Western Elements in Psychotherapy Influence Asian Patient Experience

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Study finds that therapy might not be beneficial for people with non-Western cultural values who could otherwise benefit from other treatments

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A recent article published in Counselling Psychology Quarterly explores how Western cultural values influence the likelihood of a patient seeking therapy. The study looks at people’s cultural values, adoption of a Western lifestyle, and mistrust towards other cultures to find whether they want to seek therapy and whether therapy benefits them. It found that practicing psychotherapy with a person who does not hold Western values may be useless, or even harmful. For people who have non-Western values, local cultural healing practices are better suited to treat psychological issues than talk therapy. 

Based on 377 college students in India, the results find that a person with European-American cultural values is likely to have a positive attitude towards psychotherapy. This means people who tend to verbalise feelings (use words to process emotions) and seek outside help for their problems were more likely to seek professional help for mental health issues. In contrast, people with Asian values were less likely to seek therapy and benefit from therapy. 

Psychotherapy refers to any psychological service provided by a trained professional that uses talking one-on-one to understand, diagnose, and treat emotional problems, and problematic thinking and behaviour. 

Originating in the West, psychotherapy normally deals with problems commonly seen in Western societies. It has distinct Western beliefs, values, and understand about the “Self”. Some of these include the focus on differentiating between thoughts and feelings, using mental health terms like depression, anxiety, and psychosis for people’s experiences, believing emotional expression is inherently healthy etc.

Evidence shows that for psychotherapy to make sense to a person and work for them, some degree of adoption of Western values may be important. The idea to expand its benefits globally is noble but challenging. A review of the literature gives a mixed picture of the effectiveness of psychotherapy for non-Western populations. Other evidence shows that it maybe not be as effective for Western populations as we believe. Thus, psychotherapy may not be relevant across cultures, and it’s important to find if it helps people in all cultures, or could even harm them.

Differences in individual beliefs and social factors influence how people perceive problematic behaviours across place and time. Therefore, the one-size-fits-all approach does not seem to be effective. Psychotherapy assumes many things about what is distress, anxiety, and trauma, and these assumptions are mostly Western. Most of the psychological research stems from the WEIRD population (Western, Educated, Industrialised, Rich, and Democratic). This inaccurate representation can threaten the usefulness of psychological treatments. Previous research has stated that psychotherapy often relies on beliefs that many parts of the world do not support. The authors write:

“In some cultural contexts, emotional suffering is not conceptualised as something to be eliminated but rather encouraged (in order to facilitate a spiritual transformation). In other cultural contexts, psychological pain is encouraged or accepted rather than attempted to be directly removed or reduced. 

“Rather than being beneficial or even mildly disruptive, the cultural incompatibility of psychotherapy with some non-Western cultural customs, norms, and moral traditions can lead to very harmful, iatrogenic consequences for those in non-Western countries who are not highly westernised.”

In other words, for most people across the world who do not live by Western values, psychotherapy can be harmful and cause problems instead of helping.

For example, the implementation of Western evidence-based psychotherapies for posttraumatic stress and other psychological reactions to the tsunami in 2004 worsened the psychological condition of the individuals instead of improving it. The culturally inappropriate demands of psychotherapy, like narrating their trauma, disclosing private information about self and family, and measures like Eye Movement Desensitization and Reprocessing (EMDR), exposure therapy (ERP), and play therapy added to people’s misery. Other research found that the Western construct of depression is not valid in many countries and what is considered traumatic or not traumatic shifts according to identity and context.

“In addition, Western notions underlying popular psychotherapy theories propagate Western epistemologies, ontological assumptions, traditions of understandings, and culturally-conditioned visions of what a person should be like, such as making a distinction between thoughts and feelings, valuing emotional expression, defining what a healthy relationship is, and outlining culturally-determined criteria for mental health.”

Rationale of the Study

There is contradictory evidence on the usefulness of psychotherapy. The cross-cultural applicability of Western mental health healing practices depends on how much a non-Western individual adopts the specific aspects of the Western culture. This means that an individual from an Eastern culture, for example, might have to assimilate to Western values and ways of thinking in order to receive the benefits of talk therapy. However, so far, attempts to identify the Western cultural influence in psychotherapy have been limited. 

