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Multicultural Key Strategies Multicultural Skills Training Team
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Behavioral-Multicultural (BM) Strategies for Culture-Centered Adaptation of Behavioral
Psychotherapy Interventions
BM1. Understanding Actions in their Cultural Context a. Literature: “Personal and environmental factors do not function as independent determinants; rather, they determine each other" (Bandura, 1977, p. 345). b. Marker: IF a client is unsure of which factors have influenced certain actions, THEN it may be helpful for the therapist to query about the cultural environment within which the behavior is taking place. c. Consequence: IF clients understand their actions within a cultural context, THEN they will have relevant contextual information needed to either maintain and/or change behaviors as desired. d. Example: "So it's been difficult for you to talk with your boss because he's older than you and in a position of authority. Is there a way you could address him that is more consistent with your cultural values?" BM2. Illuminating Cultural Reinforcement a. Literature: "Behavioral analysts are well aware that different events may and may not be reinforcing for different behaviors of different individuals at different times...an event serves as reinforcement because of an individual's biological endowment, learning history, and current situation" (Milan, 1990, p. 71). b. Marker: IF a client is unable to verbalize reasons they always perform certain actions in different situations, THEN explore and consider which cultural values may be operating to reinforce these actions. c. Consequences: IF you illuminate the cultural reinforcements of a client's behavior, THEN enhanced insight is more likely to occur. d. Example: “We've discussed relationship issues and your concern about why you've chosen to be with your current partner. Were cultural factors, such as, sharing similar ethnic backgrounds, or, having similar views regarding marriage and family, an influence in your decision to become romantically involved with this person?” BM3. Setting Culturally Appropriate Goals a. Literature: "The term 'behavior' is used in the broad sense to include a complex of observable and potentially measurable activities including motor, cognitive, and physiological classes of responses. After the intended goals have been specified in performance, and preferably in measurable terms, decisions can be made about the experiences that are most likely to produce the desired outcomes" (Bandura, 1969, p. 73). b. Marker: IF a client is unsure about what the consequence of enacting a particular behavioral goal would be, THEN explore the impact cultural factors will have on goal implementation and outcome. c. Consequence: IF you assist a client to develop culturally appropriate goals, THEN the client will be better able to implement and achieve their goals with higher rates of success. d. Example: “How will your occupational goal of becoming a physician be perceived within your culture?” BM4. Prescribing Actions within the Cultural Context a. Literature: "A number of techniques used by behavior therapists include ongoing homework assignments, in which the client must keep a record of various behavioral events between sessions, or practice certain skills in vivo" (Goldfried & Davidson, 1994, p. 27). b. Marker: IF between session behavioral assignments are needed to pursue therapeutic goals, THEN therapists should understand the cultural factors that will influence how the behavioral assignments are prescribed. c. Consequence: IF therapists' prescribe behavioral assignments within a relevant cultural context, THEN clients will experience respect from the therapist, congruence with the prescribed actions, and enhanced motivation to complete the assignment. d. Example: "Therapeutic success is complemented by the actions we perform between sessions. In some cases, clients like to utilize outside resources to develop these between-session assignments, and in others, client prefer the therapist to be more directive. Which would be more helpful and consistent with your own cultural practices?" BM5. Exposing Clients to Multicultural Experiences a. Literature: "It has been increasingly realized that the many behavioral treatments that reduce morbid anxiety share a common procedure--continued exposure to the stimuli that evokes anxiety until discomfort subsides. Exposure therapy resembles the way in which repeated presentations of the relevant stimuli habituate and extinguish normal innate and acquired fear" (Marks, 1987, p. 457). b. Marker: IF a client is interested but hesitant to pursue a new cultural experience, THEN explore relevant coping skills that will reduce their level of discomfort associated with new situations. c. Consequence: IF you help to increase clients' exposure to new multicultural experiences, THEN clients' cultural identities will further develop, and they will be better able to cope with future culturally relevant growth experiences. d. Example: "Your idea to enroll in a Hawaiian language course seems an important one that supports the goal of increasing your cultural identity. You've also expressed some anxiety with regard to embarking on this new cultural experience. Perhaps we could imagine you actually being in the classroom and utilize relaxation skills to reduce any anxiety that may arise." BM6. Providing Cultural Skills Training a. Literature: "As used from a behavioral frame of reference, behavioral rehearsal is used primarily in helping the client to learn new ways of responding to specific life situations. We have used the terms "behavioral rehearsal" and "role playing" interchangeable. Although both refer to the simulation of real-life situations within the consultation room, the function of behavioral rehearsal is less ambiguous. This chapter deals with behavioral rehearsal as a way to train new response patterns" (Goldfried & Davidson, 1994, p. 136-137). b. Marker: IF a client is unaware of, or, interested in, how certain behaviors will impact a particular culture, THEN providing feedback about this will foster appropriate cultural knowledge and growth. c. Consequences: IF clients are given feedback and/or new skills to facilitate interactions within a particular culture, THEN they are more likely to behave in culturally appropriate ways and have successful cultural exchanges. d. Example: “If you're interested in approaching a Pacific Islander ethnic group on health issues, you will want to learn of their cultural values regarding health and well-being before engaging in any discussion. For example, many Pacific Islander groups value the use of traditional practitioners over western practices, thus, they may be less trusting of non-traditional service programs and/or practices. Consider preparing yourself by reviewing literature, and seeking information from other individuals knowledgeable about minority population health.”
Copyright © 2004
D. Jennette, J. Oliveira-Berry, K. Wagner, G. Hanawahine, C. Castagnini.
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