International Case Studies in Mental Health

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Edited by: Senel Poyrazli & Chalmer E. Thompson

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    Foreword

    Modernism has produced remarkable advances in the science and practice of psychology. The modernist perspective is grounded in logical positivism: investigative approaches that separate the person from the intertwined conditions in which he or she is situated and the linear interpretation of objective measurements of basic psychological structures and processes. Modernism has its limitations, however. It has become increasingly clear that the tenets and methods of a modernist psychology are not universally applicable but instead reflect the ecological milieu in which this variant of the discipline thrived. Very likely, this realization has been influenced by globalization, which has made explicit a new reality comprised of many diverse psychologies, including U.S. psychology. All psychologies have distinctive as well as common features, each of which expresses a larger worldview shaped by culture, economics, history, politics, religion, and, of course, the individual.

    Globalization can be seen in the increased worldwide movement of capital as well as goods and services, the rise of representative forms of government and concern with human rights, growth in the transnational migration of large numbers of peoples, and the explosive exchange of information through digital communication technologies. Irrespective of its benefits and costs, globalization has led to innovative adaptations to an ever more interconnected and interdependent world. The speed and extensiveness of globalization, and its psychosocial and sociocultural consequences, have challenged psychologists to review the implicit assumptions on which their theories, research, and applied practices rest. This critical examination has energized alternative disciplinary perspectives and movements, such as multiculturalism and indigenization, which offer a counterweight to the modernist paradigm. Such developments have been a clarion call for greater multilateral, horizontal dialogue among psychologists in the industrialized and majority (developing) worlds. Such dialogue has enriched the conceptual, empirical, and applied knowledge and skills of all psychologists in their efforts to understand more fully and respond more effectively to the nuanced domains in which human beings live.

    The Universal Declaration of Principles for Psychologists was conceived as common moral framework that would inspire and guide psychologists worldwide toward the highest ethical ideals in their professional activities. The four principles of the Universal Declaration are Respect for the Dignity of Persons and Peoples, Competent Caring for the Well-Being of Persons and Peoples, Integrity, and Professional and Scientific Responsibilities to Society. These principles are especially relevant for the growing number of counselors, psychotherapists, and healers who often are tasked to work with highly diverse and underserved indigenous and immigrant, refugee, or sojourner populations in their home countries or abroad. Ethical practice mandates not only that practitioners do no harm but also that they endeavor to improve quality of life by offering contextually appropriate services to individuals, couples, families, groups, communities, and society as a whole. Thus, problems in living and psychological dysfunction need to be viewed as the local expression of symptoms found in either universal or culture-bound disorders or as an adjustment to oppressive circumstances (e.g., poverty, violence). Western taxonomies like the Diagnostic and Statistical Manual of Mental Disorders may need to be augmented by locally meaningful representations of mental illness. Procedurally, practitioners need to respect local customs and weigh the advantages and risks of introducing folk remedies, community healers, and normative styles of relating to their standard treatment repertoire.

    Paradoxically, while practitioners are expected to provide ethically unimpeachable and evidence-based interventions domestically and internationally, there frequently is a wide gulf between the idealized depictions and the stark realities of treatment that can leave practitioners confused, frustrated, and hesitant to work with clients and in settings where their talents are sorely needed. Practitioners may find themselves hand-tied as they strain to improve lives if equipped with didactic and experiential learning that is frozen in a monocultural and monolingual status quo or that falls prey to simplistic exhortations to assess a host of client demographics and explore overgeneralized group differences. Psychology associations, professional training programs, faculty instructors and clinical supervisors, and organizers of continuing education are at a crossroads: The demand for effective multicultural and international interventions requires that curricular materials and pedagogical techniques evolve to ensure the preparation of full-capacity global citizens, a necessary precondition for context-centered, ethical engagement by current and future practitioners. One unmistakable response to the challenge just noted is this book: International Case Studies in Mental Health.

