Brad Alford's View on CT and Cultural Diversity

Brad Alford wrote:

"I am going to give a long response to a short question, because your post touches upon an issue about which I have given some thought over the past few months: the question of modifying CT in specific ways for individuals of particular racial groups.

One of my clinical mentors was a part of the community about which you ask (as well as being a part of many other communities). I never needed any special reading materials to have an "African American" as my supervisor. Nor did he feel the need to read up on "European Americans" to provide my training in cognitive therapy.

There have been published clinical supervision articles that draw analogies between the patient-therapist relationship and the trainee-supervisor relationship in cognitive therapy, the content of which shows my point above to be directly relevant to the question you raise.

My suggestion to the participant in your lecture would be as follows: "Why would special race-oriented reading materials be needed to engage a specific person in cognitive therapy? The effective establishment of rapport and working from an individual patient's point of view insures reaching the goal implicit in your question."

I do not know of any competent cognitive therapist who takes a cultural, theory-driven, overgeneralized point of view that assumes stereotyped race-based characteristics, beliefs, or automatic thoughts of an individual seeking therapy.

On a personal note, many years ago I considered moving to Colorado and therefore I took their licensing exam, a full 1/3 of which was (still is?) on treatment issues in conducting therapy with people from diverse cultures. My exam answer -- which was accepted -- elaborated how the intrinsic nature and design of CT is such that no consideration of group characteristics, such as racial/cultural, is needed. The skilled cognitive therapist always assesses and considers the specific thoughts and beliefs of the individual patient. Indeed, this is one distinguishing aspect between REBT and CT. REBT has identified beforehand common irrational beliefs (which might or might not vary by group identity), but CT is more empirical, inductive, individualistic.

I would be interested to learn others' opinions on whether we need special techniques to approach the diverse variables (versus beliefs) on which people may differ, including variables such as race, socio-economic status, age, gender, sexual orientation, religion, citizenship, special physical status (weight, height), political affiliation (Republican, Democrat, or Libertarian clients).

The lecture participant probably assumes that recommended readings are necessary to understand differences in world view that might obstruct therapeutic alliance. This seems unnecessary for patients in the mainstream.

If any ACT Member can provide an example of how standard CT needs to be modified for therapy with African Americans, then perhaps they can share it with us. I am skeptical that any such specific example can be provided. Also, in making the attempt, one must be careful to avoid overgeneralization, which is to assume that knowing a patient's race alone provides any other meaningful information (e.g., cognitive themes or core beliefs) about that person.

My own position is to treat the individual, not their supposed group identities."

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