Abnormal Psychology

Foundations of Treatment 145

health clinician only after the symptoms continue for a long period or become so

bad as to be intolerable. In addition, some patients (and their family members) seek

alternative services—for example, from a minister or traditional healer from their

community—before they turn to standard mental health services; they might consult

mental health clinicians only when other types of treatments have failed (Chung,

2002; Nebelkopf & Phillips, 2004).

Furthermore, minority patients are less likely to come to mental health clinicians

directly; instead, they often seek treatment from their primary care physician

(Snowden & Pingitore, 2002; U.S. Department of Health and Human Services,

2001). (As mentioned in Chapter 3, though, primary care physicians generally

treat mental health problems less effectively than do mental health clinicians.)

Compared to white patients, members of minority groups (Blacks, Latinos, and

Asian Americans) prefer counseling over medication (Givens et al., 2007).

Bridging a Cultural Gap Between Patient and Clinician

Let’s examine in more detail factors that mental health professionals must take into

account when providing treatment and discuss ways that mental health professionals

address the unique needs of different populations. (Of course, even when clinician

and patient have similar backgrounds, the clinician should always try to understand

the patient’s unique experiences that infl uence the disorder and that may infl uence

treatment and recovery.)

Research has shown that when mental health services are

tailored to the needs of a specifi c cultural group, members of

that group are more likely to make use of, and benefi t from,

the treatments. The term cultural competence refers to the

ability of the mental health system and individual clinicians

to provide treatment in a way that is sensitive to people from

different backgrounds.

A clinician’s cultural competence rests on an awareness

of the biases and assumptions he or she has about mental

health, mental illness, and treatment in general and in ref-

erence to particular ethnic groups; cultural competence also

refl ects an understanding of the different biases and assump-

tions held by people from other ethnic groups. The clinician

and patient together develop treatment goals that respect

the context in which the patient lives—family, cultural, and

spiritual values, the patient’s identity, cultural explanations

of the psychological problems the patient is experiencing,

and issues related to the relationship with the mental health clinician (Malik &

Velazquez, 2002).

For instance, a Latina woman may attribute her depression to nervios, or

nerves, whereas a clinician, hearing about a history of depression in her family,

might partly attribute her depression to family-related factors (U.S. Department

of Health and Human Services, 2001). Or a patient of Asian descent may frame

his or her problem with depression in bodily terms rather than psychological

ones. In both cases, the clinician should not dismiss the patient’s views but rather

should incorporate them into the treatment goals and plans that are developed

with the patient.

Cultural Competence and Medication

Clinicians who prescribe medication should be aware that people from different eth-

nic groups may respond to medication differently than do Whites. In fact, members

of different ethnic groups may metabolize drugs differently. Asian Americans and

African Americans, for instance, may be more sensitive to the effects of psychotro-

pic medications than are Whites; a standard dose for a white patient might be too

high a dose for an African American or Asian American patient and would lead to

Therapists should be aware of cultural differences

that may exist between themselves and their

patients, and they should try to learn how

patients’ experiences of their culture infl uence

their understanding of their problems and their

goals for treatment.

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