Is psychotherapy based on individualism?

[ClinPsycMasters]

Is psychotherapy based on principles and values associated with individualism--as opposed to collectivism?

Consider that most forms of psychotherapy are focused on the individual, with the extreme example being the classical Freudian stance, though more two-person views (child-parent or patient-therapist shared reality), and more (family therapy) have also become available.

An interesting example is the DSM inclusion of dependent personality disorder, and not "indepedent" personality disorder.

Anyhow, like to hear your views, to see if you agree with me, but also what you consider are problems for using therapy with patients from more collectivist cultures.

Personally I think that there are plenty of problems that have their roots in person's psyche and behavior. However, I also believe there are many problems that are best conceptualized at the family level, and also at the societal level.

Wouldn't it be interesting if one day you see a patient, and at the end of the session you get up and ask him to leave, prompting him to say "huh?" with a puzzled look on his face. This is what you say: "You are absolutely fine! Nothing wrong with you whatsoever! Nothing wrong with your individual psyche and behavior. The thing that needs fixing is the group to which you belong, not you! Your social group's values and worldviews are in terrible conflict with the larger reality. So here are two things I can do for you: I and another 100 therapists will work with your group, so that you guys can organize yourself politically and put pressure on the government so that you guys are not the subject of discrimination and injustices of all sorts. We are trying to change the day to day reality that you guys experience. At the same time we will work with you guys to modify your values and worldviews in a way does not damage your identity but also does not create so much conflict. Good day!"

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[deleted343839]

I think you are conflating the mode of delivery (individual therapy) with conceptualization (your problems all come from things you think and do). Clearly, the DSM reflects very Western, individualistic notions of pathologenesis. But individual help-seeking per se is not exclusively Western. It's just that not everyone goes to see a person called a psychotherapist for help. Someone might go to the oldest person in their family, or to a religious leader, or to a person of special standing in their community. And the help might look different. So be it. Though it's wonderful that people are working to make psychotherapy better adapted to the needs of a diverse population, psychotherapy will never be the best or only choice for everyone.

Now, let me stop here and ask - who are these "collectivists" you speak of? We hear the term thrown around a lot, but it's really easy to slap the label onto anyone you consider an "other," regardless of whether it actually applies. On that point, it would be pretty damaging for a therapist to tell me that there isn't anything wrong with me personally, that it's the particular group I belong to that has the problem. (Oh my goodness, how many times have I heard some iteration of THAT one??)

And then for the therapist to declare authority on what constitutes the "larger reality" that I am supposedly out of touch with.... yikes.

What I truly hope you are getting at, though, is the problem of focusing so much on individual behavior to the exclusion of external forces that create problematic conditions. This is absolutely a problem. When all of a person's problems are boiled down to individual choices and thoughts, we neglect attention to more insidious socio-political forces that maintain their circumstances. We don't pay enough attention in therapy to the problems caused by cultural hegemony, socioeconomic inequality, and privilege (though feminist therapy and gay affirmative therapy are some counter-examples). I think that the solution is never to impose the therapist's worldview onto an individual or group. Perhaps sometimes the greatest "therapy" is being the only person who won't stand in the client's way.

 

[deleted343839]

One thing I forgot to mention is that you might appreciate learning more about community psychology. A good introduction is written here:
http://people.vanderbilt.edu/~douglas.d.perkins/commpsy.htm

Here's a little preview snipped from the site:
"Community psychology is not only a professional and scientific discipline. It is also an intellectual/ value orientation that is applicable to virtually any field or profession. The community perspective challenges traditional modes of thought. It looks at whole ecological systems, including political, cultural, and environmental influences, as well as focusing on institutional and organizational factors. It realizes that the "interaction" between a person and the environment may have as important an effect on his or her behavior as the effect each factor has separately. The community approach also emphasizes the effects of stress and social support, and the practicality of prevention and self-help. Furthermore, it recognizes the demand for local empowerment and bureaucratic decentralization (and anti-professionalism) and the importance of cultural relativity and diversity. The community perspective simultaneously stresses the utility of research, not only for theory development, but for program evaluation and policy analysis--and the omni presence of values (implicitly or explicitly) throughout society and even science. An important aspect of the community orientation is its appreciation of the authority of historical and structural contexts. And, finally, it emphasizes community and personal strengths and competency, as opposed to weaknesses and pathology."

 

[Psy01]

Your social group's values and worldviews are in terrible conflict with the larger reality.

