Models of Psychopathology (Core Concepts in Therapy)

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This relationship has been explained through material deprivation but also increased adverse life events such as unemployment, abuse and neglect , with consequences for treatment outcomes, including among children and adolescents [e. Given the recent recession period and current socio-economic strain for many individuals, it seems relevant to recognize that people living in poverty are more likely to experience mental health problems 29 , less likely to access treatment 30 and less likely to achieve full recovery from emotional psychopathological problems In addition, contemporary migration has an unprecedented mobility with an estimated number of million international migrants in the world [World Migration Report; 32 ].

Forced migration, steadily increasing as a result of armed conflict both within and between nations , but also political, economic, social, and climate changes, has most recently been discussed in the mental health field, with undeniable impacts on health and psychological functioning The effects of pre-migration and migration-related trauma among refugees have been acknowledged and documented Recent literature has emphasized the role of not only explicit discrimination, but also implicit attitudes in interpersonal interactions [evaluations automatically activated by the actual or symbolic presence of a social object; 35 — 38 ; see Hall et al.

Micro-aggressions in daily life [continuous experiences of aggression, often invisible to the perpetrator, who unconsciously holds biases and prejudice; 40 — 42 ] have also been investigated, and have been found to have significant effects on an individual's well-being. In sum, culture and other related socio-contextual factors, such as minority stress, discrimination and exposure to interpersonal violence, influence the development of clinically significant distress and resulting disability. This construct and method bias has a variety of sources e.

For instance, the use of the Minnesota Multiphasic Personality Inventory MMPI-2; one of the most widely used and researched psychodiagnostic self-report measures in the world among diverse patients has raised concerns related to conceptual, metric, and functional equivalence as it may not be appropriate among those whose worldviews differ from the Euro-American culture In an effort to strengthen culturally-sensitive assessment practices, aligned with the DSM-5 7 , the Cultural Formulation Interview 3 was developed. This interview represents a proposal for cultural assessment for use in routine clinical care.

It presents a conceptual framework for clinicians to identify the role of culture on the patient's clinical presentation and care, in four domains: 1 cultural identity of the individual; 2 cultural explanations of the experienced signs and symptoms i. Addressing the patient's explanatory models may, hence, maximize engagement and adherence; improve therapeutic alliance; strengthen empathy and positive expectations, while decreasing stigma, shame and other catastrophic beliefs [i. Even though the evaluation of specific psychosocial stressors has been emphasized, a strength-based approach has also been pointed out as a valuable perspective on culturally-sensitive assessment among patients of stigmatized social groups 3.

This includes the evaluation of the social network of the patient e. In light of the aforementioned definition of culture, cultural identity is conceptualized in a intersectional perspective, and encompasses i aspects related to national, ethnic, and racial background, including language and migration, as well as social economic and educational status; ii spirituality, religion, and moral traditions; and iii gender, gender identity, and sexual orientation.

Hence, a particular example of an important aspect to assess is patient's religiosity and spirituality. Indeed, religion and spirituality represent key dimensions when aiming a complete understanding of an individual [e. Purpose, meaning making and connection to others and the transcendent through religion and spirituality may influence one's core beliefs, emotions and behaviors Religiosity and spirituality may have different impacts across one's life spam, on mental health outcomes and to the psychological treatment process, with some positive and some negative impacts 46 — Another particular example of a key dimension to consider in culturally-sensitive assessment is related to gender roles, gender identity and sexual orientation, as culture clearly shapes the roles of women and men in a society, their expressions of distress, and their interpersonal relations 14 , Culture also determines the way diversity in gender identities and expressions are understood, as well as diversity in human sexuality i.

Since the seminal work by Frank and Frank 53 , psychotherapy has been compared with diverse healing practices or treatments across different times and different cultures Still, in a globalized world, even though the need for culturally competent mental health services has been well recognized, health and mental health care disparities have been largely documented. While meta-analysis have shown a moderate effect size of culturally adapted interventions 55 , studies in psychotherapies across many disorders have concluded that outcomes for minority cultural groups are not as good as for the majority populations and found greater rates of premature termination 1 , The sources of these disparities in healthcare are complex and exist in a broader historical and contemporary context of social and economic inequality, prejudice, and systematic bias In fact, the Western biomedical health model has created a professional culture, based on specific values e.

Psychotherapeutic theoretical models e. In other words, the healthcare system itself can be less in accordance with the cultural perspectives of some patients than others. Therefore, clinicians' sense of social responsibility and social justice concerns have arisen as a response to social inequalities in mental health care, and specific culturally-sensitive treatments have been developed [e. A recent special issue of the Journal of Contemporary Psychotherapy critically reviewed the practice and development of psychotherapy in Nigeria 57 , China 58 , India 59 , Saudi Arabia 60 , Pakistan 61 , and Israel Iwakabe 63 had already done so for the Japanese context.

Another relevant, recent example is a special issue of Counseling and Psychotherapy Research 27 , which brings light to the role of social inequalities in psychotherapy research and practice, acknowledging that, for a long time, psychotherapy was seen as an endeavor for the middle- and upper-class of educated and psychologically minded clients. Moreover, only recently the impact of cultural diversity on practitioner-patient interactions has been examined, for instance in medicine That is, issues of stereotyping and discrimination may be as real in the clinician-patient relationship as in any other interpersonal relationship.

