Psychotherapy

Psychotherapy is a special practice involving a designated healer or usually we call as a therapist and an identified client, with the purpose of solving the problem of which the client is suffering and promoting health to the client's mind (Tseng, 1999). The purpose of therapy, has been a lot of confusion, every therapist have their own goals, however, for the consensus there is one term that can be use, which is self actualization. The purpose of therapy is therefore to help person who are vulnerable in their personal development to develop to become a more self actualizing persons (Patterson, 1974).

Western and Eastern

Before, practicing culture in psychotherapy have not yet been realized, but since cultural factors effects the practice of psychotherapy, it cannot be ignored that cultural adjustment are needed in order to provide effective therapy. Since last decade, there has been an increase interest in cross-cultural psychotherapy, however, there are a lot of books that appear to have a negative writings and focusing only on the difficulties associated with cultural differences (Patterson, 1978). They emphasis on some aspects, such as the ability for the therapist to build a relationship, to accept the client, to understand the client as a person, avoid any type of stereotyping the client.

            The other problem was the disagreement of the western approaches in counseling, which are known for the directive and controlling methods (Patterson, 1978). They assume that it is the therapist job to evaluate, define and giving advice to the client sometimes even imposing solution to the clients, without any consideration on the individual perceptions of the clients. Of course this will create a complication to clients from other culture, who might have to considerate their cultural belief.

            The differences of culture are associated with different personality, individual in western cultures are more independent, compared to some other cultures, they do not have pressure to sacrifice themselves in the family. They are more extroverted, they are more verbal compared to other cultures (Patterson, 1978). This is the main reason why western approaches are not applicable to other cultures, because western individuals, they are open to introspection, more ready to self disclosure which is important especially in psychotherapy. In the other hand, people from oriental and some other culture are more reserved in talking about themselves and personal relationship with others including families, they are more respectful (Patterson, 1978).

            In terms of the culture differences, research concluded that it is not necessary to develop new theories or approaches for counseling clients. There are only two major categories of problem, the first one is to relate an understanding of communication to the clients, the second is to relate those things to adapt the client behavior necessary for the therapy progress (Patterson, 1978). There are two barriers in understanding communication to the clients, the first is language, there is no doubt that therapist must be fluent in the clients language. The second barrier is the non verbal cues, it might be a problem, since the non verbal cues might be different in other culture or even the opposite.

            Therefore, there are core conditions for effective psychotherapy which are empathic understanding, respect and nonpossesive warmth, and the last is therapeutic genuineness. Empathic understanding means therapist should listen to the clients, they must understand the world, and the last communicating this understanding to the clients. Respect is the most important thing, this  is the part where the justice ethical principle came in, the therapist should not be judgmental, and see the client as a person, warmth meant by acceptance and concern to the clients. Therapeutic genuineness means the therapists have to be honest and sincere, as it is in the ethical principle of veracity.

            Supporting the point above, Kitchner (1984) presumed that four basic ethical principles which are autonomy, beneficence, nonmaleficence, and fairness (justice) to be universally valued regardless of the cultural context. Autonomy refers to client’s freedom for self-determination. Beneficence refers to actions that promote the growth and development of the client. Nonmaleficence means refraining from hurting clients. Justice or fairness refers to equal treatment of all people.

            Pedersen (2002) mention that the ethical dilemma faced by therapist is the fact that they are forced to choose between doing the right thing ethically, and bending the professional ethical guideline, or in the other hand, following the professional ethical guideline and disregarding the clients cultural context (as cited in Pedersen & Marsella, 1982).

Bias

For decades, it was taken for granted that the correspondence bias was universal: People everywhere, we thought, applied this cognitive shortcut when forming attributions (Norenzayan, Choi, & Nisbett, 1999). But social psychologists are focusing more and more on the role of culture in many aspects of social behavior. Given that social psychology is the study of how the situation affects the individual, we can think of culture as an all encompassing, higher level situational variable. You are born into a culture; as you grow up, you learn the rules, norms, and ways of labeling reality that define your culture. In short, culture is one of the biggest “situations” affecting your daily life. In the past decade, social psychologists have explored the correspondence bias cross-culturally (Aronson, Wilson, & Akert, 2007).

