The Papago Psychology Service: A community mental health program on an American Indian reservation

A community psychology service run by the Papago Indian tribe and staffed largely by Papago Indians who have been trained as mental health workers is described. This service is unique among mental health services for Indians in that the tribe has complete control of the funds for the service and sets its own policies. It was developed for a rather traditional Indian group, and the culture, the traditions, and the wishes of the Papago community were respected. Consultation with medicine men was built into the program from the start, and adaptation of mental health techniques to fit the culture is stressed. Before this clinic was established, few mental health resources were directly available to the reservation. Similar to other Indian tribes, the Papagos are economically disadvantaged, with an unemployment rate of over 50%, low educational attainment, and very high rates of alcoholism, suicide, and vehicular accidents. The topics covered are the tribe's view of health programs for its people, the present Papago community and traditional means of treatment, traditional psychotherapy adapted to Papago culture, the indigenous Papago mental health worker, and the non-Indian professional consultant.     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

The school psychologist and early education: An ecological view

An ecological view of psychological services to preschool children is described here as a proactive, seeking-out, mental health delivery system that concentrates its effort on prophylactic activities rather than the “diagnosis recommend” or “diagnosis psychotherapy” ritual. Activities for psychological services, training of staff, and competencies for effective delivery are described. Staff competencies to facilitate children's mental health are also described.     

Linking Job Characteristics and Mental Health among Middle Level Indian Managers: Testing the Mediating Role of Psychological Empowerment

The present study examined the relationship between job characteristics and mental health by testing the mediating role of psychological empowerment. Data were obtained on a sample of middle level Indian managers (n=290) from two manufacturing organizations of North India. Results of the hierarchical regression analyses revealed that all the core job characteristics significantly positively predicted psychological empowerment and mental health after controlling for the effects of demographic variables. The results also showed that psychological empowerment significantly positively predicted mental health over and above the demographic variables. The mediated regression analyses procedure developed by Baron and Kenny (Journal of Personality and Social Psychology 51:1173–1182, 1986) was used to test the mediating effect of psychological empowerment. Results of mediated regression analyses indicated that psychological empowerment significantly mediated the relationship between overall job characteristics and mental health. Further it partially mediated the relationship between core job characteristics (skill variety, task identity, task significance, feedback from work) and mental health. In addition the Sobel test for mediation confirmed the statistical significance of the mediated relationships. The implications of the findings are discussed in order to confirm the importance of core job characteristics to empower employees.     

Mental health and North American Indian/Native communities: Cultural transactions,education, and regulation

Critical issues in the delivery of mental health services to North American Indians/Natives residing in rural areas are discussed by describing Indian populations/communities; briefly summarizing available literature concerning the nature of mental health problems within Indian communities; examining Indian belief systems relevant to participation in mental health service delivery processes; exploring community expectations for structuring participatory interactions which may inhibit utilization of mental health services; and describing transactions between Indian consumers and non-Indian professionals which have become typical over time. The rural context was examined as it interacts with individual and community characteristics to affect Indian mental health. Relations between geography and culture, important in understanding the mental health problems of Indian people, are discussed in regard to expanding community healing resources through empowerment, and viewing "education as transformation" as a key concept in enhancing community healing processes.     

Autonomy and relatedness in psychopathology and treatment: a cross-cultural formulation

A cross-cultural view of psychopathology is proposed, contending that there are two basic systems of self-organization. These two systems of self-organization, labeled autonomy and relatedness, are essential to a person's well-being regardless of the culture or society to which the person belongs. The degree of autonomy and relatedness required to maintain mental health in a specific society is affected by cultural mores. People in collectivistic (primarily non-Western) cultures require high levels of relatedness and moderate levels of autonomy to maintain mental health. People in individualistic (primarily Western) cultures require high levels of autonomy and moderate levels of relatedness to maintain mental health. This view, based on a review of past work in various areas of psychology, is discussed in the context of various forms of psychotherapy existing in individualistic and collectivistic cultures.     

“We Never was Happy Living Like a Whiteman” : Mental Health Disparities and the Postcolonial Predicament in American Indian Communities

In the context of increasing attention to disparities in health status between U.S. ethnoracial groups, this article examines the dilemma of divergent cultural practices for redressing disparities in mental health status in American Indian communities. Drawing upon an ethnographic interview with a tribal elder from a northern Plains Indian reservation, a prototypical discourse of distress is presented and analyzed as one exemplar of the divergence between the culture of the clinic and the culture of the community. Situated in the context of continuing power asymmetries between tribal nations and the U.S. federal government, the implications of this cultural divergence for the efforts of mental health professionals, practitioners, and policymakers are identified as a predicament that only the conventions and commitments of a robust community psychology have the potential to resolve.     

