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Multicultural Key Strategies Multicultural Skills Training Team
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Interpersonal-Multicultural (IM) Strategies for Culture-Centered Adaptation of
Interpersonal
Psychotherapy Interventions
Case
Example: IM1. Recognizing How Interpersonal Relationships are Shaped by Cultural Contexts a. Literature: "Although terminology varies and different facets are emphasized, the bedrock of all interpersonal/dynamic treatment approaches is identifying the repetitive relational patterns that are central to the client's problems" (Teber, 2000, p. 47). b. Practice Marker: IF a client presents information about a relationship episode, then the therapist should attempt to identify patterns of how culture shapes the client's interpersonal relationships. c. Expected Consequence: IF the therapist can gain an understanding of the cultural context within which the client's interpersonal relationships are shaped, then the client and therapist can effectively identify how culture impacts relationship patterns. d. Example: "On several occasions I have heard you describe how it is sometimes difficult for you to get along with the elders in your family. Throughout your life how do you think cultural expectations have shaped your interactions with elders in your family?" IM2. Honoring Resistance that may be Culturally Appropriate a. Literature: "The therapist is honoring the client's resistance by collaborating with the client in trying to understand why this defense was once a necessary and adaptive coping mechanism" (Teyber, 2000, p. 132-133). b. Practice Marker: IF the client appears to be showing resistance, THEN the therapist should explore with the client cultural factors that may help them better understand why such a defense is being utilized. c. Expected Consequences: IF the therapist and client are able to identify cultural factors influencing the client's need to remain resistant, then the therapist can effectively honor the resistance and create a safe environment in which the client's conflicted feelings can emerge. d. Example: “On several occasions I have heard you talk about how depressed you become because it is culturally inappropriate for you to question any of the elders in your family. At this time let's not talk about how you feel. Let's talk instead about what might go wrong if you did decide to break this cultural expectation.” IM3. Understanding Past Interpersonal Conflicts within the Context of Culture a. Literature: "It can be liberating for clients to explore the familial interactions and developmental experiences that shaped their current conflicts. As they gain understanding of their childhood dilemmas, they become more accepting of the choices, compromises, and adaptations they had to fashion in their lives" (Teyber, 2000, p. 288). b. Practice Marker: IF the client shares information about interpersonal relationships from their childhood, then the therapist should attempt to understand such relationships within the context of culture. c. Expected Consequence: IF the therapist is able to understand the client's past interpersonal conflicts within a cultural context, then the therapist will be more capable of understanding how early cultural influences on relationships may shape or distort current interpersonal perceptions. d. Example: “What I heard you say was that in past intimate relationships, going all the way back to high school, it was culturally expected of you to make sure all of your partner's needs were met first. Is that cultural expectation still influencing the way you view your current relationship with you husband?” IM4.
Understanding the Therapeutic Relationship as a Cultural Exchange
IM4a. Cultural Transference: Examining How Cultural Worldview Influences Clients' Perceptions of Therapist a. Literature: "A good therapeutic relationship provides an ideal medium for experiencing one's maladaptive interpersonal predispositions, while at the same time facilitating their correction...Transference...refers to the patient's proclivity for enacting emotional conflicts through the relationship to the therapist" (Strupp & Binder, 1984, p. 143). b. Practice Marker: IF a client presents as one who has strong feelings, perceptions, or reactions toward the therapist due to differences in cultural worldviews, THEN the therapist should attempt to hold a discussion with the client that emphasizes the relationship as being a cultural exchange. c. Expected Consequence: IF the therapist is able to accentuate to the client how the therapeutic relationship is a cultural exchange, THEN the client will feel empowered and often may become more authentic with the therapist and others. d. Example: "KC, I noticed you had a strong reaction to the suggestion I made to you at the end of our last session. From what I've learned about you, questioning me about something I may say that you don't agree with would be culturally inappropriate for you. Can we explore together those feelings by taking a look at the cultural influences impacting your reactions?" IM4b. Cultural Countertransference: Examining How Cultural Worldview Influences Therapists' Perceptions of Clients a. Literature: "Substantial problems occur when therapists become overinvolved with a client. When they do so, they lose sight of the fact that clients have their own subjective worldview, shaped by many factors that actually differ from those of the therapist" (Teyber, 2000). b. Practice Marker: IF the therapist sees herself reacting to a client due to a difference in perspective that is influenced by a difference in cultural worldview, THEN the therapist should attempt to communicate to her client the struggle she is experiencing. c. Expected Consequence: IF the therapist is able to openly communicate with her client the struggle she is experiencing in response to the nature of her client's decisions, then the therapist can better avoid the trap of responding to her client in a way that is not helpful. d. Example: "When I hear you talk about all the stress you are experiencing and how it is negatively impacting all aspects of your life I become very concerned. At the same time I understand how being involved with these Native Hawaiian groups, going to school, working, socializing with extended family, and taking care of your immediate family at home are cultural expectations that have been placed on you. My immediate reaction, which is based on my cultural background, would push me to tell you to drop some of these responsibilities so you can better take care of yourself, but I realize that may not be possible. How do you think we could go about addressing this struggle you are up against?" IM5. Helping Clients Cope with Role Transitions Related to a New Culture or Subculture a. Literature: "In general, difficulties in coping with role transitions are associated with the following issues: (1) loss of familiar social supports and attachments; (2) management of accompanying emotions, such as anger or fear; (3) demands for a new repertoire of social skills; and (4) diminished self-esteem" (Weissman, Markowitz, & Klerman, 2000, pp. 89-90). b. Practice Marker: IF clients are facing significant interpersonal cultural transitions, THEN the therapist should help facilitate the client through the process of cultural adaptation by helping them to understand the interpersonal transition they are in. c. Expected Consequence: IF the therapist is able to help the client better understand the cultural interpersonal transitions they are going through, THEN the client will be better able to decide on how they could effectively adapt to such changes. d. Example: "It seems that with your current transition into the classroom as an instructor you have found it extremely difficult to connect with your students who are younger than you. From a cultural perspective it appears acceptable for you to demand that these younger students never question your authority. This seems to have worked against your goal of better connecting with them. What other things do you think could be done to improve your chances of relating better with your students?"
Copyright © 2004
D. Jennette, J. Oliveira-Berry, K. Wagner, G. Hanawahine, C. Castagnini.
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