Ethnicity, Culture, and Group Psychotherapy

Ethnicity and culture have great therapeutic import in the practice of group psychotherapy, especially given the increasing diversity of the population of North America, and this issue has not received appropriate recognition in the literature. In this paper these terms are defined, and the literature is reviewed. Ethnicity, culture, and psychopathology are discussed, focusing on treatment issues including transference, countertransference, resistance, group cohesion, group process, and multi-ethnic groups. The group therapist must be knowledgeable about ethnic and cultural issues in the lives of the group members in order to promote group cohesion and therapeutic effectiveness. The recognition and exploration of ethnic/cultural differences enhances the work of the group. Recommendations for treatment are discussed.     

Psychotherapy in Saudi Arabia: Its History and Cultural Context

The introduction of modern mental healthcare standards and services in the Kingdom of Saudi Arabia (KSA), has resulted in a gradual shift towards a more positive perspective on mental health issues and related services, and has increased the demand for qualified mental health professionals and psychological interventions (WHO 2016). Despite recent advances in mental healthcare services, psychopharmacology remains the main treatment modality for the majority of mental health issues in KSA. Psychotherapy has had a rather slow developmental trajectory in KSA, and its provision requires an understanding of many specific aspects of Saudi culture (Dubovsky 1983). This paper will shed light on the historical development and current challenges of psychiatric and psychological services and the availability of psychotherapy in KSA. By offering an explication of a selection of local social phenomena, this paper will attempt to explain how unique Saudi cultural constructs and social contexts influence the training, perception, and practice of psychotherapy in the country, outlining existing challenges as well as some expected future directions.     

Die Therapeutenvariable

Background

The objective of this study was to investigate the therapeutic attitude as a self-contained dimension of the therapeutic process.

Patients and methods

The psychotherapists’ beliefs and attitudes in therapeutic matters are measured according to the Therapeutic Attitude Scales (TASC) of the Therapeutic Attitude Questionnaire (ThAt) and were applied to investigate the therapist variable. The investigation concentrated on the therapist’s belief in the curative value of a number of ingredients of psychotherapy, on the therapist’s individual style of conducting psychotherapy and on basic assumptions about the nature of psychotherapy and the nature of the human mind. A total of 451 psychotherapists (81 psychodynamic psychotherapists, 208 psychoanalytic psychotherapists and 162 behaviour therapists) were investigated.

Results

There were highly significant differences between the three groups of therapists, a finding which is in line with the basic theory. Adaptation and insight of the assumed curative factors as well as supportiveness and neutrality of the technique factors, differentiate the groups highly significantly. The multivariate analysis underlines the importance of adaptation and insight to differentiate between all groups.

Conclusion

The results by and large confirm the general assumptions held on the differences between the groups. Thus the ThAt appears to be a valid instrument to grasp more subtle features of the therapist variable that may influence the outcome of psychotherapy.     

Non-Traditional Women's Group

This paper focuses on an intensive large group experience for women that addresses issues of female identity and the cultural constructs that contribute to women's basic experience of self. It includes a discussion of self-concept and the social constructionist theory of the social, emotional, and psychological processes of the development of an individual's view of herself and the world. The author contrasts aspects of traditional group psychotherapy leadership, which tends to perpetuate society's devaluation of the feminine, with the leadership style of this workshop. The use of story and metaphor and other techniques used to achieve the workshop goals--including narrative therapy, guided imagery, movement and dance, and ritual enactment--are also discussed.     

Constructing Cultural Competence: Perspectives of Family Therapists Working with Latino Families

This article focuses on developing an understanding of how nine therapists working with Latino families construct the idea of cultural competence in the counseling room. In-depth interviews were conducted and analyzed yielding five themes in cultural competence from the therapists' perspectives: the use of language in therapy; the impact of social class, gender, and power on the therapeutic relationship; immigration and culture clash; definitions of family; and unique constructions of cultural competence. The therapists'narratives in this study are best understood through a postmodern paradigm suggesting that the field of psychotherapy needs to move beyond a “checklist” modernistic approach to developing cultural competency.     

