THERE IS EVIDENCE THAT MANY MENTAL HEALTH PROBLEMS
EXPERIENCED BY MEMBERS OF ETHNIC AND CULTURAL MINORITY GROUPS ARE RELATED TO
PREJUDICE, DISCRIMMINATION, CULTURAL DIFFERENCES AND OTHER EXPERIENCES
ASSOCIATED WITH MINORITY GROUP STATUS.
SELF AWARENESS ABOUT ONE’S OWN
ATTITUDES, VALUES AND BELIEFS ABOUT CULTURAL DIFFERENCES AND A WILLINGNESS TO
ACKNOWLEDGE RACIAL/CULTURAL DIFFERENCES ARE CRITICAL FACTORS FOR THE SOCIAL
WORKER IN WORKING WITH DIVERSE POPULATIONS.
THERAPIST-CLIENT
MATCHING
MATCHING CULTURE, RACE, ETHNICITY-REDUCE PREMATURE DROPOUT
RATES BUT DOES NOT HAVE A PREDICTABLE EFFECT ON THERAPY OUTCOME (ATKINSON,
1986; SUE, ET AL., 1991)
ACCULURATION, TRUST OF WHITES, ETHNIC IDENTITY-IMPACTS THE
EFFECT OF MATCHING
Common Traits of Ethnic Groups
ASIAN
● CONFUCIAN/BUDDHIST PHILOSOPHIES
● Percived as the “successful” or “model
minority”
● Family is the basic unit. Family needs, prestige and welfare are deemed
more important than Individual success.
● PATRIARCHAL SYSTEM- The father or the oldest
male in the family is afforded the most respect.
● Often reluctant to share personal matters
with strangers.
● COMMUNICATION-INDIRECT Communication is
commonly used to avoid direct confrontation.
There are more reserved, they show less emotional expressiveness.
● Seek help from the family or cultural
community-mental health problem is highly stigmatized because family is viewed
as less acceptable and less likely to arrange marriages for their children.
● Emotional
problems are expressed through physical complaints; tend to come to treatment
with somatic complaints. Regard professional as person who has
expert advice to solve a problem. May use a combination of traditional and
Western Medicine (Lee, 1996)
● Common Presenting Problems: Family conflicts.
Among refugees traumatized by war, PTSD and dissociative disorders are common.
● Effective Approaches: Problem- focused,
directed, goal oriented, structured, problem solving approach and symptom
relieving approaches. A psychoeducational approach is congruent with Asian
values. Social support and resources (Lee, 1996)
● Asian patients respond to psychotropic drugs
differently than Caucasian patients. They typically require lower doses of
medication than others and will experience more side effects from regular doses
given to other patients.
● Family therapy, encourage parents to
communicate with Children openly. However, children may be perceived as
“talking back” and insolent. (Hepworth, et. Al., 1997)
● Be aware
of the role of shame and guilt in Asian cultures (i.e. reinforce adherence to
prescribed obligations and responsibilities).
Need to know the degree of assimilation and ethnic identity
when working with Asian clients.
“SOCIAL DISPLACEMENT
THEORY”- Research on Asian refugees found they had a pattern of Optimism
upon arriving to the U.S which is followed by frustration, depression and
confusion. Refugees and immigrants are
expected to exhibit the most severe mental health problems at the end of the
first year through the third year after arriving in the U.S
Intergenerational conflict is one main source
of stress; resulting from different degrees of acculturation by family members
(with the younger members adapting more quickly and rejecting of their family’s
cultural traditions).
BLACK
● Multigenerational family systems. STRONG
KINSHIP BONDS; EXTENDED FAMILIES AND RELATIVES WITHOUT BLOOD TIES.
● High Value placed on Religion (CHURCH)
COMMUNITY, education and work.
● Flexible family roles, parentified child
common. Egalitarian marital relationship, Great respect for the Elderly
● will
seek help from community representatives and organization for problems and
mutual support
● High
Tolerance for suffering.
● Due to
slavery they may exhibit signs of “healthy cultural paranoia”. Tend to self
disclose to BLACK therapist and not disclose to an Anglo therapist due to
reaction to racism that is based in the past.
● Physical punishment sometimes used as a way
of disciplining children.
● Black woman is viewed as being “all
sacrificing” and the strength of the family”
● Higher percentage of blacks living in
poverty and vulnerable to health problems.
● Reason
for treatment: poor school adjustment, acting out behavior, depression,
psychosis, drug addiction and alcoholism. Schizophrenia is diagnosed most in blacks.
●
Identified patient: child referred by another agency or school.
● Non verbal communication very common: less
eye contact, higher level of emotional expressive ness, and brief to the point
communications.
●Effective Treatment: ethnically
sensitive; time limited, problem-focused, directive techniques, child focused,
family therapy. RESPECT-Making eye
contact and building rapport is critical to establishing trust, use last name
until client gives permission for less formality.
NATIVE AMERICAN
● The TRIBE IS THE SUPREME. It is responsible
for raising children and making all major decisions.
● Complex
Family Organizations that include without blood ties, strong kinship bonds,
multigenerational, extended families. GROUP takes preference over individual. Husband and wives show a tendency to
communicate more with their gender group than with each other.
● When a Native American child is being placed
in foster care or adopted; a social worker must contact the administrative
office of the child’s tribe. The Indian Child Welfare Act of 1978 (P.L.
95-6087) gives jurisdiction to tribal authorities in these cases.
● Native American tribes operate under their
own rules and laws.
● Tribal customs and rituals must be
respected.
