Early Cultural Dialogues in Cross-Cultural Clinical Practice

Abstract

This article examines the quality of cultural dialogues between clients and therapists when they initiate and integrate verbal references to culture in the beginning process of therapy. Six cross-cultural dyads in short-term–oriented community mental health services participated in the study. The initial three sessions of actual clinical encounters were taped, and conversation analysis was used for an intensive analysis of the treatment sessions. Despite the presence of a wide range of affectively charged cultural content raised by the clients, the therapists showed only minimal responses to these topics. The potential of therapeutically germane cultural dialogue was lost, and the discussion of material involving cultural differences regressed to monologues expressed by clients. In this sample, there was little talk that focused on cultural differences or similarities between clients and therapists. Implications and limitations of the study in cross-cultural clinical practice are discussed.

Keywords:

• cultural dialogue
• cross-cultural competencies
• cross-cultural clinical practice
• conversation analysis
• multicultural training
• clinical social work

ACKNOWLEDGEMENTS

This article is based on a part of the dissertation study conducted by the first author. She wishes to acknowledge the Fahs-Beck New York Trust Fund Experimental Research Dissertation Grant and the Smith College Roger Miller Dissertation Grant for research funding support. She also greatly appreciates Drs. Kathryn Basham and Joyce Everett for their helpful comments and support on the earlier work of this study.

Notes

1. To capture interpersonal and dynamic aspects of negotiating multiple intersectionalities of difference between the client and therapist, we prefer using cross-cultural competencies (CCC; Lee, 2010) or cultural responsiveness (Lee & Horvath, 2013) to using cultural competence or multicultural counseling competence (MCC; Worthington et al., 2007). CCC expands our attention “beyond a one-person psychology or conceptualization” (i.e., cultural competence as a clinician's characteristics across different clients) to “a two-person psychology” by focusing on relational aspect between a particular client and therapist and dynamic aspect that acknowledges its ever changing quality across treatment (Lee, 2010, p. 273). Cultural responsiveness is not a level of skill or “thing” that can be obtained. Rather, it resides in the ways we are conversing and interacting with clients in clinical practice. These terms deeply acknowledge that culturally relevant issue is not context or background but an integral part of our client's presenting issues and our clinical practice.

2. In Vignette 1 and all other vignettes in the article, numeric numbers indicate speaking turns. Transcript symbols are listed in Table 1. All names are pseudonyms.