It is critical that the culturally sensitive clinician working with an ethnically diverse patient examines the cultural differences that exist between himself and the patient. The examination of how cultural and racial differences affect the therapeutic dynamic minimizes potential cultural misunderstandings, helps to elucidate the patient’s cultural perception of mental illness and mental health treatment, and allows for the uncovering of the therapist’s own biases and ethnocentric related countertransferences. But how does this really play out in reality, within the context of the therapeutic setting?
Avoiding the discussion of cultural and racial differences can be like ignoring the proverbial elephant in the room. The intrinsic power differential that exists between a patient and therapist comes with the territory of the profession, but this differential can be compounded by racial and ethnic differences, especially if the therapist is a member of the dominant culture. Therefore, it is essential for the therapist to convey a willingness to address the relevance of these differences by initiating this difficult conversation if the patient has not done so. Obviously, the sensitive clinician should not shove the issue down the throat of the patient, but he should at the very least communicate a sense of availability to the issue so that the patient feels comfortable broaching the subject.
The nature of psychodynamic psychotherapy training is such that we are taught to believe in certain universal truths regarding human development, attachment, psychopathology, etc. While there exists a high degree of scientific credibility to pyschodynamic theory, we also have to acknowledge that the theory is heavily steeped in Western beliefs and values, and that most of our theoretical notions are based off of samples/phenomena/observations of Western people made by Western psychologists. Consequently, patients with diverse backgrounds who come to psychotherapy may be misunderstood because of the enthnocentric lens from which they are viewed.
Psychodynamic theory, for instance, tends to regard the origin of paranoia as a result of persecutory, critical, suspicious parenting. However, when considering ethnic and racial factors, one can see how paranoia may actually be an adaptive defense of historically persecuted people (e.g., African Americans) in response to aversive environmental demands, not poor parenting. In fact, African American parents may actually instill certain paranoid qualities (e.g., suspiciousness) in their children—qualities that are completely adaptive to survival in hostile and racist environments. This illustrates the importance for clinicians not to exclusively rely on psychodynamic conceptualizations without considering the patient’s cultural and racial framework.