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.     

An Evolutionary Account of Suicide Attacks: The Kamikaze Case

Explanations for suicide attacks abound. Yet the literature remains conceptually fragmented, with different authors focusing on different attitudes, incentive structures, values, psychological processes, strategic imperatives, and cultural, historical, and personal circumstances. Curiously, however, there have been few efforts to cast suicide bombing within the extensive evolutionary literature on human altruism—in which it clearly belongs. Neither have there been more than occasional efforts to mobilize the distinction between “proximate” and “ultimate” explanations, with most proposed explanations being proximate. Here we draw on content analyses from materials written by Japanese Kamikaze pilots to propose an evolvable cognitive algorithm—by hypothesis, species typical—that (1) specifies environmental circumstances under which such “heroic” behavior is likely; (2) is consistent at the proximate level with the Japanese data; and (3) that is not inconsistent with many of the diverse proximate attitudes, values, and psychological mechanisms that dominate discussions of contemporary suicide campaigns. The evolutionary perspective is not an alternative to most of the proximate explanations offered in discussions of contemporary cases but is, rather, a paradigm around which diverse proximate explanations can be organized.     

One country,two cultures: Implicit space–time mappings in Southern and Northern Vietnamese

What determines how people implicitly associate the “past” and “future” with “front” and “back”? According to the Temporal Focus Hypothesis (TFH), people's cultural attitudes toward time influence their implicit space–time mappings. However, previous research mainly used cross‐cultural comparison in which the cultures compared differ not only in attentional focus on temporal events, but may also differ in other cultural values. Thus, the specific role of cultural attitudes toward time has not been tested. In the current study, we compared Southern and Northern Vietnamese who have many aspects in common but demonstrate cultural differences in attitudes toward the past and future. The results showed that the two groups of participants tended to think about time according to their temporal focus. Taken together, this pattern of results showed that within‐cultural differences in temporal focus can also predict variation in space–time mappings, which provides further supporting evidence for the TFH.     

Psychotherapy in the aesthetic attitude

Abstract: Drawing upon the writings of Jungian analyst Joseph Henderson on unconscious attitudes toward culture that patients and analysts may bring to therapy, the author defines the aesthetic attitude as one of the basic ways that cultural experience is instinctively accessed and processed so that it can become part of an individual's self experience. In analytic treatment, the aesthetic attitude emerges as part of what Jung called the transcendent function to create new symbolic possibilities for the growth of consciousness. It can provide creative opportunities for new adaptation where individuation has become stuck in unconscious complexes, both personal and cultural. In contrast to formulations that have compared depth psychotherapy to religious ritual, philosophic discourse, and renewal of socialization, this paper focuses upon the considerations of beauty that make psychotherapy also an art. In psychotherapeutic work, the aesthetic attitude confronts both analyst and patient with the problem of taste, affects how the treatment is shaped and ‘framed’, and can grant a dimension of grace to the analyst's mirroring of the struggles that attend the patient's effort to be a more smoothly functioning human being. The patient may learn to extend the same grace to the analyst's fumbling attempts to be helpful. The author suggests that the aesthetic attitude is thus a help in the resolution of both countertransference and transference en route to psychological healing.     

Creative Group Living in a Children's Institution Edited by Susanne Schulze

Psychoanalytic psychotherapy is not well developed in Japan (Kotani, 1996). Until recently, group psychotherapy in particular has not been well received by patients or clinicians. Cultural difficulties in using group psychotherapy with Japanese patients have now been overcome and a theory of systematic intervention techniques has been developed. The basic dynamic factors of group psychotherapy such as culturally embedded aspects of social and personality structure are analyzed in this article. Culture-bound psychodynamic characteristics of Japanese patients as activated and worked through in the group process are first described with case illustrations. A systemic hypothesis linking cultural and psychodynamic structure is then delineated and the focal points of interventions are explained in terms of the field dynamics of social structure and boundary dynamics of personality structure.     

The Edge of Chaos: Enactment,Disruption, and Emergence in Group Psychotherapy

The author outlines his approach to the theory and practice of group psychotherapy. The emphasis is on therapy by the group rather than therapy in the group. The therapist's task is to help the group itself become the agent of change. The group is conceived as being composed of many multiple selves. The process of group psychotherapy unfolds through enactments that involve the whole group and the group therapist entering into the grip of repetitive and unmentalized self-states. These enactments are resolved when the group members, with the therapist's help and containment, can access alternative self-states that allow for new and unformulated experience to emerge. This dialectical movement between the rigid “familiar chaos” of enactment and the reflective and related working through is compared to the dynamic systems theory articulation of the tension between rigidity and chaos captured by Kauffman's notion that “life exists at the edge of chaos.” A group session is described that involves a painful enactment. It illustrates how the therapist allows the enactment to unfold by holding and containing intense affect and how the group members are helped to find their own meaning and new experience in interaction with each other.     

