Cultural Considerations for Psychologists in Primary Care

Many health concerns in the United States (e.g., diabetes) are routinely managed in primary care settings. Regardless of the medical condition, patients’ health is directly influenced by factors such as healthcare providers and cultural background. Training related to how behaviors influence health, coupled with training on how cultural diversity intersects with mental health, allows psychologists to have the relevant expertise to assist in the development of primary care behavioral health interventions. However, many psychologists in primary care struggle with how to integrate a culture-centered paradigm into their roles as behavioral health providers. This paper provides an introduction on how three culture-centered concepts (providers’ cultural sensitivity, patient–provider cultural congruency, and patients’ health literacy) can be applied in primary care using the Five A’s Organizational Construct and a model of cultural competence. In addition, the paper includes a section on integration of cultural considerations into consultation and training and concludes with a discussion of how the three culture-centered concepts have implications for health equity.     

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.     

Cultural Psychotherapy: A Consideration of Psychosocial Class and Cultural Differences in Group Treatment

Most psychotherapists are aware of the many social issues and cultural factors that influence development throughout each individual life. Human nature, being a social nature, exists within relationships to others, the community, and a culture, sometimes a mixture of cultures. One social parameter, social class, redefined here as psychosocial class, has not received the same attention from psychotherapists as gender issues or ethnicity, two other important sociocultural spheres of influence on everyday life. It is suggested that group therapists are in a unique position to develop a cultural psychotherapy that addresses psychosocial class and cultural aspects of mental health. This paper includes a preliminary model of cultural psychotherapy that highlights the psychology of social class and culture for psychodynamic group psychotherapy.     

A Model for Cultural Diversity Training

We are fast becoming a multicultural, multiracial, and multilingual society. Such demographic changes are having a major impact on economic, social, legal, political, educational, and cultural systems. For businesses and industries to survive, they will need to meet the inevitable challenge of cultural diversity. A model for incorporating cultural diversity in organizations is presented. The model is based on a 3 × 3 × 3 matrix, which analyzes an organization's functional focus (recruitment, retention, and promotion), barriers (differences, discrimination, and systemic factors), and cross-cultural competencies (beliefs/attitudes, knowledge, and skills). Although it was originally developed for business and industry, the model seems to have usefulness in application to education and mental health organizations as well. Estamos llegando a ser rápidamente una sociedad multicultural, multiracial, y multilingue. Estos cambios demográficos han tenido un gran impacto en los sistemas económico, social, legal, politico, educativo, y cultural. Para que los negocios e industrias sobrevivan, necesitarán enfrentarse al desafío inevitable de la diversidad cultural. Se presenta un modelo para incorporar la diversidad cultural en organizaciones. El modelo se basa en una metriz 3 × 3 × 3 que analiza el foco funcional de una organizacion (reclutamiento, retención, y promoción), bloques (diferencias, discriminación, y factores sistémicos), y competencias interculturales (creencias/actitudes, conocimientos, y habilidades). A la vez que se desarrolló el modelo originalmente para negocios e industria, se vio que el modelo también tiene utilidad para aplicarse en organizaciones educativas y de salud mental.     

Cultural issues in

Reviewed here are cultural issues which should be included in the study of the relation between child disabilities and child abuse. Variations in child care, parenting, discipline, and health practices are noted and examples of cultural practices that could impact the perceived relation between disabilities and abuse are discussed. Two programs incorporating culturally sensitive approaches in interactions with clients in an applied setting are reviewed.     

Cultural Lens on Mental Illness: Four Clients Share Their Perspectives

People served by mental health providers represent diverse cultural groups. In-depth qualitative interviews were used to collect data to examine: “How do people, diagnosed with a mental illness, perceive their experience in a partial care mental health program from the perspective of their cultural context?” Four participants described cultural identities that included ethnic, health status, and sexual orientation identities. The participants' way of participating in the world was often in conflict with cultural values and expectations of the family and counselors. Cultural competence must include understanding how complex, multiple cultural contexts interact and influence a person's participation in the therapeutic process.     

