Acerca del capital cultural y la educación

As indicated earlier, the therapeutic relationship is replete with opportuni-ties for misunderstanding that can compromise the efficacy of treatment.

The following are suggestions for the therapist who may encounter some of the challenges of culturally sensitive treatment.

1. Become familiar with the culture, subculture, and political history of the patient when these differ from those of the therapist. Although it would be impossible for a therapist to gain the degree of cultural insight that an anthropologist or historian may have, investing some time to develop a basic grasp of these issues yields valuable rewards. First, it gives the therapist a contextual understanding of the patient that will be useful in avoiding the common therapeutic blunder of overgeneralization. For example, when working with patients from Vietnam, knowing their ethnicity (some Vietnamese are ethnically Chinese), political affiliation in their country of origin (oppressed minority vs. empowered majori-ty), religious beliefs (some Vietnamese are Christians who lived in a majority Buddhist country), and expectations of gender roles all con-tribute to providing the therapist a more precise framework from which therapy can be applied. In other words, the therapist will appreciate that being Vietnamese is not an all-encompassing cultural descriptor for patients from Vietnam. A second benefit is that patients usually will recognize and appreciate the therapist’s attempt to learn about their culture, and this enhances the therapeutic alliance.

2. Recognize that because the concept of boundaries varies across cultures, therapeutic elements related to boundaries must be modified to adapt to this variance. For example, do not assume that confidentiality is implicitly restricted to the therapist and the designated patient. In many cultures, confidentiality is neither expected nor therapeutic.

3. Recognize that the patient is part of a larger cultural context. Representa-tives of this larger system, which may include family members, societal elders, and so forth, may be enlisted as therapeutic allies, or they may be alienated, with disastrous results to the therapy. For example, when working with Arabic families, which operate along a well-defined hier-archical structure, the therapist is advised to create a pseudofamilial relationship in which he or she is a member, rather than attempting therapy on the basis of the concept of a two-person (dyadic) relation-ship. The strictly dyadic relationship may cause the patient to become alienated from his or her cultural supports.

4. Recognize that common issues in the therapeutic relationship, such as gifts, touch, eye contact, medication compliance, and choice of vocabulary, are all influenced by culture. The therapist is advised not to adhere to any rigid theoretical approach to dealing with these phenomena; rather, the therapist is advised to seek out the cultural meaning of these issues on a case-specific basis. When necessary, the therapist should enlist the expertise of a “cultural informant.” This person is generally from the

same culture as the patient, is not an active participant in the therapy, and functions as a consultant to the therapist by interpreting or identi-fying culture-specific issues. In this manner, the efficacy of the thera-pist is enhanced.

5. Recognize that the therapeutic paradigm (e.g., psychodynamic) must be flexible. The degree of active intervention by the therapist, definition of therapeutic goals, techniques used, and outcome measures must all be modified to reflect cultural differences in the therapy.

6. Recognize that transference and countertransference interactions influ-enced by culture will occur. Be familiar with the common varieties of interethnic and intraethnic transference and countertransference reac-tions that occur in therapy. Recognize that phenomena such as cultural stereotyping often occur even when the therapist and patient share the same ethnocultural background.

The psychotherapeutic relationship is complex and operates on many overlapping levels. The therapist and the patient bring to the relationship a panoply of sociocultural beliefs and behaviors. Together they share the chal-lenge of forming a therapeutic alliance, identifying a problem, and working toward a solution that may have implications beyond the traditionally de-fined therapeutic dyad. The therapist who works from a culturally sensitive framework must be prepared to identify problems and modify his or her therapeutic repertoire to meet the challenges imposed by this meeting of minds and cultures.

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Psychological Aspects of