Cultural Differences in Cognitive Therapy

Description of the Strategy

One of the greatest challenges facing contemporary behavior and cognitive therapy is to distinguish universals in human mental and behavioral processes from those that are culturally specific. All of the great systems of psychotherapy have incorporated elements of the zeitgeist, the cultural assumptions that form the tacit basis of that particular culture at that particular time, generally without explicit awareness. For example, Sigmund Freud's theory of drive reduction and symptom substitution was based in part on 19thcentury mechanics and hydraulics. Symptoms that were suppressed and prevented from entering consciousness would, hydraulically, emerge somewhere else. Discharge of emotional energy led to relief. Even his focus on sexual repression as the source of neurosis can be traced to the heavily sexually repressed culture of 19th-century central Europe. A more contemporary form of psychoanalysis might begin with the “denial of death” instead of the denial of sex. Thus, where Freud assumed that he had found universals in human mental life, he likely found mostly cultural specifics, bound to place and time.

Later, Carl Rogers's client-centered therapy can be seen as reflecting two cultural aspects of mid-20th century American life: the increasing egalitarianism that reduced the status of the therapist and the increasing material affluence that permitted the leisurely exploration of one's inner life. In today's managed care environment, with diminishing resources available to health care, by contrast, brief therapy in its various manifestations (e.g., solution-focused therapy) is important.

Early behavior therapy was concerned with a mechanized approach to therapy (with one article referring to the behavior therapist as a “reinforcement machine”) and may have reflected American fascination with the power of technology and its perceived ability to solve our problems. A similar cultural icon of the period was seen in the gadgets in the James Bond movies. Behavior therapists found that symptom substitution did not, in fact, necessarily occur when symptoms were removed; quite the contrary, there was often a “ripple effect,” resulting in better functioning in domains not explicitly addressed in therapy. Behaviorists, however, fell into the same universal trap in arguing that reinforcement was a universal attribute of human motivation. Bandura discovered that the perception of reinforcement was more important than actual reinforcement. Behavior also persisted in the apparent absence of a reinforcer, leading to the creation of ex post facto concepts such as functional autonomy. Adlerians argued that behavior was purposive (anticipatory) rather than reinforced (consequential). The various forms of cognitive therapies were created to explain why reinforcement was not the universal and invariant process it had been thought to be.

The recent interest in constructivistic approaches to therapy may be a result of the clash of cultures caused by increased and rapid transportation and communication, leading to a new appreciation of the relativity of cultural realities.

Cognitive therapy may have created universals of its own from what might turn out to be cultural specifics. It is almost exclusively a North American phenomenon that has translated well to the Americanized societies of Western Europe but perhaps less so to other more radically different societies with different cultural assumptions. This is likely to be true of all cognitive phenomena: cognitive contents (what we [Page 245]say to ourselves), cognitive processes (cognitive distortions), and cognitive structures (core or tacit cognitive assumptions). The latter phenomenon includes cultural knowledge, the tacit or implicit knowledge we all have that is derived from the unspoken (and often unspeakable) rules and assumptions we learn from our cultures. These assumptions are automatically laid down early in life by our constant interaction with our cultures and thereafter only elaborated upon rather than radically changed. They are experienced by people as a “given” so obvious as to require no explanation. If challenged on them, we may say, “But that's just the way things are,” “That's just reality,” or “Everyone knows that!” If the challenges are serious and sustained, however, individuals may experience a crisis, partially decompensate, feel depersonalized, and begin to lose their sense of identity. This may be expressed by statements such as, “I don't know what's real anymore” or “I don't even know who I am anymore.”

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