    In International Case Studies in Mental Health, Senel Poyrazli and Chalmer E. Thompson designed a unique chapter template that introduces the reader to the rich detail with which to situate each case study. After summarizing the background and treatment orientation of the chapter authors and featured practitioner, the cultural and sociopolitical conditions of the country from which the case was drawn are highlighted, along with local perspectives on mental health problems, mental healthcare, and mental health providers. Relevant life-history data, selected client variables, presenting concerns, and a case conceptualization are described; followed by the form, process, and course of treatment; and concluding with an evaluation of its successful outcomes and unresolved issues. Several chapters provide guidelines for working appropriately and effectively in similar circumstances, particularly suggestions for harnessing community resources to enhance the viability and impact of intervention. The authors and practitioners, who often partnered internationally on each chapter, are acknowledged experts in counseling, psychotherapy, and healing and represent industrialized and majority countries from the six inhabited continents, including the United States. The case studies range from problems in living to occasionally debilitating psychopathology and are written so masterfully that they invariably evoke the strengths and limitations of the client and practitioner and the humanity of their therapeutic collaboration. Poyrazli and Thompson also include introductory and concluding chapters that orient the reader to the case study format and integrate significant thematic material across case studies.

    There is much to learn from International Case Studies in Mental Health, whether the reader is a graduate student, clinical supervisor, faculty instructor in a professional training program, or a mental health practitioner interested in or currently working with diverse and underserved populations domestically or abroad. Among the recurrent themes of the volume are the synthesis of diverse yet complementary frameworks for treatment (e.g., contextual action theory, multicultural case conceptualization); the fusing of modernist approaches with indigenous procedures and religious and social customs (e.g., Mayan cosmology, curanderismo, and the Catholic mass in Guatemala); the importance of the personal and reputational qualities of the practitioner that serve to mitigate cultural mistrust and permit accurate understanding of symptoms (e.g., headaches, eccentric thinking); the co-creation of a working relationship unencumbered by biased assumptions via inclusive cultural empathy (i.e., balancing client and practitioner similarities and differences and understanding the treatment relationship in its cultural context); the empowerment of clients by strengthening mindfulness and protective factors and by improving psychological and social harmony; the expanded definition of the helper role to include the support functions of culture broker and advocate when building needed community linkages; the assessment of multiple acculturative stressors and acculturative strategy when working with immigrants, refugees, and sojourners; and caution not to overgeneralize from a single case study given the demographic and sociocultural heterogeneity found within groups.

    Psychology has a social responsibility to address the needs and facilitate the aspirations of the world's peoples. For psychology to become more responsive, it must undertake with imagination and vigor the increasingly urgent challenge of becoming more attuned to diverse cultural and sociopolitical worldviews without abandoning entirely the modernist theories, research methods, and applied practices that have enriched our understanding of human functioning and experience. One heartening response to this challenge is the emergence of international psychology, a field whose mission is to increase the frequency, broaden the scope, and enhance the meaningfulness of communication and collaboration among psychologists and psychology students with shared interests from diverse countries and cultures via curriculum, scholarship, advocacy, and networking. Without a doubt, International Case Studies in Mental Health advances the mission of international psychology. It is a groundbreaking volume, which given its relevance and timeliness, will only gain in stature.

    Michael J.Stevens, PhD, DHC Illinois State University, United States The Lucian Blaga University, Romania

    Preface

    This book presents a variety of cases from around the world. The people described within these pages—the ones who seek help to eliminate their distress and those who provide the help—come from both developed and developing countries. In most of the cases, the helpers share a similar heritage with the help seekers and are influenced at least partly by Western psychotherapy traditions. The treasure to behold in these cases is the authors’ strivings: Academic psychologists and practitioners collaborate to describe the confluence of cultural and sociopolitical influences that tailor the treatment and in so doing, inform a pathway to effective healing. Each chapter is a showcase of how psychologists and mental health practitioners worldwide collaborate to achieve invaluable work.

    Our purpose in writing this book is to help prepare both mental health trainees and practicing professionals to be effective in the provision of healing in their work with people in different regions of the world. Consequently, we hope to offer practitioners a glimpse of what can be achieved in these regions by people whose reputations within the respective communities are strong. Far from representing what occurs in each and every case, we instead attempt to provide details about these contexts, about the particular skills and mindsets of the practitioners, and details of the people in search of psychic relief. Moreover, with increases in migration, sojourning, and the disappearance of borders, we believe this book responds to the call of many university training program leaders who want to expand their curriculum to include cases from countries outside of their own.