            North American and some other Western cultures stress individual autonomy. A person is perceived as independent and self contained; his or her behavior reflects internal traits, motives, and value (Markus & Kitayama, 1991). The intellectual history of this cultural value can be traced from the Judeo-Christian belief in the individual soul and the English legal tradition of individual rights (Menon, Morris, Chiu, & Hong, 1999). In contrast, East Asian cultures such as those in China, Japan, and Korea stress group autonomy. The individual derives his or her sense of self from the social group to which he or she belongs.

            Another study that found cultural differences in the prevalence of the correspondence bias compared newspaper articles in Chinese- and English-language newspapers. The researcher targeted two mass murders, one committed by a Chinese graduate student in Iowa and one committed by a Caucasion postal worker in Michigan (Morris & Peng, 1994). They coded all the news articles about the two crimes that appeared in the New York Times and the World Journal, a Chinese-language U.S. newspaper. The result showed that journalists writing English made significantly more dispositional attributions about both mass murderers than journalists writing in Chinese did. For example, American reporters described one murderer as a “ darkly disturbed man” with a “ sinister edge” to his personality. Chinese reporters, when describing the same murderer, emphasized more situational causes, such as “ not getting along with his advisor” and his “ isolation from the Chinese community” (Aronson, Wilson, & Akert, 2007).

            Thus people in Western cultures appear to be more like personality psychologists, viewing behavior in dispositional terms. In contrast, people in Eastern cultures seem to be more like social psychologists, considering the situational causes of behavior (Aronson, Wilson, & Akert, 2007).

Recent research indicates that a tendency to think dispositional about others, the correspondence bias- appears in many cultures. However, members of collectivistic cultures are more aware of how the situation affects behavior and more likely to take situational effect into account (Choi, Dalal, Kim-Prieto, &Park, 2003). Thus, the difference is that people in collectivist cultures are more likely to go beyond dispositional explanations, including information about the situation as well.

            People in collectivist cultures like the East Asian ones, because of their values and experience, also seem able to override this dispensationalist tendency. They are more likely than people in Western, individualistic cultures to take situational information is particularly salient and noticeable. ( Choi, Dalal. Kim-Prieto, & Park, 2003).

            The Euro-American or Western psychological study of cultures assumed that there was a fixed state of mind, whose observation was obscured by cultural distortions and that related cultural behaviours to some universal definition of normative behaviour (Corey, 2000). When counselors have applied the same interpretation to the same behavior regardless of the cultural context, cultural bias has been the consequence. While there is clear evidence of cultural bias in American psychology, much of it is unintentionally done by people who see themselves as moral, just, and fair-minded professionals (Corey, 2000). Ridley (2005) points out that unintentional racists may be well intentioned, and they are likely to deny their racism.

            Lewis-Fernandez and Kleinman (1994) have identified three culture-bound assumptions about mental health and illness based on North American values. The first assumption is the egocentricity of the self. The second assumption is the mind-body dualism, which divides psychopathology into organic disorders and psychological problems. The third assumption is the view of culture as an arbitrary superimposition on the otherwise “knowable biological reality”.

Tunnel Vision

Tunnel vision also referred to as visual perceptual narrowing, is a process that occurs when one is visually aware only of central visual information, while simultaneously ignoring or being unaware of information located in the peripheral field of vision (Edward & Godnig, 2003 ). Tunnel vision is also when one views a certain environment or situation, with a narrow view. It is a situation whereby one has a high attention on a particular stimulus but on the other side ignores other important stimulus.

In terms of the tunnel vision under culture perspective, it is defined as when a training student or therapist walks into therapy, they only come in only having knowledge on their own culture, which leads to cultural tunnel vision, which is a perception of realty based on very limited set of cultural experiences. This may be a disadvantage as they may influence their own values on their clients since they may think that everyone shares the same cultural norms or values. The other disadvantage maybe that the clients may not respond to therapy as it is on with a different cultural perspective. One of the researchers discovered that this tunnel vision has always been there, racism has always been present in mental health delivery systems for quite some time, stated that in the studies from 1950s to the present have been documented enduring patterns of racism in mental health care deliveries systems (Ridley, 2005).  

The cultural encapsulated counsellor exhibits tunnel vision, which is characterised by five basic indentifying features of culture encapsulation described by Wrenn (1962, 1985). First, reality is defined according to one set of cultural assumptions. Second, people become insensitive to cultural variations among individuals and assume their own view is the only right one. Third, assumptions are not dependent on reasonable proof or rational consistency but are believed true, regardless of evidence to the contrary. Fourth, solutions are sought in technique-oriented strategies and quick or simple remedies. Fifth, everyone is judged from the viewpoint of one’s self-reference criteria without regard for the other person’s separate cultural context.

