The challenge of cross-cultural quality of life assessment

Abstract

As a result of an increased international cooperation in the health care field, the demand for cross-culturally applicable, patient-oriented instruments to assess the need for and to evaluate the outcome of medical interventions has also grown. However, basic problems exist in assessing health-related quality of life—one of the most prominent outcomes—across cultures. Conceptually it is unclear to which extent the quality of life construct is transferable from one cultural context to another. Methodologically, ways to assess the construct have to be sensitive to different cultures and practically, application of quality of life measures may be difficult. The current paper addresses these issues, presenting the current state of the art in cross-cultural development of health-related quality of life assessment instruments as well as a critical review thereof. Examples are provided from internationally active working groups in terms of the translation, psychometric testing and norming of quality of life questionnaires.     

Controversies and Conflicts in the Institution of "Open" Psychoanalysis: Cases from the History of the Therapeia Foundation

The institution of psychoanalysis has included controversies, dissensions and expulsions at both the theoretical-methodological and personal-organizational levels. There have also been several intra- and intergroup conflicts in the history of psychoanalysis, and in constructing and patterning the future of psychoanalytic knowledge. In the context of Finnish psychoanalysis, the Therapeia Foundation (founded in 1958) met from the start with resistance from official psychiatry and also from the IPA. For example, in the mid-1960s, D. W. Winnicott, as the President of the IPA, supported the orthodox Finnish psychoanalytic study group (later to become the Finnish Psychoanalytical Society), and pronounced that the Therapeia group was too loose and was not strictly able to use the IPA-recognized designation "psychoanalytic." The Therapeia Foundation and its Training Seminar combined classical psychoanalysis and its new versions with existentialphenomenological views, anthropological medicine, research on "social pathology" and even modern theological research. On the basis of their Swiss analytic training, three Finnish psychiatrists, Martti Siirala, Kauko Kaila and Allan Johansson, organized Therapeian training to incorporate sciences and arts, and skills involving the therapeutic "carrying" of burdens. The multifacted nature of open psychoanalysis was seen to find its proper organizational expression when the Training Seminar of the Therapeia Foundation became, in 1974, a Member of the IFPS.     

The Attitude of College Students toward God and the Church

Summary

The Porteus Maze has been used as a cross-cultural test for more than 50 years. The Maze may be of use to the cross-cultural researcher or cross-cultural practitioner because it is a performance test, has high intrinsic interest for most persons from various cultural groups, has simple instructions, is easy to administer, and has ease and objectivity of scoring. Variables that may have confounded the results of the cross-cultural studies of the Maze consist of background factors, prior learning, inherited factors, physiological factors, and sampling problems. Other difficulties of equating cultural groups were discussed. It was suggested that the future use of the Maze be in conjunction with various environmental variables and measures of performance.     

Reflections on Psychoanalysis,Peer Review and Evidence

During these times, when society wants "evidence" that treatments are effective, ethical and cost effective, quality assurance and evidence-based medicine have become catchwords. The powers that be place their hopes on them when they find that they have to prioritize forms of treatment. There are different attempts to define these concepts and there are different approaches, most of them based on quantitative studies. This article describes a different approach. It also discusses how you can use the model for peer review among psychoanalytical colleagues as a qualitative study and a base for both quality assurance and a learning process. It also has its place in any formulation of 'evidence' for psychoanalysis and psychotherapy.     

Test Anxiety: A Cross-Cultural Perspective

The present paper examines test anxiety from a cross-cultural perspective with specific reference to the Indian and American cultures. The construct of test anxiety has been examined in many cultures all over the world. In this review, the importance of understanding and incorporating contextual factors in cross-cultural research is emphasized. Moreover, some of the methodological issues related to investigating culture-behavior relationship are discussed. Specifically, the derived-etic approach for conducting cross-cultural research is espoused. Then, research findings from western, cross-cultural, and Indian studies on test anxiety are reviewed. Consistent with the individualistic orientation of the western society, much of the research in the western world has adopted a de-contextualized approach. Inasmuch as many of the cross-cultural and Indian studies on test anxiety have their roots in western research, they have ignored the cultural context as well. To address this void, contextual variables relevant to test anxiety in the Indian setting are examined and hypotheses regarding the nature of test anxiety in Indian children are proposed. Finally, a research agenda is presented to examine these hypotheses using a derived-etic approach.     

The significance of Gadamer’s hermeneutics for cross-cultural understanding

Abstract

Edward Said’s book Orientalism stands in a long lineage of critique of European scholarship responsible for shaping European understandings of foreign cultures. His book contributed significantly to the debate about the epistemological presuppositions informing European scholars of other cultures. However, while Said exposed in considerable detail the ways in which the Orient was distorted by the theories of the European academy, he left unexamined the possibility of genuine cross-cultural understanding. This article considers the significance of hermeneutics for cross-cultural rather than historical understanding. It explores the implicit claim Gadamer makes for the universal validity of hermeneutics not only for understanding in history, but for a genuine intellectual rapprochement across geographical and cultural lines as well.     

