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Multicultural Key Strategies Multicultural Skills Training Team
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Cognitive-Multicultural (CM) Strategies for Culture-Centered Adaptation of Cognitive
Psychotherapy Interventions
CM1. Understanding Cognitions in their Cultural Context Practitioners can help clients recognize that their cognitions might have adaptive consequences in some cultural contexts, but not in others. a. Literature: “The typical cognitions show a variety of deviations from logical thinking, including arbitrary inferences, selective abstractions, overgeneralizations, and magnifications" (Beck, 1967, p. 256). b. Marker: IF a cognition is adaptive in one cultural context but not adaptive in another cultural context, THEN it might be useful to facilitate recognition of the role cultural contexts play when forming an adaptive cognition. c. Consequence: IF clients identify some cognitions as adaptive in limited cultural contexts, THEN clients might experience adaptive consequences in other cultural contexts. d. Example: "I gather that you felt angry when your American classmate rested his feet on the chair next to you so that the bottom of his feet were pointed at you. Raam, you said you felt angry because you thought your classmate was insulting you, which could be an adaptive thought in Nepal since the bottom of feet are believed to be jutho (or polluted) in that context. What evidence can you identify for and against the same thought in the cultural context of the United States?" CM2. Identifying Culturally Sensitive Alternative Cognitions Interventions that dispute maladaptive cognitions and identify adaptive replacement cognitions can seek culturally sensitive alternative cognitions. a. Literature: "The effective therapist should continually keep unmasking his patient's past and, especially, his present illogical thinking or self-defeating verbalizations by...teaching him how to re-think, challenge, contradict, and re-verbalize these (and other similar sentences) so that his internalized thoughts become more logical and efficient" (Ellis, 1962, p. 58-59). b. Marker: IF disputing a maladaptive cognition and identifying an adaptive replacement cognition, THEN consider the adaptiveness of the alternative cognition in its cultural context(s). c. Consequences: IF the alternative to the maladaptive cognition is adaptive in the expected cultural context(s), THEN the alternative cognition will be strengthened relative to the old maladaptive cognition. d. Example: “Raam, given that you plan to return to Nepal after you graduate, how would the possible alternative core belief you identified ('I'm a warrior fighting to overcome my problems') relate to the caste system if caste continues to be an important aspect of your family values?” CM3. Exploring Cultural Schemas Practitioners can facilitate clients' exploration of schemas that originate from cultural contexts and shape cultural assumptions. a. Literature: "Early Maladaptive Schemas refer to extremely stable and enduring themes that develop during childhood, are elaborated throughout an individual's lifetime, and are dysfunctional to a significant degree" (Young, 1999, p. 9). b. Marker: IF a theme emerges among maladaptive cognitions, THEN practitioners might help by facilitating exploration of culturally influenced cognitive structures behind the pattern. c. Consequence: IF exploration reveals a schemata that supports maladaptive cognitions and originates from cultural influences to a significant degree, THEN understanding the cultural influences could aid work toward long-term change. d. Example: “I might be able to help you understand the pattern of thoughts that seem to be associated with you feeling angry and anxious. You might benefit from exploring how cultural influences are related to the theme among the thoughts. For example, what did it mean about you if you expressed some of these thoughts in the presence of the more traditional members of your culture?” CM4. Testing Hypotheses about Culture Clients can form more accurate beliefs, assumptions, and automatic thoughts about their cultural contexts through testing relevant hypotheses. a. Literature: "A direct challenge violates a fundamental principal of cognitive therapy, that of collaborative empiricism: The therapist and the patient together examine the automatic thought, test its validity and/or utility, and develop a more adaptive response" (Beck, 1995, p. 108). b. Marker: IF cognitions about clients' cultural contexts do not become ore adaptive through mere verbal exploration, THEN practitioners can help construct experiments to test the accuracy of the cognitions. c. Consequence: IF experiments provide clients with experiences that disconfirm maladaptive cognitions about cultural contexts, THEN the maladaptive cognitions likely will be weakened, allowing for the possibility of forming more adaptive alternative cognitions. d. Example: "I understand that when your classmate who originally comes from India passed you the bread at lunch with her left hand, you felt insulted because it is more respectful in Napalese and Indian culture to use your right hand to pass food. I wonder if you could test what she meant through asking her directly or finding out if she has become acculturated to American culture to the point of it not mattering to her which hand she uses to pass food." CM5. Education about Cross-Cultural Variations Clients can benefit from psychoeducation about similarities and differences across cultures. a. Literature: Among the variety of techniques cognitive therapists use to help identify more adaptive thoughts is the strategy of psychoeducation (Butler & Beck, 1995). b. Marker: IF the client experiences a problem resulting from a lack of understanding about an unfamiliar culture, THEN the therapist can help the client learn about the unfamiliar culture. c. Consequence: IF the client learns about relevant cultural differences, THEN the client will resolve the problem and become more aware of cross-cultural variations, preventing future problems. d. Example: "Raam, I hear you saying that you are experiencing a lot of anger in response to the manner in which your American classmates turn down your requests for favors. As we explore your thoughts in those situations, would you like me to share with you some of my perceptions of what appears to be the norm for politeness in this region of American when it comes to turning down requests?" CM6. Facilitating Cultural and Cognitive Flexibility Practitioners can facilitate clients' development of cultural and cognitive flexibility to help them become more adaptive in a multicultural society. a. Literature: Research showed that successful students are more cognitively and culturally flexible than less successful students. The more successful students could shuttle among various cognitive and culture styles (Ramirez, 1999). b. Marker: IF the client would like to cope better in a multicultural society, THEN the therapist can help the client develop unfamiliar cultural and cognitive styles. c. Consequences: IF the client develops the unfamiliar cultural and cognitive styles, THEN the client will become more adept at navigating a variety of contexts in the multicultural society and will become more open to new experiences and opportunities. d. Example: “Raam, when you said that you tend to have a more difficult time getting along with your classmates who grew up in major American cities instead of rural areas, I wondered if you might find it helpful to learn more about the characteristics and values more frequently found among people from urban parts of America since you plan to be a businessman who deals with the same people. Also, as we explore your thoughts and feelings about what you called 'urban styles,' you might benefit from finding people and institutions that can provide immersion experiences with 'urban styles' if you want to increase your flexibility interacting with people from various cultures.”
Copyright © 2004
D. Jennette, J. Oliveira-Berry, K. Wagner, G. Hanawahine, C. Castagnini.
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