Tag Archives: Cultural Issues in Therapy

Education as a Therapeutic Intervention

I’ve been seeing a client for about six months, and she recently told me about witnessing domestic violence between her parents when she was young. I used to volunteer at a DV family shelter, so I have a lot of information about how she may have been affected by this. Is it appropriate for me to share what I know as part of her therapy?counseling

This is a good question and brings up a common situation in therapy. You have information that may be useful for the client in understanding and resolving the difficulties that led her to seek therapy, and you are wise to think through the decision to take an educational role. I will share some of my thoughts about the factors to consider in deciding how and when to bring educational information into therapy.

First, I would affirm your sense that providing education can be a useful therapeutic intervention. As a mental health professional, I am aware of how do mental and emotional illnesses affect social health. Often, poor mental health leads to problems such as social isolation, which disrupts a person’s communication and interactions with others. We have knowledge about trauma, relationships, communication, human development, family dynamics, and many other topics that are relevant to our clients’ concerns. This particular client has introduced the topic of domestic violence, and it could be empowering for her to gain knowledge that she can apply to her life.

As you consider talking with your client about the impact of witnessing domestic violence as a child, pay particular attention to the timing of her decision to share this with you and to your countertransference feelings in learning this new detail of her history. She chose to wait six months before telling you about this powerful and traumatic experience, so this means she has been waiting to feel a sufficient level of trust before disclosing this to you. Think about what it means for her to have chosen this moment in the therapy to share the domestic violence and reflect on what she wants and needs from you in response. Notice how you felt when she told you and what you feel as you anticipate giving her educational information. There may be an intense emotion you are avoiding or attempting to modify by introducing psychoeducation, especially if it represents a shift from your usual therapeutic style. Consider the possibility that your client will benefit from education about the impact of domestic violence at a later time in the therapy after you and she have talked about the meaning and feelings she has about telling you now.

Another factor to consider in your decision is your client’s culture and what this means for her expectations of you and the therapy. She may view you as an expert who has knowledge that she is lacking, and it may be more therapeutic for you to work on developing a more collaborative alliance before you adopt an educational role. Alternatively, it is possible that conforming to her expectations of your role may help her to feel more safe and trusting. Reflection on the therapeutic process so far and consultation with your supervisor will help you to sort out the cross-cultural implications of sharing your knowledge about this topic. If your client comes from a different cultural community than you, also give thought to her cultural values and norms for family relationships and the presence of physical violence in the home. Providing education requires sensitivity to cultural differences and to her current relationship with the cultural values of her childhood.

Last, I would recommend thinking about your client’s general description of her relationship with her parents and how your use of education may provide a different experience for her. If she experienced her parents as unavailable and preoccupied, you will provide a different experience by being engaged and attuned to her needs and questions. If she experienced her parents as intrusive and acting on their own agenda, it will be helpful to introduce your ideas tentatively and ask for her responses and thoughts about the information you provide.

I hope you found this blog post helpful in considering the use of psychoeducation in therapy. Please email me with comments, questions, or suggestions for future blog topics.

Cultural Values in Treatment Goals

counselingI just completed my first session with a 21-year-old Latina who is a first generation American. She seems to rely too heavily on the opinions of her parents and other older members of her family in making decisions about her career and dating life. She said she wants to feel less anxious, and I think that will only happen if she becomes more independent of her family. How shall I talk with her about this?

Before talking with your client about her goals, I would suggest doing some exploration of your views and how they differ from your client’s. This situation highlights the impact of cultural values on treatment goals, and it is important that we examine our values and assumptions before recommending a treatment approach.

The first step in this situation is to recognize that you have developed an agenda that is different from your client’s. Any time this happens, you need to pause, examine the discrepancy, and work to understand your client’s perspective on what is best for her. In this case, you seem to have made some assumptions about your client’s relationship with her elders that will interfere with the therapeutic alliance. Her alliance with your depends on experiencing your respect and support for her in working toward her priorities. Over the course of time, your client may come to desire greater independence from her elders, but your task at the beginning of treatment is to join with her in working toward reducing her anxiety. Otherwise, she may feel undermined in defining what she needs.

The second issue to recognize is the extent to which values and beliefs about developmental goals and relationships are embedded in a cultural context. Your view that independence from parents and other family members is a desirable goal for young adults is no doubt consistent with the values of your cultural community, but your client comes from a cultural community that values interdependence and respect for elders. Talking with your supervisor and other colleagues about these cultural differences will help you to identify the strengths and benefits of your client’s values rather than assuming that she should come to share yours.

Another more complex issue to consider is the extent to which your response to your client may reflect her own conflict about her family relationships. It is helpful to reflect on your countertransference feelings and to talk about them in supervision. If you usually find it easy to join with your client’s agenda, it is possible that your strong opinion about this client’s need for independence represents your resonance with a part of herself that she is reluctant to articulate. If this seems plausible, you can support your client to recognize and sort through the complicated nature of her feelings toward her parents and other family members. This will work in her best interest if you can express an attitude of curiosity rather than judgment and if you help her identify and honor the mixture of different feelings she holds.

I hope you find this helpful in working with clients whose initial treatment goals are different from yours. Please email me with comments, questions, or suggestions for future blog topics.