Culture and the Treatment of Mental Disorders
Psychologists have discovered that there are cultural and ethnic differences in the rate at which people seek psychological treatment. African Americans, Hispanic Americans, Asian Americans, and Native Americans are less likely than White Americans to become involved in psychotherapy (Hall, 1997). Many of the therapies discussed in chapter 14 were developed by European or White American therapists. Until relatively recently, it was assumed that cultural or ethnic differences among clients were inconsequential. However, each cultural group has its own attitudes, values, behaviors, and unique adjustment problems. Recognizing the diversity among cultures helps provide the most effective treatment. Some of these differences are discussed briefly in the next section. Many African Americans are reluctant to share personal information with counselors who are of a different race. They are more likely to be open with other African Americans. Since African Americans are more likely to have extended families, therapists should be sensitive to the outside social forces during therapy. Also, since African Americans more often accept blame for consequences of behavior than do people of other cultures, therapists need to help clients understand the many outside influences on adjustment (Casas, 1995). Many Native American children have been taught to avoid eye contact with adults out of respect. Unless the therapist is aware of this cultural tradition, it may be misinterpreted in a counseling session. Likewise, Native Americans tend to be cooperative rather than competitive, a trait that could be misinterpreted as laziness by a therapist. Because it is vital to understand cultural traditions before attempting to treat individuals with problems, more emphasis has recently been placed on learning about them. Many Hispanic Americans have been raised in a male-dominated family. Because of this, many Hispanic American men are very reluctant to express weakness, such as fear or anxiety. Unless care is taken to understand the strong family values and traditions, therapists can misinterpret family struggles. For example, the decision of many young Hispanic women to marry rather than to pursue a career can be difficult for non-Hispanics to understand and deal with. Asian Americans are more likely to deny psychological problems because they do not want others to know their personal information. Many Asian Americans are reluctant to express emotions publicly, thus often not acknowledging symptoms to the therapist. Sue and Sue (1992) argue that therapists need to be aware of the cultural values of Asian Americans and understand that sometimes direct advice is required rather than the vague encouragement provided by many White American therapists. As therapists become more aware of the cultural diversity of clients, they can make strides toward successful outcomes. Also relevant is the increasing number of minority psychologists willing to share their perspective on counseling. And despite these generalities about various groups, it is important to remember that we cannot stereotype any minority group, as there is great diversity within each cultural group as well as well as among individuals.

Casas, J.M. (1995). Counseling and psychotherapy with racial/ethnic minority groups in theory and practice. In B. Bongar & L. Beutler (Eds.), Comprehensive textbook of psychotherapy: Theory and practice. New York: Oxford University Press.

Hall, G.C. (1997). Cultural malpractice: The growing obsolescence of psychology with the changing U.S. population. American Psychologist, 52, 642-651.

Sue, D.W., & Sue, D. (1992). Counseling the culturally different (2nd ed.). New York: Wiley.