    We wanted to create a volume that stands out from others in important ways. To date, there have been no books devoted entirely to describing cases from an international perspective. This book therefore fills a void in the field. Furthermore, rather than examining case studies that include individuals from outside of the United States to the exclusion of U.S. cases, we accomplish both. We believe this feature of inclusion reflects our desire to resist a practice of othering in cultural psychology, that is, of subtly conveying that the United States is the rightful purveyor of countries outside of itself. In addition, readers of the volume learn not only of the cases themselves but also about different contextual conditions that may affect an individual's mental health functioning. The work of mental health practitioners in each chapter shows how different factors (racial-ethnic culture, gender, age, sexual orientation, religion and spirituality, socioeconomic status, sociopolitical conditions, etc.) contribute to an individual's functioning. Each chapter shows how these factors may influence the counseling and psychotherapy relationship between the client or patient and the mental health practitioner.

    We envision this book will benefit a variety of different groups and can be used in many contexts:

    • This book benefits students in the mental health professions and particularly those who intend to work abroad or with immigrant populations.
    • This book benefits mental health practitioners who are already working in the field in broadening their scope of practice.
    • The book can be used as a main textbook in graduate internship seminars.
    • The book can be used as a companion book in required courses in multiculturalism, such as multicultural competency, cross-cultural counseling, or cross-cultural therapy.

    We would like to acknowledge the contribution and help many individuals provided that led to this book coming to fruition: the authors of the chapters; editors and assistants at SAGE Publications, particularly Ms. Kassie Graves; and many friends and family members who motivated us and provided encouragement.

  • Concluding Remarks: What Can We Learn from Mental Health Practitioners Around the World?

    Chalmer E.Thompson
    SenelPoyrazli

    We have much to learn from the contributors of this volume. But we begin with a look at the clients and patients first rather than the practitioners, as the accounts of these individuals can reveal much about the relationship. From the start of their contact with the practitioners to the end, these individuals were awakened to the possibility that they could discover better ways to cope and to feel more whole than when they first encountered these professionals. They practiced new ways of being in the world, found relief from the distress and trauma that plagued their lives, and improved their relationships with their children and parents. They stayed on with the relationship, experienced the struggle of seeming rejection by the therapist (e.g., Young Soon from Korea), encountered struggles that brought on further problems (e.g., Margaret Rukuni from Zimbabwe), and received encouragement to express themselves and behave in ways that departed from tradition, especially among the women clients (e.g., client JeeYoun from Korea and Mona from Lebanon). In Consoli, a los Ángeles Hernández Tzaquitzal, and González's chapter, the practitioners talked of the elicitation of solidaridad — mutual collaboration and commitment when faced with difficult, challenging, or painful situations; and personalismo —to treat one another with appreciation, consideration, and respect—born out of a view of one another as “you are I and I am you.” Rukuni speaks of ubuntu which appears to have a similar meaning to Consoli et al.'s personalismo, and pertaining to the idea of one's own humanity as being wrapped up in another's humanity. In Gerstein, Kim, and Kim's chapter, a similar concept is conveyed in Han ideology with the lack of separation between the therapist and client. These concepts inform the practices of these professionals and there is evidence that these clients were in synch with them ideologically.

    To us, that these people received the help they needed is a call to celebrate the maturity of a global mental health profession.

    Also noteworthy is that the stigma in seeking help was perhaps lessened by the reputation of several practitioners. Regard had already been accorded María de los Ángeles Hernández Tzaquitzal in Guatemala, Young Soon Kim in Korea, and Mehmet Eskin in Turkey, as examples, likely making the decision for people in their communities to seek out the practitioner less of a challenge. Their exemplary practices stood out and the people showed that they were honored to know them and optimism about the care they would receive.

