Tom Sensky's View on CT and Cultural Diversity

Tom Sensky wrote:

"This is an interesting and important question, I think, not least because it arises quite often. I've struggled to make sense of the principles underlying the question for some years and on balance, I agree with Brad's response.

I've been struck by the very close similarity between the basic Socratic questioning we use in CBT and the enquiry techniques used by anthropologists in ethnographic studies. For example, James Spradley's 'The Ethnographic Interview' (Holt, Rinehart & Winston, 1979), an often quoted manual for ethnographic techniques, reads very like a standard CBT manual except that the techniques have been given different names. The purpose of interviewing might be different, with CBT focussed on the individual and ethnography on the society, but the underlying principles appear similar if not identical.

My basic answer to this question is, therefore, that for CBT to be effective, it must always be culturally sensitive, but it is for us to learn from each patient what the particular cultural sensitivities are. Classifying people as 'African American' or 'Chinese' or whatever may be helpful to epidemiologists but doesn't, I would argue, help therapists or therapy. Knowing when the Chinese New Year happens, or something about the history of slavery, doesn't get one very far in therapy. In fact, assuming an individual's culture on the basis of the overt signs runs the risk of making complacent assumptions or, at worst, stereotyping, as Brad notes. Thus I've lived in London much longer than anywhere else. Most people regard me as British. However, I was born in Zimbabwe and still have an affinity with Africa that others would not have experienced. The rest of my family is Czech. My father was Jewish, my mother was Catholic, and I was baptised a Methodist. To which culture do I therefore belong?

I wonder if there isn't an analogy here with treating people who have complex physical illnesses? There's a temptation to think, as a therapist (particularly as a doctor) that one ought to know at least as much about the patient's illness as the patient does. However, I have come to regard this, in most instances, as a dysfunctional belief on the therapist's part. Apart from the impossibility of achieving such knowledge, this isn't the reason why the patient is seeing me. I am offering expertise to help the patient understand his or her cognitions. Some of these will relate to the illness, but it's up to the patient and myself to explore and understand them, rather than either of us making assumptions about them.

I'd be interested to learn the views of other colleagues."

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