An Integrative Clinical Approach to Cultural Competent Psychotherapy

To provide effective psychotherapy in cross-cultural situations, cultural issues need to be adequately addressed. We describe core concepts of cultural competence relevant for psychotherapists to consider. A contextualized approach to conducting cultural competent assessment and formulation is recommended, including the use of DSM-5 Outline for Cultural Formulation and Cultural Formulation Interview. We introduce a cultural competent framework to help therapists become more mindful of culturally relevant interactions in therapy. Finally, a three-tier system is proposed for the examination of psychotherapy models through a cultural lens. The concepts and framework described can be flexibly and pragmatically integrated into a therapist’s regular clinical work, increasing the therapy’s effectiveness across diverse populations.     

How to Begin A Therapy Group: Six Approaches

Japanese “groupism,” or the tendency to emphasize groups rather than individuals, often favors the use of group psychotherapy with Japanese patients. However, the author recommends that the clinician should be sensitive to other cultural phenomena, which are thought to be related to groupism that will influence the nature of group treatments. For example, the traditional Japanese relationship to authority may make it difficult for many patients to express negative attitudes and to share intimate material. Differences regarding confidentiality and gender, distinction between “miuchi” (families) and “tanin” (strangers), and attitudes toward silence may also influence the nature of group therapy. The author discusses these and related cultural differences and highlights implications for the therapist's style of intervention. Finally, the amount of influence that groupism has on group psychotherapy must be considered. The author suggests that it is greater for patients with mild neurosis than severe psychosis.     

Emerging Practices of Counseling and Psychotherapy in China: Ethical Dilemmas in Dual Relationships

A qualitative study was conducted with 48 Chinese counselors and psychotherapists who were interviewed in 2006 and an independent sample of 50 participants who responded to a survey in 2014. This study aims to explore how the new emerging expansion of mental health practice is related to issues and challenges of dual role relationship and how the well-engrained values and social characteristics of Chinese culture influences perceptions and resolution of ethical dilemmas. The participants identified similar dual relationships in 2006 and 2014: (a) Incidental boundary crossings, a sexual or romantic relationship, a dual social relationship, and a professional dual relationship were the most frequently reported types of dual relationships encountered by Chinese practitioners, and (b) the socioeconomic and cultural context and the development trajectory of counseling and psychotherapy in China play a significant role in shaping practitioners’ behaviors. The comparison of the data in 2006 and 2014 indicated that practitioners in psychotherapy and counseling have an improved awareness and understanding of ethical issues, evidenced by the decreasing cases of romantic and sexual relationships and increasing cases of social dual relationships influenced by the interrelatedness of traditional Chinese culture.     

Coming together and remaining a part: Development of a group-as-a-whole compass. Part II

Group-as-a-whole theory is an attempt to explain the collaboration and synergy that results when patients share their care. The art and science of treating individuals within psychotherapy groups is enriched by an understanding of the unique mediums ³ through which a group comes into being and the more general domains within which it comes to be known. This paper continues the development of a group-as-a-whole compass, as an integration of extant models and theories (Ettin, 1996). The focus shifts from conceptual and spatial models to an exploration of the cultural and relational processes that make up whole-group functioning. The paper comes full circle with hypotheses drawn about how a psychotherapy group, as a holistic phenomenon, is composed and maintained.Private practice, East Brunswick, New Jersey.     

Gegenübertragung im stationären Therapie-Setting

Background

Countertransference is seen as an instrument of research into a patient’s unconscious and is therapeutically useful in furthering psychodynamic work. For inpatient psychodynamic psychotherapy, where patients are treated by a team of psychotherapists, countertransference is much more complex and makes consideration and integration of different countertransference feelings necessary. Using the first German translation of the countertransference questionnaire (CTQ, Zittel Conclin and Westen, the countertransference questionnaire, 2005) an attempt was made to identify differences in countertransference phenomena in a team of psychotherapists and to show the impact countertransference has on therapy outcome.