    What we hope is also strongly evident in these pages is that culture is not fragile. It cannot be nor should not be ignored in the work of assessing individual or family problems, intervening with the people who need our help, and evaluating to determine if what we do is working. Culture is maintained despite people's transitions to new lands, as in the case of Mr. P. and Dr. Shea's personal accounts of migrating from China to the United States. Likewise, communities ruptured from natural disasters, civil wars and internments, and the spread of disease pose challenges to the unfurling of cultural learning, yet adults shore up their culturally based ways of coping for themselves and their children. In juxtaposition with modernity and hegemonic influences both within and outside of nations, culture both yields and resists simultaneously. Because of its utter complexity, there is the need for a stage on which culture can be understood, where people as cultural beings can be aptly described, and where healers can seriously contemplate how best to resolve the inevitable problems that surface when people experience distress in their lives.

    What we illustrate in this volume is a glimpse of the stage on which their interventions take shape and some clues as to why these practitioners have been successful in building up the reputation of the profession in all corners of the world. The contributors to this volume are a sample of the best of what the mental health profession offers its local public because what these clients found was a professional who was able to capably understand them and caringly attend to their needs, or as Yujia Lei of China put it, who could lead them like “a guide that travels along on a journey.”

    In each and every one of the cases, the practitioner was perfectly clear about the value they place on their relationship with their clients or patients. As Valach and Young stated, “We addressed establishing the working alliance and relationship as the first issue in the client-counselor/psychotherapist encounter and it remains the highest priority throughout therapy.” In other cases, the quality of the relationship comes across in the authors’ description of the care and attention that is paid to the initial phases of the therapy (e.g., Guatemalan chapter). Intriguingly, although the theoretical tenets of U.S. theorist Carl Rogers's treatment model is mentioned in many of the chapters (i.e., providing empathy, being genuine and congruent, and providing unconditional acceptance as a way to build rapport and facilitate growth), in none of these instances are the facilitative conditions considered as sufficient to treatment success as Rogers proposed. Most authors emphasize the importance of establishing a sense of rapport and trust, especially in those cases where counseling and psychotherapy are new or when many people view these practices as stigmatizing.

    Mental health practitioners in all of our chapters display how multicultural competency can be established in working with different people seeking help. As often discussed in the literature, a practitioner starts to become more culturally competent when he or she moves from being “culturally unaware to being aware … and to valuing and respecting differences” (Sue, Arredondo, & McDavis, 1992, p. 482). In addition, it is important to interview, design a treatment plan, and deliver psychological services based on client or patient characteristics, such as his or her sexual orientation, religious belief system, gender, age, socioeconomic background, or race-ethnicity (Hays, 2007). The practitioners in our book illustrate how they paid attention to these characteristics in their clients or patients. We also see that our practitioners paid attention to their own backgrounds (e.g., their gender, age, race-ethnicity, etc.) and how their backgrounds may have affected their dyadic relationships and also the treatment they provided. For example, Dr. Eskin discussed how being a heterosexual clinician who was supportive of lesbian, gay, bisexual, and transgendered (LGBT) rights contributed to his Turkish bisexual client's self-acceptance.

    Spiritual aspects of the chapters were most evident in Roysircar's chapter (Haiti) as well as the chapters from the United States (Washington, DC), United States-China (Chinese-Immigrant), Guatemala, Lebanon, and Sierra Leone. These practitioners were able to understand and incorporate these spiritual aspects into the treatment, illustrating an aspect of the client or patient's being that is not conventionally addressed in Western literature. For practitioners like María de los Ángeles Hernández Tzaquitzal, this integration is part and parcel of their practice: According to Consoli et al., de los Ángeles Hernández Tzaquitzal “has been working on honing in an integrative perspective that organically brings together the Western ways of counseling and psychotherapy with the traditional ways of the Mayan cosmovision as narrated in the Popol Vuh, the sacred book of the K'iche’ Maya people, curanderismo or indigenous healing, Catholic customs, and contemporary, alternative-healing methods.”