Assumption

Making an assumption about something maybe difficult, as for example, therapist may not be quite sure if they are making or giving the correct answer or thought to a client. Not only that when one makes an assumption towards a person and it is the correct assumption, it does not mean that the next time the same assumption is made on a different client it will work.  Moral visions are constellations of cultural values and assumptions that shape our experience of life and the stances we adopt toward it (Christopher, 1994, Christopher & Fowers, 1996).

Assumptions about self disclosure

            According to some cultures, it is quite hard for clients to open up about thier lives and their personal prolems or family problems. As one would find that some cultures are collectivist meaning that the are more together and they deal with their problems as one. Meaning that a one person’s prolem is everbodies problem within the family. In which they are not allowed to disclose thier personal information to outsiders or strangers. This makes the therapist life harder to obtain infomation from the client also looking at the way they were trained. Which also gives the therapist a challenge to find a way to inorder to aquire the information from the client. Clients might find it hard to disclose their information due to lack of trust and the client maybe obliged to fully guard and protect themselves by not revealing their problems. Yet there are some cultures in which the people are quite open about revealing their problems.

Assumptions about asertiveness

It is assumed that people who are more assertive are better than those who are nonassertive. If one is non assertive it makes it harder for the therapist to help the client as they cannot obtain information unlike if the are dealing with a person who is assertive.

Assumptions about self actualization and trusting relationship

            Its assumed that Americans tend to form quick, though not necessarily deep, relationships and perhaps more readily talk about their personal lives compared to the other cultures which makes it hard for the therapist to deal with the other clients (Corey, Corey & Callanan, 2007).

Assumptions about directness and respect

It is known that in some cultures a form of directness is percevced as a sign of rudeness and something to be avoided. Yet again a counsellor could assume that lack of directness is evidence of pathology, or at least lack of assertiveness rather than a sign of respect (Corey, Corey & Callanan, 2007). 

Stereotype

            Stereotype is an act of assigning particular qualities to a group of people related to their race, nationality and sexual orientation. According to Robert Baron (1990), stereotype is cognitive components of attitudes toward a social group, beliefs about what a particular group is like. In therapy, stereotype should be avoided because it can lead to discrimination. Discrimination concerns the behavioral component or differential actions taken towards members of specific group.

Stereotype can defy the ethical principle of justice. Clients who are awarded certain characteristics superior to others will be treated inferior by therapists. The following example is evident to justify stereotype unethical: “a therapist Ms Adzes have a therapeutic assessment with a client who happens to be black, the client’s problem is experiencing physical abuse from her significant other”. The therapist originally stereotype black to be aggressive people. And because of the therapist belief about blacks, she could not diagnose the client rather referred the client.

Stereotype can also be caused by counter-transference, where in the therapist has a client who reminds him of someone or previous client, the therapist can handle the client’s problem in the same way he handle the previous client. 

In a nut shell, stereotype may result in overgeneralization. Wherein, the therapist assess a client from a particular group and ends up generalizing or considering everyone from that particular group the same. However, generalization does not result in stereotype (Gerald Corey, 2005). 

Code of Ethics

Code of Ethics: Principles and Relevant Value Statements for Chapter Authors to Consider.

The Code of Ethics for psychologists working in Aotearoa/New Zealand, 2002 incorporates that commitment to Rule 3 in its principles, value statements, and practice implications. The new handbook will be organised around the Code principles. Below are key points from the Code which will be useful to consider, alongside the points made above, in the preparation of your chapter submission. The Principles and relevant value statements are listed below. Authors are encouraged to be familiar with the specific practice implications which align with the principles and value statements.

The National Standing Committee on Bicultural Issues (NSCBI, 2002).

Principle 1 Respect for the Dignity of Persons and Peoples.
This principle requires that each person and all peoples are positively valued in their own right, and are shown respect and granted dignity as part of their common humanity. Respect requires sensitivity to cultural and social diversity and recognition that there are differences among persons associated with their culture, nationality, ethnicity, colour, race, religion, gender, marital status, sexual orientation, physical or mental abilities, age, socio-economic status, and/or any other personal characteristic, condition, or status. Such differences are an integral part of the person. In New Zealand, the basis for respect between the indigenous people (tangata whenua - those who are Maori) and others (those who are not Maori) is set out in the Treaty of Waitangi.

