Assessment of psychopathology across and within cultures: issues and findings

Research based information on the impact of culture on psychopathology is reviewed, with particular reference to depression, somatization, schizophrenia, anxiety, and dissociation. A number of worldwide constants in the incidence and mode of expression of psychological disorders are identified, especially in relation to schizophrenia and depression. The scope of variation of psychopathological manifestations across cultures is impressive. Two tasks for future investigations involve the determination of the generic relationship between psychological disturbance and culture and the specification of links between cultural characteristics and psychopathology. To this end, hypotheses are advanced pertaining to the cultural dimensions investigated by Hofstede and their possible reflection in psychiatric symptomatology. It is concluded that the interrelationship of culture and psychopathology should be studied in context and that observer, institution, and community variables should be investigated together with the person's experience of distress and disability.     

Kognitive Verhaltenstherapie bei schizophrenen Psychosen

Cognitive behavioral therapy (CBT) can be regarded as an established intervention for the treatment of patients with schizophrenia. Based on randomized clinical trials and meta-analyses, which found evidence for the efficacy of CBT, almost all evidence-based treatment guidelines recommend CBT for routine treatment. This paper demonstrates that in psychoses CBT is a disorder-specific adaptation of general principles of CBT for the treatment of patients suffering from schizophrenia. The CBT procedure draws on cognitive models of symptoms for the identification of treatment targets and focuses on everyday problems of patients by implementing a self-management approach. Fostering motivation and the application of behavioral and cognitive treatment strategies characterize this approach. If the patients live in a family, other family members should be involved in order to improve crisis management and problem solving within the family. A major challenge for the future is to improve the availability of CBT under the German conditions of routine mental health care.     

Culturally Adapted Psychosocial Interventions for Schizophrenia: A Review

Recent research examining the potential efficacy of culturally adapted interventions for various mental disorders illustrates increasing interest in the integration of cultural perspectives into mental health systems. Despite recent evidence demonstrating that culturally adapted interventions may be more effective than a one-size-fits-all approach, few psychosocial treatments for schizophrenia consider cultural factors that may enhance their efficacy with diverse populations. The aim of this review is to discuss the empirical evidence examining the potential utility of culturally adapted group interventions for schizophrenia, as a means to encourage further work and expansion in this area. Specifically, this article provides an in-depth review of the empirical literature on culturally adapted psychosocial interventions for individuals with schizophrenia and their family members, with a focus on group-based interventions. This review is followed by a discussion of a few cultural constructs that may impact patient and family member functioning, and therefore may be important to address in psychosocial treatments for schizophrenia. Finally, we end this review with a broad discussion of research limitations and potential areas for additional research, clinical implications for adapting EBTs to better address cultural concerns, and a case vignette to illustrate how cultural considerations can be integrated into a traditional multifamily group therapy approach.     

The evolution of family interventions for schizophrenia. A tribute to Gianfranco Cecchin

Family intervention for schizophrenia has informed the whole history of family therapy, although in different fashions. This presentation will deal with the main phases of such intervention, outlining the characteristic features of each one. We can roughly divide the history of family intervention for schizophrenia into four phases: Phase 1 – Conjoint family therapy (1955–1965). Family interventions were aimed at modifying family communication patterns, implying the possibility of a definitive resolution of psychopathology. Phase 2 – Antipsychiatry (1965–1975). This, rather than a treatment model, was a philosophy of psychiatry, which considered schizophrenia as an epiphenomenon of the distortions of Western society. Family treatment was aimed at promoting the awareness of such a dynamic. Phase 3 – Milan systemic therapy (1975–1985). The systemic model was aimed at helping people with schizophrenia to recognize their position within their families (and other significant systems), giving all family members a new sense of their relationships to each other. Phase 4 – Psychoeducation (1985–2005). In most psychoeducational models, schizophrenia was conceived of as a biologically determined disorder. Psychoeducation was a way of helping the not diagnosed family members to cope with problems brought about by the illness, eliciting consensus towards psychiatric treatments such as medication and rehabilitation. A fifth phase of family intervention for schizophrenia is probably developing right now. If this is happening it should probably be an integrative phase, in which different approaches to family dynamics might be bridged and blended, in order to give more effective help to all members of families with schizophrenia.     

