Multicultural concerns cover a broad range of topics and identities including race, religion, ethnicity, culture, sexual orientation, and/or disability. Culture, or customs, beliefs, and products of various institutions or people at any particular time, can greatly influence how people interact and how we see one another–both positively and negatively.
People from different cultural groups may be negatively stereotyped or heavily discriminated against because of their differences from a main culture. Historically, multicultural concerns have affected people of Native American, African-American, Italian, Irish, Jewish, and other cultural groups. Other racial and religious minority groups continue to be ostracized or persecuted in various parts of the world.
School, work, and social situations can bring together people of various cultures, which may or may not result in friction between individuals. Regardless of one’s background or heritage, healthy social environments can depend on tolerance, compassion, and a willingness to learn about others’ differences. Ever-changing societies rely on refraining from negative stereotyping and discrimination.
Race or heritage can play some role in health throughout one’s life. Studies have shown that some ethnic groups are more at risk for some health concerns. Cardiovascular problems, HIV/AIDS, and osteoporosis are all more likely to occur in marginalized populations. In addition, some people of color are more susceptible to concerns such as eating or food issues.
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Multicultural factors may affect how a person is medically treated or whether they receive medical treatment at all. Cultural views of health and health problems may differ and create a problematic dynamic in medical treatment. Misunderstandings of and/or ignorance toward cultural differences may lead to physical violence, which may require medical attention. Studies have also demonstrated minorities may be less likely to seek both medical and mental health treatment, which may be because of fear, stigma, discrimination, or other factors. Many minorities might not have any access to treatment at all.
Individuals and families may choose to relocate for a vast array of reasons, from health benefits in a new country to escaping terrorism and danger in their home countries. People move in hopes of better living situations, higher-paying jobs, healthier environments for raising children, improved medical care, and many more promises in a new land. If they find those elements, they may survive and thrive in a new country once settled there. For example, some evidence suggests immigrants from Mexico to the United States have even better rates of mental well-being than Mexican-Americans born in the US.
Problems with immigration, however, can pose extreme risks to mental health, and immigration status can threaten individuals’ access to medical and mental health care. Every country has different policies regarding how immigrants and asylum seekers are allowed into the country, how long they may stay, and their rights upon arrival. Whether a person or family receives permanent visas, temporary visas, or time in a detention facility can have a profound effect on the mental health results of their immigration. People with temporary visas face higher rates of mental health issues such as worry, financial stress, health problems, discrimination, loneliness, and isolation. For detainees, the effects can be even more damaging.
Detained refugees are found to have pervasive stress, depressive episodes, and posttraumatic stress (PTSD) that can manifest with flashbacks, sadness, and feelings of hopelessness. Though detainees have generally escaped traumatizing and terrorizing environments, there is a high likelihood they will experience even more trauma during detention, setting them up for even more risk of negative mental health outcomes. Detention centers frequently eliminate or restrict access to work, housing, education, welfare, and even basic health care services. These factors may exacerbate any mental health issues and negative experiences immigrants faced prior to detention.
Culture plays an extremely relevant role in psychotherapy. The likelihood of a person seeking help, available treatments used by mental health professionals, and the outcome of treatment are greatly affected by cultural considerations.
Depression or other mental health conditions that one culture may view as a reason for therapy may be seen as a matter to be handled by family or religion in another culture. A recent immigrant to the United States might be experiencing depression, but could also be facing the very different cultural landscape of her new home. A therapist with an understanding of multicultural issues can detect whether the problem is one of depression or adjustment. They can also make suggestions about how to acclimate to a new culture and anticipate potential problems. For example, a person who lived in an extremely small tribal society where she knew everyone she saw every day might struggle with the crowds and anonymity that are so often a part of life in the U.S.
In a psychotherapeutic relationship, the culture of both therapist and person in therapy play a role in that dynamic. It is important for the therapist or mental health professional to be aware of any possible cultural differences of the person in therapy, even when multicultural issues are not a direct focus of the therapy sessions. Most therapists receive training or education on cultural competency and multicultural counseling, and therapists who wish to learn more can pursue continuing education.
