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Effective psychotherapy in a racially and culturally diverse society

  • Kamaldeep Bhui and Neil Morgan

This article is aimed at psychotherapists and health practitioners who have not reflected on the role of race, culture and ethnicity in the provision of psychological treatments. We highlight the key issues of importance in engagement, assessment and ongoing therapy, supporting practitioners to reach a stage of pre-competency. Competency will be achieved with additional training, supervision and innovation.

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BJPsych Advances
  • ISSN: 1355-5146
  • EISSN: 1472-1481
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Effective psychotherapy in a racially and culturally diverse society

  • Kamaldeep Bhui and Neil Morgan
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Psychotherapy in a multi-cultural society

Tanvir Ahmad Rana, Visiting Senior Lecturer
21 May 2007

Bhui and Morgan (2007) have highlighted the need for psychotherapists to be aware of the sensitive role of race , cultureand ethnicity.

Even in general psychiatric practice these factors can influence assessment, diagnosis , treatment and prognosis. For example, the distress conveyed by a patient may not necessarily be psychopathological but may be culturally grounded (Drenan & Swarz, 2002). In African and West Indian groups ‘paranoid beliefs’ may be culturally sanctioned ( Ndetei & Vadher, 1984). It is known that people from Asian cultures are more prone tosomatizing their (depressive) symptoms. Sometimes, a prolonged assessment is required to distinguish between religious beliefs and true delusions.

Psychotherapy is greatly dependent upon the therapeutic relationship. Unless the therapist takes into consideration cultural and racial variations , there is a high likelihood of ineffective communication and misunderstanding , which in turn influences transferenceand countertransference, processes that are pivotal in psychodynamic therapy.Many Western concepts and theories , like Freud’s injunction ‘to share everything that comes to mind’, Klein’s emphasis on negative transference,and ideas like separation anxiety are not equally applicable to clients from differing ethnic backgrounds.

It is also important to appreciate this problem from a different but related angle i.e. the desired need for therapists from BME backgrounds to have a clearer understanding of ‘white culture and norms’ and the awareness of the possible influence oftheir own beliefs and values might have in the psychotherapeutic process.

Some authors have suggested the need for reconciling different explanatory models regarding communication with patients from other cultures ( Bhui & Bhugra, 2004). Ethnic matching has been suggested as one solution but apart from lacking sufficient empirical evidence, this may not always be a pragmatic option because of scarcity of therapists. It has, moreover, been reported that some therapists and patients belonging to the same ethnic background experience ‘internalised racism’ .

For psychotherapy to be successful, there is a need for a common language for the subtle communication of thoughts andfeelings. It has been proposed that third parties may be included inthe treatment to bridge the cultural gap between the therapist and the client( Heilman & Wilztum, 1994).

Not understanding the racial, cultural and religious backgrounds and differences can be one of the greatest barriers and challenges for psychotherapists.


Bhui & Bhugra (2004) Communication with patients from other cultures: the place for explanatory models Advances in Psychiatric Treatment 10: 474-478

Bhui & Morgan (2007) Effective psychotherapy in a racially and culturally diverse society. Advances in Psychiatric Treatment , 13: 187-193.

Drenan, G. & Swarz, L. (2002) The paradoxical use of interpretingin psychiatry. Social Science and Medicine, 54, 1853–1866.[CrossRef][Medline]

Heilman, S.C. & Wilztum,E. ( 1994) Patients, chaperones and healers: enlarging the therapeutic encounter. Social Science and Medicine,39, 133-143

Ndetei, D. M. & Vadher, A. (1984) A cross-cultural study of the frequencies of Schneider's first rank symptoms of schizophrenia. Acta Psychiatrica Scandinavia, 70, 540–544.
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