The Worldview of Memory Lane

This article is a response to Jacob Belzen’s Towards Cultural Psychology of Religion, Principles, Approaches and Applications (New York: Springer, 2010) from a cross-cultural pastoral perspective and identifies seven issues where the book and cross-cultural pastoral thinking impact each other: definition, research methodology, object of research, flexibility of research, the relationship between cultural and cross-cultural psychology, culture, and private religious experience. Below I will view Belzen’s book through the prism of my primary concerns as a Dutch academic trained in cross-cultural pastoral care and counseling who pastors in a diverse and fluid cultural context.     

Psychoanalysis in the Netherlands during World War II

To understand what happened in the psychoanalytic world in Holland during the German occupation (1940-1945) we must have knowledge of the conflicts within the Dutch Society of Psychoanalysis in the nineteen-thirties. Those conflicts mainly deal with the subject of lay analysis, the compulsory training analysis and in general if compliance with foreign, with IPA rules was advisable. These differences of opinion reached their peak when four Jewish psychoanalysts arrived from Germany in 1933. The Dutch Society broke up in two parts, but was reunited in 1938. During the German occupation the training was finally regulated according to the IPA rules. This lead to a new splitting in the world of Dutch psychoanalysis that has not been healed to date.     

The meaning of boundaries and barriers in the development of cultural identity and between cultures

Abstract

In this paper I shall argue that, although currently in the world of psychotherapy and counselling allusions to culture and cross-cultural work are becoming increasingly frequent, the issues are often talked about in simplistic ways. I shall unpack some of the complexities in the notions of culture and identity to show that they are not the monolithic self-evident natural categories that they are often taken to be. I will do this primarily by focusing on the function of cultural difference rather than the usual procedure of focusing on the differences in the contents of cultures. Although the subject matter of this paper is not drawn directly from the clinical sphere, the contention is that it is pertinent to it none the less.     

On the Psychoanalytic Treatment of the Depressive Personality

In order to discuss the depressive personality we have first to distinguish between this clinical entity and other types of depressive psychopathology that might also be chronic. The character traits and psychodynamics of the depressive personality confirm that there is a special group of patients, who belong to a depressive disorder continuum. The particular technical problems that depressive personality present are: (1) the inability to enjoy anything and the consequences of this on the therapist's experience and interventions, and (2) the negative therapeutic reaction which threatens the analytic process and the therapist's competence. If we combine transference/extratransference interpretations with an "empathetic understanding" approach to systematic confrontation and interpretation, we can therefore justify the need for a slightly modified psychoanalytic technique in the treatment of the depressive personality.     

Salutogenic constructs across Pakistan and Germany: A cross sectional study

Background/ObjectiveProtective factors are relevant for mental health in general, however, universality of the instruments has been rarely tested. Therefore, the current study aimed to examine psychometric properties and cross-cultural measurement invariance of salutogenic constructs.MethodData was collected from university students of Pakistan (n = 1,841) and Germany (n = 7,890). Single-group confirmatory analysis (CFA) and multiple-group CFA was tested to examine the proposed factor structure and measurement invariance of Positive Mental Health Scale, Resilience Scale, Perceived Social Support Questionnaire, and Life Satisfaction Scale across student samples from Pakistan and Germany respectively.ResultsWe found strong measurement invariance for the Positive Mental Health Scale, Life Satisfaction Scale, and partial strong measurement for the Resilience Scale, and Perceived Social Support Questionnaire.ConclusionsThe results indicate that these scales could be recommended for the meaningful comparison of latent means across cultures. Understanding these differences would further advance our knowledge about the mechanism underlying positive mental health.     

Special Issues in Psychotherapy with Minority Deaf Women

Abstract

Minority Deaf women have been traditionally underserved by mental health professionals, and specifically, therapists are unaware of issues unique to this population. It would be highly unlikely for a minority Deaf woman to have a therapist who matches her in racial background, hearing status, and communication mode. Therefore, the therapy process will be completely cross-cultural. Therapists who provide psychotherapy services to minority Deaf women need to be aware that their clients are members of a community where deafness is a culture and not a disability. Minority Deaf women are also likely to report feeling forced to choose between competing identities in order to get important needs met. In the following article, case examples are provided which illustrate some of the major issues that are likely to arise in therapy with minority Deaf women. These issues include: access to important information; communication, support and level of involvement with biological families; competing cultural demands; health concerns; and coping with chronic mental illness.     

Conceptions of the Opposite-Sex Ideal by International Students in the Netherlands

Abstract

An exploratory cross-cultural survey was used to investigate similarities and differences in stereotypes of good and evil. Students from the United States, West Germany (Federal Republic of Germany), Singapore, Nigeria, and Argentina responded projectively to a 62-item questionnaire, completing it as they imagined an extremely “good and virtuous,” an extremely “wicked and evil,” or an extremely “weak and helpless” person would. Two factors consistently emerged: control (the impulse to influence or dominate others) and power (the impulse to accomplish objectives). Stereotypes of good, bad, and helpless were related to extreme positions on these factors, suggesting that the concepts of good and evil are richer than simply opposite poles of a single, evaluative dimension. Strong similarities in factor structures were found across the five samples, but inconsistencies also emerged. In general, control and power appear to have been common across cultures; however, the five samples operationalized them, as well as good and evil, somewhat differently.     

