Professional Documents
Culture Documents
Early Pioneers
• William Tuke (1732-1822)
– Was appalled by how paents
were treated in asylums
– Opened the York Retreat
• Paents received good food,
frequent exercise, and friendly
interacons with sta,
• Became an example of humane
treatment that many in Europe
and the US followed
• Began a movement to improve
the treatment of mentally ill
paents
Early Pioneers
• Philippe Pinel (1745-1826)
– Like Tuke, was a liberator of
the mentally ill
– Moved the mentally ill out of
dungeons in Paris where they
were held as inmates rather
than treated as paents
– Convinced others that
• The mentally ill were not
possessed by devils
• Deserved compassion and hope
rather than maltreatment and
scorn
Early Pioneers
• Philippe Pinel (1745-
1826)
– Trease on Insanity
(1806)
• “To rule [the mentally ill]
with a rod of iron, as if to
shorten the term of an
existence considered
miserable, is a system of
superintendence, more
disnguished for its
convenience than for its
humanity or success.”
Early Pioneers
• Eli Todd (1762-1832)
– Learned of Pinel’s e,orts in
France and helped to spread
the word in the US
– Opened The Retreat in
Har?ord, Conneccut in 1824
• Ensured that paents were
always treated in a humane and
digni@ed way
• He and sta, emphasized
paents’ strengths rather than
weaknesses
• Allowed paents input in their
own treatment decisions
Early Pioneers
• Dorothea Dix (1802-1887)
– Worked in a jail in Boston
• Saw that many inmates were
there as a result of mental
illness or retardaon than crime
– Collected data in many cies
demonstrang this
• This resulted in the
establishment of more than 30
state instuons for the
mentally ill throughout the US
– E,orts provided decent and
compassionate treatment for
the mentally ill
The Creaon of Clinical Psychology
• In the late 1800’s, psychologists didn’t pracce
psychology, they studied it
– Psychology had liEle of the applied funcons that
it has today
The Creaon of Clinical Psychology
• Lightner Witmer (1867-1956)
– Founded the @rst psychology
clinic at the University of
Pennsylvania in (1896)
• This was the @rst me that
psychology was applied to
people’s problems
– By 1914 there were 20 clinics
in the US
– By 1935 there were 150 in the
US
The Creaon of Clinical Psychology
• Lightner Witmer (1867-1956)
– Founded The Psychological Clinic
• The @rst scholarly journal in the
@eld of clinical psychology
• Witmer authored the @rst arcle,
tle “Clinical Psychology”
– The @rst known use of the term
– “During the last ten years the
laboratory of psychology at the
University of Pennsylvania has
conducted, under my direcon,
what I have called a ‘psychological
clinic’
Assessment
• Labeling systems for mental illnesses in the late
1800s were rudimentary
– Mental illnesses were oHen placed in one of two very
broad categories: neurosis and psychosis
– Neuroc individuals
• Thought to su,er from some psychiatric symptoms, but
maintain an intact grasp on reality (e.g. anxiety and depression)
– Psychoc individuals
• Demonstrate a break from reality in the form of hallucinaons,
delusions, or grossly disorganized thinking (e.g. schizophrenia)
Assessment
• Emile Kraeplin (1855-1926)
– Considered the father of
descripve psychiatry
– Di,erent two-category
system of mental illness
• Exogenous Disorders
– Caused by external factors
• Endogenous Disorders
– Caused by internal factors
• Suggested that exogenous
disorders were the far more
treatable type
Assessment
• Emile Kraeplin (1855-1926)
– Assigned names to speci@c
disorders
• Demena praecox
– An endogenous disorder similar to
what we now call Schizophrenia
• Also coined
– Paranoia, manic depressive psychosis,
involuonal melancholia, cyclothymic
personality and ausc personality
– Many of his terms have been
replaced
• He sll set a precedent for the creaon
of diagnosc terms
– This eventually led to the DSM
The Diagnosc and Stascal Manual of
Mental Disorders (DSM)
• Before the DSM
– Original reason for categorizing mental disorders was
to collect stascs on the populaon
• In 1840, the US Census Bureau included a single category
for this purpose
– “Idiocy/Insanity”
• In 1880, there were seven categories
The Diagnosc and Stascal Manual of
Mental Disorders (DSM)
• DSM-I and DSM-II
– The DSM was published by the American Psychiatric Associaon in 1952
– DSM-II followed in 1968
• Was not considered to be signi@cantly di,erent from DSM-I
– Both gave vague descripons of each disorder
• DSM-III was released in 1980 and was an enrely new way of
thinking
– Provided speci@c diagnosc criteria
• Lists indicang exactly what symptoms constute each disorder
– Introduced a mulaxial system
• A way of cataloguing problems of di,erent kinds on di,erent axes
