The Impact of the Caribbean Culture on the Outcome of Therapy

The impact of the Caribbean culture on the outcome of therapy _____________________________________
Culture may be defined as the long-term behaviors, ideas, attitudes, and traditions shared by a large group of people and communicated from one generation to the next. It is in essence the lens through which a person sees their world. What is completely healthy and normal in one culture may subsequently be defined as unhealthy and abnormal in another.

Culture is what people think, value, and do to ensure their existence. As each generation inherits a culture, modifications will be made, with basic features left untouched such as language, religious, practices and government systems.

Like a river, culture has many sources (Mosterin, 1992). There are at least five tributaries that merge to make us who we are. We are first influenced by our biology. Our genders, sexual preferences and socialization processes produce several combinations of behaviour, which cut across national and possibly international boundaries. Human beings however will naturally seek

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to adjust their behaviours to „fit‟ with the dictates of the world in which we inhabit.

Our culture is influenced by our ecology. The various environments existing worldwide will be hot or cold, tropical or temperate, mountainous or flat. Understandably, persons living in Iceland will develop a different way of life to those living in Hawaii.

Our national grouping will influence specific culture. Generally, inhabitants of countries will share common language, style of government, mode of dress etc., which may be vastly different from the variable in another country. For example, the language and mode of dress in India is significantly different from that of Spain.

Within a country there may be differences between regions, which may contribute significantly to the national culture. For example, in the United States of America, people living in California and Texas long the Mexican border present cultural characteristics that are unique to that part of the country (Vontress, 2001). Similarly, certain parts of Canada have French as their first language eg. Quebec, while other parts have English as the first language, eg. Ontario.
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In certain countries of the world, the racio-ethnic group into which individuals are born and socialized plays a tremendous role in influencing culture. In the USA, many African-Americans manifest a culture quite different from the Caucasian-Americans. In Trinidad, the Indian and the Negro population exhibit vastly differing beliefs, dress and traditions. Although culture is a complex construct, it undoubtedly affects our entire existence.

Anthropologists often describe culture as a system of shared meanings. Because there are a variety of ways to define a cultural group (e.g., by ethnicity, religion, geographic region, age group, sexual orientation, or profession) so consequently, some persons consider themselves as having multiple cultural identities.

Culture and society play critical roles in mental health, mental illness, and mental health services. Understanding the wide-ranging roles of culture and society enables the mental health professional to design and deliver services that are more responsive to the needs of racial and ethnic minorities. Psychologically speaking, major perceived cultural differences between people can cause initial uncertainty, misunderstanding and fear. Culture is
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relevant, however, even in matches of very similar cultures, as in situations where there is a good therapeutic fit or where the therapist over identifies with the patient and makes unwarranted cultural assumptions (Moffic et al., 1988). With a seemingly endless range of cultural subgroups and individual variations, culture is important because it bears upon what all people bring to the therapeutic setting. It can account for variations in how clients communicate their symptoms and which ones they report. More often than not, culture influences whether persons seek help in the first place, what types of help they seek, what coping skills and social supports they have, and how much stigma they attach to mental illness. All cultures also feature strengths, such as resilience and adaptive ways of coping, which may safeguard some persons from developing certain mental disorders. Potential clients will most likely carry this cultural diversity directly into the treatment setting.

Culture is a concept not limited to clients. It also applies to the therapists who treat them. Every group of professionals embodies a "culture" in the sense that they too have a shared set of beliefs, norms, and values. This is as

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true for counselling professionals as it is for other professional groups such as engineers and teachers. Any professional group 's culture can be inferred from the jargon they use, the terms of reference and emphasis in their writings, and from their worldview. Most therapists hold a worldview about the interrelationship between body, mind, and environment informed by knowledge acquired through their course of study. It also means that therapists view symptoms, diagnoses, and treatments in ways that sometimes contradict their clients ' views, especially when the cultural backgrounds of the client and counsellor are different. This divergence of viewpoints can create barriers to effective therapy. . Psychotherapy originated in the Judeo-Christian ambience of Central Europe in the early twentieth century and evolved as a white, middle class phenomenon primarily in North America. Counselling theories presently emphasize the relational nature of therapeutic encounters and the importance of interaction between counselor and client, which are both likely to be more beneficial to the therapeutic needs of marginalized clients. African-Americans born in the USA differ greatly in culture from their African or their Caribbean counterparts. In fact, there are distinct differences even among Negroes hailing from various islands in the Caribbean.

