General Issues in Cross-Cultural Treatment

Our culture guides how we act and think as well as how we come to understand who we are and how we fit into the world. Cultural norms are rules of conduct that are internalized by the members of the group and embody the fundamental expectations of the group. Cultural rules resemble family rules—often the strongest are the ones not spoken. Because cultural rules are usually reinforced by parents or special people in one’s life, the rules are hard to defy. In addition to cultural norms, five general aspects of culture need to be considered if cross-cultural treatment is to be effective. They are as follows:

Values of a culture play an important role in determining how one behaves. Cultural values vary among different groups. For example, some cultures admire assertive behavior, but some Asian cultures consider such behavior rude or disrespectful. In American Indian culture, silence is highly valued—a difficulty for counselors who are trained to assess commitment by verbal expression.

Language is the primary tool for our work. Certainly, a client whose native language is not spoken in treatment is at an extraordinary disadvantage. All languages are complex, and immigrants find adjusting to the nuances of a new language difficult. The meaning of many words or phrases varies depending on context, tone, audience, and intended message. For some clients, using bilingual services and staff greatly increases the effectiveness of treatment. However, translation into the client’s primary language is not enough. Materials or oral translations need to be adapted to be culturally appropriate for the intended audience. Historical factors such as discrimination and how a person interprets another’s actions also impact communication and need to be considered. Counselors should verify with the client that the message is understood as meant. This verification should be done in a sensitive manner that does not embarrass the client.

Nonverbal behavior is extraordinarily powerful. Interpretations of touches, gestures, and eye contacts are shaped by personal experience and culture. For instance, a person in a prison community does not use direct eye contact because it is a sign of disrespect in that circumstance. In the Latino culture, touching the person being addressed is a sign of attentiveness. It is important for counselors to be sensitive to a client’s style of nonverbal communication and to consider the degree of familiarity and the context of the contact. Counselors should ask clients about any nonverbal behavior they do not understand. If counselors question clients in a nonthreatening way, the clients usually are willing to explain.

Learning styles vary among individuals and cultures. Typically, treatment programs use a Western learning style of formal, often written instruction. For example, many treatment centers require that clients read literature from Alcoholics Anonymous and write out the step work without assessing whether the clients understand the information. Nonliterate clients or those with low reading comprehension would be better served if culturally appropriate audiotapes or videotapes also were used. Clients from a cultural group with a tradition of storytelling also may welcome alternative forms of communication and the use of a variety of methods to transmit information.

Healing is the essential task of treatment. With all clients, counselors need to create a drug rehab environment where clients can heal. It is critical for counselors to assess each client’s sources of comfort, to understand the individual’s beliefs and customs around healing—what will make the client feel better—and to understand the person’s definitions of illness and health. The Western health care tradition tends to compartmentalize health issues and assumes that healing should be left to those who know best—medical personnel. However, this assumption is being challenged by some people and health care providers who are seeking alternative treatment methods such as folk medicines, acupuncture, herbs, and massage. Some health care providers and patients are also forming new treatment partnerships instead of the authoritarian model of physician-patient. Substance abuse counselors need to determine what the client believes will make him or her healthy and what needs to be included in the treatment plan. This determination is particularly important because what a person believes will make him or her healthy has a great impact on the recovery process. Clients’ resistance to a particular treatment method can sometimes be traced to their healing belief system.