Cultural context, obsessive-compulsive disorder symptoms, and cognitions: a preliminary study of three Turkish samples living in different countries

Previous research findings have suggested that recent cognitive accounts of obsessive-compulsive disorder (OCD) are valid across different cultural contexts for both clinical and nonclinical samples; however, there is evidence that cultural differences may have an impact on a number of cognitive variables. For this reason, immigration provides an exceptional opportunity for an examination of the role of cultural context in cognitions and possible changes in cultural characteristics. To this end, the present study examined the interrelationships between thought-action fusion, thought control strategies and OCD symptoms in three nonclinical samples, taking the immigration factor into consideration. Thus, the current study included three Turkish sample groups: those who remigrated to Turkey from Bulgaria, those still living in Bulgaria, and those that have always resided in Turkey. The findings of the study supported the role of thought and action fusion and control strategies in OCD symptoms in a cross-cultural context. To illustrate, worry, as a thought control strategy for OCD symptoms, was a common factor in all three sample groups. However, differences were also noted between the groups, despite having the same ethnic origin. Although they immigrated back to Turkey and have been living there for a considerable period of time, the Turkish remigrants retained similar characteristics to the respondents in Bulgaria on cognitions in general. Consequently, it may be suggested that cultural context might have a relative impact on certain correlates. A replication of these findings using different immigration groups and examining various cultural factors is strongly encouraged.     

Latina/o Children Living With an Immigrant Mother With Depression: Developmental and Cultural Nuances in Recognition and Coping

The psychological experience of maternal depression and its impact on immigrant Latina/o families often goes unrecognized and unaddressed. Children may feel especially helpless and confused about the changes they observe in their mothers’ mood and behavior, and about the deterioration of family relationships. Given the interdependence of family structures of immigrant Latina/o households, maternal depression can be detrimental to Latina/o youth attributions and coping strategies, and to their relationship with their mothers. The quantitative focus of most research on maternal depression in Latina/o samples limits our understanding of family processes in maternal depression. The current qualitative study explores the perceived impact of maternal depression on Latina/o youths’ attributions and coping strategies. This inquiry involved focus groups with 12 participants aged 9–16 years to explore their perspectives on maternal depression. All youth had participated in a 12‐week multifamily group intervention focused on building family and cultural strengths to address maternal depression on immigrant Latina/o families. Findings of the focus groups illuminated the essential experience of youth living with maternal depression, and indicated that there are developmental considerations for how youth recognize and make meaning of maternal depression, and cope with disrupted family life. Additionally, youth reported engaging in these culture‐specific ways of coping: using close sibling relationships and family structure as support, having fathers and extended family members engage in additional and restorative parenting practices, and participating in religious practices to seek refuge from family stress. We propose considerations for intervention and further areas of research.     

Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.     

'Can I (let you let me) leave?’ Therapy with the adolescent and his family

A number of dimensions are reviewed in relation to adolescence. The focus is primarily on adolescence in the context of the family, but it is acknowledged that this is an arbitrary and restricted view of wider social and cultural contexts. It is briefly suggested why this area of work may have been under-represented in professional work in the past. An outline is given of varying ways of defining adolescence, and the impact of this developmental stage in the family life cycle for the adolescent and his family. Within this context, choices must be made over approaches to treatment, and a structural hierarchical framework is proposed. Some of these dilemmas are discussed in relation to therapy with a family where the presenting problem was drug addiction in the younger son. This case was chosen for the many difficulties it raised for the therapist and the other professionals directly involved. The subsequent discussion looks at the implications of some of the mistakes made in therapeutic strategy.     

HIV/AIDS prevention support resourcing with family and peers: University student perspectives

This study explored how students construct family and peers as resources for their HIV prevention. The participants were 20 education students from a South African technology education university (female = 60%, black = 85%; age range = 18 to 24). They completed a semi-structured interview on their access to family and peers talking about HIV/AIDS prevention in the context of perceived cultural influences. The data was thematically analysed using open-coding. Findings suggest that students shared information about HIV/AIDS prevention with peers, and less so with family. They perceived cultural taboos around sex talk to be a barrier to open discussion of HIV/ADS. Students may need to acquire strategies to negotiate HIV/AIDS prevention approaches with family in the context of culture.     

Therapists' Perspectives on Working with Interracial Couples

SUMMARY

This paper is based on interviews with seven marriage and family therapists (AAMFT Clinical Members) on their experiences of providing therapy to interracial couples in the course of their private practices. The interviews were conducted by the author as part of a masters thesis project. Interracial couples may frequently present for therapy with a variety of generic couples' issues and concerns. However, therapists often find that underlying these more generic concerns are issues related to the ethnic, racial, and cultural differences that the partners bring to the relationship. This paper focuses on the historical context of intermarriage, specific concerns and issues that interracial couples experience in their relationships, and on the experiences of therapists providing therapeutic services to this diverse and challenging client population.     