个体心理治疗的复杂性

本文尝试从复杂适应系统理论的角度对个体心理治疗的复杂性加以阐述。依据复杂适应系统理论,心理紊乱并不必然是心理健康的敌人;在个体心理治疗的动力发展过程中,治疗师与来访者相互适应突现配对联盟,来访者的心理变化或新的心理结构的突现具有不可预测性;心理治疗的目标是使得僵化有序、封闭、适应不良的系统朝向日益复杂、开放、灵活适应的状态转化。复杂适应系统理论为探索人类的心理体验与发展提供了新的思路和方法。     

Preferences for Online Mental Health Services Among Australian and Indian Samples: A Cross-Cultural Comparison

Online mental health services provide a point-of-access to mental healthcare that may otherwise be unavailable or limited, particularly in developing countries. Nevertheless, there is a lack of research into individual differences between those who prefer online mental health services and those who prefer traditional in-person services, and whether these differences vary as a function of culture. This study investigated differences in preferences for online or in-person mental health services on e-health literacy, age, education level, and comfort using the internet in a general community sample recruited from Australia and India. A total of 487 participants (31.6% male; mean age?=?33.55, SD?=?12.20, range 18–78), 297 Australians and 190 Indians, completed an online or paper-and-pencil survey. A significant negative relationship between age and e-health literacy was found with younger ages associated with higher e-health literacy. Furthermore, e-health literacy scores were significantly higher for the Australian sample. Age, e-health literacy, country-of-residence, education level, and comfort in using the internet did not predict mental health service preference. The results suggest that preference for in-person or online mental healthcare is independent of demographic and cultural factors and indicate that online mental health services may be acceptable to Indian health service consumers.     

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.     

Barriers between mental health services and Mexican Americans: An examination of a paradox

The paradox of underutilization of mental health services by Mexican Americans is critically examined. It is argued that Mexican Americans live under high levels of psychological and environmental stress that would ordinarily lead to mental health problems and an increased utilization of mental health services. A number of barriers to the use of mental health services by Mexican Americans are examined. Included among these barriers are such factors as the relationship between social class and treatment offered, stereotypes concerning Mexican American folk psychiatry, limitations imposed by language differences, and the effects of stereotypes between Anglo Americans and Mexican Americans. Paradoxical findings in some studies which show a positive perception of mental health services by Mexican Americans are seen to further underscore the need for more research on the Mexican American's position. Stereotypes and generalizations about Spanish-speaking and bilingual Mexican American's approaches to psychotherapy are challenged in the light of recent empirical findings. Recommendations for future research directions and for improving the delivery of mental health services are presented.     

A quality assurance programme for psychotherapy — The finnish experience

In many respects the status of psychotherapy in public health-care systems is similar to that of alternative medicine. The roots of training are outside universities. Legitimation and public funding have been non-existent or insufficient as compared with other fields of health care. Also a great deal of mysticism is attached to both. It is therefore relevant to study the role of psychotherapy from the frame of reference given by research into alternative health care.

Formal health care is characterised by (1) legalised status, (2) access to public funding and (3) integration in the formal medical curriculum. On the other hand there are several treatment philosophies which remain as outsiders from the point of view of formal health care. Informal health care approaches are characterised by (1) lack of legalised status, (2) no access to public funding and (3) no integration in the medical curriculum. Alternative medicine is a term usually attached to forms of informal health care like acupuncture, Spa-culture etc.

Psychotherapy in the public health sector lies somewhere between formal and informal health care. While it has no legalised status, anyone may call himself ‘psychotherapist’. Its definition remains obscure and its public accountability poor.

In this paper I have tried to show how one country — Finland — has tried to grapple with this problem as it attempted to set up psychotherapy services whose quality could be properly monitored — ‘Quality Assurance’ — allowing for public accountability. Now that psychotherapy is well established as a valuable treatment in the field of mental health it is possible to consider future expansion as a cost-effective way to improve the general mental health of the country.     

Responding to unemployment and inequalities in income and health

This paper discusses the social and economic context in which counselling and psychotherapy are practised. The use of ‘outplacement counselling’ and personal skills training programmes for dealing with unemployment and redundancy is criticized. It is argued that they involve a form of psychological reductionism which fails to acknowledge socio-economic realities. Research showing a strong link between inequalities of income and physical and mental health is reviewed. It is suggested that counsellors and psychotherapists have a professional obligation to acknowledge the social and economic circumstances likely to contribute to clients' mental distress and avoid the dangers of reductionism.     

Social and political perspectives on the psychotherapy and counselling profession: Returning caravelles

The counselling and psychotherapy profession is changing. For the first time in its history, it has begun to receive substantial Government funding in the UK and it also has to contend with the principles of evidence-based practice and the policies of the New Public Management systems in many countries. This paper argues that such recent developments present challenges to the profession’s historical apolitical standpoint. More importantly, it argues that the present social and political climate offers many opportunities such as the possibility of learning from psychosocial practices in other countries. The paper will look, in particular, at what can be learned from Latin America and India where mental health care and psychological therapy have adopted grassroots involvement, health-focused approaches and innovatory therapeutic methods.     

Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees

This paper examines with a somewhat critical eye the primary role that psychotherapy and other clinic-based services currently play in addressing the mental health needs of political refugees in the industrialized countries. Two factors are considered which suggest that refugee mental health needs might be better served by complementing clinic-based treatments with a variety of community-based interventions. The first factor concerns the pervasiveness of psychological distress within refugee communities, coupled with the reluctance of many refugees to utilize formal psychological and psychiatric services. This calls into question both the adequacy and appropriateness of clinical-based services as cornerstones of our response to the mental health needs of refugees. More precisely, it suggests the need to complement such services with a variety of culturally grounded, community-based strategies that do not require attendance in formal mental health settings. Second, recent findings have shown consistently that a considerable amount of the distress reported by refugees is related not to prior exposure to violent events, but to a constellation of exile-related stressors such as the loss of one's community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles. It is suggested that while psychotherapy can play an important adjunctive role in helping people confront these exile-related stressors, they may most effectively be addressed through targeted community-based interventions. Examples of such community-based approaches are briefly described, and suggestions are offered for community-level strategies that might be explored. The paper concludes by emphasizing the complementary nature of clinical and community-based programs, and by suggesting that psychotherapy might best be conceptualized as one component of a more comprehensive approach to addressing the mental health needs of refugee communities.     

双文化认同整合与心理适应的关系:辩证性自我的中介作用

本研究从双文化人对于文化认同的主观感知视角出发,采用问卷调查法,以藏汉杂居区的藏族大学生和汉文化区域的藏族寄居大学生为例,探讨双文化认同整合、辩证性自我与心理适应之间的关系,以及辩证性自我在两者之间的中介作用。结果表明:(1)对于两类被试来说,双文化认同整合问卷的和谐冲突维度与心理适应呈显著正相关,与辩证性自我呈显著负相关;但不同的是,藏族杂居区的被试,双文化认同整合的混合区分维度与辩证性自我和心理适应的相关都不显著(2)辩证性自我在双文化认同整合(和谐-冲突维度)与心理适应的关系中起中介作用。实践中,应通过加强少数民族大学生的双文化认同整合,降低其冲突心理、增强矛盾容忍性等辩证主义思想,进而增强其心理适应。     

儒家文化与中国人健康心理的交互建构

中国传统文化的主体是儒家文化,文化与健康心理之间存在着相互作用、相互建构的关系。儒家文化与中国人的健康心理的交互建构作用主要表现在三个方面:一是心理问题躯体化,即文化心理与躯体症状的交互建构; 二是心理问题道德化,即文化心理与德行标准的交互建构; 三是心理问题生活化,即健康心理与伦理规范的交互建构。它们既是中国人健康心理与行为的典型表现特征,也是儒家文化与中国人的健康心理和行为交互建构的结果。心理健康、道德健康、伦理健康三者之间是一个相互作用、相互建构、协调发展的完整体系。中国心理健康服务要充分发挥心理健康理论的建构特性和行动特征,促进心理健康服务理论与实践协调发展。     

Finding One’s Voice: Psychotherapy for Dissociative Motor Disorders in the Indian Context

Dissociation is a prevalent disorder in India, however there is a lack of evidence-based psychological interventions worldwide. The present paper includes two case studies of dissociative motor disorder with onset in the perinatal period, seeking treatment in the Indian tertiary mental health set-up. Both cases presented with disabling symptoms of paraparesis, and mutism in one. The case series discusses similarities in presentation, socio-cultural contexts, and the psychotherapeutic approach. The psychotherapy process is discussed in detail, with a focus on challenges encountered, therapist reflections and supervision. Insights from treatment are presented, including the melding of approaches, and sensitivity of interventions to the larger socio-cultural framework.

     

A Japanese View of Dependency:

White American culture celebrates independence, self-reliance, and individual choice as hallmarks of healthy mental and emotional functioning. However, from a feminist perspective, the disproportionate emphasis on independence in American culture reflects the predominance of the white, middle-class, male point of view; appropriate models for health dependency have been neglected. This paper offers an alternative view of dependency from the perspective of Japanese culture. The structure of Japanese society is predicated on subordinating the needs of the individual to that of family or community and interdependency is highly valued. A psychodynamic theory proposed by Doi (1973) is used to explain the role of dependency in Japanese society. The concept of amae is examined as the central organizing dynamic and its influence on Japanese psychotherapy is also discussed. The Japanese emphasis on amae is often misunderstood by Western thinkers and one example of a racist interpretation of Japanese behavior by a prominent Western theorist is critically reviewed. Lastly, some suggestions are made regarding applications of amae psychology to feminist theory and therapy.     

Mental Health Clinicians' Beliefs About the Biological, Psychological, and Environmental Bases of Mental Disorders

The current experiments examine mental health clinicians' beliefs about biological, psychological, and environmental bases of the DSM-IV-TR mental disorders and the consequences of those causal beliefs for judging treatment effectiveness. Study 1 found a large negative correlation between clinicians' beliefs about biological bases and environmental/psychological bases, suggesting that clinicians conceptualize mental disorders along a single continuum spanning from highly biological disorders (e.g., autistic disorder) to highly nonbiological disorders (e.g., adjustment disorders). Study 2 replicated this finding by having clinicians list what they thought were the specific causes of nine familiar mental disorders and rate their bio–psycho–environmental bases. Study 3 further found that clinicians believe medication to be more effective for biologically based mental disorders and psychotherapy to be more effective for psychosocially based mental disorders. These results demonstrate that even expert mental health clinicians make strong distinctions between psychological and biological phenomena.