Culture and Psychotherapy A Guide to Clinical Practice Washington, DC London, England Culture and Psychotherapy A Guide to Clinical Practice Edited by Wen-Shing Tseng, M.D. Jon Streltzer, M.D. Note: The authors have worked to ensure that all information in this book concerning drug dosages, schedules, and routes of administration is accurate as of the time of publication and consistent with standards set by the U.S. Food and Drug Administration and the general medical community. As medical research and practice advance, however, therapeutic standards may change. For this reason and because human and mechanical errors sometimes occur, we recommend that readers follow the advice of a physician who is directly involved in their care or the care of a member of their family. A product’s current package insert should be consulted for full prescribing and safety information. Books published by the American Psychiatric Press, Inc., represent the views and opinions of the individual authors and do not necessarily represent the policies and opinions of the Press or the American Psychiatric Association. Copyright © 2001 American Psychiatric Press, Inc. ALL RIGHTS RESERVED Manufactured in the United States of America on acid-free paper 04030201 4321 First Edition American Psychiatric Press, Inc. 1400 K Street, N.W. Washington, DC 20005 www.appi.org Library of Congress Cataloging-in-Publication Data Culture and psychotherapy : a guide to clinical practice / edited by Wen-Shing Tseng, Jon Streltzer.—1st ed. p. ; cm. Includes bibliographical references and indexes. ISBN 0-88048-955-3 (alk. paper) 1. Psychiatry, Transcultural. 2. Psychotherapy—Cross-cultural studies. 3. Cultural psychiatry. 4. Cross-cultural counseling. I. Tseng, Wen-Shing, 1935– . II. Streltzer, Jon. [DNLM: 1. Psychotherapy. 2. Cross-Cultural Comparison. WM 420 C9678 2001] RC455.4.E8 C836 2001 916.89′14—dc21 00-061805 British Library Cataloguing in Publication Data A CIP record is available from the British Library. Contents Contributors ix Preface xiii Wen-Shing Tseng, M.D. Jon Streltzer, M.D. PART 1 Introduction 1 Culture and Psychotherapy: An Overview 3 Wen-Shing Tseng, M.D. PART 2 Case Presentations and Analysis 2 The Man Who Became a Child in the Face of Death 15 Jon Streltzer, M.D. 3 The Woman With One Foot in the Past 27 M. Fakhr El-Islam, F.R.C.P., F.R.C.Psych. 4 The Woman Who Could Not Escape Her Spirit Song 43 Louise Jilek-Aall, M.D., M.A., D.Trop.Med., F.R.C.P.(C) Wolfgang G. Jilek, M.D., M.Sc., M.A., F.R.C.P.(C) 5 The Woman Who Alienated Her Family After Losing Her Son 57 Alan A. Buffenstein, M.D. 6 One Patient, Three Therapists 67 Barry S. Carlton, M.D. PART 3 Special Issues in Therapy 7 Lessons From Folk Healing Practices 81 Richard J. Castillo, Ph.D. 8 Therapist-Patient Relations and Ethnic Transference 103 David M. Bernstein, M.D. 9 Psychological Aspects of Giving and Receiving Medications 123 Iqbal Ahmed, M.D. PART 4 Treating Special Populations 10 The African American 137 Howard C. Blue, M.D. Ezra E.H. Griffith, M.D. 11 The Hispanic Veteran 157 Jose M. Cañive, M.D. Diane T. Castillo, Ph.D. Vicente B. Tuason, M.D. 12 The Southeast Asian Refugee: The Legacy of Severe Trauma 173 J. David Kinzie, M.D. 13 The Adolescent 193 Danilo E. Ponce, M.D. 14 The Ethnic Minority Elderly 209 F. M. Baker, M.D., M.P.H., F.A.P.A. Junji Takeshita, M.D. PART 5 Special Models of Therapy 15 Marital Therapy for Intercultural Couples 225 Jing Hsu, M.D. 16 Group Therapy With Multiethnic Members 243 Leslie Ann Matsukawa, M.D. PART 6 Integration and Conclusions 17 Integration and Conclusions 265 Wen-Shing Tseng, M.D. Jon Streltzer, M.D. Index 279 ix Contributors Iqbal Ahmed, M.D. Professor and Vice Chair, Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii; Program Director, University of Hawaii Affiliated Residency Training Program, Honolulu F. M. Baker, M.D., M.P.H., F.A.P.A. Professor, Department of Psychiatry, University of Maryland School of Medicine; Medical Director, Lower Shore Clinic, Salisbury, Maryland David M. Bernstein, M.D. Clinical Associate Professor, Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu Howard C. Blue, M.D. Assistant Clinical Professor of Psychiatry, Yale University; Director of Clinical Services, Division of Mental Hygiene, Yale University Health Services, New Haven, Connecticut Alan A. Buffenstein, M.D. Assistant Professor, Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu Jose M. Cañive, M.D. Director, Clinical Psychiatry Research, Albuquerque Veterans Affairs Medical Center; Associate Professor of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico x Culture and Psychotherapy: A Guide to Clinical Practice Barry S. Carlton, M.D. Associate Professor, Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii; Chief of Psychiatry, Queen’s Medical Center, Honolulu Diane T. Castillo, Ph.D. Psychologist, Albuquerque Veterans Affairs Medical Center and University of New Mexico School of Medicine, Albuquerque, New Mexico Richard J. Castillo, Ph.D. Professor, Department of Psychology, University of Hawaii at West Oahu; Clinical Professor, Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu M. Fakhr El-Islam, F.R.C.P., F.R.C.Psych. Emeritus Professor of Psychiatry, Cairo University, Cairo, Egypt; Former Secretary, Transcultural Psychiatry Section, World Psychiatric Association Ezra E. H. Griffith, M.D. Deputy Chairman for Clinical Affairs, Professor of Psychiatry and of African and African-American Studies, Department of Psychiatry, Yale University, New Haven, Connecticut Jing Hsu, M.D. Clinical Professor, Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii; private practice of psychiatry, Honolulu, Hawaii Louise Jilek-Aall, M.D., M.A., D.Trop.Med., F.R.C.P.