ISLAM AND BIOETHICS IN THE CONTEXT OF “RELIGION AND SCIENCE”

This paper places “Islam and bioethics” within the framework of “religion and science” discourse. It thus may be seen as a complement to the paper by Henk ten Have ( 2013 ) with which this thematic section in Zygon: Journal of Religion and Science opens, which places “Islam and bioethics” in the context of contemporary bioethics. It turns out that in Zygon there have been more submitted articles on Islam and bioethics than on any other Islam‐related topic. This may be a consequence of the global nature of the bioethical issues, driven by advancement in science and technology, which allows for conversation across cultural and religious boundaries even when the normative references and argumentative methods are tradition‐specific.     

Culture and attitudes toward psychological help-seeking influence clients’ self-disclosure

Cultural factors are known to influence aspects of psychotherapy. The influence of cultural values on self-disclosure was explored through surveys of Greek migrants to Australia (n?=?106), native Greek Cypriots (n?=?189), and Australians (n?=?35) on individualism–collectivism, attitudes toward seeking professional psychological help, and measures of self-disclosure. It was hypothesized that more collectivist participants would have less positive attitudes regarding self-disclosure. Against our predictions, all three groups showed highly similar attitudes toward seeking help and self-disclosure that were not related to the predicted links with individualism–collectivism.     

The associations in our heads belong to us: Searching for attitudes and knowledge in implicit evaluation

Explicitly, humans can distinguish their own attitudes from evaluations possessed by others. Implicitly, the viability of a distinction between attitudes and evaluative knowledge is less clear. We investigated relations between explicit attitudes, cultural knowledge and the Implicit Association Test (IAT). In seven studies (158 samples, N=107,709), the IAT was reliably and variably related to explicit attitudes, and explicit attitudes accounted for the relationship between the IAT and cultural knowledge. We suggest that people do not have introspective access to the associations formed via experience in a culture. Ownership of mental associations is established by presence in mind and influence on thinking, feeling and doing. Regardless of origin, associations are influential depending on their availability, accessibility, salience, and applicability. Distinguishing associations as “not mine” is a self-regulatory act and contributes to the distinction between explicit evaluation, where such acts are routine, and implicit evaluation, where they are not.     

Personal attitudes toward time: The relationship between temporal focus,space‐time mappings and real life experiences

What influences how people implicitly associate “past” and “future” with “front” and “back?” Whereas previous research has shown that cultural attitudes toward time play a role in modulating space‐time mappings in people's mental models (de la Fuente, Santiago, Román, Dumitrache & Casasanto, 2014), we investigated real life experiences as potential additional influences on these implicit associations. Participants within the same single culture, who are engaged in different intermediate‐term educational experiences (Study 1), long‐term living experiences (Study 2), and short‐term visiting experiences (Study 3), showed their distinct differences in temporal focus, thereby influencing their implicit spatializations of time. Results across samples suggest that personal attitudes toward time related to real life experiences may influence people's space‐time mappings. The findings we report on shed further light on the high flexibility of human conceptualization system. While culture may exert an important influence on temporal focus, a person's conceptualization of time may be attributed to a culmination of factors.     

Parallel Group Treatment of Pre-School Children and Their Mothers

Object relations concepts are applicable in children's group psychoanalytic psychotherapy. The author attempts to explore and delineate areas in which developmental conflicts in object relations, emotional deprivations, traumas, and family pathologies are recapitulated in the group, and how the manifestations of pathologies can be rectified by the process and formation of the group and the role of the therapist as a “new object” in the management of individual and group transferences. Clinical examples are presented.     

The Worldviews of Healing Traditions in the East and West: Implications for Psychology of Religion

This article will compare the worldviews of psychotherapy traditions in Eastern and Western culture, particularly the therapeutic factors and principles indigenous to the Chinese culture. The author will first define the meaning of culture and psychotherapy from a postmodern anthropological approach. By referring to history and literature in the study of cultural psychology, a comparison will be made between the value systems lying behind therapeutic methods used in the East and West. This includes the worldviews on the body and mind, the self, mental health, relationship, community, healing, and spirituality. Lastly, a famous Chinese legend will be used as an example to illustrate how worldview differences between the East and West determine the goals and process of psychotherapy. It is hoped that psychology of religion would be sensitive to the underlying worldviews across different cultures, without imposing its definition of “mental health” and method of “healing,” as different religions embody different cultural traditions as well. It is argued that whether spirituality or religion is helpful to the wellbeing of local people, it should be defined by the local persons and expressed in their mother tongue. Hence a psychology of religion for Chinese people should respect its customs of healing and particular set of worldviews.     

Patterns and determinants of attitudes of psychiatric residents toward group therapy

The nature and origins of psychiatric residents' attitudes toward group psychotherapy were assessed by means of a semistructured interview. Subjects were 10 PGY-4 residents from five different residency training programs. Questions focused on subjects' perceptions of the possibilities and limitations of group therapy as a treatment modality, the efficacy and dangers of combined and conjoint treatment, the nature and extent of their training experiences in group approaches, the salient characteristics of their group therapy teachers and supervisors, and the attitudes of faculty about group psychotherapy that they were able to infer. Results suggest enormous variability of residents' attitudes. Hypotheses about the reasons for such variability are offered.     

