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THERAPISTS AND CLIENTS FROM DIFFERENT CULTURES.
Term Paper ID:30328
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Essay Subject:
Examines clinical issues and interventions that therapists could use working with the elderly Hispanic population.... More...
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8 Pages / 1800 Words
9 sources, 15 Citations,
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Paper Abstract:
Examines clinical issues and inteventions that therapists could use working the the elderly Hispanic population. Devising interventions that work. Acknowledging differing values and perspectives. Sociocultural factors. Components of Hispanic culture. Family relations. Developmental issues of the elderly; psychological problems and dementia. Types of therapeutic interventions. Possible approaches.
Paper Introduction:
Clinical Issues and Interventions with the Elderly Hispanic Population
Introduction
Although the movement is still small, there has been recognition that multicultural factors impact the therapeutic process, and that acknowledgment of differing values and perspectives is important in devising interventions that work. The intention in this paper is to look specifically at the elderly Hispanic population and the kinds of clinical issues and interventions that might be effective with these individuals.
Sociocultural factors
First, it is important to note that this is a diverse population in itself. There is both an immigrant population and a native population. Among the immigrants there are diverse gro
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Qualitative Inquiry, 5(3), 353-376. They were presented with writtenscenarios depicting a 75-year-old woman with a problem, varying bycognitive capacity, behavior problem, and living situation. Not all were Catholic,with two members who were Evangelical or Pentecostal Protestants. Problems of aging The problems of old age, as noted by Newman and Newman (1995) aremany. Breunlin, D.C., Schwartz, R.C. While both the African-American andHispanic communities placed a premium on familial support and caregiving,there were special characteristics within the Hispanic community that madethat intensive interrelationship more common. Wong et al. She always addressed her subjects formally, and with therespectful title of dona, even though they addressed her by her firstname. Sinnott, J.D., Burgio, L.D., Lakein, D. Specifically, language barriers, distrust of institutions,and fear of authorities or formal agencies represent important barriers tohelp-seeking behavior or responsiveness to outside intervention.Conclusion Breunlin et al. Research on Aging, 21(2), 144-175. In her research, Olmedo (1999) focused on several cultural issues inthe research design itself, such as the formality required when dealingwith the elderly. What she also learned, though, was that despite the similaritiesamong group members, there were also differences. Surprisingly enough, all wereconsidered acceptable interventions by the older respondents, but person-centered individual therapy was rated as the most acceptable. Transcending the models of family therapy. They impose a multiculturalmetaframework on the family systems approach that acknowledges theimportance of the sociocultural contexts of families. For example, Jewett (1973) describedcharacteristics common to those he described as successful agers. (1992) inrelationship to family therapy approaches. Pacific Grove, CA: Brooks/Cole Publishing Company. Do they validatediversity in their practice? and Kaplan, G.A. (1999) conducted a study looking specifically atcognitive functioning, and impairment, among the Hispanic elderly comparedto non-Hispanic Whites in rural areas. (1992) noted that a good beginning in working withclients from different cultures - of whatever age - is for therapists toexamine their own presuppositions and cultural beliefs. The authorsdid not explore differences based on ethnicity, however.Possible barriers to treatment The barriers mentioned by Wong et al. and Markides, K.S. The eight women were between 66 and 82 years,with seven of them coming to the United States as adults after World WarII. Newman, B.M. What is the impact of their practice onmembers of this family and this minority group? All of these, according to them, contributeto a specific multicultural context that impacts the therapeutic process infamily systems therapy. These included a history offamily immigration, sometimes more recent, language barriers, traditionalmistrust of institutions because of situations from their home countries,and fear of interacting with authorities and formal agencies in thiscountry. Theassociation between chronic diseases and depressive symptomatology in olderMexican Americans. (1995). (1999) also noted that Hispanic adult children aremore likely to have an unmarried parent and more likely to have a parentover the age of 9 than the other two cohorts. In order