Clinicians always impose their individual style, personal belief, cultural background, professional knowledge, and own’s value on the patient when do assessment interview. Their background and values will influence the interview process and outcomes. It is because clinicians might have cultural biases and expectations about the behavior. To be clinically competent, clinicians should be able to work in multiethnic, multicultural societies, and provide care for patients with diverse backgrounds.
Key words: culture, background, values, belief, clinician
The influence of clincian’s background and values in the interview
According to J. H. Resnick (1991) defined and descibed clinincal psychology as “The field of clinical psychology involves research, teaching, and services relevant to the applications of principles, methods, and procedures for understanding, predicting, and alleviating intellectual, emotional, biological, psychological, social and behavioral maladjustment, disability and discomfort, applied to a wide range of client populations”. The assessment interview is the most basic and the most helpful technique used by the clinical psychologist to evaluate an individual’s strength and weaknesses, conceptual the problems, and prescribe a treatment. The ultimate goal of assessment is to accomplish effective solutions to the problem. However, all clinican have their own values, background, and biases, and those kinds of things will affect clinicans’ perceptions during the interview process.
A consideration of culture is very important for the clincian in the process of the interview, diagnosis, and treatment. It is because clinicians need to formulate an precise diagnosis and treatment plan which will be most acceptable for their patient. Doing the assessment with minority patients is much more complex than doing the assessment with nonminority patients, especially when the patient has a different cultural or ethnic background from the clinician. Clinicians are required to develop culturally competent knowledge, attitudes, and skills. Budman, Lipson and Meleis (1992) believed that the clinician should have some knowledge of the patient’s cultural identity in order to avoid biases and misdiagnosis.
The word culture refers to meanings, values, and behavioral norms that are learned and transmitted in the dominant society and within its social groups. Culture is the unique behavior patterns and lifestyle shared by a group of people that distinguish it from other groups. Linton (1945) defined culture includes the collection of ideas and habits shared, learned and transmitted from generation to generation. It generated a shared snse of community, history and heritage among those who come from the same society. It contains two components, external and internal. The external components include beliefs, laws, traditions, customs, morals, and habits, whereas the internal components include norms, rules, standards, ideals, and values. Culture and people influence each other interactionally. Culture shapes people’s behavior, and people’s behavior form culture. Mezzich, Kleinman and Fabrega (1993) indicated that culture has a great impact to influence cognitions, feeling, self concept, the diagnostic process and treatment decisions as well.
Cultural norms will influence clinician judged the particular behaviors. What may be abnormal and psychopathological in Western culture may be considered normal and culturally acceptable in a Eastern society. At the same time, abnormal and psychopathological in Eastern culture may be considered normal and culturally acceptable in a Western society. Each culture has its own communication style, such as different language, gestures, and rituals, eating behaviors, family roles, beliefs and rituals, and ways of regulating aggressive and sexual drives. When clinician and patient do not come from the same ethnic or cultural background, there is greater potential for cultural differences to occure. Clinicians may tend to ignore symptoms that the patient thinks that is important, or less likely to understand the patient’s fears, concerns, and needs. Westermeyer (1987) pointed out that clinician should not typically rely on behavioral cues when doing assessment with a patient from another culture. Clinicians found it hard to make an accurate diagnosis and treatment because the norms and expectations which are used to evaluate the patients may be different for different cultures.
A Chinese Woman, 48 years old had been receiving antipsychotic and antidepressant medication for psychotic depression. As she reported that she had seen her deceased mother in her dream, had traveled from the place of the dead to induce the patient’s own death and to bring her to the next world. In western culture, the woman should be suffered from depression, as she fulfil the one of the major symptoms of depression, thoughts of death. However, it is very common harbinger of death in the dreams of some Asian patients. It is not a delusional belief but as a culturally consistent belief. Culture-bound syndromes are a sets of symptoms which much more common in some societies than in other cultures. Culture-bound syndromes may be considered as illness behavior of the predominant culture. It is necessary that clinicians should judge possible symptoms and syndromes of psychopathology against a knowledge of the cultural norms of the patient’s cultural identity. If clinician is not aware of his or her lack of understanding, it is such a easy thing to make errors either by overpathologizing what is considered normal in that culture or by attributing to cultural normality what is actually considered psychopathological in that culture.
Religious and spiritual beliefs which are an important aspect of cultural identity and that affect mental health. The most often seen is religious delusions which involve patients’ belief. Religious delusions can be defined as people have delusions, and that religious content is not socially acceptable or shared by other religious people. They believed that they have a special relationship with God. Most claimed that they have ability to communicate with God, they are able to speak to God directly and hear replies, or to be in communication with a spirit from another dimension. Some may believe that they are God, or God’s chosen messenger. Clinician who does not believe in God, or even they have no religious belief, find it hard to impact their patients. The patients also have a rejecting attitude towards clinician. It may be necessary to use a ‘culture broker’,who from the same religious group as the patient. The culture broker acts as the patient’s advocate. However,It is the best way to require referral to religious professionals.
On the other hands, some clinician with religious belief tend to impose their religion value on their patients. During the assessment interview, patients are easy to be influenced by their clinician, especially the religious beliefs of clincians. Actually, the religious beliefs of clinicians should not be allowed to influence patients.