• This was retained unl DSM-5 (May, 2013)
Assessment of Intelligence
• Assessing intelligence
– This was even more characterisc of clinical psychology
than therapy was
• Dispute among psychology’s pioneers about the
nature of intelligence
– Edward Lee Thorndike
• Promoted the idea that each person possesses separate,
independent intelligences
– Charles Spearman
• Argued for the existence of “g,” a general intelligence thought to
overlap with many parcular abilies
Assessment of Intelligence
• Alfred Binet (1857-1911)
– Created the @rst Binet-Simon
scale in 1905
• Test yielded a single overall score
– Endorsing the concept of “g”
• Was the @rst to compare mental
age to chronological age
– Yielding an “intelligence quoent”
– Was revised by Lewis Terman in
1937
– Now called the Stanford-Binet
Intelligence Scale
– Mostly a child-focused measure
of IQ
Assessment of Intelligence
• David Wechsler (1896-1981)
– Published the Wechsler-
Bellevue test in 1939
– Wechsler Adult Intelligence
Scale (WAIS)
• Currently in its fourth revision
– Wechsler Intelligence Scale
for Children (WISC)
• Currently in its @Hh revision
– Wechsler Preschool and
Primary Scale of Intelligence
(WPPSI)
• Currently in its fourth revision
Assessment of Personality
• Projecve Personality Tests
– Based on the assumpon that people will “project”
their personalies onto ambiguous or vague smuli
• The way people perceive and make sense of the smuli
corresponds to the way they perceive and make sense of
the world around them
– What’s your favorite movie?
– What’s your favorite song?
– Why?
Assessment of Personality
• Hermann Rorschach (1884-1922)
– In 1921 released his set of 10
inkblots
• The Rorschach Test
Assessment of Personality
Assessment of Personality
• Themac Appercepon
Test (TAT)
– Projecve test using
cards depicng people in
scenes or situaons
– Paents are asked to tell
stories to go along with
the interpersonal
situaons presented in
the IAT cards
Assessment of Personality
• Other projecve tests
– Draw-a-Person test
• The psychologist infers personality characteriscs from
clients’ drawings of human @gures
– Incomplete sentence Blank
• The psychologist assesses personality by examining the
ways clients @nish sentence stems
• The popularity of projecve tests had decreased
over me in light of quesons about their
reliability and validity
Assessment of Personality
• Objecve Personality Tests
– Typically pencil-and-paper instruments of
mulple-choice or true/false quesons
– Content is on the client, their experiences, and/or
their preferences
Assessment of Personality
• The Minnesota Mulphasic Personality Inventory
(MMPI)
– Published in 1943 by Starke Hathaway and J.C. McKinley
– Consisted of 550 true/false statements
– Responses were compared with those of groups in the
standardizaon sample who represented many diagnosc
categories
– Included over 200 separate scales consisng of combinaon
of MMPI items
– Included validity scales to detect random responding or
intenonally misleading responses
Assessment of Personality
• The NEO Personality Inventory (NEO-PI)
– Scales are based on universal personality characteriscs
common to all individuals
– Based on three of the “Big Five” personality traits
• Neurocism, extraversion, and openness
Psychotherapy
• Psychotherapy was not always the primary acvity of
clinical psychologists
– In 1930, almost every clinical psychologist worked in academia
• The demand created by the psychological consequences of
World War II on US soldiers likely played a role in making
therapy more prominent
Current Controversies in Clinical
Psychology
Prescripon Privileges
• Historically been one of the primary disncons between psychiatrists and
psychologists
– Within the general public, it is a dening dierence
• Recent years have seen some clinical psychologists acvely pursue prescripon
privileges
– Roots of the movement were established in the 1980s
– The 1990s and 2000s saw high-prole, high stakes debates
• The APA has published numerous arcles
– Endorsing prescripon privileges
– Oering suggesons for training of psychologists to become procient in prescribing
safely and eecvely
• Several prominent psychologists have promoted the movement towards
prescribing
– Patrick H. DeLeon
– Morgan T. Sammons
– Robert McGrath
Prescripon Privileges
• Three states have granted prescripon
privileges to trained psychologists
– New Mexico in 2002
– Louisiana in 2004
– Illinois in 2014
– Others have given serious consideraon
• Several psychopharmacology training programs
are available for psychologists in the US military
Why Clinical Psychologists Should Prescribe
• Shortage of psychiatrists
• Clinical psychologists are more expert than primary care