    The cultural accommodation model (CAM) presented by Shea and Leong offers practitioners a means to integrate cultural and sociopolitical influences into practice. For Shea, the revelation of her development as a practitioner is important to the chapter as many practitioners before her have and likely will continue to contemplate how they fit together traditional theories with life experiences that defy or question their application to all people. In the Shea and Leong chapter, Shea states, “The training in psychodynamic and cognitive-behavioral therapy (CBT) approaches has given me a breadth and depth of knowledge, strategies, and techniques to apply during the treatment process. The multicultural and postmodernist perspectives challenge me to consider my position and relation to my clients and how my clients and I construct the meaning of therapy together. I have learned to allow room for clients to tell their stories so I can understand problems and challenges from their perspectives. Rather than merely applying diagnostic labels and implementing treatment without cultural accommodation, I believe that it is important to understand the deeper meaning of clients’ psychological problems, distress, functioning (whether adaptive or maladaptive), and indigenous coping within their sociocultural contexts.” Shea mentions that she is humble in learning about her patient, even though the two share some commonalities. Humility is a word that comes to mind in our reading of Roysircar's chapter on the treatment of a Haitian family following the catastrophic January 12th earthquake.

    A major thrust in preparing this volume was to identify international scholars and ask them to identify practitioners they knew who were well-known in their countries. In selecting these colleagues, all of whom we met in the United States, we took care to consider their dedication and talent. We chose the persons we believed to be some of the very best among the international psychologists we knew from our many years of involvement in the American Psychological Association (APA). These are scholars whose original homes were in countries other than the ones they currently reside, or who have studied and worked in more than one nation. In our minds, their scholarship emulated worldliness and sensitivity in the peoples of the world. We have come to respect them, knew that they passed on their knowledge to students and colleagues alike, and when we asked that they again share their wisdom to new readers, they heeded our calls. And of our practitioners, we found what we were looking for: caring and competent professionals who wanted first and foremost to know their helpees well and to gain their trust in what they do.

    Earlier as noted, our selection of scholars was composed of colleagues we met in the United States. We limited ourselves to those whose associations crossnationally were tied to others who were trained using Western models of therapy. Consequently, we were not surprised that most of the practitioners had been influenced by these models. For example, in Duan et al., the authors make liberal use of two theories that can be seen by many as having incompatible aims: Rogerian and insight-oriented therapies. They make use of the psychodynamics theories, ever mindful of the pathological leanings of the language (e.g., weak ego strength) but keep a steady focus on the client growth and the here-and-now. Their departure from this primarily here-and-now approach is seen in the provision of insight to the client but not the sort of insight related to family dynamics and intrapsychic conflicts. Instead, the therapist attends to the contextual forces that obstruct his ability to function optimally and feel worthy as a human being. The authors address the pressures that can occur for young people in Chinese society when the competition for highly prized placements at universities is stiff. Being every mindful of the need to bring honor to the family combined with cultural values that suppress outward revealing about parental weakness or shortcomings, the counselor shows her regard for her client as she focuses attention on the cultural context and talks of her admiration of the client.

    Departures from Westernized therapies were also observed. Brigitte Khoury spoke definitively of the salience of family members taking part in psychotherapy as the family becomes “one of the most important allies in treatment.” Although family systems theorists from the United States and Europe address this salience, Khoury's treatise about the family's role shows regard for the curiosities—indeed, suspicions, that occur when the individual is in treatment and the need for parents to assume their rightful positions culturally in knowing what the therapy is about and how it is proceeding. Khoury's chapter beautifully illustrates how some of the intrusions of family can be incorporated into this respect for family and balanced with the wishes of her patient to have a less-obtrusive life with her husband and son while affirming her love and respect for her parents.

    As Cushman (1995) noted in his statement that psychotherapy occurs within context and is therefore never universal, these practitioners reveal to us that they take into account matters of modernity as they necessarily and wisely contemplate the integration of approaches that are Western-based and indigenous to the region. When the helpee receives help from a country outside the one in which he was reared, as in the case of Mr. P from Vietnam, the practitioner needs to avail him or herself of the cultural resources that can best help the client while determining ways to inform him of new cultural practices. Questions like “How does an increasing proclivity toward individuality (over collectivism) influence my work with youthful clients?” are the sort that have to be contemplated as the professional sets forth the essential goal of knowing his helpee.