The Relation of Emotion Knowledge to Coping in European American and Chinese Immigrant Children

Emotion knowledge contributes to emotion regulation and coping among adults, but few studies have investigated its role in children’s coping development, especially in a cross-cultural context. We examine relations between children’s emotion knowledge and coping in European American and Chinese immigrant families. One hundred and three 7- to 10-year-old children and their mothers from European American and Chinese cultural background participated in this study. Children's emotion knowledge was assessed using emotion-situation knowledge production task. This task examines their understanding of situational antecedents o discrete emotions. Children’s use of coping strategies was reported by mothers using the Children’s Coping Strategies Checklist. Results showed that Chinese immigrant children had greater emotion knowledge of fear and pride but were reported using less variety of coping strategies than European American children. The relationship between children’s knowledge of self-conscious emotions and their use of distraction coping strategies was moderated by culture, whereby knowledge of self-conscious emotions was negatively associated with the parent-reported distraction strategies only for European American children but not for Chinese immigrant children. The importance of culture in both theory and practice related to emotion knowledge and coping is discussed. Findings in this study suggest that family intervention and children’s emotion training programs may need to consider children’s cultural background.     

Mind the gap: the need for a generic bridge between psychoanalytic and systemic approaches

The context for this paper is the ongoing systemic/psychoanalytic debate. It offers an alternative perspective to the recent contribution by Brodie and Wright (2002), in which they are concerned to underscore difference between the two therapeutic approaches. Here it is argued that the relationship is a great deal more complex than Brodie and Wright's analysis might suggest. Attention is focused on significant areas of commonality, in particular the impact of social constructionist thinking across the two therapies as well as current developments in technique. A case is made for the consolidation of generic space where there is opportunity for cross-fertilization and for integrative and combined systemic/psychoanalytic approaches to be nurtured and developed where appropriate. Case vignettes are used to highlight different aspects of the generic component in child and family therapy and to underline the need for bridge-building between these key therapeutic approaches in the field.     

Brief Strategic Family Therapy: Twenty-Five Years of Interplay Among Theory, Research and Practice in Adolescent Behavior Problems and Drug Abuse

This article describes a systematic program of research that focuses on Brief Strategic Family Therapy (BSFT) and the adaptations that were developed based on BSFT principles. The culture-specific origins of BSFT are reviewed, as well as its broader applications to the field of family therapy. Research is reviewed demonstrating that BSFT is a promising family-based approach to treating Hispanic youth behavior problems and drug abuse. Treatment innovations are described that address the combination of intergenerational and cultural differences that occur among youths and their Hispanic parents. Programmatic work is described that challenges basic principles of family therapy by expanding BSFT to a One Person modality and a strategic engagement procedure. Both of these novel approaches are intended to add tools to therapists' repertoire in working with difficult-to-engage families. A preview discussion of results is presented from a randomized clinical trial that is an application of an ecosystemic prevention version of BSFT. The implications of the work of the Center for Family Studies are discussed in the context of the broader service system. Ultimately, this article articulates a way of thinking about adolescent problem behavior, its social interactional determinants, and a range of theoretically consistent family-centered strategies that attempt to change social ecological processes that impact adolescent developmental trajectories.     

'Stuckness' in live supervision: Expanding the therapist's style

'Stuckness' in the live supervision of family therapy trainees can be used creatively to affect their style and expand their use of self in therapy. Supervisors, after clarifying the contract with their trainees, need to examine how their therapeutic style is constrained by personal qualities. These personal constraints may be related to generic difficulties in their personal, professional and cultural context. These include anxieties generated by the situation oflive supervision, or learning to increase stress to a greater level than the trainees learned to tolerate in their families of origin. Observing an impasse that is influenced by these qualities, the supervisor, who also analyses his or her part in the process, can change the supervisory relationship.     

Developing a Culturally Sensitive Treatment Modality for Bilingual Spanish-Speaking Clients: Incorporating Language and Culture in Counseling

The article examines the role of language and culture in the mental health treatment of Hispanics. Although mental health practitioners and researchers have turned their attention to developing culturally sensitive therapeutic practices, an integrative framework is lacking. The proposed conceptual framework illustrates how the dimensions of acculturation, language dominance and preference, and cultural norms, values, and beliefs affect the assessment ofpsychological and physical health. Furthermore, a number of intervention strategies are described in a cultural context. This framework provides a meaningful method of developing an effective treatment program for the bilingual Spanish-speaking client.     