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Each culture brings with it its own and often incongruent perception of power, authority, interpersonal boundaries and family dynamics (Tsui, Schultz & Chen, 1988). All persons manifest varying levels of ethnic or racial bias. However, the therapist‟s and client‟s awareness of their own prejudices can minimize resistance and promote treatment goals (Addison 1977).

There are blind spots that each counsellor brings to the therapeutic setting which, if left undetected, can result in negative therapeutic outcomes. Some of these blind spots are: the issues of individuality, insight, intimacy and selfexpression.

As therapists it is important to understand the client‟s view of the individual and of family. Western culture is typically very individual-centered while many other cultures such as Asian, African-American or Caribbean are family-oriented. This individualism that many of us have inherent to ourselves is seen as a encumbrance to others who come from non-Western cultures. In these cultures they view life from a group orientation. For example, in the Japanese culture, the word „I‟ is rarely used in communication. Another example of this orientation is how we speak to one

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another. We greet one another, by asking how are you? In group-oriented cultures, they ask, „How is your family?‟ Counsellors who neglect this reality will face difficulties when counseling people from such cultures.

A basic assertion of psychotherapy is that to receive insight

into one‟s

problems and issues is good. When it comes to someone from a different culture the same is not always true. Many cultural groups do not value this method of self-exploration. In fact, many Asian elders believe that thinking too much about something can cause problems. Lum (1982) discovered that many such Asians believe that in order to achieve mental health one must avoid “morbid thoughts.” They suggest that when they encounter feelings of frustration, anger, depression or anxiety the best remedy is simply “don‟t think about it.” Similarly, many persons who seek counseling from a different culture do not appreciate the value of insight, simply because their problems are practical. We will often hear questions like, “I need to get a job,” or “How am I going to afford my children‟s school fee?” before we get to emotional or spiritual issues. Their response to our probing for insight might be “I don‟t have time to think about those things. My life is just too hectic. In these instances, we may as counselors refer them to the organizations that can assist them in

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these difficulties.

Therapy is established through talking and expressing oneself, yet different cultures talk in different ways. Often clients who come from Asian and Indian cultures do not value verbal expression as much as Westerners do. Ways of speaking and communicating are vertical, that is, adults or one who has higher standing and reputation initiates the conversation. Similarly, we may push our clients to be more assertive and yet this may push them to do something that goes against their family and community beliefs. There are many cultural groups in which restraint of strong feelings is highly esteemed. For example, traditional Asian cultures emphasize that maturity and wisdom are associated with one‟s ability to control emotions and feelings.

Many non-Western cultures prefer a depth of friendship before sharing at a deeper level. The Western traditional counseling process, where deep sharing soon encouraged can seem wrong to those of different backgrounds where one does not open up to those they do not know well.

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Caribbean culture is characteristically linked to the approaches to survival taken by her peoples. The major ethnic groups of the region are namely the East Indians, Africans, and Europeans peoples, which have maintained connections with their ancestral heritage in most instances. European traditions account in many respects for the official expression of culture, but are often supplemented by ethnic identity, especially with relation to the majority having African tendencies. The characterization of the region can be most clearly identified through the European colonial legacies of the specific countries seen as follows: Haiti, Dominican Republic, Cuba, and Puerto Rico for example, are to the French and Spanish what Jamaica and Trinidad & Tobago are to the British. These territories constitute the largest islands as well as populations, and therefore have the largest respective impact on the region 's culture. Haiti singularly holds the critical mass of Afro-Caribbeans in the region. Cuba holds the critical mass of European descendants, in particular Spanish, population. Culturally this has resulted in a continuum of cultural manifestations ranging from overwhelming African cultural presence in Haiti

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and Jamaica to a predominantly Spanish influence in Cuba, the Dominican Republic and Puerto Rico. Jamaica accommodates the large majority of Afro-Caribbeans in the English speaking West Indies. To this extent the language, food, ideologies, and ethnic tempo of Jamaica are similar in character to many parts of Africa from which enslaved Africans were brought. The cultural artifacts (visual and performance, material and non-material) produced in Jamaica are the embodiment of African retentions and in many cases symbolize a struggle to achieve liberation from systemic oppression. Resistance for this reason is seen as a major motivating source of cultural expression. Populations of marooned Africans also still inhabit the island. Trinidad & Tobago is chiefly known through the music of Calypso and the creation of the steel pan. This nation state along with Guyana holds the critical mass of East Indians in the Caribbean. This factor has given both Trinidad and Tobago and Guyana greater identity with Asian cultural practices especially with respect to food, religion and the subsequent worldview this inculcates. African retentions are particularly evident in the ideas of celebration and worship, and artistic expressions. Jonkanoo exists in the Bahamas, Santaria in Cuba, Vodun in Haiti, and Rastafari in Jamaica are some examples. Some of these forms have been transferred from the Caribbean to the world such as