    Another emergent feature in these chapters is that people all over the world differ in terms of the availability or access to mental health care in their respective communities or societies. In Switzerland, for example, universal health care exists. As a result, individuals wanting to receive psychological treatment are provided extensive coverage that allows utilization of different treatment approaches and provides the opportunity to treat cases requiring long-term therapy. As another example, we read that in Turkey, a non-Western country, mental health treatment is treated at the same level as physical health treatment in that clients and patients can see a psychiatrist or a psychologist as many times as they like. In addition, their visits are covered by their insurance. Despite the positive side of insurance coverage, we also would like to point out that in some of these communities finding a professional seems to be a challenge due to having a smaller number of mental health practitioners in comparison to the need in the community. Moreover, on college campuses in Korea and China, counseling centers are flourishing, as indicated in the chapters by Duan et al. and Gerstein et al. The cost of these services is absorbed in students’ fees.

    In far too many countries, the availability of mental health practitioners is limited, as pointed out in the chapters by Roysirscar on her work in Haiti, and by Kalayjian and Sofletea in Sierra Leone. Abject poverty, combined with the ravages of war, the spread of disease, and the crimes that are an outgrowth of a disintegration of communities and tribes that arise from these formative ills, far too frequently translates into an absence of professional care of any sort, and this matter of such meager resources available to some while others are swollen with wealth, is a reality that bears reckoning. In cases from all over the world, mental health practitioners who deliver only counseling and psychotherapy are a luxury. And from what we have read in our crisis cases, the expanded offer of services is essential to the lives of those they service.

    Four of the chapters in the volume address people whose regions are populated mostly by African-descended people, specifically Haiti, Sierra Leone, the United States (Washington, DC), and Zimbabwe. In all but one of the chapters, the interventions are crisis related. The exception is in the U.S. case where the client was relatively (presumably) wealthy. This issue of economics figures prominently in our display of cases around the world.

    We were strongly motivated to select chapters not only from developing countries but also from those regions of the world where there ostensibly are recorded accounts of economic, social, and political progress in addition to seemingly intractable challenges. We believed strongly that our volume would not be quite complete without addressing the experiences of those whose lives are affected by the onslaught of the world's disasters, natural or human-made, and combined; and in the cases of these nations, the impacts of prolonged exposure to poverty and oppression on the well-being of a people.

    Andrew Mwenda (Mwenda, 2007) talks about the need of Western media to refrain from devoting most of their attention to negative aspects of Africa and hence, concentrating on poverty and despair, rather than the strengths and potential that exist on the massive continent. The reframing should be one of moving from a poverty reduction need to one of creating wealth. Sending charity for the hungry or peace-keepers to the countries that experience civil wars, as Mwenda notes, are efforts to treat the symptoms, not the causes of Africa's fundamental problems. As the editors of this book, we make the same appeal to those growing numbers of professionals who see a need to reduce the incidences of psychological despair in Africa and other developing countries already strapped with serious problems. There is no question that the despair ought to be erased, just as poverty needs to be reduced. Creating wealth in psychological terms is to advance partnerships that will foster the establishment of mental health as a fixture in these societies.

    Reporting on the impacts of some sociopolitical factors is controversial and it is not uncommon that many practitioners around the world may hesitate to discuss these factors in writing, fearing possible repercussions. In some of the chapters, especially in societies where speaking openly is an aspiration, we see lengthy discussions of sociopolitical contexts and their impact on the person receiving help. In some other chapters, however, many authors could not discuss these contexts freely in writing, while we knew from our private communications with them that they were fully aware of the impact these contexts had on the individuals.

    Finally, we want to conclude that this book could be taken as merely more of the same: pandering to the notion that psychological problems are treated and people then merely return to living their lives, many of whom experience considerable torment and oppression because of societal forces that impose dehumanizing messages about the worth of a people based on their race or ethnicity, religion, economic standing, and sexual orientation. Do mental health practitioners continue to try fixing problems that are outgrowths of sick societies (Smith, 1985) or do we broaden our skills as Rukuni, Kalayjian and Sofletea, and Roysircar do, or infuse approaches that attune to the more systemic ills as with Shea and Leong?