physicians
• Other nonphysician professionals already have
prescripon privileges
• Convenience for clients
• Professional autonomy
• Professional idencaon
• Evoluon of the profession
• Revenue for the profession
Why Clinical Psychologists Should Prescribe
• Shortage of Psychiatrists
– Low rao of those who can prescribe medicaons
and those who need them
– Underserved segments of society would benet
from a higher rao of prescribers to paents
• The lobbying for privileges in New Mexico and
Louisiana
– The low number of psychiatrists per capita was a
cornerstone of the (successful) argument
Why Clinical Psychologists Should Prescribe
• Professional Autonomy
– Clinicians may feel restricted in what they can do
– With prescripon privileges, clinicians provide a
wider range of services to clients
Why Clinical Psychologists Should Prescribe
• Professional Idencaon
– It might be di=cult for the general public to disnguish
between psychologists and other non-prescribing
therapists or counselors
– The ability to prescribe would set psychologists apart
(and above) other professions
Why Clinical Psychologists Should Prescribe
• Narrow de)nion
– Limited to race, ethnicity, and/or naonality
• Broad de)nion
– Any and all potenally salient ethnographic, demographic,
status, or aJliaon idenes
– Sue, Ivey, and Pedersen (1996)
• Any group that shares a theme or issue(s)
• Therefore, language, gender, ethnicity/race, spirituality, sexual
preference, age, physical issues socioeconomic status, and survival
a-er trauma all de)ne “cultures”.
– Some argue that broad de)nions are not parcularly
helpful
Culture and Worldview
• Worldview
– Sue (1977)
• The way in which people perceive their relaonship to nature,
instuons, other people, and things.
• Worldview constutes our psychological orientaon in life and can
determine how we think, behave, make decisions, and de)ne
events
– Dierent cultural groups perceive, de)ne, and interact
with their environment in dierent ways on the basis of
their past learning experiences
– People from dierent cultures may see or experience the
same thing but interpret it in drascally dierent ways
What is Race?
• Biological concept
– Zuckerman (1990)
• “To the biologist, a race, or subspecies, is an inbreeding,
geographically isolated populaon that diers in disnguishable
physical traits from other members of the species.”
– Casas (1984)
• Race is a group of people who share a speci)c combinaon of
physical, genecally inherited characteriscs that disnguish them
from other groups
– Negroid, Caucasoid, and Mongoloid
• These groups are disnguished from one another by phenotype,
or noceable physical features
– Skin color, texture of hair, shape and color of eyes, thickness of nose
and lips
What is Race?
• Biological concept cont.
– Dierences between racial groups are strictly
phenotypic, represented in super)cial physical
manifestaons.*
– It is generally accepted that human beings came
from the same beginnings in Africa and that
genec dierences among groups can be
explained by migraon paEerns
What is Race?
What is Race?
• Sociocultural concept
– The perspecve that characteriscs, values, and behaviors
that have been associated with groups of dierent physical
characteriscs serve the social purpose of providing a way
for outsiders to view another group and for members of a
group to perceive themselves
– Concept resulted from the geographic isolaon of groups
sharing similar physical characteriscs
• Once these groups migrated to dierent parts of the globe, they
also developed their own unique set of values, beliefs, and
pracces.
What is Race?
• Sociocultural concept
– Atkinson (2004)
• The sociocultural use of the term “race” connues
because it provides people a way of organizing the
world and reducing complexity
• Also provides a vehicle for identy and empowerment.
Ethnicity
• Atkinson (2004)
– Ethnicity – the combinaon of race and culture
• Ethnicity is determined by both physical and cultural
characteriscs.
Mulcultural Psychology vs. Cross-cultural
Psychology
• Mulcultural psychology
– The systemac study of all aspects of human
behavior as it occurs in seOngs where people of
dierent backgrounds encounter one another
• I know, this is slightly dierent than before…
– Bochner (1999)
• Concerned with the psychological reacons of
individuals and groups caught up in culturally
heterogeneous seOngs
• These include the behaviors, percepons, feelings,
beliefs, and aOtudes resulng from living in these
condions
Mulcultural Psychology vs. Cross-
cultural Psychology
• Cross-cultural psychology
– The study of comparisons across cultures or countries, as
opposed to comparisons of groups within one society.
