146 CHAPTER 4
more and greater side effects—which in turn might lead the patients to stop taking
the medication (Lin et al., 1997; Lin & Cheung, 1999; U.S. Department of Health
and Human Services, 2001). As noted earlier, Blacks generally prefer counseling
to medication for psychological problems, at least in part because of concerns
about side effects and how effective the medication will be (Cooper-Patrick et al.,
1997). Such concerns can arise because of metabolic differences (Dwight-Johnson
et al., 2000). (Note that although these fi ndings about medication apply to groups
of people, they may not necessarily apply to a given individual who is of African
or Asian descent.)Culturally Specifi c Treatment
Clinicians may address a patient’s culture in a variety of ways, depending on the
patient’s facility with English and the community in which the patient lives. When
immigrant patients do not speak English well, treatment should be provided by a
clinician who speaks the patient’s language, or who makes use of a translator.
Community health centers in ethnic neighborhoods are most likely to have such
resources available. In fact, such health centers may have specifi c programs to reach
out to community members about mental health treatment and may use approaches
that are consistent with the particular ethnic group’s view of mental health and
mental illness. Such culturally sensitive approaches result in increased use of mental
health services and decreased rates of dropping out of treatment (Lau & Zane, 2000;
U.S. Department of Health and Human Services, 2001), particularly among patients
who are less assimilated and who do not speak English well (U.S. Department of
Health and Human Services, 2001).Cultural Sensitivity in Treatment
A therapist should not assume that a patient’s different ethnic or racial background
or sexual orientation will necessarily lead to misunderstandings. As long as the
therapist is sensitive to possible differences and asks the patient about ways that
his or her culture or sexual orientation may infl uence symptoms or treatment, the
difference in backgrounds need not be a stumbling block. In fact, ethnic similarity
of patient and therapist alone does not reduce the likelihood of dropping out of
treatment or produce better outcomes (Ito & Maramba, 2002; Karlsson, 2005).
This fi nding suggests that therapists can bridge most gaps that arise from different
backgrounds as long as there is no signifi cant language barrier. Case 4.3 illustrates
why therapists shouldn’t make assumptions about how cultural differences must
infl uence treatment.CASE 4.3 • FROM THE OUTSIDE: Emotional or Physical Problem?
Mrs. Corrales, a 70-year-old Puerto Rican, was referred to a mental health clinic by her local
priest. Mrs. Corrales had no friends within [her neighborhood]. She had migrated from
Puerto Rico eight years earlier to live with her two sons and her 45-year-old single and mildly
developmentally impaired daughter. Two years before she came to the clinic, her sons had
moved to a nearby city in search of better jobs. Mrs. Corrales remained behind with her
daughter, who spoke no English and did not work. Among other questions, the Latin Ameri-
can therapist asked her if she was losing weight because she had lost her appetite, to which
she quipped: “No, I’ve lost my teeth, not my appetite! That’s what irks me!” Indeed, Mrs.
Corrales had almost no teeth left in her mouth. Apparently, her conversations with the priest
(an American who had learned to speak Spanish during a Latin American mission and was
sensitive to the losses [that people endure as the result] of migration) had centered on the
emotional losses she had suffered with her sons’ departure. The priest thought this was the
cause of her “anxious depression.” Though well meaning, he had failed to consider practical
issues. Mrs. Corrales had no dental insurance, did not know any dentists, and had no fi nan-
cial resources.
(Falicov, 1998, p. 255)