Selecting ethical treatment choices
In Western medicine it is a common practice to treat psychological and psychiatric problems with pharmacotherapy, individual psychotherapy and/or psychoeducation. However these modalities are not suited to all cultures’ worldviews, values or practices, and finding the best approaches within and outside of these modalities is necessary. The practice of medicine is increasingly culturally pluralistic in nature requiring that governing bodies sanction the incorporation of complementary and alternative therapies.
Within a Western psychotherapeutically-oriented environment, the following frameworks may be more useful than traditional psychodynamic approaches:
- Story-telling and narrative therapy is a culturally responsive framework for many CALD groups, particularly those who have strong oral traditions (some collective cultures).
- More directive counselling styles (such as cognitive behavioural therapy – CBT) may suit clients from collective cultures where there is high power distance (such as Asian and Middle Eastern clients). In these approaches the therapist is seen as the expert and is expected to direct the treatment. However, other therapeutic approaches can be integrated into treatment as long as the therapist meets the primary expectations of the client. The clinician needs to be aware that not all cultures are familiar with goal-setting and homework, and the structure of CBT may need adapting.
- Family therapy may be appropriate for clients from collective cultures, however if the issues are stigmatised in the family’s culture, there may be hesitancy (Stade et al., 2015).
- Group therapy can be successful when the facilitator speaks the same language as the participants or an interpreter is provided; and the group is homogenous (ie a group of Syrian men or a group of Iraqi women). It is important that participants are not acutely or severely unwell (Sijbrandij et al., 2017; Silove et al., 2017; Stade et al., 2015).
- Narrative exposure therapy (NET) is an effective short-term culturally universal intervention for trauma victims, particularly those with severe PTSD symptoms (both children and adults).
- Motivational Interviewing (MI) is a client-centred, directive therapeutic style that enhances readiness for change by helping clients explore and resolve ambivalence. Research shows its efficacy for addiction treatments, especially in reducing alcohol and other substance abuse (Miller & Rollnick 2002).
Clients who have been through torture and trauma can find support groups helpful once they feel stabilised through therapeutic support.
There are a number of intervention options – thought needs to be given to what will be most appropriate for each client and/or the family. Remember that each client needs to be assessed individually. Unique circumstances and differences in acculturation render generalisations ineffective or inappropriate or can result in stereotyping. Generalisations need to be used for points of consideration ONLY.
Caraballo et al (2006) offer the following pointers for selecting ethical treatment choices:
- Can the expectations and cultural preferences (eg authoritative or co-operative figure) of the client be met?
- Is there adequate flexibility to incorporate the client’s illness explanatory model and treatment needs?
- It is important to explain and clarify misconceptions about mental health and that seeking help for mental health issues does not equate to being ‘crazy’.
- Has the client’s ‘health literacy’ been taken into account?
Please note that treatment modalities will be addressed in the two additional resources that supplement this training.