Cultural Difference in Clinical Psychology
It is never an easy task for a person to rise above the socially stigmatizing role of “Otherness,” or as an outsider. While in recent years accredited clinical psychology programs have introduced the concept of cultural diversity training into their academic curriculum, and while this is certainly something that is absolutely necessary to do, the fact of the matter is it may not be enough. Matsumoto notes a number of cultural barriers and cites a variety of ways in which culturally and ethnically different patients and clinicians fail to see eye to eye, so to speak. It is absolutely of the utmost importance that any person who wishes to work in clinical psychology with a client base which will inevitably include a variety of cultural diversity understands that these differences exist and that they will prove to be a barrier in treatment. But knowing that will not necessarily prepare them to actually deliver culturally-sensitive and appropriate treatment. Additionally, the clinical psychologist himself is just as much of an “other” or “outsider” to the patient and his family and he is to the clinician, and no amount of cultural-sensitivity training can wash away that predisposed stigma in the patient’s eyes.
Matsumoto notes early on that the entire field of clinical psychology (and really, psychology as a field of medicine at all) is predominantly an Anglo-European field of study, created by Western civilization and filled with Western values and Western ways of understanding society and how people interact with the world around them. And again, this is an Anglo-European, Anglo-American, across-the-board Caucasian understanding of social interactions, with, as Matsumoto points out, a heavy emphasis on the individual as opposed to the larger group. This way of viewing the patient—as an individual, who is to spend time focusing and reflecting on the individual and his own needs and feelings—predominates the entire field of clinical psychology. Therein lies the true problem: a person can be trained to be culturally sensitive towards individual patients, but in order for any kind of treatment to be effective the entire nature of the field of clinical psychology must change and adapt to account for this vast difference in cultural understanding.
One of the major adjustments that a person studying clinical psychology would have to be sensitive towards is that in many other cultures (perhaps even the overwhelming majority) outside of the Western Anglo-European, Caucasian-American culture that is more or less considered the “norm” of clinical psychology (in that this culture is that which the field of clinical psychology is based in) place much less of an importance on the individual and much more on the group, be it the family, close neighbors, pastors, etc. Matsumoto notes, “Recognizing and involving members of the extended family instead of focusing on the individual and nuclear family may be useful and may present a more familiar approach to problem solving” (374). There is an old saying that goes, “It takes a village to raise a child.” In the case of clinical psychology, it might take that same village to treat a mental illness.
Matsumoto also points out that a number of other cultures prefer “more directive and strategic interventions…over client-centered or reflective therapy” (374). This also flies in the face of traditionally understood clinical psychology, which does focus heavily on self-reflection, introspection, and working on the individual. Certain cultures (here Matsumoto calls out the Puerto Rican culture) expect more of a “I have a problem, tell me how to fix it” approach—understandably so, but this is in direct conflict with the nature of clinical psychology. Matsumoto also refers to Asian cultures here, stating that Asian families may wait a long time to seek professional treatment, so when they finally do the situation is already at a critical point and there simply isn’t the luxury of time to nurture self-reflection. Again, this is not an issue of the psychologist not being aware of or sensitive to these cultural differences, but rather an issue of the psychologist trying to address these differences within a professional framework that doesn’t allow much room for them.
Shame is another problem, one that cannot easily be solved by cultural diversity sensitivity training. Matsumoto notes repeatedly that many people from different cultural backgrounds will not seek treatment because they are ashamed—ashamed they need it, ashamed they couldn’t fix the problem themselves, afraid of bringing shame on their family, afraid of being an outcast. Despite how culturally sensitive a clinician might be, it means very little when the stigma of the treatment prevents the patient from seeking the treatment in the first place. And this is to say nothing of the fact that a person from a different cultural or ethnic background just simply might not feel comfortable speaking so openly with a person who is not from a similar background, again rendering any kind of diversity training futile for the clinician.
In summation, for any clinician to maximize his own effectiveness for his patients, a program that teaches him about differences among races and cultures and prepares him in various ways in how to treat these differences is absolutely a necessity. The information garnered from such a program would prove invaluable to the clinician and his ability to effectively treat his patients. However, it is grossly reductive to assume that training the clinicians in different cultural understandings and ways to address them is enough to overcome the barrier that the entire field of clinical psychology seems to be facing with ethnically and culturally different groups. The truth is, the very nature of clinical psychology is in ways an insult or a stigma to these groups, that being moreso the problem than culturally dense clinicians. In order for the clinician’s training to be effective, the patient has to be willing to walk through the door in the first place. The field and practice of clinical psychology has to adapt itself to these many and varied world-wide cultural differences, and only then can real progress be made on the doctor-patient end.