The Components of Cultural Match in Psychotherapy
Available evidence suggests that when clients from ethnic minority seeking mental health treatment are paired with therapists from the similar ethnic background, the rates of drop out is lower, and there is an increased utilization of treatment. Based on previous studies about culture, I believe this is true to a large extend. For example, Hofstede (2001) pointed out that there are six cultural dimensions in the world including uncertainty avoidance, indulgence, individualism vs. collectivism, long-term orientation, masculinity vs. feminism, and power distance. These cultural dimensions might affect the relationship between the client and the therapist, and also treatment outcome. Ibaraki and Hall (2014) also contend with this claim. However, in their article, they pointed out that there are active ingredients which contribute to the effectiveness of ethnic pairing. Although this can be true, I do not think it is a major point of concern. The authors’ assumed that the effectiveness of pairing the clients with the therapists was enhanced by their shared values, cultural beliefs, and attitudes. The authors’ claim is supported by a study they conducted. The methodology they used in their study is precise, and so do their analysis. However, the data they used were collected from clinical records. Under these circumstances, other methods of data collection such as questionnaires and interviews might have revealed a true picture of the situation.
The current and past studies claim that there is an increased utilization of treatment and reduced instances of drop outs when there is an ethnic match between clients and therapists. The focus of the article is the ethnic match and the issues to be discussed during therapy sessions. According to the authors, the outcome of the therapy is a function of both the ethnic matching and the issues to be discussed. Again, the authors pointed out that the outcome was inconsistent across ethnic minorities. For example, the authors pointed out that while the African Americans are free to discuss drug abuse issues with their fellow ethnic therapist, the Asian Americans are not free to discuss alcohol abuse with a therapist of their cultural background. Therapists are professional people who are trained to handle their clients well. They are trained about how to handle clients in a multi-cultural environment. It is very ironical that the authors believe that the same therapists demonstrate a consistent level of incompetence across ethnicities. To be reliable, another study was necessary. For example, there should have been a study involving clients from various ethnic minorities being treated by a neutral therapist, say a Native American therapist. The results would then be compared. It is likely that certain clients are generally uneasy discussing certain issues irrespective of the therapist involved. There is also the issue of therapists. Was it a coincidence that all the therapists involved had the same level of competence? Clients with mental problems are not necessarily undergoing the same degree of suffering. A rape victim, a drug abuser, and a student stressed by academic challenges might have differing levels of mental problems. Consequently, the number of visits might reduce depending on the nature of the problem. For example, a rape victim might take a longer time to heal emotionally. A long-term drug addict might even take longer. Further, a drug addict, due to his/her unique nature of the mental problem, may be inconsistent in his visits to the therapist. The dropout rates should therefore not be used to conclude that certain ethnic groups’ dropout rates are higher due to a mismatch between the culture of the client and the therapist. Naturally, not all clients are expected to heal at the same rate even if they are suffering from the same mental problems. If ten clients suffering from depression are randomly assigned to therapists, some might opt to drop after the first visit if they heal immediately. This might be because they can handle depression better than others. Unless those who dropped out gave their reasons for dropping out, it could be quite hard to conclude that they dropped out or did not drop out because of a cultural mismatch with the therapist.
The studies further revealed that some ethnic minorities prefer discussing certain aspects with therapists from their ethnic background. This confirmed findings of past studies which show that pairing a client with a therapist of similar ethnic background can improve treatment utilization as well as reduction of dropout rates. The current and past studies seem to agree that ethnic matching of client and therapist should be adopted. What the researchers assumed is that the training of therapists is proportional to the needs of ethnic minorities. A better approach would be a recommendation which results in an improved treatment methodology rather than relying on ethnic matching as a long term solution. The authors agreed with past researchers that the solution is to use culturally-sensitive intervention measures. What will happen if the number of ethnic minority therapist fail to match up with the rising cases of mental health problems among the minority? The authors stated that one of the limitations of the study was complex interactions found in data. They also pointed out that the treatment success is not entirely based on the ethnic match. Further, they recommend that therapists need to be well conversant with cultural issues affecting their clients. I feel they were right in these three points. About cultural awareness, I think an ideal solution will be to explore methods which can allow handling of clients in the best way possible irrespective of cultural background. This can be achieved by hiding the identity of the therapist, perhaps conducting interviews in an environment where the client and the therapist are not in a face-to-face encounter (cannot see each other). In stating the limitations of their study and the issue of the ethnic match in general, the authors contend that understanding the interplay between the effectiveness of ethnic match and successful treatment and reduced client drop out is complex. Perhaps there is a need to understand how the interactions of the client-therapist relationships in the context of culture affect the outcome of the treatment. This might give a clue on how therapists need to be trained on cultural issues and how culture can influence relationships with their clients as supported by the investigations of Hofstede (2001).
Hofstede, G. (2001). Culture’s consequences: Comparing values, behaviors, institutions, and organizations across nations. London: Sage Publications.
Ibaraki, A.Y. and Hall, G.C.N., 2014. The components of cultural match in psychotherapy. Journal of Social and Clinical Psychology, 33(10), p.936.