    Psychology training programs that incorporate social justice approaches are needed as in the programs at Boston College (see Goodman et al., 2004) and at the Ball State University as described in this volume by Gerstein, Kim, and Kim. And as Watts (2004) points out, future developments of social justice–oriented programs need to take deliberate efforts to enfold people from all backgrounds, thereby overcoming the structural issues that keep certain people in and others out.

    We offer a final challenge to readers as we reflect on the harrowing descriptions by Rukuni and Roysircar of what the people of Zimbabwe and Haiti experience. As there are increases in the numbers of psychologists partnering across nations, we must deliberately and creatively disrupt patterns of relating by breaking down structural barriers to genuine collaboration. Wealthy nations remain wealthy and even become wealthier, while the poorest of our nations seem intractably caught up in poverty. The multiculturalism literature is swollen with research studies and theories that provide useful tools for creating needed change at different ecological levels and the need for scaling up these tools to apply to cross-national activities among psychologists is ever so ripe. We have to first believe, as former United Nations secretary Kofi Annan (2006), once stated, that global solidarity is not only necessary but also possible. Annan states further that

    it is necessary because without a measure of solidarity, no society can be truly stable, and no one's prosperity truly secure. That applies to national societies—as all the great industrial democracies learned in the 20th century—but it also applies to the increasingly integrated global market economy we live in today. It is not realistic to think that some people can go on deriving great benefits from globalization while billions of their fellow human beings are left in abject poverty or even thrown into it. We have to give our fellow citizens, not only within each nation but in the global community, at least a chance to share in our prosperity.

    When we are able to share in our prosperity as mental health practitioners and scholars, then we will have achieved the pinnacle of internationalization. But there is much work in reaching this goal. In our strivings, we need to continue summoning the knowledge of scholars and practitioners from developing countries and make every effort to create collaborations in which these perspectives are not merely included but also deemed equally as relevant and not marginalized. During our strivings we will surely wrangle, grapple, and disagree with another practitioner's perspective on forgiveness, for example, or on the use of therapy as a social justice tool. These disagreements are essential to our learning, and rather than turn away from one another in discord, we need to continue our march toward the goal of ensuring that people who need our help derive the fullest of benefits of our struggle. Ultimately, we want to ensure that there is regard for all humanity, as conveyed in the words of our contributors who speak of the humanity of each one of us as being wrapped up in the humanity in one another.

    References
    Annan, K. (2006, December 11). Secretary-General Kofi Annan's address at the Truman Presidential Museum & Library. Retrieved from http://www.un.org/apps/sg/sgstats.asp?nid=2357
    Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. New York, NY: Addison-Wesley.
    Goodman, L. A., Liang, E., Helms, J. E., Latta, R. E., Sparks, E., Weintraub, S. R. (2004). Training counseling psychologists as social justice agents: Feminist and multicultural principles in action. The Counseling Psychologist, 32, 793–837. http://dx.doi.org/10.1177/0011000004268802
    Hays, P. A. (2007). Addressing cultural complexities in practice, assessment, diagnosis, and therapy. Washington, DC: American Psychological Association.
    Mwenda, Andrew. (2007, September). Andrew Mwenda takes a new look at Africa [Video file]. Retrieved from http://www.ted.com/talks/lang/eng/andrew_mwenda_takes_a_new_look_at_africa.html
    Smith, E. M. J. (1985). Ethnic minorities: Life stress, social support, and mental health issues. The Counseling Psychologist, 13, 537–579. http://dx.doi.org/10.1177/0011000085134002
    Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling and Development, 70, 477–486. http://dx.doi.org/10.1002/j.1556-6676.1992.tb01642.x
    Watts, R. (2004). Integrating social justice and psychology. The Counseling Psychologist, 32, 855–865. http://dx.doi.org/10.1177/0011000004269274

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