By the end of this section, you will be able to:
- Explain how the sociocultural model is used in therapy
- Discuss barriers to mental health services among ethnic minorities
The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background. For example, Martin is an 18-year-old Chilean male from a traditional Catholic family. Martin comes to treatment because of anxiety and depression. During the intake session, he reveals that he is gay and is nervous about telling his family. He also discloses that he is concerned because his religious background has taught him that homosexuality is wrong. How might his religious and cultural background affect him? How might this background affect how his family reacts if Martin were to choose to tell them he is gay?
As our society becomes increasingly diverse, mental health professionals must develop cultural competence, which means they must understand and address diversity factors such as race, ethnicity, sexual orientation, gender identity, and religion. They must also develop strategies to effectively address the needs of various populations for which Eurocentric therapies have limited application (Sue, 2004). For example, a counselor whose treatment focuses on individual decision making may be ineffective at helping a Chinese client who has a collectivist approach to problem solving (Sue, 2004).
Multicultural counseling and therapy aims to offer both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients. It strives to recognize client identities to include individual, group, and universal dimensions, advocate the use of universal and culture-specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems (Sue, 2001).
This therapeutic perspective integrates the impact of cultural and social norms, starting at the beginning of treatment. Therapists who use this perspective work with clients to obtain and integrate information about their cultural patterns into a unique treatment approach based on their particular situation (Stewart, Simmons, & Habibpour, 2012). Sociocultural therapy can include individual, group, family, and couples treatment modalities.
How do your cultural and religious beliefs affect your attitude toward mental health treatment? (credit “top-left”: modification of work by Staffan Scherz; credit “top-left-middle”: modification of work by Alejandra Quintero Sinisterra; credit “top-right-middle”: modification of work by Pedro Ribeiro Simões; credit “top-right”: modification of work by Agustin Ruiz; credit “bottom-left”: modification of work by Czech Provincial Reconstruction Team; credit “bottom-left-middle”: modification of work by Arian Zwegers; credit “bottom-right-middle”: modification of work by “Wonderlane”/Flickr; credit “bottom-right”: modification of work by Shiraz Chanawala)
BARRIERS TO TREATMENT
Statistically, racial and ethnic minorities tend to utilize mental health services less frequently than White Americans (Alegría et al., 2008; Richman, Kohn-Wood, & Williams, 2007). Why is this so? Perhaps the reason has to do with access and availability of mental health services. Both ethnic minorities and individuals of low socioeconomic status (SES) report that barriers to services include lack of insurance, transportation, and time (Thomas & Snowden, 2002). However, researchers have found that even when income levels and insurance variables are taken into account, ethnic minorities are far less likely to seek out and utilize mental health services. And when access to mental health services is comparable across ethnic and racial groups, differences in service utilization remain (Richman et al., 2007).
In a study involving thousands of women, it was found that the prevalence rate of anorexia was similar across different races, but that bulimia nervosa was more prevalent among Latinx and African American women when compared with non-Latina whites (Marques et al., 2011). Although they have similar or higher rates of eating disorders, Latina and African American women with these disorders tend to seek and engage in treatment far less than White women. These findings suggest ethnic disparities in access to care, as well as clinical and referral practices that may prevent Latina and African American women from receiving care, which could include lack of bilingual treatment, stigma, fear of not being understood, family privacy, and fear of mistreatment from providers.
Perceptions and attitudes toward mental health services may also contribute to this imbalance. A recent study at King’s College, London, found many complex reasons why people do not seek treatment: self-sufficiency and not seeing the need for help, not seeing therapy as effective, concerns about confidentiality, and the many effects of stigma and shame (Clement et al., 2014). In one study, African Americans exhibiting depression were less willing to seek treatment due to fear of possible psychiatric hospitalization as well as fear of the treatment itself (Sussman, Robins, & Earls, 1987). Instead of mental health treatment, some Black Americans prefer to be self-reliant or use spiritual practices (Snowden, 2001; Belgrave & Allison, 2010). For example, it has been found that the Black church plays a significant role as an alternative to mental health services by providing prevention and treatment-type programs designed to enhance the psychological and physical well-being of its members (Blank, Mahmood, Fox, & Guterbock, 2002).
Additionally, people belonging to ethnic groups that already report concerns about prejudice and discrimination are less likely to seek services for a mental illness because they view it as an additional stigma (Gary, 2005; Townes, Cunningham, & Chavez-Korell, 2009; Scott, McCoy, Munson, Snowden, & McMillen, 2011). For example, in one recent study of 462 older Korean Americans (over the age of 60) many participants reported suffering from depressive symptoms. However, 71% indicated they thought depression was a sign of personal weakness, and 14% reported that having a mentally ill family member would bring shame to the family (Jang, Chiriboga, & Okazaki, 2009).
One way of de-stigmatizing mental illness is by offering training for people so that they can react to mental illnesses and also educate their peers about the reality of it. WSU is doing this through their mental health training program, which can be found here. https://cougarhealth.wsu.edu/mental-health-promotion/mental-health-trainings/
Language differences are a further barrier to treatment. In the previous study on Korean Americans’ attitudes toward mental health services, it was found that there were no Korean-speaking mental health professionals where the study was conducted (Orlando and Tampa, Florida; Jang et al., 2009). Because of the growing number of people from ethnically diverse backgrounds, there is a need for therapists and psychologists to develop knowledge and skills to become culturally competent (Ahmed, Wilson, Henriksen, & Jones, 2011). Those providing therapy must approach the process from the context of the unique culture of each client (Sue & Sue, 2007).
The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background. Clinicians using this approach integrate cultural and religious beliefs into the therapeutic process. Research has shown that ethnic minorities are less likely to access mental health services than their White middle-class American counterparts. Barriers to treatment include lack of insurance, transportation, and time; cultural views that mental illness is a stigma; fears about treatment; and language barriers.
Openstax Psychology text by Kathryn Dumper, William Jenkins, Arlene Lacombe, Marilyn Lovett and Marion Perlmutter licensed under CC BY v4.0. https://openstax.org/details/books/psychology
1. The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your ________.
b. socioeconomic status
c. culture and background
2. Which of the following was not listed as a barrier to mental health treatment?
a. fears about treatment
d. being a member of the ethnic majority
Personal Application Question:
1. What is your attitude toward mental health treatment? Would you seek treatment if you were experiencing symptoms or having trouble functioning in your life? Why or why not? In what ways do you think your cultural and/or religious beliefs influence your attitude toward psychological intervention?
Critical Thinking Question:
What has been the most memorable or powerful ad campaign or public message that you have seen that was made for the purpose of de-stigmatizing mental illness?
Answers to Exercises
cultural competence: therapist’s understanding and attention to issues of race, culture, and ethnicity in providing treatment