Materials and methods

A total of t multiprofessional teams of psychotherapists (15 physicians, 5 psychologists and 9 body and art therapy psychotherapists) took part in the study and completed the CTQ for 137 patients (100 female, 37 male) at the beginning and at the end of inpatient psychotherapy. In addition, the patients completed two questionnaires, the Symptom Check List Revised 90-R (SCL-90) for the severity of symptoms and the Assessment of DSM-IV Personality Disorders Questionnaire (ADP-IV) for personality disorders.

Results

Body and art therapy psychotherapists expressed more positive, protective and involved countertransference feelings whereas psychotherapists for single and group therapy expressed more aggressive and hopeless feelings. Countertransference has an impact on therapy outcome and feelings of a lack of interest, aggression and resignation at the beginning of therapy can point to a poor outcome. Patients with personality disorders activate more negative countertransference reactions than patients without personality disorders but at the same time they may also evoke parent-like feelings of protection.

Conclusions

Using the CTQ it is possible to differentiate countertransference phenomena in a team of psychotherapists treating inpatients with psychodynamic psychotherapy. The timely perception and integration of countertransference feelings has a positive influence on the therapeutic process and therapy outcome.     

Childlessness and Group Psychotherapy: Psychological and Sociological Perspectives

Women's developmental theory and sociocultural expectations typically link feminine identity to motherhood. This can lead to internal conflict for women who remain childless, whether by choice or by circumstance. Group psychotherapy can be useful in that it is a place where the intrapsychic and social interact. As an arena for personal change, group therapy is a place where childless women can heal the grief, shame, and guilt associated with their childlessness, and explore other ways to express femininity, creativity, and generativity. As a form of psychosocial therapy, group is a setting where both men and women can closely examine their sociocultural expectations regarding childlessness and debunk stereotypes.     

A Process Analysis of “Transient” Therapy Groups

Abstract

This article discusses numerous ethical issues regarding the keeping of records in group psychotherapy, those activities that have to do with the creating, retaining, storing, releasing, and disposing of them. A central dilemma for the group therapist is whether to keep records separately for each individual group member or to keep one record for the group as a whole. Confidentiality of records, patient access, and release of information tend to be more complex issues for group psychotherapists than for individual psychotherapists. Although notes written about the entire group may capture important themes, such notes can compromise the privacy and confidentiality of individual group members. An individual record for each patient is recommended.     

Therapist attitudes and countertransference as predictors of professional quality of life and burnout among psychotherapists

This study aimed to examine the role of attitudes towards psychotherapy and countertransference dimensions as predictors of professional quality of life and burnout among psychotherapists in Iran. Participants were 259 psychotherapists who worked in mental health centres in Tehran (Iran), and they completed the Professional Quality of Life questionnaire, the Therapist Response Questionnaire and the Therapist Attitudes Scale. Professional quality of life was associated with countertransference dimensions and attitude towards psychotherapy. This study concludes that psychotherapists can benefit from working on their specific countertransference issues and re-evaluating their basic attitudes towards psychotherapy to achieve the highest levels of professional satisfaction. Culture may play a role in a specific therapist's attitude and difficulties in addressing certain aspects of countertransference.     

The Future of Psychotherapy: Visions and Recommendations

Using a roundtable discussion format, the editor and new members of the editorial board for the Journal of Contemporary Psychotherapy exchange ideas about how they envision the future of psychotherapy, anticipate likely positive and negative outcomes, identify key issues to be confronted today in order to maximize future success, and clarify the role of the individual psychotherapist in protecting psychotherapy as a viable field of study and practice. The discussion closes with recommendations for the next generation of psychotherapists and general conclusions about the future of psychotherapy.     

Cultural Participation and Individual Quality of Life: A Review of Research Findings

Objectives

To examine the research evidence for the contribution of cultural participation to individual quality of life; to discuss the utility of different types of QOL conceptualisation and measurement for cultural policy making.

Materials and Methods

A literature review of English language publications over the decade from 1995.