Multicultural concerns are increasingly part of the therapeutic education landscape. Some therapists get training in multicultural issues in school, and many organizations offer multicultural training in the form of continuing education classes. These training sessions can help therapists become more sensitive to the needs of different populations and provide more effective treatment. Some common issues therapists will learn about in training and must master to competently aid multicultural people in therapy can include:
- Different approaches to therapy within different cultures and the ways culture may magnify the stigma of mental illness.
- Cultural beliefs about mental illness, including spiritual beliefs. Using a person's spiritual beliefs as a tool for healing can be helpful.
- Sensitivity to racism and ethnocentrism.
- Cultural values and the ways in which culture shapes family relationships, ethics, core beliefs, and communication styles.
- Culturally sensitive communication, including the avoidance of potentially triggering terms and figures of speech.
- Variations in communication styles; some cultures prefer close contact while others need more space during a therapy session. Some cultures encourage people to be open and animated while others encourage people to keep their problems to themselves.
- Alegría, M., Chatterji, P., Wells, K., Cao, Z., Chen, C. N., Takeuchi, D., ... & Meng, X. L. (2008). Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatric Services, 59(11), 1264-1272. Retrieved from https://ps.psychiatryonline.org/doi/full/10.1176/ps.2008.59.11.1264
- Carollo, K. (2011). 5 diseases more common in minorities. ABC News. Retrieved from http://abcnews.go.com/Health/diseases-common-minorities/story?id=14722258#
- Cusido, C. (2015). “Eat up”: How cultural messages can lead to eating disorders. NPR. Retrieved from https://www.npr.org/sections/thesalt/2015/12/07/458490852/eat-up-how-cultural-messages-can-lead-to-eating-disorders
- Escobar, J. I., Nervi, C. H., & Gara, M. A. (2000). Immigration and mental health: Mexican Americans in the United States. Harvard Review of Psychiatry, 8(2), 64-72. Retrieved from http://www.tandfonline.com/doi/abs/10.1080/hrp_8.2.64
- La Roche, M. J., & Maxie, A. (2003). Ten considerations in addressing cultural differences in psychotherapy. Professional Psychology Research and Practice, 34(2), 180-186. Retrieved from https://www.researchgate.net/profile/Martin_La_Roche/publication/232517880_Ten_considerations_in_addressing_cultural_differences_in_psychotherapyProfession_Psychology_Research_and_Practice_342_180-186/links/54e248ce0cf29666379656ae/Ten-considerations-in-addressing-cultural-differences-in-psychotherapyProfession-Psychology-Research-and-Practice-342-180-186.pdf
- Momartin, S., Steel, Z., Coello, M., Aroche, J., Silove, D. M., & Brooks, R. (2006). A comparison of the mental health of refugees with temporary versus permanent protection visas. Medical Journal of Australia, 185(7), 357-362. Retrieved from https://www.mja.com.au/system/files/issues/185_07_021006/mom10496_fm.pdf
- Silove, D., Steel, Z., & Watters, C. (2000). Policies of deterrence and the mental health of asylum seekers. JAMA, 284(5), 604-611. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/192952?redirect=true
- Steel, Z., Momartin, S., Bateman, C., Hafshejani, A., Silove, D. M., Everson, N., ... & Mares, S. (2004). Psychiatric status of asylum seeker families held for a protracted period in a remote detention centre in Australia. Australian and New Zealand Journal of Public Health, 28(6), 527-536. Retrieved from http://onlinelibrary.wiley.com/doi/10.1111/j.1467-842X.2004.tb00042.x/full
- Steel, Z., Silove, D., Brooks, R., Momartin, S., Alzuhairi, B., & Susljik, I. N. A. (2006). Impact of immigration detention and temporary protection on the mental health of refugees. The British Journal of Psychiatry, 188(1), 58-64. Retrieved from https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/impact-of-immigration-detention-and-temporary-protection-on-the-mental-health-of-refugees/B6914BF421D202CE4474C5F757BC541E
- Sue, S. (2003). In defense of cultural competence in psychotherapy and treatment. American Psychologist, 58(11), 964. Retrieved from http://psycnet.apa.org/record/2004-10969-026
- Sue, S., & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist, 42(1), 37. Retrieved from http://psycnet.apa.org/buy/1987-16319-001
- Wohl, J. (1989). Integration of cultural awareness into psychotherapy. American Journal of Psychotherapy. Retrieved from http://psycnet.apa.org/record/1990-08101-001