Value statements that are relevant include:               
1.2 Non-Discrimination:
          Psychologists' recognise that all persons and peoples are entitled to equal benefits from the contributions of psychology.

1.3 Relations Between Maori and Non-Maori:
          Psychologists' practising in New Zealand recognise that the Treaty of Waitangi sets out the basis of respect between Maori and non-Maori in this country.

1.4 Sensitivity to Diversity
          Psychologists' respect diversity, and recognise that a person lives and develops within their social, cultural and community groups.

Principle 2 Responsible Caring
The practice of psychology promotes well-being. In pursuing this goal, psychologists demonstrate an active concern for the welfare of those with whom they work and acknowledge the social and institutional power that structures their role as psychologists. Psychologists have a primary responsibility to protect the welfare of those with whom they work. They recognise that individuals, families, groups, hapu/iwi, or communities, may be in a vulnerable position In New Zealand, the Treaty of Waitangi provides a framework for responsible caring between two peoples, tangata whenua (those who are Maori) and those who are not Maori.

Value statements that are relevant include:
2.1 Promotion of Wellbeing
          Psychologists' recognise that a basic ethical expectation of our discipline is that its activities will benefit members of society or, at the very least, do no harm.

2.2 Competence
          Psychologists attain and maintain competence.

Principle 3 Integrity in Relationships
The relationships formed by psychologists in the course of their work embody explicit and mutual expectations of integrity that are vital to the advancement of social justice, scientific knowledge, and to the maint4enance of public confidence in the discipline of psychology. Expectations of professional practice include: respect, accuracy and honesty, openness, maintenance of appropriate boundaries, and avoidance of conflicts of interest. Psychologists will seek to do right in their relationships with others. In New Zealand, the Treaty of Waitangi provides a framework for integrity in relationships between the two peoples, tangata whenua (those who are Maori) and those who are not Maori.

Value statements that are relevant include:
3.2 Personal Values
          Psychologists' will enhance integrity in relationships by recognising, and where relevant, declaring their values and beliefs.

Principle 4 Social Justice and Responsibility to Society
Psychology functions as a discipline to promote the well being of society. In New Zealand, the Treaty of Waitangi is a foundation document of social justice. Psychologists, both as individuals and as a group, have responsibilities to the community and society in general. The principle of Social Justice is about acknowledging psychologists' position of power and influence in relation to both individuals and groups within communities where the psychologist is involved, and in the broader context. It is about addressing and challenging unjust societal norms and behaviours that disempower people at all levels of interaction.

Value statements that are relevant include:
4.1 Welfare of Society
          Psychological knowledge will be increased, and psychology will be practised in such ways as to promote the welfare of society.

4.2 Respect for Society
          Psychologists recognise the need to be aware of the structures and customs of the communities in which they work

4.3 Benefit to Society
          Psychologists' strive to ensure that psychological knowledge, when used in the development of social structures and policies, will be used for beneficial purposes.

4.4 Accountability, standards and ethical practice
          Psychologists' strive to ensure the appropriate and relevant use of psychological knowledge, practices and structures, and to avoid their misuse.

Australian Indigenous Psychologists Association (AIPA, 2009)

Aboriginal and Torres Strait Islander psychologists are committed to a recognition of history, in which Australian Indigenous people have suffered processes of colonisation that have created an array of social, political and psychological disadvantages and contributed to the diversity in the cultures and identities of Aboriginal and Torres Strait Islander peoples.

Indigenous psychologists are committed to social justice and reconciliation and as such will seek shared partnerships with non-Indigenous colleagues so that we can work together in culturally informed ways. Reconciliation and social justice is about power and addressing the disadvantage and lack of power experienced by Indigenous Australians. Achieving social justice is a prerequisite for reconciliation. Indigenous psychologists recognise that Australia is a shared country and has a shared future, and therefore in the process of reconciliation we need to work together in respectful relationships to bring about positive social change that will create a better future for all Australians.