It has been generally difficult to identify Western components of psychotherapy due to the false belief that therapy is already cross-cultural. However, some models of cross-cultural healing offer a basis for understanding these Western cultural elements in psychotherapy. One such model is Frank and Frank’s (1991) common factors model, which sheds light on the mechanisms that make psychotherapy effective. From their perspective, the positive impact of psychotherapy can be attributed to four factors: a) an emotionally connected relationship with a culturally recognized healer, b) a culturally endorsed healing context and setting, c) a cultural reasoning or rationale that offers an explanation for the problem, and d) a culturally appropriate ritual or intervention agreed by both the client and psychotherapist to help restore well-being. The important point here is that while psychotherapy is often thought of as universal, it is just as much a cultural healing method – the culture being Euro-America.

The study investigated six variables to assess compatibility with Western cultural components of psychotherapy: ethnic identity, collective self-esteem, European-American values, Asian values, westernisation, and cultural mistrust. 

  1. Ethnic Identity is the extent to which an individual identifies with a specific cultural group, either Western (such as European American) or non-Western.
  2. Collective self-esteem measures an individual’s value and importance on belonging to a Western or non-Western cultural group. 
  3. Cultural values are shared beliefs and norms within a specific group about what is good, desirable, and appropriate. Western values include independence, self-centredness, and emotional expressiveness.
  4. Asian values include group harmony, interdependence, and emotional self-control, among others values.
  5. Westernisation includes Western values like speaking the Western language, eating Western food, wearing Western clothes, etc.
  6. Cultural mistrust refers to the hesitancy that individuals from one group may have toward members of another cultural group. This may affect trusting their beliefs, norms, and healing practices.

Results

“The results of this study suggest that individuals most likely to have positive attitudes towards psychotherapy, and for whom psychotherapy is predicted to be maximally effective, are those who primarily hold European American values, do not hold very many non-Western values, adopt a visibly Western lifestyle, and trust the broad Western culture…Those who do not adhere to Western values, who endorse more Asian values, who live a visibly non-Western lifestyle, and who have high mistrust of Western culture may be better suited for more culturally congruent healing methods.”

Individuals who had more Western values were more likely to seek professional therapy, and individuals with a higher level of mistrust towards the Western system were less likely to rely on psychotherapy for support. However, the study did not inquire about the specific type of psychotherapy received by participants. 

The study made a unique attempt to explore the Western aspects of psychotherapy that limit its global relevance. The results imply that suggesting psychotherapy to a person who does not hold Western values may be harmful.

Therapists and researchers need to understand and respect the diverse cultural perspectives of the clients, make sure the therapy space fits the cultural norms and values of the client, and include non-Western understanding of selves in psychotherapy training.

This research contributes to the ongoing discussion on cross-cultural applicability of psychotherapy, a topic that is being questioned by researchers globally. Such empirical findings strengthen the attempts to decolonise psychotherapy, bring the person back in context, and stop importing Western values and selfhood. For individuals who hold mostly non-Western values, indigenous cultural healing practices are more appropriate to treat psychological issues than talk therapy. 

Researcher’s Contact Info: Dr. Robinder P. Bedi, 

Department of Educational and Counselling Psychology, and Special Education, University of British Columbia, Vancouver, Canada

Email: robinder.bedi@ubc.ca 

Article Link: https://www.tandfonline.com/doi/full/10.1080/09515070.2023.2173147

Ayushi Jolly

Ayushi Jolly is a PhD Candidate in Social Psychology at Jawaharlal Nehru University, India. Her doctoral research focuses on exploring the neoliberal subjectivities of student migrants. Her research aims to foster a more holistic understanding of the human psyche that acknowledges the intricate interconnections between individual lives and the broader societal tapestry. She is dedicated to restoring the 'social' in social psychology.

Outside the academic sphere, she relishes the joy of travel and trekking and finds

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