Diversity and cultural factors are key elements that have to be considered in the process of psychotherapy. These elements can influence perceptions of the world and one’s position in it, engagement with other individuals and expectations of personal interactions (social customs) and understanding of mental health and healing. Acknowledging the role of culture considers real cultural experiences which define an individual, with diverse beliefs, values, and experiences in a unique perspective. Through an understanding of the cultural and diverse issues, there is a greater opportunity for the individual to be heard and validated, which builds a strong foundation for healthy change processes. This paper will examine a case study for relevant cultural and diversity aspects and apply the cognitive-behavioral therapy model to address these issues.
Cultural and Diversity Issues
The cultural background of the client is important. It is identified that she is Mexican American and married to a Latino. While they grew up in the U.S., it is likely that their family upbringing was based in the Latino/Hispanic ethnic identity. According to Hipolito-Delgado and Diaz (2013), family dynamics is one of the most critical elements of the Latino culture which is collectivist and family-oriented, with some arguing that family is ultimately even the basis of the culture that is conveyed through the notion of familismo, which is the significance, attachment to, and identification with family. The value of family in Latino culture is vital in combination of values of collectivism and personalism – therefore, individuals are strongly encouraged to protect and support family regardless of circumstances (Hipolito-Delgado & Diaz, 2013).
The familial aspect is particularly important to consider in the situations surrounding Margaret’s abuse by her paternal uncle. The notion of protecting the family at all costs likely played a key role in the mother’s decision to keep the abuse secretive. If Margaret’s father was told, it would have likely broken the family up, while reporting the case to authorities would have led to arrest and likely imprisonment. Since familismo concept calls to protect one’s family, the client’s mother essentially covered-up abuse in order to save the family and sought to deal with it internally such as by protecting siblings from this abusive uncle. It is evident that the client struggles with this concept of dedication to family at all costs and the pain that she has gone through, a cultural issue that may have acted out in a different manner in other cultures.
Another aspect to consider is gender roles in Latino culture which typically ascribe strict gender norms where males are allowed more social and familial freedoms in comparison to females. Males are seen through the notion of machismo, and encouraged to be independent and self-determined, but still a proud, respectful man that provides for the family. Meanwhile women are encouraged to be virtuous and sentimental, spiritual, but also subservient and dependent to men. The degree to which these aspects apply depend in a highly heterogenous Latino community, and ethnic identity does play a role as to the extent to which these concepts are applied (Hipolito-Delgado & Diaz, 2013).
Gender roles may be a cultural issue affecting both the client’s perception of her place in the world as well as the relationship with her husband. Margaret is evidently successful and ambitious, being an educated, working Latino women that is also balancing her home life. In a very male-dominated patriarchal culture, that is uncommon, even in modern day, that women are dedicating that much time to education and work. The husband who is potentially taking on a machismo approach in providing for the family but participating in at-home chores may be out of place for him culturally as he saw a different dynamic from his parents. As a result, Margaret sees him as not pulling his weight and that is causing tension in the family.
Further Inquiry Questions
Some initial inquiry questions should be general to understand the needs of the client. First, it is important to ask if she has previously been to therapy regarding the abuse issue and gain any insight on potential progress she may have had previously. Furthermore, it may be important to understand what the client expects from the counseling process. This can significantly the approach and intervention-types used by a counselor. It is important to inquire more about the client’s cultural identity. It may be relevant to ask about the role of the Hispanic/Latino culture in her family and household growing up. It can be brought up into the conversation on whether Margaret believed cultural factors played a role on the response of her mother to the abuse allegations.
It can also be inquired as to what extent does the Latino culture influence her current family’s practices and traditions, reflecting potentially upon the relationship between Margaret and her husband. Also, the client can be asked if she feels prejudice because of her cultural heritage, and if so, is she attempting to disprove potential stereotypes by attempting to take on so many responsibilities at once. Exploring these culturally relevant themes can allow a counselor to better understand their client and the situation at hand, better tailoring therapy or interventions to address those needs.