Racial prejudices also influence the expectations and can lead clinicians to stereotype individuals. Whaley (1998) found that clinician bias and stereotyping of ethnic and racial minorities can lead to misdiagnosis. It is because clinicians often reflect the attitudes and discriminatory practices of their society involuntarily. Jenkins-Hall and Sacco (1991) found that white clinicians rated a videotape of an African American patient with depression more negatively than they did a white patient with identical symptoms. To think about a black patient who suffered from major depression, discrimination is a stressful event in her life. When she accept to confront the problem, she encounter the white clinician who stereotype her. Her depression should be worse than before.
In clinical psychology, it is not suprising to communicate with patient who has abnormal sexual orientation, like homosexual or bisexual. Sexual orientation is an enduring emotional, romantic, sexual, or affectional attraction toward others. It is easily distinguished from other components of sexuality including biological sex, gender identity, and the social gender role. Most of them may seek psychological help for dealing with prejudice, but not for changing the sexual orientation. They expect that such interview will take place in a professionally neutral environment, without any social bias from the clinician. If the clinician has a social bias on sexual orientation, it should influence the interview process. Patients and clinician can not develop a trustful and supportive relationship. Clinician fails to help the patient to develop strategies for dealing with the prejudice associated with homosexuality and the damaging effects of stereotypes and bias.
If the clincian have feminism background, his or her belief may influence the interview process. Feminism is the belief that women should have economic, political and social equality with men. Clincian who has feminism belief, advocate that the roles of the male and female should be equal. The couple should trust each other, share responsibilities, listen to one another, respect each other, and love one another equally. If their patients obtain unequal treats, the clinician with feminism value would like to suggest their patients to fight back. Finally, the most often outcome is the patient get divorce with her spouse. Clinician with feminism belief think that female should not be subordinate male. Their personal value would influence patient perception. Actually, it is not a right way to communicate with the patient. Each family member should have a family role or position of the family. Clinician should give an creditable advise for the patient such as how to communicate well with her family, but should not impose too much personal value on the patient.
Different approach the clinician advocate is also influence the interview process. Clinician who advocate psychoanalytic, focus on the influence of the past during the interview process. It is because Freud believed that current personal problems were founded on the repressed experiences of childhood. The goal is to make unconsious consious. Whereas clinician who advocate existential psychotherapy, focus on here and now in the interview process. The utlimate goal is to get the person to believe that life is his experience in the here and now, and they should live more fully in each moment.
In reality, the rich do not understand the difficult life the poor have. People with psychological illness may have difficulties to afford a heavy burden. If clincian fail to aware his or her patients have financial and economic difficulties, their patients might withdraw the treatment due to the expensive fee. It has a negative great impact toward the patients since they unattained a suitable treatment opportunity. As a clincian with social responsibility, provide clinical psychological service to the minority group at a reasonable price is needed.
Clinicians tend to impose their individual style, personal belief, cultural background, professional knowledge, and own’s value on the patient spontaneously. However, sometimes the culture of the clinician influences the communication with the patient during the interview process. It is because clinicians might have cultural biases and expectations about the behavior. The culture of the clinician explicitly or implicitly affects his or her attitude toward the patient, understanding of the patient’s problems, and approach to caring for the patient. To be clinically competent, every clinicians should be able to work in multiethnic, multicultural societies, and provide care for patients with diverse backgrounds. Nowadays, diverse populations in a society creates the need for training in cultural psychiatry. Even if the cultural background of the clincian is not much significantly different from the patient, it is unavoidable that some differences will exist. Therefore, all clinical practice should be considered to be transcultural (Comas-Diaz 1988). As a clinicians, it is necessary to be aware of their own cultural identity and their attitudes and beliefs toward ethnic minorities, because these kinds of value not only will affect the relationships between clinicians and patients, but also influence the assessment interview process and outcomes.
Budman, C. L., Lipson, J. G., ; Meleis, A. I. (1992). The cultural consultant in mental health care: the case of an Arab adolescent. Am J Orthopsychiatry, 62(3), 359-370.
Comas-Diaz, L., ; Jacobsen, F. M. (1991). Ethnocultural transference and countertransference in the therapeutic dyad. Am J Orthopsychiatry, 61(3), 392-402.
J. H. Resnick (1991)
Jenkins-Hall, K. D., ; Sacco, W. P. (1991). Effect of client race and depression on evaluations by white therapists Journal of Social and Clinical Psychology , 10, 322 333 .
Linton, R. (1945). The Cultural Background of Personality. New York, NY: Appleton-Centruy-Crofts.
Mezzich, J., Kleinman, A., ; Fabrega, H. (Eds.). (1993). Revised Cultural Proposals ForDSM-IV (Technical Report). Pittsburgh, PA: NIMH Culture and Diagnosis Group.
Whaley, A. L. (1998). Issues of validity in empirical tests of stereotype threat theory American Psychologist , 5, 679 680.
Westermeyer, J. (1987). “Prevention of Mental Disorder Among Hmong
Refugees in the U.S.: Lessons from the Period 1976-1986.” Social Science and Medicine