● Respect
for elders who are culture bearers that hand down traditions, legends, history.
Tradition of oral story telling.
● Spirituality: fundamental part of life: interconnectedness
of all living things; sacredness of all creation: animism.
● Use OF
TRADITIONAL & Western healing
practices: medicine man, shaman, or spiritual leaders are traditional healers.
●
Communication: indirectness; being still and quiet: comfortable with silence:
value listening. Non-verbal
communication common.
● Native
Americans may avoid making direct eye contact as a show of respect when talking
to a higher status person.
● Reason for seeking help: suicide,
alcoholism, family problems, conflicts arising from living in two worlds
(Attneave, 1982)
● Effective Treatment: culturally sensitive,
nondirective, collaborative approaches,
problem solving approach, Network therapy: use of metaphors, story telling,
paradoxical interventions; networking and use of rituals. Family therapy is consistent with the Indian value of working
together to solve problems. (Sutton and Broken Nose, 1996) Social worker should use active listening
skills. Increase his/her tolerance for silent pauses, and show patience with a
slower pace interview. Identify the client’s degree of acculturation and tribal
identity and worldview.
● Consider incorporating elders,
medicine people, and other traditional healers into the treatment process.
HISPANIC
● Largest minority group in the U.S.
●
Need to know the degree of acculturation and world view when working with Hispanics.
● Roman Catholic-Emphasis on spiritual values.
● Family is of great importance. They rely on family for support before going
to outside sources during times of economic, emotional, and social hardship. INTERDEPENDENCE
viewed as healthy and necessary and highly valued connectedness and
sharing.
● Families are patriarchal. Men characterized as machismo.
● Use of native language and non-verbal
communication can be critical to successful communication.
● “PERSONALISM”-Personalized way of relating
that imparts self worth. Display varied emotional expressiveness depending on
language being spoken. When speaking Spanish, client may be more expansive,
friendly, and playful but in switching to English, speech may be more
businesslike, rational and guarded. (Hepworth, 1997)
● Lack adequate access to health care and
experience more health problems than non-Hispanic whites: diabetes,
hypertension, alcoholism, tuberculosis, AIDS, lead poisoning, injuries, and
violent deaths. (Hepworth, 1997)
● Most important reasons to seek help: wanting
to improve their life circumstances. Locked into a cycle of poverty due to
inability to access resources. They also feel isolated and pressured to change
in order to adjust to a new culture. Culture shock and conflicting cultural
values are pervading issues.
● Effective Approach: Elicit, listen, and
validate the “cultural journey” they are experiencing. Help them build bridges
between old and new worlds. Short-Term treatment more effective than long term,
in-sight oriented interventions.
● Emphasize
formalism in therapy (e.g., address family members in a way that reflects their
status, respect conservational distances)
●
Hispanics are least likely to differentiate between emotional and physical
problems. They go to doctor with psychological complaints instead of mental
health professional.
ELDERLY
●Accurately
assess and diagnose disorders of aging, knowledge of services to the elderly
and appropriate clinical skills.
● Reminiscences
common
● Identity
transition problems- reason why they come therapy. These involve physical, psychological and
social changes they are experiencing.
● SW
workers goal is to help the elderly adapt to new roles and changes in life
style. This involves setting specific
treatment goals, helping with retirement and activity planning, and making
appropriate referrals to other professionals and services.
●DEPRESSION:
Result of loss, for example widowhood is associated with increased mortality
and hospitalization for depression.
SYPTOMS OF DEPRESSION VARY IN ELDERLY THAN THE YOUNG; LOOK FOR FEELINGS
OF USELESSNESS, PESSISMISM, APATHY, SOMATIC COMPLAINTS ARE VERY COMMON IN
ELDERLY.
●Must
differentiate between Dementia and Depression.
●SW
must have awareness about his/her own feelings of death.
●It is
presumed that the elderly come to therapy because of the dying process when
they actually seek treatment to achieve a specific goal or a sense of meaning
in their lives.
●SW must
also be aware of their own values regarding institutionalization. The
clinician’s role is to facilitate discussions of institutionalizations in a non
judgmental manner. Provide ongoing support, once the elderly is placed is
essential in coordinating treatment with the nursing home staff and assisting
the caregivers to deal with feeling of loss, guilt etc.
THERAPY FOR THE ELDERY:
Reality orientation
Reminiscence therapy
Validation Therapy-
Genuineness, accurate empathy, unconditional regard will
foster the therapeutic relationship.
Supportive therapy good-for stressors and losses.
Patients with HIV
Disease
●Lack support from others
●Internalization of the social stigma
●Hopelessness
●Lack of information about HIV Disease
●NEUROLOGICAL DISORDER: DEMENTIA, DELIRIUM, AIDS DEMENTIA
COMPLEX.
●Fear of developing visible symptoms, deteriorating completely.
●Social worker must be trained in crisis intervention and
methods for dealing with life-threatening illnesses.
●SW must be knowledgeable about HIV
Encourage client to disclose their condition to their sexual partners
●SELF AWARENESS ON THE PART OF THE SOCIAL WORKER IN REGARDS TO
HIV POPOULATION, STIGMAS “GAY DISESASE”
TREATMENT FOR HIV PATIENT:
●Crisis intervention
●Problem solving, support therapy
●Brief psychotherapy and group intervention
●HERE AND NOW
SW ROLE:
HELP CLIENT HANDLE DIAGNOSIS
Improve the Quality of the Client’s
life
Empower the client
Deal with the client’s Impending
death.
Reference :
Social Work - A profession of many faces