Applying Theoretical Model
Research in culture and diversity suggests that there is no one-size-fits-all method to working with culturally diverse individuals. It is important to consider varying ethnic identity and acculturation to balance traditional counseling theory and techniques with culturally centered practices. It is important to view the client’s problem from an intersection of client’s ethnic identity and acculturation. Therefore, an emic approach is ethnic-centered, while an etic is more of a U.S. dominant approach with low ethnic identity and acculturation (Hipolito-Delgado & Diaz, 2013). Considering the heterogeneity of the Latino culture and the individual characteristics of the client such as being a second-generation immigrant and growing up under the influence of the U.S. culture should be considered in the context of potential interventions.
Cognitive-behavioral therapy (CBT) is one of the most popular modern theoretical approaches to psychological treatment and therapy that is effective for a range of problems. CBT has shown evidence of increase in quality of life and daily functioning (American Psychological Association (APA), 2017). The foundation of CBT is based on the core principles that psychological problems stem from faulty or unhelpful ways of thinking, which commonly reflect in learned patterns of detrimental behavior (APA, 2017). Therefore, CBT suggests that by learning ways of coping with psychological problems, symptoms are relieved, and patients become more effective at life function. To summarize, CBT focuses strongly on recognizing distortions or unhealthy patterns, re-evaluating them, and improving thinking or behavior based on that (APA, 2017).
CBT can offer multiple benefits in the context of identified cultural issues. CBT can be easily adapted to be responsive to the client’s cultural identity and beliefs, but also validate the client’s experiences with consideration of the need for change to the thought process (Iwamasa & Hays, 2019). For example, without invalidating the importance of familia and her mother’s attempts to protect her, it is important to validate that the client was abused and oppressed. Margaret most likely feels that because nobody ever found out about her experience and pain, and the uncle did not suffer consequences, her experience was not validated and she ultimately did not receive the support from family, even her father that she deserved. A culturally responsive change process seeks to reconsider the helplessness of thoughts instead of their rationality. Using a culturally sensitive approach, CBT can help shift the mindset of the client away from this pain and towards forgiveness and reconciliation both in thought and in action.
Similarly, CBT can have a positive impact on perception of gender roles. The therapy approach has been successfully utilized in a wide variety of cases of gender identity and intersections with other social identities. The client perceives the issue from a highly personal thought pattern perspective – she views her roles as highly important and vital to her personal success and the survival of the family, and demands recognition of such from her husband and even her professors on tardiness or family emergencies. It is an unhealthy and unsustainable means of approaching the situation, and CBT can aid the client in changing her perception to instead of seeking certain expectations, communicating one’s needs, potentially ahead of time to the other parties. At the same time, she should be relieved of potential forced gender roles that she may culturally feel pressured to adhere to.
However, CBT can have limitations when addressing certain cultural aspects. The focus of CBT is “based on the assumption that individuals are victims of or experience faulty and irrational thinking” (Graham et al., 2013, p. 104). When working with clients from potentially marginalized backgrounds (i.e. Latino working class immigration family), applying CBT in restructuring thoughts should be done with great caution. First, because clients may experience negative thoughts that are not at all irrational based on the experience (Margaret may experience significant anxiety due to her abuse which is natural and understandable). When a client feels discriminated against, which Margaret potentially feels in life due to her situation and perceptions, other fears and microaggressions may arise such as reactions to racism or anxiety that ultimately deter positive changes (Graham et al., 2013). Application of CBT to culturally sensitive and identity issues should be done with great care and consideration, in order to help the client reframe what the experiences mean about them when living in an oppressive society or environment, but not to challenge or invalidate their “experiences and values that they may hold in the context of their cultural background” (Graham et al., 2013, p. 105).
American Psychological Association. (2017). What Is cognitive behavioral therapy? Web.
Graham, J. R., Sorenson, S., & Hayes-Skelton, S. A. (2013). Enhancing the cultural sensitivity of cognitive behavioral interventions for anxiety in diverse populations. The Behavior Therapist, 36(5), 101–108. Web.
Hipolito-Delgado, C. P., & Diaz, J. M. (2013). A conceptual approach to counseling with Latina/o culture in mind. In C. C. Lee (Eds.), Multicultural issues in counseling: New approaches to diversity. (pp. 67-86). American Counseling Association.
Iwamasa, G. Y., & Hays P. A. (Eds.). (2019). Culturally responsive cognitive behavior therapy, second edition: Practice and supervision. American Psychological Association.