Sadly, I can think of an awful lot of people this would apply to.

 

[ClinPsycMasters]

On that point, it would be pretty damaging for a therapist to tell me that there isn't anything wrong with me personally, that it's the particular group I belong to that has the problem. (Oh my goodness, how many times have I heard some iteration of THAT one??)
And then for the therapist to declare authority on what constitutes the "larger reality" that I am supposedly out of touch with.... yikes.

I agree with most of what you said, and you come across as thoughtful, intelligent, and unassuming.

Having said that, can you explain your concerns--from the quote above--a bit more?

Or don't!

You see, I had written a detailed reply but decided against posting it. Honestly, I'm not prepared to open Pandora's box. Psychotherapy has such shaky philosophical foundations, and given my own limited grasp of philosophy, sociology, and anthropology, I probably should not have started this thread. Even in individual psychotherapy, the issue of reality, change, and identity are complex enough. Trying to apply the same principles to groups is just madness. Maybe I should leave that up to sociologists and hope for the best. I was just trying to stop the leakage at the source, thinking that making changes at higher levels can be more effective than trying to change only how the person perceives the reality of, say, discrimination. In my mind, I was trying to draw parallels between personal history of abuse and group experience of mistreatment, something that can become part of the person's identity as well. Of course all sorts of groups have experienced mistreatment: women, Africans, Muslims, Jews, Christians, Americans, Canadians, Germans, the disabled, gays, etc etc. We can thank politics for that. Or maybe it's competition over limited resources. Regardless, a solution could have widespread application. However, as I said, I just realized that this is abstract and perhaps quite naive, so before further embarrassing myself, I'll just say this sounded like a good idea only before lunch. 🙂

 

[psychmama]

Clin PscyhMasters - I'd check out the field of Community Psychology a bit. I think you'll find many of your concerns are central to that discipline. Community Psychology is very interested in finding "upstream" solutions to "downstream" problems. The philosophy is to change things at a community-wide or systems level in hopes of avoiding or decreasing pathology in individuals. I always think of Community Psychology when I think of the adage "An ounce of prevention is worth a pound of cure." Community Psychologists take this idea very seriously.

 

[deleted343839]

You see, I had written a detailed reply but decided against posting it. Honestly, I'm not prepared to open Pandora's box. Psychotherapy has such shaky philosophical foundations, and given my own limited grasp of philosophy, sociology, and anthropology, I probably should not have started this thread.

I hope I didn't discourage you from continuing this discussion. In a nutshell, the point I was trying to make was that it is easy for therapists to presume knowledge of objective "reality," when in fact therapists are anything but omniscient. Our reference texts, therapy manuals, and other training materials are written from biased viewpoints, and those biases make their way downstream and into our heads. Most of our labels and diagnoses originate from from a particular worldview that is historically tied to the "shaky philosophical foundations" you mentioned.

If you buy that much, then the natural conclusion is that psychotherapists possess a potentially helpful but imperfect set of tools. More importantly, we know (or ought to know) that our tools are imperfect, and so I believe it is appropriate to approach clients with humility and to maintain awareness of all of the big and little biases and assumptions that inform our judgments. This is nearly impossible to do perfectly (again, running into the limitations of our own knowledge), but I believe that it can be done pretty well.

To get back to your original question about how to deal with clients who are more "collectivist" or otherwise different from you in individual therapy, my advice would be to monitor your defenses when you realize that you possess only superficial knowledge (if that) about the client's culture and that you don't have an ideal solution to the client's problem. Don't try to force a conceptualization on the client that will make your solutions fit better. Just be transparent about the process and learn about your client in the process of being a collaborator (just avoid using your client as a 'personal guide' to their culture - educate yourself on your own time). More than likely, you have something of value to offer your client.

And again, I urge you to check out community psychology! I think you'd find it illuminating and very relevant to the questions you've raised.

 

[DrGero]

Psychotherapy, which is at base level can be viewed as a form of psychiatric treatment (non drug therapy), can certainly be looked at as a collectivist enterprise, depending on your point of view. It's no accident that the first psychiatrists were called "alienists."

One might say what mental health clinicians often do is try and normalize the abnormal (or, if that fails, label and "other-ize" the abnormal). So often what we do is try and treat people for what society finds disturbing or distressing. There's a reason for that - we serve a collectivist function.

I could write more, but better people pick up some Thomas Szasz and read what he writes on the subject.