for therapy to be most effective,therapists need to be aware of these factors, and it helps for there to bea cultural fit between the family and the therapist. The Journals of Gerontology, 53A(3), M188-M194. She noted that ethnic outsiders might not recognize the need forthat level of respect, but that cultural communicative competence requiredit. (1989). (1999). For very old age, which Erikson (1982) defined as beyond age 75, theprimary psychosocial crisis to resolve is immortality versus extinction.The process helping with resolution of this crisis is social support, witha primary ego quality of confidence. and Pappas, K. A primary one is coping with the physical changes of old age, whichinclude behavioral slowing, loss of bodily functions, sensory changes, andincreased chronic illness. San Francisco,CA: Jossey-Bass Publishers. Most of them have also developed a multicultural perspective,although still in its infancy. (1999). Confidence, for Erikson, involvedboth a trust in oneself and a belief in the meaningfulness of life. Family relations In looking specifically at the elderly, Wong et al. The authors found that afterremoving ethnic bias from the scale they used, both NHWs and Hispanics hadmodest levels of severe impairment in old age, with 18.3 percent ofHispanic subjects so identified. Despite the many critiques of Erikson's work, there is utility inusing his divisions and looking at some of the characteristics of healthyaging and troubled aging. At the same time, they were adaptable enough toacknowledge different cultural norms and the values of some of Americanculture. For Erikson, later adulthood (from about 6 -75) had to deal with thepsychosocial crisis of integrity versus despair. In theMexican-American population conditions most associated with substantialphysical impairment, pain, and discomfort were most associated withdepressive symptoms.Types of therapeutic interventions In looking at therapy, there are four basic approaches topsychotherapy: (1) individual therapy; (2) family therapy; (3) grouptherapy; and (4) marital therapy. For example, theysuggest, what does the therapist believe about diversity? According to theauthors, these create formative values that impact interaction with thetherapist, and with the therapist's values. and Kune-Karrer, B.M. Redefining culture through the memories ofelderly Latinas. The prime adaptivequality that could be of help at this stage was wisdom, which provided adetached approach, while still engaged. Olmedo, I.M. There were also important differences between the experience ofthe women and the stereotypes of Hispanics; they were stronger, moreresilient, more involved in work and helping their families to survive.They did not portray themselves as particularly oppressed or victimized,but as needing to be resourceful for their families in a culture that theywere somewhat critical of. Participantsrated six types of psychotherapy intervention, including person-centeredtherapy, strategic family therapy, transactional analysis, play reading,group therapy, and purposeful activity. Let's start with looking at Erikson's (1982) scheme. Do they consider theconstraints and the opportunities in each sociocultural context? The intention in this paper is to lookspecifically at the elderly Hispanic population and the kinds of clinicalissues and interventions that might be effective with these individuals.Sociocultural factors First, it is important to note that this is a diverse population initself. Journal of Applied Gerontology, 17(2), 172-185. American Journal ofPublic Health, 79, 7 3-7 8. He termed it"difference" and defied it as an inability to act because of self-doubt.This sounds very similar to earlier stages in school age, where paralysisprevents actions through inhibition or inertia. The authors noted thatincreases in chronic disease and functional disability is associated withincreased psychological distress and depressive symptomatology. They postulated that developed apsychohistorical perspective, and wisdom, helped people deal with thecrises and tasks of very old age. She noted that there were certain characteristics thatmade Hispanic elderly more likely to rely on family caregivers than othergroups; these characteristics also represent barriers to therapeuticintervention. The group met biweekly for five months. Wong, R., Kitayama, K.E., and Soldo, B.J. Those with less education also tended tohave higher levels of cognitive impairment at very old ages. They haddifferent political beliefs, including one whose father had favored theindependence movement for the island, rather than American association.However, there were clear focal points, too, including an intense belief inChristianity and spiritualism, which is a central factor in Hispanicculture. Clinical Issues and Interventions with the Elderly Hispanic PopulationIntroduction Although the movement is still small, there has been recognition thatmulticultural factors impact the therapeutic process, and thatacknowledgment