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Rastafari philosophy, Reggae Music, steel pan, Jerk cooking and regional rums and spices. The emergence of creole languages is perhaps one of the more clearly identifiable cultural forms to have emerged in the Caribbean space explicitly preserving African, European, Asian ideas/ words in the common everyday popular expression. The concept of underdevelopment is often presented in discourses on the Caribbean. This concept lingers as a cultural baggage because of the ideological power play that has been perceived as being wrought on the modern Caribbean experience. Men in the Caribbean, as contrasted with women, are considered to be stronger, more dominant and expected to be more active sexually. Men are expected to be the providers, while women seek someone to be responsible for them. The Caribbean person sees marriage as a status symbol, but does not believe it should restrict the „natural‟ tendencies of men and women (Waithe, 1993). As a strategy for survival, Caribbean men and women commonly migrate to North America and the UK in an effort to „better themselves‟, leaving their children in the care of relatives and friends.

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Sexual and physical abuse, in the form of men battering their women and children, is high in the Caribbean – and socially accepted in many Caribbean countries. Gender is a central risk factor in Caribbean societies. Almost all children in Jamaica and Saint Lucia, for example, are born out of wedlock, which means that many fathers are absent from the lives of their children. [The exclusionary nature of Caribbean „fathering‟, dates back to slavery when men were not permitted to play the role of spouse and father.] At the same time, social norms promote sexual prowess and multi-fathering of children among men. These norms have important intergenerational effects. Children of absent fathers are more likely to do poorly in school. Men‟s inability to provide economic support means that women often raise children on their own, leading to greater levels of poverty and vulnerability among these women and their children. Emotional immaturity is evident among some Caribbean men and women where adults are still „attached‟ to parents (especially mothers) rather than to their partner or spouse. This is particularly harmful when there are children in the relationship.

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The Caribbean parent will typically believe that as long as their children‟s financial well-being is taken care of, they are secure. There is therefore not much concern about the emotional and psychological well-being of the child in a dysfunctional, abusive family. The incidence of rage among young people is extremely high: 40 percent of school-going CARICOM students reported feelings of rage. The proportion of Caribbean adolescent males who carry firearms is extremely high. One-fifth of students had carried a weapon to school in the 30 days previous to the survey and nearly as many had been in a fight using weapons. Gang violence is also high in the Caribbean, with 20 percent of male students and 12 percent of female students at one point having belonged to a gang. Young people in disadvantaged situations are often forced to find work and have few options except informal sector work, drug trade, or prostitution. Young girls in some countries – often at the encouragement of their mothers – will engage in opportunistic sex to relieve poverty and contribute to the household income. Childbearing is still used a strategy for gaining economic support in countries like Jamaica. The stigma and discrimination meted out to persons who have contracted HIV or AIDS is very much a part of the Caribbean society.

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The pastoral counsellor in the Caribbean who will counsel persons in the area of sexuality must be aware that he will be coming up against traditional views which have always seen the pastor as one who should not be discussing sexuality. He will also have to face the growing dissatisfaction that men in the society appear to have for the church and religion in particular. The Rogerian concept of unconditional positive regard will be an important pre-requisite in this area in the Caribbean. The traditional hardships that Caribbean women often face, with men often being absent, may cause the therapist to be less than objective in assessing her, and possibly may even adopt her position. However, taking sides blinds the counselor to the couple‟s interactions and lessens the possibility of producing positive change in the situation. The Caribbean counsellor will need to focus on helping women to build their self-esteem, have self-respect, self-love and accept that they have power to make choices which will be beneficial to them. Behaviour modification techniques could be useful in helping to break negative thought and behaviour patterns.