Results

There are few extant QOL studies, and very little empirical evidence to support the claims made by policymakers about culture and individual QOL.

Conclusions

The article suggests that a multi-dimensional, rather than a global, conceptualisation of QOL is best suited to the cultural policymaking context. Securing findings generalisable across all cultural forms, project types and all individuals or populations is not an achievable goal. Methodologies need to be developed and tested to understand how and why cultural participation affects individual QOL domains and these need to take into account differences in types of cultural participation, the quality of the experience, and between individuals in different social circumstances and in different life stages.     

Cultural fit of emotions and health implications: A psychosocial resources model

Emerging evidence on cultural differences in health implications of emotions suggests that the cultural fit of emotions (i.e., accordance with culturally normative and prevalent patterns of emotions) is associated with better health. However, the mechanisms underlying the links between culture, emotions, and health are not clear. In this paper, we propose a psychosocial resources model of cultural fit as an integrative framework to guide the future work in this area. Following the review of cultural differences in emotions, we next review the accumulating evidence showing that culture modulates the link between emotions and health in such a way that the cultural fit of emotions positively predicts health. We then propose that psychosocial resources (e.g., resilience, meaning in life, and social support) play an important role in linking the cultural fit of emotions to health. The psychosocial resources model proposes that the emotion–health link is modulated and sustained via the relevance of emotions to resources and coping in a given cultural context. The model is supported by a line of research suggesting the role of cultural fit in the attainment of resources and another line of research showing the importance of psychosocial resources in health. Lastly, future directions will be discussed for research incorporating culture into the study of emotion and health.     

Fundamental Dilemmas in Contemporary Psychodynamic and Insight-Oriented Psychotherapy

Contemporary psychotherapists are being called on to provide treatment with increased degrees of brevity and efficacy. To meet these demands, the practice of brief psychodynamic psychotherapy has turned to (a) the increased emphasis upon a specific psychodynamic focus for treatment versus the more comprehensive goals of longer-term treatment, and (b) the augmented use of confrontation of psychological defenses versus the enhanced use of emotional support as in more nondirective psychotherapy. Other approaches to insight-oriented psychotherapy that have been influenced by this trend include: client-centered psychotherapy with its focus upon the therapeutic relationship; existential psychotherapy with its focus upon death anxiety; and, the revitalization of interpersonal psychotherapy from its original Sullivanian conceptualization. The clinical dilemmas that limitations of time and restricted therapeutic focus place upon each of these methods of treatment are the central issues of this discussion.     

Translation and Cultural Comparison: Some Epistemological Reflections

In its traditional guise, cross-cultural psychology is a science of comparative measurement. Its chief method is the regulated observation or recording of behaviour in different cultural milieux and its quantitative conversion into a common metric. This method allows for the estimation of differences across cultures on the strength or magnitude of the behaviour. We can therefore speak of one cultural group doing more of Y, or being more Y, than some other group, where Y is a conceptually and operationally defined behaviour taken to apply equally well to both groups. The culture-independence of the definition supports examination of how the magnitude of the behaviour may be determined or conditioned by some cultural variable X. According to this picture, culture (the independent variable) differs from place to place and the features by which it differs produce more or less of the universally defined behaviour (the dependent variable) under study. The hypothetical contingency of ‘culture affecting behaviour’ that underlies this approach is thereby maintained. In this paper, I use the problem of translation to cast doubt on this picture of cross-cultural research and the inferential strength of its comparative method. In opposition, I argue that we never measure the same behaviour across cultures if behaviour is understood as socially significant action. Rather, the specification of analogous actions across cultures is a highly uncertain approximation involving the inevitable projection of one’s own conceptual scheme. I argue further that most social phenomena of interest to cross-cultural psychologists cannot be adequately defined in a manner that divorces them from the local linguistic conventions and normative frameworks through which they are realized as part of cultural life. For this reason, cross-cultural psychology cannot effectively model itself on the natural sciences. It is as much hermeneutics as psychometrics.