Indigenous psychologists are committed to improving holistic wellbeing approaches in psychology, and believe that Aboriginal and Torres Strait Islander mental health should be viewed in a holistic context that encompasses social and emotional wellbeing, as well as physical, cultural and spiritual health, and that land, family and spirituality should be recognized as central to well being. It is also necessary to acknowledge the history of colonisation and its consequences: that all social environments, including health, housing, education, employment, cultural safety and affirmation (cultural and spiritual health), and experiences of racism, create the living context of any Indigenous individual and must be considered at all times.

Indigenous psychologists respect the integrity and diversity of Indigenous

cultures and peoples. That is, we embrace the diversity of Aboriginal and Torres Strait Islander peoples and cultures found in urban, rural, regional and remote Australia. We do not adopt negative judgements based on colonial and western standards that have been applied to Indigenous people in recent history. Indigenous psychologists treat Indigenous and non Indigenous peers, clients and students with respect and equality.

Indigenous psychologists support the purposes and principles of the United

Nations Declaration on the Rights of Indigenous Peoples and demonstrate a

conscious commitment to cultural maintenance for Indigenous people. Maintaining our cultures influences the quality of life of all Indigenous people, and this commitment affirms our obligation to protect the fundamental human rights and diversity of all cultures, particularly those of Indigenous peoples with inherent rights as first peoples.

Indigenous psychologists contribute to the development of theoretical perspectives that are grounded in Indigenous realities and which challenge colonial versions. We support the assertion that ‘all doctrines, policies and practices based on or advocating superiority of peoples or individuals on the basis of national origin or racial, religious, ethnic or cultural differences are racist, scientifically false, legally invalid, morally condemnable and socially unjust’ (United Nations, Declaration on the Rights of Indigenous Peoples, 2007). Indigenous psychologists actively work to deconstruct colonial representations of Indigenous people and continually challenge racist ideologies by ensuring their practice and academic work adopts a critical approach to non-Indigenous theories and practices.

Indigenous psychologists are sensitive to cultural constraints placed on

sharing sacred and secret knowledge of Indigenous cultures and adopt appropriate behaviours in relation to such matters at all times. That is, we strive to be grounded, honest and wise in discussing cultural issues; to avoid exceeding any limitations placed on us by our elders; to not violate the privacy and integrity of other Indigenous individuals or groups in public forums; to not share information about specific cultural practices without seeking the appropriate permissions to do so; and to not disclose material that we would not be entitled to discuss, for instance gender-specific issues.

Indigenous psychologists are committed to working towards the empowerment of Indigenous people and groups and as such, support community controlled, locally led, strengths-based research. As well as adhering to the NHMRC and APS Guidelines for research, we will actively include appropriate Indigenous community members at relevant levels in the initiatives we undertake. Further we will respect and adhere to community and other consultation protocols and give primacy to Indigenous concepts of social and emotional wellbeing and mental health. At the same time we recognise and accept that we will need to take a leadership role in some instances.

Indigenous psychologists respect the intellectual property rights of members and communities. Indigenous cultural and intellectual property rights belong collectively to Indigenous people as part of their ongoing survival and we discourage the commercialization or commodification of Indigenous intellectual property at the expense of Indigenous communities, cultures and individuals. We also recognize that some AIPA members may own or be held accountable for cultural information and the contexts in which it is used. No information provided by an AIPA member will be used without first seeking their permission. AIPA will adhere to academic conventions to acknowledge the input of members into discussion papers, submissions, position papers and other scholarly work. AIPA also recognizes the moral rights of members, including the right to be named as author of a work (the right of attribution) that they have contributed to or developed on behalf of AIPA, and the right to object to derogatory treatment of any such work, that may be seen as prejudicial to the author's honour or reputation (the right of integrity).

Conclusion

Ethical guidelines must continue to evolve to reflect how we apply moral principles to our lives, and our lives must include those who are presently marginalized in society. The mainstream codes of ethics are good as far as they go, but they require proactive interpretation and implementation. Critics see them as falling short of meeting egalitarian and social justice aspirations. Ethical guidelines tend to lag behind the progressive thinking in society and take time to catch up (Jean, 2002).

To lead we must address the diversity of people in all aspects of society with genuine respect and caring. Community psychology, feminist practice, and social construction theories of disability show significant leadership for developing more appropriate guidelines for professionals working cross culturally. The counseling profession has been a leader in promoting multicultural sensitivity and practice (Jean, 2002).

References

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