(C) Clinical Professor Emerita of Psychiatry, University of British Columbia, Vancouver, Canada Wolfgang G. Jilek, M.D., M.Sc., M.A., F.R.C.P.(C) Clinical Professor Emeritus of Psychiatry, University of British Columbia, Vancouver, Canada; Former Chairman, Transcultural Psychiatric Section, World Psychiatric Association [...]... (Tseng 1999) The nature of psychotherapy has been examined from historical, universal, and cultural perspectives (Tseng and McDermott 1975), and the implications of psychotherapy in different cultures have been analyzed (Tseng and Hsu 1979) With regard to the practice and process of psychotherapy, the influence of culture has been explored from various directions (Tseng 1999) and is briefly reviewed here... therapist to adjust, expand, or modify his or her understanding and method of treating each patient by considering the patient’s ethnic and cultural background To reach an appropriate level of cultural sensitivity and Culture and Psychotherapy: An Overview 11 competence, the clinician needs to increase his or her cultural knowledge and expand or alter the treatment accordingly, and this needs to be done... characteristics of culture: it is learned through a process of enculturation since childhood; it is transmitted through symbols, both verbal and nonverbal; and it is shared by members of groups Culture is not a haphazard collection of customs and beliefs; it consists of integrated, patterned systems People use culture creatively and actively Culture can be adaptive and maladaptive The term culture needs... include culture as an ideal, describing behavior that the culture strives for on the basis of cultural values; actual culture, describing behavior that is actually practiced and commonly observed; or stereotype, describing behavior that is often projected by others on the basis of partial observation and biased beliefs (Tseng 1997) Culture and Psychotherapy: An Overview 7 Lessons From the Study of Culture. .. comprises chapters in which the authors present and discuss the psychotherapy xiii xiv Culture and Psychotherapy: A Guide to Clinical Practice in a variety of cases with distinctive cultural issues and overtones The third part addresses several specific issues in psychotherapy, such as cultural aspects of the therapist-patient relationship, and the giving and receiving of medication in the process of... varying backgrounds Despite general recognition that culture influences psychopathology and also has profound implications for the practice of psychotherapy, only a handful of publications have specifically focused on culture and psychotherapy This book addresses this need After publishing a book focusing on assessment of psychopathology (Culture and Psychopathology: A Guide to Clinical Assessment,... Metraux R: Culture and Psychotherapy New Haven, CT, College and University Press, 1974 Al-Issa I (ed): Handbook of Culture and Mental Illness: An International Perspective Madison, CT, International Universities Press, 1995 Comas-Dias L, Griffith EEH (eds): Clinical Guidelines in Cross-Cultural Mental Health New York, Wiley, 1988 Frank JD: Persuasion and Healing: A Comparative Study of Psychotherapy. .. Washington, DC, American Psychiatric Press, 1998, pp 3–17 Schick A: Psychotherapy in old Vienna and New York: cultural comparisons Psychoanal Rev 60:111–126, 1973 Torrey EF: Witchdoctors and Psychiatrists: The Common Roots of Psychotherapy and Its Future New York, Harper & Row, 1986, pp 73–74 Tseng WS: Overview: culture and psychopathology, in Culture and Psychopathology: A Guide to Clinical Assessment Edited... pp 1–27 Tseng WS: Culture and psychotherapy: review and suggested practical guidelines Transcultural Psychiatry 36:131–179, 1999 Tseng WS, Hsu J: Culture and psychotherapy, in Perspectives on Cross-Cultural Psychology Edited by Marsella AJ, Tharp RG, Ciboroski TJ New York, Academic Press, 1979, pp 333–345 Tseng WS, McDermott JF Jr: Psychotherapy: historical roots, universal elements, and cultural variations... her feelings with him To make matters even worse, her husband’s elder sister was showing up at the hospital every day She was continuously babying the husband, increasing his dependency and demandingness The sister had decided that a 18 Culture and Psychotherapy: A Guide to Clinical Practice relative should be with her husband at all times and had worked out a rotation schedule, with family members . Culture and Psychotherapy A Guide to Clinical Practice Washington, DC London, England Culture and Psychotherapy A Guide to Clinical Practice Edited. influences psychopathology and also has profound implications for the practice of psychotherapy, only a handful of publications have specifically focused on culture and psychotherapy. This book. which the authors present and discuss the psychotherapy xiv Culture and Psychotherapy: A Guide to Clinical Practice in a variety of cases with distinctive cultural issues and overtones. The third part