Mulculturism as the “Fourth Force”
• Three movements have
broadly been recognized as
dominant paradigms in their
respecve eras
– First force: Psychoanalysis
– Second force: Behaviorism
– Third force: Humanism/Person-
Centered Psychology
• Pederson (1990, 1999, 2008)
put forth the idea that
mulculturalism represents
the “fourth force”
Mulculturism as the “Fourth Force”
• Suggests that mulculturalism is a major in!uence of the
me
– A bit dierent than the previous forces, though…
• Each of the earlier forces was a response/challenge to the
previous one
– Behaviorism was a response to psychoanalysis
– Humanism/Person-Centered was a response to behaviorism
• Mulculturalism doesn’t challenge any of the previous forces
– It enhances and strengthens the exisng forces
– Describes how mulculturalism can be applied to individuals of
various cultural backgrounds
Mulculturism as the “Fourth Force”
• Comas-Diaz (2011)
– Encourages that clinicians ask the following
culturally relevant quesons
• What do you call your problem (or illness or
distress)?
• What do you think your problem does to you?
• What do you think the natural cause of your
problem is?
• Why do you think this problem has occurred?
• How do you think this problem should be treated?
• How do you want me to help you?
• Who else (e.g. family, friends, religious leaders) do
you turn to for help?
• Who (e.g. family, friends, religious leaders) should
be involved in decision making about this problem?
Books and Journals
• Wide variety of books oer educaon on working with
culturally diverse populaons
– Working With Asian Americans (Lee, 1997)
– Psychotherapy With Women (Mirkin, Suyemoto, & Okun, 2005)
– Counseling Muslims (Ahmed & Amer, 2012)
Emergence of American Psychological
Associaon Divisions
• New American Psychological Associaon Divisions
– Typically arise when a subset of members recognizes a
need to study or examine a speci)c topic in depth
– Some recently created, culturally focused divisions
• Division 35 – Society for the Psychology of Women
• Division 36 – Psychology of Religion
• Division 44 – Society for the Psychological Study of Lesbian,
Gay, and Bisexual Issues
• Division 45 – Society for the Study of Ethnic Minority Issues
• Division 51 – Society for the Psychological Study of Men and
Masculinity
American Psychological Associaon Ethical
Code
• American Psychological
Associaon Ethical Code
(2002)
– Compels psychologists to
work with cultural
sensivity and
competence
– Awareness of diversity
issues
• A requirement
• Not merely an aspiraon
American Psychological Associaon
Accreditaon Standards
• American Psychological Associaon (2005)
– Standards of Accreditaon
• “Cultural and Individual Dierences and Diversity”
– One of eight domains that an educaonal program must address adequately
to be accredited
– Applies to
» Doctoral programs
» Predoctoral internships
» Postdoctoral internships seeking accreditaon
– Accreditaon standards for doctoral programs list criteria such
as…
• Including people of diverse backgrounds among students and faculty
• Educang students about the role of culture in the science and
pracce of professional psychology
DSM Eorts Toward Mulculturalism
• Introducon to DSM-5 states:
– “…key aspects of culture relevant to diagnosc classi)caon and
assessment have been considered in the development of DSM-5”
• American Psychiatric Associaon, 2013, p. 14
• Informaon on cultural variaon is embedded in the descripon of
speci)c disorders
• Provides general guidance of clinicals to help with overall cultural
competence
– Outline for Cultural Formulaon
• Instructs clinicians on cultural aspects of assessment
– e.g. cultural identy, cultural conceptualizaon of distress, cultural features of the relaonship
with the therapist
– Cultural Formulaon Interview
• A series of 16 quesons that can guide a clinical towards a culturally informed
view
DSM Eorts Toward Mulculturalism
• Cultural Concepts of Distress
– Includes nine terms that represent psychological problems
observed in groups from various parts of the world
• Taijin Kyofusho (found in Japanese and some other cultures)
– When a person anxiously avoids interpersonal situaons because they
believe their appearance, acons, or odor will oend other people
• Sutso (found in some Lano/Lana/Hispanic cultures)
– When a frightening event is thought to cause the soul to leave the body,
resulng in depressive symptoms
• Maladi Moun (found in some Haian communies; similar to the
“evil eye” are more common in other parts of the world)
– When a person can “send” psychological problems like depression and
psychosis to another
– Usually the result of envy or hatred toward the other person’s success
Cultural Competence
• What is Cultural Competence?
