Cultural dynamics in psychotherapy and cultural psychotherapies: Ingredients, processes, and outcomes

Jerome Frank's definition of psychotherapy captures its essential sociocultural nature: "a healing relationship . . . [in which] the healer tries to bring about relief of symptoms . . . typically accompanied by changes in emotional state, attitudes, and behavior . . . The healing influence is exercised primarily by words, acts and rituals in which sufferer, healer, and sometimes a group participate jointly" (Frank and Frank 1991, p. 2). It follows that the practice of psychotherapy requires both training and expertise and a solid cultural competence. Cultural competence is the individual clinician's demonstration of respect for and interest in the cultural factors that shape a given patient's context and behavior (Tseng 2004; Lu 2006). While exercising the ability to translate and integrate cultural information into a comprehensive therapeutic approach, clinicians must remain aware of their own perspectives or biases. At the same time, the cultural norms of the society in which the psychotherapeutic encounter takes place dictate the roles of therapist and patient. The therapist's methods and skills, the nature of the transactions, and even the outcomes of treatment reflect expectations nurtured by culture. Thus, culture itself becomes a therapeutic tool, a different lens through which to evaluate human transactions. Culture and psychotherapy mutually or reciprocally infl uence one another. Some psychotherapeutic schools have, on occasion, changed the cultural climate of their time; the best example is the "liberating" effect of psychoanalysis on the rigid Victorian codes of late nineteenth-century Europe. Psychoanalysis provided seemingly rational and logical ("scientifi c," as Freud claimed) explanations for mysterious or profoundly troubling inner feelings or emotions and the behaviors that expressed them (Assoun 1981). Freud and his followers precipitated a dramatic shift in the surrounding culture, placing the effort to understand human subjective life in scientific terms, on an equal footing with religion and moral philosophy. Against culture as a conceptual frame, as outlined in a chapter 5, patient and therapist interact in ways that express culturally derived knowledge, beliefs, and the very notion of who they are and what made them the way they are. Participation in therapy exposes these qualities to scrutiny by another person, as each expresses views and emotions in an effort to understand the other. This dynamic, then, follows two converging routes: one that defines the patient and his or her problems and the therapist's perceptions and skills (we call them "cultural endowments"), and another that delineates the psychotherapeutic encounter and its outcomes as a thoroughly cultural occurrence. In this chapter we explore the influence of culture on the participants in the psychotherapeutic encounter and discuss how culture structures the encounter and its outcome in light of the thoughts and perspectives expressed by Jerome Frank in Persuasion and Healing.