12.5 Culturally sensitive assessment of abnormal behavior.

If culture has an impact on defining normal behavior within the cultural context, cultural values also have a modifying affect as the framework for abnormal behavior. Cultural factors valid in psychotherapy involve the relationship between the patient, the therapist and the cultural context of society. The cultural context must of necessity be understood since it influences both the manifestation of symptoms and how to understand the disorder from the patient’s and the therapist’s point of view. The recommended treatment is framed by the cultural context (Beardsley & Pedersen, 1997). In Western psychotherapy the healing relationships between therapist and patient have developed out of theoretical orientations prominent in psychology including learning theory, humanistic theory and gestalt approaches. These therapeutic approaches can be considered culturally specific to Western countries, although they may have relevance to other culturally different societies.

The importance of the culturally context of mental disorders require us to evaluate whether the assessment and tests used in one cultural setting are applicable to another culture. To what extent can we transfer clinical assessment that will produce both reliable and valid measurements of mental disorder? It is clearly important to develop culturally sensitive testing since we have already observed that mental disorders that are universal have a somewhat different expression in various cultures. The Diagnostic and Statistical Manuel has gone through a number of revisions since first published in 1952. The current edition takes into account how expressions of disorders might vary by culture. In addition the appendix contains a number of culturally specific syndromes, some of which we have discussed. Further the DSM now has guidelines to probe for relevant cultural variables that influence the manifestation of symptoms. In particular the specific factors are stressed that are relevant in the person’s cultural context, and differences in the cultural outlook between the patient and the therapist (Kawa and Giordano, 2012).

Still many challenges remain for clinicians to define what is and what is not culturally specific in mental disorders (Paniagua, 2000). In response to the need for culturally specific guidelines Chinese specialists have created a separate Chinese Classification of Mental Disorders that has been influenced by the DSM, but nevertheless include issues unique to Chinese cultures, and have also eliminated other disorders in the DSM that are thought to be irrelevant like sibling rivalry. Since most Chinese have only one child sibling rivalry is not an issue for most families. In Africa other clinicians have developed guidelines thought more appropriate for dealing with patients in that context (Douki, Moussaoui & Kacha, 1987). Ultimately culturally sensitive assessments depend on cross-cultural research identifying relevant variables that can provide valid guidelines for the therapist.