– “Mulcultural counseling competence is de)ned as the
counselor’s acquision of awareness, knowledge, and skills
needed to funcon eecvely in a pluralisc democrac
society… and on an organizaonal/societal level, advocang
eecvely to develop new theories, pracces, policies, and
organizaonal structures that are more responsive to all groups”
• Sue and Sue, 2008, p. 46
– Three primary components:
• Awareness
• Knowledge
• Skills
Cultural Self-Awareness
• Cultural competence begins with cultural self-
awareness (J. E. Harris, 2012)
• Cultural awareness – the understanding that our
viewpoint (like everyone’s) is unique and idiosyncrac
– Basic facts such as where one’s parents or ancestors came
from
– The values, assumpons, and biases that one has
developed as a result of all cultural in!uences
– Cultural awareness leads to several conclusions
• e.g. dierences between people are not necessarily de)ciencies
– Especially if the dierences are valued in a cultural group
Knowledge of Diverse Cultures
• Not enough to know your own culture…
– The therapist must also know of the client’s culture
• Eorts to know the client’s culture should be
connual
– Through reading, direct experiences, relaonships with
people in various cultures, and other means
Knowledge of Diverse Cultures
• Cultural knowledge should include history
– Parcularly with regard to social and polical issues
• e.g. African Americans
– Slavery, cruelty, exploitaon, and overt and covert racism
• These can have an eect on therapeuc alliance
– A clinical psychologist who fails to recognize this
history
• May form expectaons or make interpretaons that are
culturally insensive
• Jeopardize the therapeuc relaonship
Knowledge of Diverse Cultures
• Heterogeneity
– The psychologist should not assume that every
individual is typical of his or her cultural group
• To assume that a member of a cultural group will
exhibit all the characteriscs common to that group is
to prejudge
– The psychologist should appreciate the cultural
group norms, but also appreciate the
heterogeneity inherent in every culture
• This is might be what’s so frustrang to me…
Knowledge of Diverse Cultures
• Acculturaon
– When people )nd themselves in a new cultural environment,
they may respond in a variety of ways
• Retaining elements of their original culture
• Adopng elements of the new culture (acculturaon)
– Four separate acculturaon strategies (Berry, 2003; Rivera, 2008)
• Assimilaon – the individual adopts much of the new culture and
abandons much of the original
• Separaon – the individual rejects much of the new culture and retains
much of the original
• Marginalizaon – the individual rejects both the new and the original
culture
• Integraon – the individual adopts much of the new culture and retains
much of the original
Culturally Appropriate Clinical Skills
• Microaggressions
– Comments or acons made in a cross-cultural context that
convey prejudicial, negave, or stereotypical beliefs and may
suggest dominance or superiority of one group over another
• Foaud & Arredondo, 2007; Sue, 2010, Sue et al., 2007
– O-en “liEle things” said without any intenon of hoslity or
any awareness that the comments might be insulng or
invaliding – but, in fact, they are
– The best way for psychologists to avoid microaggressions
• Examine the thoughts and beliefs that underlie them
• This will result in greater humility and self-awareness for the
psychologist
• I hate this idea for so many reasons…
Microaggressions
Emic vs. Ec Perspecve
(Dana, 1993)
• Ec Perspecve
– Emphasizes the similaries between all people
• Assumes universality among all people
• Generally does not aEach much importance to dierences among cultural groups
– Common in the early days of psychology
• When most psychologists were male, of European descent, and of middle-class or higher
socioeconomic standing
• Emic Perspecve
– Recognizes and emphasizes culture-speci)c norms
– Considers a client’s behaviors, thoughts, and feelings within the context of the
client’s own culture
• This is opposed to imposing norms of another culture on the client
– Stresses that individuals from various cultural groups “must be understood on their
own terms” (Dana, 1993, p. 21)
• The terms were derived from the )eld of linguiscs
– Phone!cs – sounds common to all languages
– Phonemics – sounds that are speci)c to a parcular language
Triparte Model of Personality Identy
(Sue & Sue, 2008)
• Three-level model in which all levels hold some degree of
importance
– Individual level
• “All individuals are, in some respects, like no other individuals”
– Group level
• “All individuals are, in some respects, like some other individuals”
– Universal level
• “All individuals are, in some respects like all other individuals”
• Argue that a psychologist should appreciate a client on all three
levels
– Some characteriscs are enrely unique to the client
– Others are common within the client’s cultural group
– Sll others are common to everyone
Triparte Model of Personality Identy
(Sue & Sue, 2008)
Comparing Incidence and Prevalence Rates