Understanding cross-cultural sales manager–salesperson relationships in the Asia-Pacific Rim region: a grounded theory approach

Abstract

As more organizations implement multinational strategies, sales managers leading sales forces encounter complex cultural challenges that affect relationships, processes, and outcomes. We undertake a qualitative study with the objective of understanding the sales manager–salesperson relationship when the sales manager is leading sales representatives located in other cultures. Because of the significant size and growth of Asian countries, we focus our study on the Asia-Pacific Rim region. In-depth interviews conducted with 21 sales managers working for a large multinational technology firm in our focal region provide the data for our analysis. Using a grounded theory approach, we identify five key themes: building and sustaining cross-cultural relationships, cross-cultural communication effectiveness, acquisition and maintenance of trust across cultures, language, and decision-making. From our findings, research propositions are offered and implications for researchers and practitioners are discussed.     

A Cross-Cultural Perspective on Couple Differences

SUMMARY

This paper challenges the idea that differences between partners in couple relationships are inherently problematic. A “cross-cultural” perspective on differences in couples that considers partners' reactions to difference as the problem is presented. Couples therapy from a cross-cultural perspective begins with a detailed' assessment of perceived differences, reactions to differences, the context in which the differences have developed, and the purposes they serve. Therapeutic tasks involve managing maladaptive reactions to differences, learning to accept differences, and co-designing a common couple culture.     

Exploring Emotive Verbs in Persian and English Short Stories: A Contrastive Sociopragmatic Approach

Current developments in the areas of discourse analysis and cross-cultural studies have led to an increased interest in the way people of different cultures express their affections on various occasions. Individuals learn how to regulate their emotional reactions according to sociocultural norms of behavior defined by the cultures to which they belong. Accordingly, this article aimed to investigate the linguistic expression of emotions in English and Persian short stories in order to fathom out the impact of culture on the way feelings are expressed cross-culturally. For this purpose, a corpus of eight different English and Persian short stories, four in each language, was selected based on a purposive sampling method. Then, using Devon’s (The origin of emotions, 2006) typology of emotions, different types of emotive verbs were selected as the unit of analysis. Finally, the frequency and percentage values of emotive verb tokens used in these stories were carefully tabulated in terms of types and their respective metalinguistic categories introduced by Wierzbicka (Emotions across languages and cultures: diversity and universals, Cambridge University Press, Cambridge, 1999). The results obtained from the analysis of the targeted corpora reflected that English and Persian writers employ different types of emotive verbs in expressing their feelings. Essentially, the findings of the present study may have important implications for language teachers, material developers, and course designers.     

Team Spirit,Team Chemistry,and Neuroethics

Abstract

This paper examines the phenomenon of team spirit from a neurobiological point of view. It argues that ethical judgment should be involved in understanding and evaluating the idea. Adopting a liberal individualist point of view helps us understand the phenomenology of team spirit, while also helping us to articulate a critique of communitarian approaches that celebrate the sort of de-individuation that occurs in team spirit. The paper recognizes further complexity in terms of cross-cultural issues, as well as the tendency to toward reductionism. It concludes by imagining a thought experiment involving chemically enhanced team spirit, which shows how our larger ethical framework helps us evaluate possible responses.     

Personality in Cultural Context: Methodological Issues

Methodological issues in cultural and cross-cultural personality research are described. A taxonomy of these studies is presented, based on whether a study is exploratory or tests hypotheses, and whether or not contextual information is measured. Core methodological issues are bias and equivalence: a taxonomy and a brief overview of statistical procedures to examine equivalence are presented, with a focus on procedures for assessing structural equivalence (i.e., similarity of meaning of an instrument across cultures). Examples are given of studies in which cultural and cross-cultural approaches, often seen as antithetical, have been fruitfully integrated. Finally, multilevel models are described in which personality characteristics are examined at individual and cultural level.     

Psychoanalysis and Human Values

Psychoanalysis can contribute quite a lot to the question of values and to a theory of ethics. While the first part of this presentation is focused on the impact psychoanalysis continues to exert on present day ethical theory, the second part discusses Erich Fromm's particular approach to psychoanalysis. Fromm was the first to reformulate in his psychoanalytic approach the idea of an ethic of the virtues. With his theory of character (and of social character) he made values an integral part of psychoanalytic theory. Hence, what matters most morally from a psychoanalytic stance is the quality of character orientation. Despite the fact that - in Fromm's own socio-psychoanalytic approach - man's character is the product of adaptation to the environment, morality for him is dictated by economic and social requirements - whatever common sense may tell us to the contrary. For Fromm there is an intrinsic primary tendency to growth in all human beings. Thus, morally good is whatever furthers the growth of our own powers by which we relate to the outside world and to ourselves in a loving, "sane" and creative way. The last section reflects some implications of Fromm's approach to understanding values as an integral part of psychoanalytic theory, and finally discusses whether the search for truth and human values is as obsolete as postmodern thinking claims.