Research has consistently shown that therapy is least useful and successful for racial and cultural minority group patients and patients from lower socio-economic status(SES) groups. One study found that therapits typically prefer clients who are young, attractive, verbal interlligent and successful. Many investigators believe that failure of psychotherapy to successfully treat minority and lower SEX patients is due to problematic patient-counselor interactions that result from differences in racial, ethnic and class backgrounds. For example, lower SES patients frequently have different expectations of counseling than members of the middle-class. They may view therapy as a means of obtaining advice and suggestions for dealing with specific, concrete problems. Attempts to explore personality dynamics or the history of the problem may frustrate, anger, or confuse the lower SES patients.
Five processes have been identified that can create special problems when the therapits and patient are from different racial or cultural groups and when patients are from lower SES groups;
1. Stereotyping: Both stereotyping and a therapist's attempt to avoid stereotyping can inhibit the development of a therapeutic relationship. For instance, a therapist who tries to treat a racially different patient as "just another patient" may end up engagng in "color or culture blindness." As a result, he or she may neglect to address important issues related to the differences that exist between the therapist and the patient.
2. Resistance: When working with patients whose background differs from his/her own, a therapist must be careful not to misinterpret racial, cultural or class differences in bahvior as a manifestation of resistance.
3. Because minority group members may bring to therapy intense emotions derived from experiences with the majority group, transferences can be particularly problematic with culturally different and lower SES patients.
4. Counter transference: It can be difficult for majority group therapists to free themselves from all stereotypic attitudes towards minority group patients. Thus, majority group therapists must monitor their behaviors to ensure that unconscious feelings, beliefs and attitudes are not being manifested as counter transferences.
5. Patient expectations: Patient expectations can have a potent influence on therapy outcome. Negative feelings on the part of the patient that result from therapits-patient differences can bias the counseling experience toward failure.
CONSIDERATIONS WHEN COUNSELING MINORITY GROUP PATIENTS
1. Acknowledge to the patient your awareness of the difference and ask the patient in a supportive way if he or she has any concerns about the issue.
2. Be aware of the many factors that contribute to a person's orientation and values, e.g., socioeconomic class, dominant language, and, in the case of immigrants, the degree of embeddedness in the culture of origin versus the degree of assimilation or acculturation in the dominant culture. Accurate assessment of language is especially important when testing is involved.
3. Emphasize respect for differences and appreciation for the strengths of different cultures.
4. Be aware of social and community support groups to which you can refer the patient(e.g., social service agencies, religious organizations).
5. Reconize that social economic, political discrimination and prejudice are real problems in the U.S. Validate these realities while focusing on ways to maximize their personal effectiveness. Recognize that suspiciousness and mistrust may reflect a realistic response to past experiences rather than paranoia or pathological defensiveness.
6. Do not generalize about all patients who belong to a particular racial, cultural or class group. Draw on your knowledge of cultural patterns to develop hypotheses regarding values, behaviors and attitudes toward therapy; but always focus and understanding the particular individual you are working with. For instance, while both Latinos, an immigrant white Argentinian professor from Buenos Aires and an Indian or Mestizo Mexican from rural Michoacan have very little in common.
RACE AND PHARMACOTHERAPY
Recent work has highlighted some differences among racial groups in their response to pharmacological intervention. In their review of psychopharmacological treatment and the Asian population. Lin and associates (1993) mentioned various clinically important differences. For instance, Asian's lower tolerance to alcohol and the "flushing response" are due to polymorphism of aldehyde and alcohol dehydrogenase. In comparison to Caucasians and African-Americans, a much larger percentage of Asians are said to be "fast acetylators." This has an impact on the metabolism of drugs such as clonazepam, caffeine, and phenelzine. The higher incidence of dyskinesia in Asia Parkinson's disease patients has been associated with racial differences in the activity of catechol-0-methyltransferase. The lower response threshold of Asians for various anti-psychotics antidepressants, and anxioltics has also been associated with racially based differences in metabolism.
African-Americans develop higher plasma levels of tricyclic antidepressants and have faster clinical responses to these agents compared to similarly treated Caucasians. Another finding is the slower metabolism of lithium in African-Americans, who may require doses that are lower than those required by their Caucasian counterparts. This is a new area, and studies are being conducted with Hispanics and Native Americans.