理想情感及其影响的跨文化差异

理想情感是人们期望获得的情感状态。情感评估理论认为文化对理想情感的塑造有着重要影响,主要的影响途径有文化体验、文化价值观和社会文化变化。理想情感对个体会产生具有文化特异性的影响,主要会影响个体的偏好及选择行为、混合情绪体验、身心健康和社会认知决策。理想情感研究未来发展可以着眼于4个方向:使用纵向视角研究理想情感,进一步探索理想情感的前因变量,打造适合中国文化的心理健康标准和通过认识理想情感来消除文化隔阂。     

The Client Cultural Competence Inventory: An Instrument for Assessing Cultural Competence in Behavioral Managed Care Organizations

The rapid growth in Behavioral Managed Care Organizations has led to increasing concern about the future availability of culturally competent mental health services for ethnic minorities. Prior efforts to assess cultural competence of mental health services have focused exclusively on agency providers and individual mental health professionals rather than on clients' perceptions of care. We introduce the Client Cultural Competence Inventory, which has several advantages over other cultural competence measures including its (a) lower susceptibility to social desirability bias, (b) ability to assess attitudes concerning a broader range of therapists, providers and plans, and (c) focus on clients rather than the psychiatric community as the central force in determining cultural competence. Preliminary psychometric analyses of the inventory are presented from data gathered in a group of parents with children who are severely emotionally disturbed.     

The Role of the Self in Responses to Health Communications: A Cultural Perspective

To the extent that cultures vary in how they shape individuals' self-construal, it is important to consider a cultural perspective to understand the role of the self in health persuasion. We review recent research that has adopted a cultural perspective on how to frame health communications to be congruent with important, culturally variant, aspects of the self. Matching features of a health message to approach vs. avoidance orientation and independent vs. interdependent self-construal can lead to greater message acceptance and health behavior change. Discussion centers on the theoretical and applied value of the self as an organizing framework for constructing persuasive health communications.     

Revisiting the Cultural Dope

This essay focuses on the ??cultural dope,?? an ironic reference in Harold Garfinkel??s Studies in Ethnomethodology to the rule-following actor in conventional sociological theories. In the nearly half-century since the publication of that book, the ??cultural dope?? has been incorporated into numerous criticisms of ??models of man?? in the human sciences. Garfinkel??s account appeals to many writers because it seems to present an alternative picture of the actor: an individual who is self-aware, reflective, and skilled in the conduct of daily affairs. A problem with such a generalized picture of the actor is that it may seem to encourage uncritical acceptance of whatever ??the public?? (or a broad segment of the public) happens to believe or support. This paper revisits Garfinkel??s account of the cultural dope, and contrasts ??conservative?? and ??radical?? readings of what Garfinkel does with that figure. The ??conservative?? reading leaves the edifice of a social-structural model largely intact, and provides an alternative, more complex, picture of individual action than that of a cultural dope. The ??radical?? reading places relevant social structures in a dependent relation to the contingencies of action, and thus destabilizes the very theoretical edifice that sets up the problem of how to integrate individual actions with stable social structures. In line with the ??radical?? reading, this paper suggests that Garfinkel creates serious difficulty for any generalized ??model of man,?? regardless of whether it portrays the individual as active or passive, well-informed or ignorant, or reflexive or not.     

Cultural Embeddedness of Health,Illness and Healing: Prospects for Integrating Indigenous and Western Healing Practices

Culture influences conceptualizations about illness, health and healthcare. In this article we argue that Western-oriented health care models have limited success when applied to health conditions of people of non-Western cultures and contend that culture is an important factor in health, illness and healing. We present two cultural modes of illness and healing to illustrate that many health conditions are meaningful and can be effectively managed with consideration of the cultural contexts of the communities concerned. We illustrate, by case examples, how these cultural conceptualisations influence the treatment of illness in three different cultural settings. In addition, we identify some of the key challenges to integrating traditional healing into counselling and psychotherapy. Integration of different cultural healthcare models is a best practice in comprehensive context sensitive delivery of healthcare.     

Rehabilitation of the Culturally Different: A Model of the Individual in Cultural Change

Services of rehabilitation agencies and facilities tend to be structured to the needs of the larger American culture. It is important, however, to reconsider our social service programs in view of the needs of different cultural groups when providing services that will aid these individuals to move across cultural boundaries. An attempt is made in this paper to develop a model of the individual who undergoes such cultural transition. Such a model should help define problems in service programs, assess the value of current service activities, and identify areas for developing new services that will aid the overall process of cultural transition. A model of behavior development is outlined, followed by a formulation of a model of the individual in cultural change.     