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The counselor should seek to maintain flexibility and an appreciation of where each person is coming from, as well as what psychological factors may have motivated the client‟s actions. Caribbean men should be encouraged to reflect on the reasons behind their seemingly promiscuous, irresponsible, and less than genuine behaviour in relationships. Exploration of the possibility of their „acting out‟ what they believe is expected of them by their peers and society, should prove fruitful. Caribbean counsellors should be willing to promote maturity in relationships and couples must be encouraged to keep their issues confidential unless permission is obtained from their partner to share them. Counsellors may have difficulty in convincing persons to share openly about very personal problems. For example, in either sexually, incestuous or physically abusive relationships, Caribbean persons will often not discuss these problems outside of family, if at all. The importance of treating families as one unit will be more crucial in the Caribbean context. Many children and adolescents who are seen as being „bad‟ are really reacting to family issues, which have affected them, and they feel powerless to change. It will therefore be important to visit or counsel

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with as many family members as possible to better ascertain where the real problems lie. Caribbean Guidance Counsellors have a crucial role to play in helping children and adolescents cope with themselves, their environment, and still be able to succeed in school - with limited available resources. Teachers will often end up supplementing the Guidance Counsellor‟s role, and so require all the psychological support that can be given. „Culture‟ affects every area of our lives whether we recognize it or not. The culture of the therapist and the culture of the client will both need to be identified and understood in order to more accurately determine what therapy techniques and/or theories will best „fit‟ the presenting problem. Clients can be helped or hindered, and even discouraged, because of a lack of appreciation for the value of culture in the therapeutic relationship. It all boils down to knowing who the client is and who they are outside of your idea of who you think they are. It is essential that just as we prepare to know the right techniques for each client, we must also do the necessary preparation in know who our clients really are, from the viewpoint of their cultural heritage. It is also essential that we know who we are and understand our own selves, so that we can counsel with discernment and patience.

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Put simply, the writer George Bernard Shaw provided the core guideline to cultural competence when he said: "Do not do unto others as you would that they should do unto you. Their tastes may not be the same." Only then can we expect not only a positive outcome in therapy, but change that is observable, impacting and long-lasting.

REFERENCES Kelly, James (2002) FindingourBlindSpots: Multicultural Counseling BonewellSpring Psychotherapy in Scotland, Copyright © 2002-2004 Douglas McFadzean. http://www.mcfadz.fsnet.co.uk/therapy/#outcome U.S. Department of Health and Human Services, Office of the Surgeon General, SAMHSA Mental Health: Culture, Race, and Ethnicity (2001) A Supplement to Mental Health: A Report of the Surgeon General Vontress, C. E. (2002). Culture and counseling. In W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler (Eds.), Online Readings in Psychology and Culture (Unit 10, Chapter 1), (http://www.wwu.edu/~culture), Center for Cross-Cultural Research, Western Washington University, Bellingham, Washington USA. Waithe, Neilson A. (1993) Caribbean Sexuality. A Pastoral Counsellor looks at Family patterns and the influences of Culture on Caribbean people. The Moravian Church in America, Bethlehem PA.

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Waithe, Neilson A. (1995) Family Relationships. Caribbean Experiences. The Moravian Church in America, Bethlehem PA. Welcome To The Caribbean. Caribbean Culture. Retrieved from http://www.welcometothecaribbean.com/culture.htm

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References: Kelly, James (2002) FindingourBlindSpots: Multicultural Counseling BonewellSpring Psychotherapy in Scotland, Copyright © 2002-2004 Douglas McFadzean. http://www.mcfadz.fsnet.co.uk/therapy/#outcome U.S. Department of Health and Human Services, Office of the Surgeon General, SAMHSA Mental Health: Culture, Race, and Ethnicity (2001) A Supplement to Mental Health: A Report of the Surgeon General Vontress, C. E. (2002). Culture and counseling. In W. J. Lonner, D. L. Dinnel, S. A. Hayes, & D. N. Sattler (Eds.), Online Readings in Psychology and Culture (Unit 10, Chapter 1), (http://www.wwu.edu/~culture), Center for Cross-Cultural Research, Western Washington University, Bellingham, Washington USA. Waithe, Neilson A. (1993) Caribbean Sexuality. A Pastoral Counsellor looks at Family patterns and the influences of Culture on Caribbean people. The Moravian Church in America, Bethlehem PA. 17 Waithe, Neilson A. (1995) Family Relationships. Caribbean Experiences. The Moravian Church in America, Bethlehem PA. Welcome To The Caribbean. Caribbean Culture. Retrieved from http://www.welcometothecaribbean.com/culture.htm 18