15. TherapyTherapist Match Clients - RonaldMah

Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist,
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15. TherapyTherapist Match Clients

Therapist Resources > Therapy Books > All Relationships MultiCult

All Relationships and Therapy are Multi-Cultural- Family and Cross-Cultural Complications
by Ronald Mah

The principle of matching therapies to client populations is quite provocative.  LaTaillade discusses two therapeutic approaches for working with African-American clients that emphasize the context of the clients' experience: Enhanced cognitive-behavioral therapy for couples (ECBT) and Integrative behavioral couple therapy (IBCT).  "…enhanced cognitive-behavioral therapy for couples (ECBT; Epstein & Baucom, 2002) extends traditional CBT approaches by giving equal emphasis to affective as well as behavioral and cognitive factors that impact relationship functioning.  ECBT employs a contextual approach that recognizes relationships are affected by the environment in which they exist and thus addresses environmental factors that may affect the couple relationship, including but not limited to family systems, community supports, stressors, and life circumstances.  In addition, ECBT promotes the use of interventions designed to highlight and maximize positive aspects of the couple relationship. Integrative behavioral couple therapy (IBCT; Jacohson & Christensen, 1996) similarly extends CBT approaches by adopting a contextual focus; balancing traditional behavior change interventions (e.g., communication and problem-solving training) with techniques designed to foster acceptance as an alternative solution to problems that are not amenable to typical change interventions; and rather than targeting specific, discrete problem behaviors, IBCT focuses on the unifying themes (i.e., closeness-distance) that serve as the common thread uniting couples' seemingly diverse complaints.  These integrative approaches increase the applicability of CBT to diverse populations by attending to stressors and resources in the couples community and sociocultural environment that impact relationship functioning, using a contextual focus that prevents adoption of a "value and culture free" approach to assessment and treatment, identification of themes that often characterize conflict in couple relationships (i.e., balancing power and respect), and fostering empowerment by helping couples build on their strengths and resources and generalize treatment gains" (page 347-48).

Duba and Watts (2009) summarized potentially matching religious faiths for positive fit to theoretical orientations.  "Some research has examined matching treatment approaches with certain religious faith.  In a representative study, investigators found the following positive correlations: (a) Eastern beliefs with humanistic, existential orientations; and (b) orthodox Christian beliefs with cognitive and behavioral orientations… The ideology of Christian clinicians may conflict with concepts and injunctions of humanistic theories.  For the same reasons, Christian clinicians might use cognitive- and behavioral-based theories.  Clinical and theoretical literature suggests that an Adlerian approach might be useful in working with Christian couples…. (There is) significant common ground between Adlerian therapy and Christian beliefs.  Both perspectives are relationship-focused and affirm that relationships (e.g., between client and clinician, between client and others, between client and God) is an integral aspect of one's growth.  Both Adlerian psychology and the Bible highlight the importance of understanding one's lifestyle and how that affects one's relationships, one's sense of belonging or attachment, and one's ability" (page 214).

Since both ECBT and IBCT recognize that relationships do not exist in isolation, but are affected by the environment that they exist, layers of cultural factors including race, economics, class, history, and so forth are addressed in addition individual psychodynamics and family systems.  Alternative solutions sought by IBCT are analogous to cross-cultural perspectives and solutions.  Unifying themes point to the core themes of successful or functional dynamics that serve all members versus unsuccessful or dysfunctional dynamics that cause all members harm.  This is not to be interpreted as recommendations per se to use ECBT or IBCT with African-American couples.  Rather, what may be recommended is the therapies' emphasis in using contextual examinations of environment to serve assessment of relationships for potential multiple cultural influences.  Cognitive behavioral perspectives posit a logical interpretation of behavior and choices as working or not.  The practical application is whether relationship functioning is working or not to enhance and increase the survival of a relationship.  What may work for one relationship may not work for another.  Their contexts may differ.  What works for one African-American couple may not work for another pair of African-Americans in a relationship.  What works for one Native American relationship may not work for another but dissimilar Native American pair of individuals.  While there may be contextual similarities or life experiences that are similar, there may be other issues that are unique enough to significantly qualify the therapy.  

Duba's and Watts' recommendations appear to match therapies and religions for similar worldviews or ways of conceptualizing people in the world.  Referring out to appropriate therapists including for religious match (or religious orientation to matching therapy as suggested by Duba's and Watts' information) is an ethical obligation whenever therapists believe that they are not a good fit for clients or if clients have strong issues with them.  Ripley, et al in "The Effects of Religiosity on Preferences and Expectations for Marital Therapy Among Married Christians" (2001) discusses how individuals who are highly committed to their religiosity tend to prefer to meet with a similarly religious therapist.  They also rate therapists more favorably if they are labeled as religious.  They also may use religion to judge or evaluate therapy itself (page 40).  Theoretical orientation appears less important than religious match, or it may be that the therapist with strong religious commitment would gravitate to theories and therapies that are compatible with such religious beliefs.  "For the person of low-moderate religiosity, whether marital therapy was offered by a Christian or non-Christian therapist did not matter, which was consonant with research in individual therapy.  Nor did the issue of whether a therapist was willing to use interventions in therapy that were derived from ecclesiastical practices… highly religious Christians... did not necessarily seek highly religious Christian therapists as much as they rejected a marital therapist who was religiously different and appeared uninterested in the client's religion." (page 51).  For the therapist that does not self-identify or advertise him or herself as religious therapists ("Christian therapists," for example) may need to accept that he or she may not be appropriate for such highly religious Christian clients.  "Many moderately or nonreligious therapists might have few interactions with highly religious clients simply because highly religious people usually either (a) seek therapy from clergy or their religious community, (b) seek therapy from an explicitly like-religious professional, or (c) do not seek therapy even when they need it" (page 52).

In earlier historical times, the function of modern therapy was often served within religious institutions and serviced by religions' priests, ministers, rabbis, imams, and so forth.  The use of therapy services outside pastoral counseling may be indicative of changes in society.  Societal changes may have caused emotional, psychological, and relational needs to be separated from the domain of spiritual and religious leaders and institutions.  Societal changes, especially in technology have largely separated medical care from the churches.  People have shifted their healthcare from churches and religious people because of the effectiveness of modern medicine and ineffectiveness of faith-based healing.  The modern use of psychotherapy may reflect a comparable shift also due to the ineffectiveness of faith-based treatment of emotional, psychological, and relational needs that arise amidst the stress of modern society.  The historical and social context of religious based treatment may have been altered to render it less effective or less well received.  Churches and other religious institutions and personnel may be deemed still to be relevant to meeting spiritual needs, while emotional, psychological, and relational needs may have been split off to be met by other societal resources.  The lower religiosity or greater secularization of society may also be relevant for diminished use of religiously oriented treatment. The therapist that always view the clients from the clients' cultural contexts including religious contexts may be best able to adapt therapy to clients with low to moderate religiosity.  The therapist would seek to work with a diversity of clients who need to have therapeutic flexibility and a vast spectrum of theoretical backgrounds.  While this may be very challenging, and the therapist may not be able to "match" for the entire variety of clients or couples who present for therapy, the skillful eclectic therapist may nevertheless be able to work with the widest diversity of clients.

3056 Castro Valley Blvd., #82
Castro Valley, CA 94546
Ronald Mah, M.A., Ph.D.
Licensed Marriage & Family Therapist, MFT32136
office: (510) 582-5788
fax: (510) 889-6553
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