So I was glad when a colleague brought to my
attention the Control Mastery annual workshop
happening at the beginning of March. I cut short a trip
to Patagonia and literally flew from the last place on
earth (Cape Horn) to the Presidio in San Francisco so
I could attend the workshop. The workshop confirmed
my intuition. I had the opportunity to spend a week with
distinguished clinicians and scholars devoted to the
development and dissemination of a Control Mastery
approach to therapy.
The model offered by Control Mastery's plan
formulation, including its components of trauma,
pathogenic beliefs, passing tests, and therapist-
initiated interventions (Silberschatz, 2005) can be
extremely helpful for the practitioner working with
populations from a culture other than his/her own.
In this article I will discuss the notion of passing
tests and its significance for cross-cultural therapy.
The other Control Mastery components
aforementioned, although exceedingly relevant to
cross-cultural therapy, will hopefully be addressed in
future articles.
In the case of a therapist treating a patient from a
different culture the concept of passing tests acquires
an additional layer of relevance. Not only must the
therapist often treat a patient in a different language,
but he/she must also understand and incorporate the
patient's cultural background at every step of the
therapeutic process to be truly culturally competent,
thus to be able to pass the tests.
Although it has not been named as such in the
cultural competence literature, passing tests is a
central underlying requirement for an effective
therapeutic relationship.
One of the main complaints of cross-cultural
literature both in public health in general as well as
mental health in particular is the lack of cross-cultural
competence exhibited by health providers and/or
therapists (Kar and Alcalay, 2001; Council of National
Psychological Associations for the Advancement of
Ethnic Minority Interest, 2003). The lack of cultural
competence often prevents a satisfactory patient-
provider alliance, thus limiting the effectiveness of the
therapeutic process.
The lack of understanding a patient's cultural
beliefs and values can make the therapist
unconsciously or consciously pass judgment on
his/her behaviors and attribute them to individual
pathology rather than cultural patterns in the patient's
background. Even with the best intentions, this
judgment will affect the course of therapy, often in a
way that may not be helpful to the goals of the specific
therapy.
An illustration of this challenge to passing tests
became apparent at a recent meeting where a
therapist presented the case of a family she was
seeing. The father was a Mexican immigrant from a
small village in Mexico, while the mother and the
teenage daughter were Mexican-American (both born
in the United States).
The therapist was treating the family as a result of
the parents finding a letter in the daughter's room
where she expressed her hatred towards her parents
and her desire to commit suicide.
After the risk of suicide was assessed and found
to be low, the therapy focused on what provoked such
a letter. The cause presented by the therapist, was
that the father had recently informed his wife and
daughter he had another family besides them, which
included the existence of two half-siblings, and he
wanted the children to meet. According to the
therapist, the daughter became angry and distraught
whereas the wife seemed to accept this situation with
passivity.
The therapist defined this as an abusive situation
and did a CPS report to which CPS did not respond.
When asked about other abusive behaviors, such as
physical or verbal violence, or alcoholism from the part
of the father, the therapist responded there was no
evidence of these so far. Nevertheless, it was clear
that she judged the father's behavior as aberrant and
abusive and the mother as passive and co-
dependent. Now, the therapist's assessment of
abuse may be absolutely true.
On the other hand, the existence of a second
family is not uncommon in Mexico and in other Latin
American countries. Although the therapist has valid
concerns and strong ethical reservations with such
behavior, she will probably not pass the tests with the
father, or the mother, if she does not see this behavior
within a cultural context. She must understand where
this behavior comes from culturally, and the meaning
in a Mexican/Latin context for a man to have
another "casa chica" family before she judges it.
As a matter of fact, in many Latin American
communities such behavior is expected from
a "macho" man. In other words, if we as therapists are
to exhibit cultural competence, we must be able to
pass the tests with the father, as much as it is
antithetical to our beliefs, if we want to help the family.
Maybe the father felt that from his point
of view by bringing the children together he was acting
responsibly and in a loving manner. Maybe he grew
up seeing this behavior around him being legitimized
and even praised. I am not justifying the behavior, and
certainly the teenage daughter needs the support of
therapy and hopefully the validation and modeling
from the therapist and other adults of alternative ways
of parenting.
Although obviously this family needs
help, an understanding of the cultural context will
make the therapist better able to pass tests
successfully with the father and eventually with all
family members and therefore increase the chances
of a successful therapy.
Thus, the requirement of passing tests as a
central component of treatment may be a key factor
contributing to enhance cultural competence, and a
good guiding principle for cross-cultural therapy.
Therapy that incorporates the notion of passing
tests, in addition to Control Mastery notions such as
pathogenic beliefs which result from trauma, may
result in improved effectiveness in cross-cultural
treatment. It is worth pursuing research and scholarly
work examining possible Control Mastery's
contributions to enhancing cultural competence in the
treatment of culturally diverse populations.
References
1. Council of National Psychological Associations
for the Advancement of Ethnic Minority Interests.
Psychological Treatment of Ethnic Minority
Populations, Association of Black Psychologists,
Washington, D.C., November, 2003.
2. Kar, S. and Alcalay, R. (Eds.) Health
Communication: A Multicultural perspective. Sage
Publications, Thousand Oaks, CA, 2001.
3. Silberschatz, G. (Ed.) Transformative
Relationships: The Control-Mastery Theory of
Psychotherapy. Routledge, New York, 2005.