Indeed, social, educational and economic disparities between patients and clinicians are often evident Moreover, there is evidence of stereotyping and bias among healthcare providers [e. This is due to the fact that, even though negative explicit attitudes toward stigmatized groups have been declining, substantial implicit negative attitudes still exist and exert influence on behavior, from everyday encounters to clinical interactions Still, blatant examples persist in the practices of many clinicians in helping patients redirect or change same-sex sexual orientation The present paper argues for mainstreaming culture in research and clinical training in psychopathology, acknowledging that each clinical interaction is a cultural one.

As aforementioned, different characteristics of one's identity are salient in different contexts and interactions. In the practitioner-patient interaction, this is no exception and thus clinicians need to be able to be responsive to this cultural encounter—i. Cultural competence is generally defined in a tri-dimensional model, as the extent to which clinicians possess appropriate awareness, relevant knowledge, and practical skills in working with individuals from diverse cultural backgrounds 11 , 15 , The first dimension—awareness—refers to the way the clinicians' attitudes, beliefs, values, assumptions, and self-awareness affect how they interact with those patients who are culturally different from themselves.

It involves the exploration of the self as a cultural being, and of one's own cultural preconceptions. The second dimension—knowledge—relates to the informed understanding of cultures that are different from one's culture, including their histories, traditions, values, practices, and so forth. It also involves knowledge about such concepts and processes as cultural impacts on psychosocial development, acculturation models and acculturation stress, social minority stress and identity development, cultural communication styles in the helping relationship, perceived discrimination and socioeconomic adversity as risks factors for well-being, among others.

Finally, an important third dimension consists in the ability to engage in effective and meaningful interactions with diverse individuals, including the development of a relationship, by integrating one's awareness and knowledge into practical skills in the clinical relation, assessment and intervention. Cultural competence has been proposed as a strategy to respond to diversity in contemporary societies and make health care services more accessible, acceptable and effective for diverse communities.

Initially intended for work with migrants and ethnic minorities, cultural competence has been extended to include other forms of client diversity, such as age, gender, sexual orientation, gender identity, religion, social class, language, and ability status [e. It has been proposed as a developmental process, both at an individual i. Despite recent debates and criticisms [cultural safety, cultural sensitivity, cultural responsiveness, and cultural humility; 11 ], developing cultural competence in psychopathology is a key process aligned with person-centered care, where patient narratives and meanings are shared and interpreted in the clinical encounter.

However, research is still needed on the processes of implementation, clinical effectiveness, clinical communication, wider social impact, and outcomes of culturally competent services and interventions 11 , Indeed, Delgadillo 27 argues for a better integration of the literature on social inequalities, power imbalance, and cultural competence into clinical training programmes. The recent aforementioned understandings of culture and of psychopathology in a social and cultural context, rather than an exclusively intra-individual process, provide a possible route to develop these clinical competences.

While some have reported training pilot studies and their evaluation, and guidelines have been proposed [e. Addressing this gap and mainstreaming cultural competence in clinical training seems to be a key future development if we are to enable clinicians to provide support and address mental health concerns in a diverse world. The author confirms being the sole contributor of this work and approved it for publication.

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The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. National Center for Biotechnology Information , U. Journal List Front Psychiatry v. Front Psychiatry. Published online Aug Author information Article notes Copyright and License information Disclaimer. This article was submitted to Psychopathology, a section of the journal Frontiers in Psychiatry.

Received May 25; Accepted Jul The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Abstract The present paper discusses the role of culture in understanding and treating psychopathology. Keywords: psychopathology, culture, explanatory models, cultural competences, psychotherapy. New perspectives on the definitions of psychopathology and of culture The focus on culture when understanding psychopathology has not always been present and it is still not mainstreamed in clinical psychology and psychiatry. Explaining psychopathology: the role of culture, discrimination and minority stress on mental health Culture has a recognized role in not only conceptualizing psychopathology, but also in explaining and accounting for experienced distress, health and illness 14 , Psychotherapy: working with cultural diversity Since the seminal work by Frank and Frank 53 , psychotherapy has been compared with diverse healing practices or treatments across different times and different cultures Mainstreaming culture in research on psychopathology and in clinical training The present paper argues for mainstreaming culture in research and clinical training in psychopathology, acknowledging that each clinical interaction is a cultural one.

Author contributions The author confirms being the sole contributor of this work and approved it for publication. Conflict of interest statement The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Footnotes Funding. References 1. Rathod S. Contemporary psychotherapy and cultural adaptations. J Contemp Psychother. Kirmayer LJ. Beyond the 'new cross-cultural psychiatry': cultural biology, discursive psychology and the ironies of globalization. Transcult Psychiatry 43 — Cultural dimensions of psychopathology: The social world's impact on mental illness.

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Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)
Models of Psychopathology (Core Concepts in Therapy) Models of Psychopathology (Core Concepts in Therapy)

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