19.3: Connections Across Cultures
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Understanding Culture’s Effects on Cognitive Style as a Prerequisite for Effective Cognitive-Behavioral Therapy
An essential element of all cognitive therapies is the desire to identify and challenge a client’s underlying dysfunctional cognitions, whether they are mistaken beliefs, schemas, automatic thoughts, cognitive distortions, whatever the case may be. To do so, requires that the therapist knows when cognitions are dysfunctional, and to some extent, what would be a reasonable cognition in the client’s personal situation. While it may seem obvious that any psychologically healthy person, particularly a trained therapist, would be able to recognize the difference between functional and dysfunctional thoughts, feelings, and behaviors, this assumes that the therapist and the client come from similar environments. This may very well NOT be the case when the client and the therapist come from dramatically different cultures. Furthermore, as G. Morris Carstairs noted regarding psychiatric interviews (1961), it makes a significant difference whether it is the therapist or the client who is outside of their familiar culture. For example, when a psychologist conducts research in a foreign country, particularly in small towns or villages, local people may simply fear and avoid strangers.
Kelly discussed culture at length in The Psychology of Personal Constructs (Kelly, 1955a,b). Both the commonality corollary and the sociality corollary are directly influenced by our understanding of culture. We, and by “we” I mean to include therapists, tend to expect that people from similar cultures have experienced basically similar upbringings and environments. We also tend to believe that people from a given culture share their expectations regarding the behavior of others from that culture. Thus, in order for a therapist to gain access to the personal constructs of their client, it is important for the therapist to learn as much as possible about the client’s cultural heritage. Failure to do so may interfere with the therapist’s ability to understand some of the client’s disruptive anxieties about either therapy itself or their life in general. Indeed, Kelly shares an example in which a White therapist (whom Kelly was supervising) found it difficult to help a Black client, because the Black client was overly anxious about discussing racially charged feelings regarding interracial sexual relationships. Since the client had discussed sexual issues before, the White therapist did not readily recognize the discomfort with which the Black client addressed his attraction to White women (remember, this was in the 1950s!).
Kelly goes on to discuss cultural differences in mannerisms, language, expectations regarding mental illness, the influence of religion, and how a therapist might go about learning more about a client’s cultural experiences. He does caution, however, that one should not attribute too much value to the influence of culture:
…It is important that the clinician be aware of cultural variations. Yet, from our theoretical view, we look upon the “influence” of culture in the same way as we look upon other events. The client is not merely the product of his culture, but it has undoubtedly provided him with much evidence of what is “true” and much of the data which his personal construct system has had to keep in systematic order. (pg. 688; Kelly, 1955b)
For example, it is often considered the mark of a sophisticated clinician that he considers all of his clients in terms of the culture groups to which they belong. Yet, in the final analysis, a client who is to be genuinely understood should never be confined to the stereotype of his culture. (pg. 833; Kelly, 1955b)
Albert Ellis and Aaron Beck, originators of the best known cognitive-behavioral therapies (see Beck & Weishaar, 1995; Ellis, 1995), also discussed cultural influences, though not as extensively as Kelly had. Ellis emphasized that each individual develops a belief system which helps them make judgments and evaluate situations. Although each person’s belief system is unique, they share many beliefs with other members of their society and/or culture. Perhaps more importantly, different cultures can have very different belief systems. To complicate the situation even further, cultural beliefs can change, either due to gradual evolution of the culture or in a more dramatic fashion when an influential thinker or leader offers a different perspective on life (Ellis, 1977). Beck has discussed how culturally-determined schemas can be so fundamental that they contribute to how and who we both love and hate (Beck, 1988, 1999).
Today, studies on the relationship between culture and cognition continue, both in clinical and non-clinical settings. There are at least two handbooks focusing on cross-cultural and multicultural factors in personality assessment (Dana, 2000; Suzuki, Ponterotto, & Meller, 2001). According to Suzuki, et al. (2001), these handbooks are necessary due to “the growing number of racial and ethnic minorities in the United States and in recognition of the multitude of variables that affect performance on cognitive and personality tests…” As assessment transitions to therapy, it becomes quite a challenge for any therapist to be familiar with the wide variety of cultures in America. Axelson (1999) has identified six basic cultural groups in America: native Americans, Anglo-Americans, European ethnic Americans, African Americans, Hispanic Americans, and Asian Americans. This list obviously does not include the many immigrants living in this country who are not considered to be American. When faced with such cross-cultural challenges, the essential skills for a therapist include careful and active listening, genuine verbal and nonverbal responses that indicate successful communication, being honest about what you do not understand, respecting and caring about the client, and being patient and optimistic (Axelson, 1999).
Additional studies have suggested that cultural knowledge influences the interpretation of stimuli in a dynamic, constructivist fashion (Hong, Morris, Chiu, & Benet-Martinez, 2000), that these processes occur automatically (Bargh & Williams, 2006), and that experiencing a wider variety of cultures in one’s education may actually lead to more complex cognitive processing (Antonio, Chang, Hakuta, Kenny, Levin, & Milem, 2004). When considering fundamental cultural differences, what some consider the core values that distinguish amongst cultures, most psychology students are familiar with the distinction between individualistic and collectivistic cultures (cultures in which one favors one’s own goals as compared to subordinating one’s own goals in favor of group goals). However, Laungani (1999) suggests that there are three other common dimensions: free will vs. determinism, materialism vs. spiritualism, and cognitivism vs. emotionalism. According to Laungani, Western cultures tend to be work- and activity-centered. Thus, they operate in a cognitive mode that emphasizes rational, logical, and controlled thought and behavior. Non-Western cultures, in contrast, tend to be relationship-centered, operating in an emotional mode. Public displays of feelings and emotions, both positive and negative, are not frowned upon (Laungani, 1999). These core values carry over into cognitive styles. For example, the cognitive style prevalent in Africa tends toward synthesis, as opposed to analysis. Africans tend to integrate their experiences into an inclusive whole, and they view such tendencies as more natural than the typical Western alternative (Okeke, Draguns, Sheku, & Allen, 1999). Thus, one can imagine a therapeutic situation in which the client resists analyzing their problems, and the therapist considers that resistance to be a specific problem unique to the client. Any subsequent attempts by the therapist to break down that resistance would be flawed, since the therapist has not understood the underlying cognitive style of the client. The failure of therapists to properly address the significance of cultural factors in therapy, regardless of whether or not their failure was unintentional, has been described as cultural malpractice (Iijima Hall, 1997).