of differing values and perspectives is important indevising interventions that work. The framework that they provide seems to create a good starting pointfor working with the Hispanic elderly, as well as other minoritysubpopulations, since it recognizes the multiplicity of ways in whichfamilies vary, impacting each individual within them. Longevity and the longevity syndrome.Gerontologist, 13, 91-99. Guralnik, J.M. Olmedo (1999) did just that with a group of elderly Latinaswho she asked to explore the adjustments they made to living in themainland United States, and what they were able to retain from their owncultures. (1973). Some of the important elementsin their system include gaining an understanding of the culturaltransition, historical/generational sequences, immigration andacculturation, economics, education, ethnicity, religion, gender, age,race, and regional background. (1999) exploredtime transfers, family relations, and family assistance, noting that therelations between adult children and their elderly parents were much morehomogenous in the Hispanic community than in either the African-American orEuropean-American communities. At a minimum, theyrecommend assessing the family's multicultural context in planinginterventions which take into account its evolving circumstances.Possible approaches Out of the various approaches utilized in working with older adultswith behavioral problems, the most common are medication or behavioralinterventions (Sinnott et al., 1998). TheJournals of Gerontology, 54B(4), P222-P23 . (1999).Cognitive functioning and impairment among rural elderly Hispanics and non-Hispanic whites as assessed by the Mini-Mental State Examination. The core pathology to be concernedabout was disdain, or a feeling of scorn for oneself and others because ofweakness. (1992)Metaframeworks. Mulgrew et al. These were more physical factors, with healthy functioninglater adults having average weight, higher family income, no symptoms ofhypertension, arthritis, or back pain, and they did not smoke and consumedonly moderate amounts of alcohol. (1998) explored theacceptability ratings of various other kinds of therapeutic interventionswith a group of adults aged 6 and older. This may lead to more needfor time assistance and hands-on care.Developmental issues of the elderly Although Erikson was the first to develop a detailed approach todevelopment throughout the lifespan, there is much more informationavailable now about the kinds of issues that impact older adults and theelderly. There is both an immigrant population and a native population.Among the immigrants there are diverse groups, too, including refugees fromoppression in several different countries (e.g., Nicaragua and Guatemala).To try to define values, social traditions, and orientations for such adiverse group is a difficult task, but there are suggestions about somegenerally important components of Hispanic culture. Theseincluded such things as an ability to maintain social contacts that meettheir need, the ongoing pursuit of activities that challenge them and areconsistent with their life goals, adaptability, a sense of humor, broadreligious perspective, and an enjoyment of life. Ethnic differencesin time transfers from adult children to elderly parents: Unobservedheterogeneity across families? One interesting framework is provided by Breunlin et al. (1998).Acceptability ratings of psychotherapeutic treatments for elderlyindividuals. References Black, S.A., Goodwin, J.S. (1998) looked at the associationof chronic disease, functional disability, and psychological distress amongmembers of the Mexican-American population. Sinnott et al. Any of these may become relevant in veryold age. Guralnik and Kaplan(1989) looked at predictive factors in middle adulthood that were linked tohealthy aging. Mulgrew, C.L., Morgenstern, N., Shetterly, S.M., Baxter, J. Olmedo's project was called Project Memorias and she began itwith a group of Puerto Rican grandmothers (abuelas) in a residential seniorcitizen center in Chicago. (1998) are substantial ones forthis population. The psychological problems that bring individuals to the attention ofcounselors and social service agencies include such things as situationaldepression from grief, clinical depression, despair, anxiety, substanceabuse, withdrawal, and the beginning of what may turn out to be dementia,including Alzheimer's disease. The immigrant experience One of the more useful ways to gain information about the experienceof an individual or group is to ask that group to reflect upon itsexperience. Development through life - Apsychosocial approach. Adults also need to manage patterns ofnew living arrangements, often brought about by death or physical loss. Thecore pathology, to Erikson, is difficult to understand. Jewett, S. (1998). Predictors of healthy aging: Prospective evidence from the Alameda County study. and Newman, P.R. In yet another study, Black et al.
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