How semantic content of stimuli works on episodic memory processes in negative schizophrenia: Evidence from picture recognition

IntroductionEven though episodic memory is impaired in schizophrenia, semantic processing strategies can improve patients’ performance. However, it is less clear if negative schizophrenia patients can benefit from semantic strategies, and if both familiarity and recollection processes can be enhanced in patients with schizophrenia.ObjectiveThe aim of this study was to investigate the possibility for negative schizophrenia patients to enhance their familiarity and/or recollection processes in the presence of concrete images.MethodA recognition memory task using concrete versus abstract images as stimuli was designed to assess the performance of schizophrenia patients for single item recognition and the recollection of spatial context, allowing us to calculate the estimates of familiarity and recollection processes. Thirty-six patients with schizophrenia and 18 healthy individuals participated to the study. Schizophrenia patients were divided into two groups according to their scores on the negative scale of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS).ResultsResults showed that, while healthy participants enhanced their recollection estimates in the presence of concrete images, both schizophrenia groups could enhance their familiarity estimates.ConclusionSemantic strategies are helpful to promote successful familiarity process in schizophrenia patients, independently from clinical dimension of negativity. However, recollection process seems not to respond to such strategies.     

'Paradox: a pivotal point in therapy'

This paper describes a family who had been known to the professional caring agencies for some five years. At the time of treatment, the family had fifteen-year old twin sons whose frequently aggressive behaviour was the focus of the referred problem. It was agreed that the author would attempt to work with this family should they be re-referred, with a view to offering an alternative mode of treatment. A structural framework of therapy was tried, but very shortly therapeutic attempts to help solve the problems were assimilated by the family and seemed to serve only to ensure their continuation. At this point, a powerful paradoxical intervention was tried in order to free both family and therapists from perpetuating a 'more of the same'. This tactic allowed time for treatment from a more structural base to continue. In this context, consideration is given to the nature of pathological and therapeutic double binding. Some of the difficulties inherent in attempting new methods of treatment from within a traditional casework setting with its statutory responsibilities are also discussed.     

Family interventions in schizophrenia: evidence for efficacy and proposed mechanisms of change

Family intervention for psychosis developed from empirical work on the role of emotion in families of those caring for someone with schizophrenia. The level of expressed emotion (EE) has been shown to be a robust predictor of subsequent outcome for service users returning to live in family settings. There is also evidence that staff have similar attitudes. This has led to the development of specific family interventions for schizophrenia. NICE Guidelines for Schizophrenia (2003) confirm that family intervention is effective at reducing service user relapse rates and recommends it for those in contact with carers. Exactly how family intervention improves outcome is less clear. A recent model of psychosis proposes a primarily emotional rather than cognitive route for family factors, and some evidence is presented which supports this. Implications for family interventions are discussed.     

Parenting after Weight Loss Surgery: A Conceptual Model and Two Case Reports

The ways families approach eating, shape, and weight can result in stress for individual family members and challenge the overall functioning of the family. This is further complicated among families with a parent who has history of obesity or undergone weight loss surgery (WLS). Although WLS can positively impact other family members, it can also exacerbate conflicts regarding feeding and weight. Such conflicts can involve uncertainty regarding the extent to which the entire family should make the dietary changes recommended for the post-WLS parent. Conflict might also center on the appropriate level of concern regarding the children’s risk of developing (or maintaining) obesity. This paper uses two case examples to describe the application of a specialized, time-limited intervention: Parent-Based Prevention following Bariatric Surgery (PBP-B). The program was developed to address the unique challenges and concerns that arise after, or are exacerbated by, WLS. Each detailed case example illustrates a common child-feeding challenge and the employment of key PBP-B strategies throughout the course of treatment. In the first case, the parent who had undergone WLS believed the family’s current eating behaviors were the same as those that had led to her own overeating, obesity, and co-occurring psychiatric symptoms, while her husband disagreed. In the second case, both parents were concerned about their son’s weight, yet due to their prior eating histories, they felt unable to construct boundaries around the feeding experience. Both cases follow families through the entire intervention and illustrate key points and challenges. These cases underscore the need for novel treatment modalities to support families following parental WLS.     

The transactional model of early home intervention

This article describes a developmental model for early home intervention and treatment of environmentally and biologically at-risk infants and their parents: The Transactional Model of Home Intervention. The model identifies the development of both infants and parents as targets of intervention and considers their ongoing interactions or transactions within the family context as the vehicle of intervention. The child and his physical/social environment are conceptualized as actively influencing one another in their reciprocal transactions. An early intervention program based on this transactional model is described. The intervention is tailored to suit the needs of both child and parents and, more generally, the needs of the family. The intervention process involves a problem-solving model of education by which parents acquire cognitive strategies that will enable them to assess the needs of their child and to design a program to fulfill these needs.