Religion as Cultural Models: Developing an Emic Measure of Religiosity

Despite a century's worth of work, lacunae remain in our understanding of the religion‐health relationship. Scholars in this field have called for increasingly sophisticated conceptualizations of religiosity that refine its connection to well‐being, accounting for both positive and negative associations, while being sensitive to the cultural variations in the experience of religion. This article argues that cognitive anthropological methods provide a novel approach to these issues by conceptualizing aspects of religion as culturally shared “styles of life.” Specifically, the combined approaches of cultural consensus and cultural consonance provide an emically valid measure of religiosity that is then linked to health through the psychosocial stress paradigm. Utilizing research among Brazilian Pentecostals within the state of São Paulo, this intrareligious study evaluates the predictive power of religious cultural consonance relative to widely used and established religiosity scales. Religious consonance is found to have a stronger correlation with psychological well‐being than comparable measures, suggesting that existing standardized measures miss important dimensions of the religion‐health relationship. As such, this article outlines an important area of collaboration between anthropologists and other religion‐health researchers.     

文化对个体风险感知的影响:文化认知理论的解释

文化认知理论旨在从个体层面研究与文化因素相关的个体风险感知差异。它以"格-群"维度划分文化世界观,"格"维度衡量社会的制度化程度,"群"维度衡量社会群体对个体的影响程度,由此编制文化认知量表以测量个体文化理念差异。目前已验证认同保护认知、偏见同化与群体极化、文化易得性、文化可信性、文化认同确认五种作用机制,并在情感启发式研究的基础上引入文化冲突模因作为中介变量建立理论模型。后续研究可推进文化认知测量工具的跨文化检验与本土化修订,并在具体风险主题研究的基础上探索切实可行的公共风险管理对策。     

A Structural Model of Racial Discrimination, Acculturative Stress, and Cultural Resources Among Arab American Adolescents

Despite evidence towards the risk for discrimination and acculturative stress that Arab American adolescents may face, the link between socio-cultural adversities and psychological well-being in this population has not been established. This study examined the role of socio-cultural adversities (discrimination and acculturative stress) and cultural resources (ethnic identity, religious support and religious coping) in terms of their direct impact on psychological distress. Using structural equation modeling, the proposed model was tested with 240 Arab American adolescents. The results indicated a strong positive relationship between socio-cultural adversities and psychological distress. Furthermore, this study supported a promotive model of cultural resources, where a negative association between cultural resources and psychological distress was found. Understanding the manner in which socio-cultural adversities and resources are linked to psychological distress can inform the development of culturally appropriate interventions that can effectively mitigate mental health concerns for understudied and vulnerable populations.     

Cultural accommodation model of counseling

The current article provides an overview to the cultural accommodation model (CAM) of counseling (Leong & Lee, 2006) that may help guide employment counselors' work. The integrative multidimensional model of cross‐cultural counseling (Leong, 1996), a precursor to the CAM, is also reviewed.     

Cultural Mistrust of Mental Health Professionals Among Black Males Transitioning from Foster Care

We examined cultural mistrust of mental health professionals among Black males who are transitioning from the foster care system (N = 74) and its relationship to their level of satisfaction with child welfare services and the frequency of negative social contextual experiences. Results of hierarchical regression analysis showed that the level of satisfaction with child welfare services moderated the relationship between negative social contextual experiences and cultural mistrust of mental health professionals. Specifically, more frequent negative social contextual experiences were related to greater cultural mistrust of mental health professionals for Black males reporting low satisfaction with child welfare services, but not for those reporting high satisfaction with child welfare services. Implications for service delivery are discussed.     

心理健康服务的文化胜任力：理论取向与实践策略

心理健康服务的文化胜任力随着欧美对多元文化群体的重视而逐渐发展起来。该领域存在两种不同的理论取向及相应的实践策略。内容取向关注静态的、结构化的文化胜任力; 过程取向则关注动态的、非结构化的文化胜任力。两种取向的异同体现了文化胜任力的研究和实践中对文化特异性和普遍性因素的平衡。在此基础上, 本文最后讨论了如何参考国外经验, 立足中国现实问题和加强社会心理服务体系建设的大背景, 来发展中国的文化胜任力。