12.7.2 Homogeneity of patient and therapist.

Successful outcome in helping relationships is based on cultural understandings by the therapist. The role of the therapist is to interact with the client in a process of negotiation where the client is encouraged to outline the distressing problem or issue, the therapist seeks to explain the model of therapy to the patient, and the two components are then compared and translated into mutually acceptable definitions and plan of therapy (Kleinman, 1980). Successful outcomes therefore depends on the degree to which there is effective communication between the two parties based on mutually shared cultural meanings of the distress experienced by the patient (Frank & Frank, 1991). In a broader sense developing culturally effective services depend on understanding the patient’s cultural history and traditions as well as the important cultural value systems that support behavior.

In the therapeutic relationship the cultural values of both the patient and therapist matters. Cultural values have an impact on the diagnostic process and on subsequent treatment. It is generally accepted that matching the cultural backgrounds of patients with mental health providers is helpful (Tanaka-Matsumi, 1989). The approach to treatment should make a good fit to the cultural perspective of the client in order to achieve maximum effectiveness (Sue & Sue, 2003). Similarity between client and therapist on relevant variables are important including matching cultural background and ethnicity. While ethnic similarity is less important effectiveness depend greatly on the similarities of cultural perspectives between therapist and client. Research shows that when a client identifies strongly with a culture the patient prefers similarity with the therapist in ethnic backgrounds. In some cases there is also a preference for similarity of gender as clients may think this creates a basis for mutual understanding (Ponterrotto, Alexander, & Hinkston, 1988). However, in a meta-analysis ethnic matching did not appear important compared to similarity of cultural perspectives and values (Shin, Chow, Camacho-Gonsalves, Levy, Allen, & Leff, 2005).

12.7.3 Approaches based in indigenous forms of treatment.

The activity of people in the course of daily living form the basis for understanding the cultural factors that is important to psychological functioning. That assertion in turn requires an understanding of indigenous culture for successful intervention. Indigenous psychology is usually thought of in opposition to and as a rejection of Western psychology as the dominating force in psychological theory. However, Western psychology can also be thought of as an indigenous approach within the cultural norms of Europe and North America. Researchers working within the indigenous field of psychology seek to develop theory and treatments that reflect the social and cultural realities of the local cultural group (Sinha, 1997). Western psychology when imported to India underwent adaptation to local needs. Sinha believed that the ultimate goal of psychology is to develop a universal theory, but that indigenous theories must be considered important inputs toward that final goal. For example, to understand Mexican culture it is essential to understand the values of machismo, the respect demanded and the male role in protecting women (Diaz-Guerrero, 1990).

Western psychology has been severely criticized (Enriquez, 1993) because its values are thought to perpetuate the dominance of colonial exploitation. Since Western psychology was developed in industrialized countries it is thought by indigenous psychologists to have limited value elsewhere. Over time efforts have been made to draw together research findings appropriate for different regions like China (Bond, 1996), Africa (Nsamenang, 1995) or Latin America (Diaz-Guerrero, 1994). On the other hand indigenous psychology has also been criticized as a form of infinite regression to ever more local standards in establishing psychological principles. Further, it has been argued that indigenous psychology is oversensitive to differences between people and cultures, but don’t pay enough attention to the obvious similarities between people all over the world who face many similar trials and developmental tasks in human development.

Indigenous treatment utilizing therapeutic beliefs dominant within a culture must be considered an intuitive art rather than a science. In contrast to modern Western approaches rooted in empirically verified treatment and scientific practices, indigenous treatments are often derived from religion and cultural conceptions of spirituality. In traditional societies there is a greater reliance on family as a source for help in distress and in the hope that are believed to come from the healing power of religion. There are also religious groups in the West that have similar beliefs, even to the exclusion of medical assistance, and seek to heal by prayer and consequently allow their children to die rather than permit medical intervention. Nevertheless such beliefs are contrary to rationality although people who believe deeply do not easily lose their grip on superstitious hopes (Yeh, Hunter, Madan-Bahel, Chiang, & Arora, 2004).

Yeh et al describe stress reduction techniques in Japanese culture that seeks to promote balance and relaxation in the practice of Reiki. Many indigenous treatment approaches promote health by a holistic understanding of distress that perceives the emotional and mental components of the person as totally interdependent. Indigenous approaches in varying cultures have in common an effort to encourage healing powers that already exist within the person, since distress is believed to have emerged from disharmony between the person and the sociocultural or natural environment.