Psychological Therapies 611immediately began assertiveness training and role playing to prepare K. to deal
with her father. The therapist was disappointed when K. failed to keep her second
appointment.This example of an actual case demonstrates a problem that exists in the
therapist– client relationship for many clients when the ethnicity or culture of the cli-
ent is different from that of the therapist. This cultural difference makes it difficult for
therapists to understand the exact nature of their clients’ problems and for clients to
benefit from therapies that do not match their needs (Matsumoto, 1994; Moffic, 2003;
Wedding, 2004). The values of different cultures and ethnic groups are not universally
the same. How, for example, could a female therapist who is white, from an upper-
middle-class family, and well educated understand the problems of a Hispanic adoles-
cent boy from a poor family living in substandard housing if she did not acknowledge
the differences between them? In this case, gender, ethnicity, and economic back-
ground of client and therapist are all vastly different.
In the case of K., for example, the therapist mistakenly assumed that the key to
improving K.’s situation was to make her more assertive and independent from her
family, particularly her father. This Western idea runs counter to Korean cultural values.
Korean culture stresses interdependence, not independence. The family comes first, obe-
dience to one’s elders is highly valued, and “doing one’s own thing” is not acceptable.
K.’s real problem may have been her feelings of guilt about her situation and her father’s
anger. She may have wanted help in dealing with her family situation and her feelings
about that situation, not help in becoming more independent.
For therapy to be effective, the client must continue in treatment until a suc-
cessful outcome is reached. K. never came back after the first session. One of the
problems that can occur when the culture or ethnic backgrounds of the client and
therapist are mismatched, as in K.’s case, is that the therapist may project his or her
values onto the client, failing to achieve true empathy with the client’s feelings or
even to realize what the client’s true feelings are, thus causing the client to drop out
of therapy. Studies of such situations have found that members of minority racial
or ethnic groups drop out of therapy at a significantly higher rate than the majori-
ty-group clients (Brown et al., 2003; Cooper et al., 2003; Flaherty & Adams, 1998; For-
tuna et al., 2010; Sue, 1977, 1992; Sue et al., 1994; Vail, 1976; Vernon & Roberts, 1982).
Traditional forms of psychotherapy, developed mainly in Western, individualistic
cultures, may need to be modified to fit the more collectivistic, interdependent cultures.
For example, Japanese psychologist Dr. Shigeru Iwakabe has pointed out that the typi-
cal “talking cure” practiced by many psychotherapists—including psychodynamic and
humanistic therapists—may have to be altered to a nontalking cure and the use of non-
verbal tasks (like drawing) due to the reluctance of many traditional Japanese people to
talk openly about private concerns (Iwakabe, 2008).
Are differences in gender that important? For example, do
women prefer female therapists, but men would rather talk to
another man?Research on gender and therapist–client relationships varies. When talking about
white, middle-class clients, it seems that both men and women prefer a female thera-
pist (Jones et al., 1987). But African-American clients were more likely to drop out of
therapy if the therapist was the same sex as the client (Vail, 1976); male Asian clients
seemed to prefer a male therapist; and female Asian clients stayed in therapy equally
long with either male or female therapists (Flaherty & Adams, 1998; Flaskerud, 1991).