A new intervention improves communication and trust between therapists and clients from different cultures

A growing body of research shows that ethnic and cultural differences hamper the bond between therapists and client. That can be even more true when the clients are parents who may already feel insecure about seeking help for a young child with disruptive behavior.

Aiming to help bridge that divide, SSA Assistant Professor Miwa Yasui has developed a clinical intervention that engages clients to literally explain where they are coming from. The two-part Culturally Enhanced Videofeedback Engagement (CEVE) both strengthens the bonds between client and therapist and builds therapists’ cultural competence.

“The way we understand culture is a very academic approach,” Yasui says. “For families who are seeking help with their young children, culture is defined by what they do, what’s important to them and how they raise their kids. This intervention helps clinicians see culture from the client’s standpoint and discuss their problems together using that frame.”

To start the CEVE, the therapist asks the parent to choose parenting influences or barriers from the cultural ecogram, an interactive activity Yasui created that has cards that depict factors such as “my family,” “education,” and “spirituality/ religion” (as well as blank cards if parents want to name other influences). This helps the therapist understand the culturally anchored beliefs and thought patterns that lead to a particular behavior, providing a cultural framework to understand the client’s behaviors and goals for treatment. For example, a parent who selects family as an influence might discuss the experience of her grandfather working multiple jobs but still making time for family.

The second tool is integrated videofeedback, where the therapist and parents jointly observe a videotaped interaction of the parents doing a puzzle or reading a book with their child, and asking the child to sit quietly while she fills out a questionnaire. The parent and the therapist review and discuss these parent-child interactions from the framework derived from the cultural ecogram, which fosters shared understanding.

In a paper in the Journal of Clinical Psychology, Yasui and her co-author, David B. Henry, a professor of Health Policy and Administration at University of Illinois–Chicago, explain how the CEVE helped families of three- to six-year-old children with disruptive behavior at the UIC Institute for Juvenile Research. In comparisons to a control group, they found that more parents who participated in the CEVE reported that they felt they had a stronger relationship with their therapist and he or she valued learning who they were as people through understanding their individual culture.

Yasui says that the CEVE can build therapists’ awareness of each individual case and also improve their clinical skills in understanding clients’ cultural contexts and background, helping them treat their clients more effectively.

“It’s kind of a cliché, but culture permeates our lives and every part of our belief systems,” Yasui says. “Sometimes clients feel like they are a horrible parent because they have tried as well as they can and still their kid is not acting the way a kid should. As a clinician you can help them understand, ‘From where you come from, it makes sense why you did that–let’s work together to make some changes, but still acknowledge who you are as a person.’”

— Gordon Mayer