather than longer sequences in the therapy.

Do therapists address ethnic and racial differences in cross-cultural psychotherapy?

Ethnic and racial differences between client and therapist affect therapy processes and outcomes, but little is known about the extent to which therapists have dialogues about their differences in therapy. A survey on this topic was completed by 689 APA-licensed psychologists with experience conducting cross-cultural therapy. Most psychologists reported having such discussions, but with less than half of their cross-ethnic/racial clients. Therapists and clients were equally likely to initiate discussions. Reasons for discussing differences varied greatly. Therapists consistently described themselves as comfortable with and skilled at these discussions, and reported that discussions facilitated therapy. Therapists who were female, older, nonminority, less experienced with diverse clients, and viewed training as an important factor were more likely to have discussions about differences. Results point to the need to better understand if, when, and how ethnic and racial differences should be addressed in therapy. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

A cultural accommodation model for cross-cultural psychotherapy: Illustrated with the case of Asian Americans.

As an extension of F. T. L. Leong's (1996) integrative model, this article presents the cultural accommodation model (CAM), an enhanced theoretical guide to effective cross-cultural clinical practice and research. Whereas F. T. L. Leong's model identifies the importance of integrating the universal, group, and individual dimensions, the CAM takes the next step by providing a theoretical guide to effective psychotherapy with culturally different clients by means of a cultural accommodation process. This model argues for the importance of selecting and applying culture-specific constructs when working with culturally diverse groups. The first step of the CAM is to identify cultural disparities that are often ignored and then accommodate them by using current culturally specific concepts. In this article, several different cultural "gaps" or culture-specific constructs of relevance to Asian Americans with strong scientific foundations are selected and discussed as they pertain to providing effective psychotherapy to this ethnic minority group. Finally, a case study is incorporated to illustrate application of the CAM. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Micro Ruptures and Repairs in the Beginning Phase of Cross-Cultural Psychotherapy

The article discusses misunderstandings and misattunements that occur in the beginning phase of cross-cultural psychotherapy. Sources of micro ruptures are outlined, including client maladaptive patterns, therapist misunderstandings, cross-cultural misunderstandings due to cultural variations, and asymmetrical power relations involving the impact of prior experiences or current therapy practices. Multiple clinical vignettes illustrate the rupture/repair process, drawing on Safran and Muran’s (2000) list of direct and indirect techniques.