KAUFMAN'S DEBT TO KANT: THE EPISTEMOLOGICAL IMPORTANCE OF THE “STRUCTURE OF THE WORLD WHICH ENVIRONS US”

Gordon Kaufman's “constructive theology” can easily be taken out of context and misunderstood or misrepresented as a denial of God. It is too easily overlooked that in his approach everything is an imaginary construct given no immediate ontological status—the self, the world, and God are “products of the imagination.” This reflects an influence, not only of theories on linguistic and cultural relativism, but also of Kant's “ideas of pure reason.” Kaufman is explicit about this debt to Kant. But I argue there are other aspects of Kant's legacy implicit in his method. These center around Kaufman's engagement with “observed patterns” in nature. With Paul Tillich's aid, I bring this neglected issue to the fore and argue that addressing it allows one to more readily capitalize upon the Kantian influence in Kaufman's method. This, in turn, encourages one to tap more deeply into the epistemic underpinnings of Kaufman's approach to the science–religion dialogue.     

Commentary on Steven H. Cooper’s Paper “Blurring Boundaries or Why Do We Refer to Sexual Misconduct With Patients as ‘Boundary Violation’”

In this commentary on Steven H. Cooper’s paper, the author acknowledges that the term boundary violation presents a vexing problem when we try to integrate it with the traditional use of the term boundary in psychoanalytic thought. He suggests that the two discourses represent two separate but somewhat related levels of discourse and that overlap occurs in some areas but not in others. While the use of “boundary violations” to describe ethical misconduct presents problems, the author suggests that it may be useful for some analysts who have experienced a collapse of analytic space and can no longer “play” in a symbolic realm. He also suggests that we may be stuck with the term because of the unconscious function it serves for the analytic community.     

The “Perseverant” Personality: A Preattachment Perspective on the Etiology and Evolution of Binge/Purge Eating Disorders

The author integrates “psycho-digestive” metaphor with contemporary relational perspectives and developmental research to propose a way of thinking about the etiology and evolution of binge/purge eating disorders—including “purging anorexia,” bulimia, and “yo-yo” binge/dieting—and the personality organization that may underlie them. Focusing on the unifying, cyclical nature of these disorders, the author hypothesizes that an early-developing, fear-based form of somatopsychic perseveration may be set in motion from the beginning of life when a nursing infant is unable to achieve a psychic connection with a physically present and feeding (m)other. Without intervention, such a preattachment failure in (m)other/infant synchrony would inevitably impact all subsequent development. The author proposes that it may also lay the foundation for a uniquely intertwined somatopsychic personality organization—what she calls a “perseverant” personality—that fosters the development of binge/purge eating disorders. A perseverant personality is defined as a solitary and circular mode of being, thinking, and relating that is organized around a sustained physiological and psychological reliance on the feeding as a mode of thought-processing and affect regulation.     

Differences Between Australian and Japanese Students in Reported Use of Decision Processes

Decision making is an activity found in all cultures. Although many theoretical models have been developed to explain human decision making, very few have taken the role of culture into account. In this paper the importance of cultural influences on self-reported decision-making styles is examined, with particular emphasis on the dominant cultural pattern (i.e. “group orientation” versus “individual orientation”). Results of a questionnaire study of 743 Japanese and 309 Australian university students are presented. As predicted, Japanese students reported greater use of decision processes or behaviours associated with the involvement and influence of others (“collateral role”), while Australian students reported greater use of decision processes associated with self-reliance and personal ability (“individual role”).     

Is the Impact of Psychotherapy Processes on Outcomes Already Quacking and Waddling? Comment “A Primer on Psychotherapy Process Research (Pfeifer & Strunk, 2015)”

The article by Pfeifer and Strunk on psychotherapy process research offers a highly thoughtful review on the state of psychotherapy process research in cognitive therapy for depression, and the inherent challenges in establishing causal relationships between process and outcomes. In this commentary, I argue that the goal of internal validity in psychotherapy process research may be unattainable, and possibly unnecessary. Finally, I suggest that psychotherapy process research should shift from “does it affect change?” to “how does it affect change?”, “when does it affect change?”, and “for whom does it affect change?”     

Sigmund Freud: Four Centenary Addresses by Ernest Jones

Group psychotherapists, primarily members of the American Group Psychotherapy Association, were surveyed to determine their practice and attitude toward inclusion of patients receiving psychotropic medication in their “typical” outpatient psychotherapy groups. One hundred forty-three questionnaire responses were received from 258 contacted practitioners (55.4% return rate). More than two-thirds of the physicians, social workers, and psychologists reported including medicated members, and the professions did not significantly differ. Mood disordered patients were most frequently and schizophrenic and manic patients were least frequently reported to receive medication.

Overall, clinicians' attitudes favored including medicated patients in the group. Indeed, therapists did not view inclusion of drugs as a detriment to the treatment process. Clinicians having only one medicated patient in their group felt more strongly that such individuals did not interfere with the treatment process when compared with those having none or more than one medicated patient. The one difference by discipline was that social workers and psychologists did not endorse the idea that medicated patients needed to be in groups led by psychiatrists.