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Cross-Cultural Therapy

2012 October 29

Therapy Across Cultural & Linguistic Barriers

“It’s been reported…that most Latinos who seek mental health services never return after that first visit.” That disturbing comment was part of Neal Conan’s introduction to a National Public Radio broadcast of several months ago. Conan and guests explored some of the problems mental health professionals may face in working with immigrant clients who don’t speak English, or speak it as a second language, and who have different cultural traditions and expectations.
            The interviewees were Stacey Lambert, Director of the Latino Mental Health program at the Massachusetts School of Professional Psychology in Boston, and Karen Hanscom, Director of Advocates for Survivors of Torture and Trauma (ASTT), which serves the Baltimore and Washington, DC, areas. ASTT is an Outreach Partner of the Refuge Media Project, and is one of the founders of the Voices of Love project which trains interpreters to work with torture survivors. I won’t try to summarize their fairly free-flowing discussion, but some of the themes touched upon were: 

  • The crucial importance of both cultural competence and linguistic competence – beyond classroom level – for therapists;
  • The differing weights given to family ties vs. individual autonomy in many immigrant cultures;
  • Differing understandings of the origins and meanings of the states we refer to as mental illness, and of appropriate treatments;
  • The frequent necessity of using family members as interpreters, which can create a number of issues: for example, clients may be unwilling to speak openly, and those interpreting may not translate things they think are inappropriate. Hanscom pointed out that “most of the individuals that we see have never told another family member or anyone else about the experiences that they’ve had. This is sometimes the very first time that they’ve spoken about these things.”

The discussion ranged from the somewhat theoretical to the very down-to-earth. For example, the lack of linguistically-competent therapists may not only lead to serious misunderstandings, but it also means that a great many non-English-speaking clients wait longer to get an appointment.
            With regard to differing world views – often expressed through religion, Hanscom points out that immigrants may have different views of “why bad things happen to good people. For example, we have some people who believe that their trauma is related to karma. Others believe that they’re being tested by God…In the United States we’re taught, as psychologists, that we really don’t get into one’s religion. Yet with the torture survivors that we see, to not do so would be quite an error.”

A caller, Mark, who described himself as a
substance abuse counselor, related this story… 

We had an incident where a translator was called to an emergency room because the ER people had this Mexican guy who was reporting hearing voices, so they thought he was schizophrenic. She sits down with him and says, “I understand you’re hearing voices when no one is there.” And he says, “Yes, that’s right.” And she says, “Well, what are the voices saying?” He says, “I don’t know.”
            She says, “Can’t you hear them?” And he says, “Oh, I can hear them just fine, but they’re speaking in English.” So he’s having oratory hallucinations in a language he doesn’t speak, which is unusual, to say the least. And at that point, the page clicks in and says, “Dr. Jones to the emergency room.” The patient looks at the translator and says, “You see? There it is again.”

Both photos above are from the website of Advocates for Survivors of Torture & Trauma. The first one was taken by a survivor as part of ASTT’s Healing Images project. Its caption reads: “Look at these girls! Their lives are beautiful and without worry. They reflect the joy of life. Will my life one day resemble that of these little ones?”

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