Melissa Hunt's View on CT and Cultural Diversity

Melissa Hunt wrote:

"I've followed this discussion with much interest. About 4 months ago, one of our more experienced graduate students, who was/is in the process of applying for internship, came to me asking whether I thought she should seek out extra course work and/or readings in diversity issues and psychotherapy. My answer was a confident "no" with the following caveats.

I agree entirely with Brad that CT has within it's theoretical foundation the corrective behaviors that will help us fix any mistakes we make secondary to incorrect assumptions about our clients. On the other hand, I DO think it is helpful to have SOME basic knowledge about the beliefs and behaviors clients from different cultural subgroups may be MORE LIKELY to demonstrate.

Here's an example. I worked with an AA woman in her midfifties. It was a very complex case involving bipolar disorder, PTSD secondary to a serious assault in which she almost lost her life, and tertiary panic with severe agoraphobia. Prior to the trauma, she had been an extremely successful professional who was also fairly obese. As a result of the physical trauma, she had lost an enormous amount of weight. She appeared quite "normal" to my caucasian eye. It took me quite a while to understand her underlying belief that weight loss represented a decline not just in physical health, but in "matriarchal power." She was articulate enough to express this, and we had a good enough therapeutic relationship that we joked frequently about how only "whispy white girls" want to be skinny. I am certainly more sensitive now to the POSSIBILITY that AA women will feel very differently about weight and body image than my white female clients do.

In another example, I recently completed a full battery assessment on a young, asian-american female student, from a second generation family. She clearly had bipolar disorder, but was extremely resistant to the diagnosis, in part because she feared her family would not understand or accept her "mental" illness. Cognizant of the fact that Asians are MORE LIKELY to present with primarily physical symptoms, I tried the approach of emphasizing the biological aspects of the "disease" and the need for appropriate medical management. This overcame her resistance to the diagnosis, and helped her seek and receive appropriate support from her family.

Thus, I do believe that the basic approach of CT - which insists that we do our best to try to get inside the client's frame of reference - will eventually get us where we need to go with most of these issues. On the other hand, I think some basic training about how some attitudes and perspectives may be likely to differ in certain subcultures can be quite useful, and can help us avoid errors and faulty assumptions we might otherwise initially make.

The intriguing question to me is where this training should take place. Should we offer courses in it? I think not - it's like trying to learn a language in a lab. Better, I think, is that our training programs provide sufficient breadth of experience and training, combined with good, sensitive supervision, that these topics can be addressed as they come up in clinical practice."

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