Credibility and the Therapeutic Dyad

In a reformulation of techniques for working with ethnic minority clients, S. Sue and Zane (1987) identified credibility as a process that is central in the beginning stages of treatment for minority clients. In their analysis of credibility, S. Sue and Zane distinguished between credibility that is ascribed and credibility that is achieved. Ascribed credibility derives from the position or role that is assigned by others in society. In Asian cultures, characteristics that often go with higher ascribed status include older age, male sex, and higher expertise or authority (as connoted by titles such as "doctor" and "professor"). Achieved credibility comes from what the clinician actually does to instill faith, trust, confidence, or hope in their clients. S. Sue and Zane further stated that high ascribed credibility may compel the Asian American client to seek mental health services from a particular service provider, but that credibility must also be achieved in early sessions for the client to stay in treatment long enough to gain therapeutic benefits.

These two aspects of credibility are extremely important for Asian American clients, because mental health treatment in general, and Western psychotherapy and psychological assessment (particularly if conducted by non-M.D.s), may be treatment modes that have relatively low ascribed credibility in the minds of many Asian Americans. The clinician must be able to quickly assess to what extent low credibility is an issue for a particular Asian American client, then work to achieve credibility in a culturally appropriate manner in the first session.

What is the role of the clinician's ethnicity in the credibility process? Research with the community mental health services has shown that ethnic and language matching between therapists and clients is associated with the length of treatment for ethnic minority clients but that the relationship between ethnic and language match on treatment outcome is equivocal (S. Sue et al., 1991). Jung (1998) discusses various myths that Asian mental health professionals have toward treatment of Chinese clients, and some of his points are relevant to this discussion of ascribed versus achieved credibility. One such myth is that an Asian American therapist only needs to be bilingual and bicultural to be effective with a particular Asian American client. The consideration of diversity among Asian American clients applies equally to Asian American therapists; thus, an acculturated third-generation Chinese American therapist may not necessarily share the cultural history or value system of a recently immigrated Chinese client from Vietnam. Another myth is that non-Asian therapists cannot be effective in working with traditional Asian clients or families. Jung discusses various techniques he uses in his Chinese American Family Therapy (CAFT) Model to gain the trust of Chinese American clients, many of which can be used by non-Asian clinicians.

On the other hand, it can be argued that the ethnicity of the therapist may play a significant role in the "real" aspects of the therapeutic relationship (i.e., therapeutic alliance) as well as the "projected" aspect of the relationship (i.e., transference relationship). Demographic similarity between clinician and clients increases the likelihood of shared values, beliefs, and experiences (Beutler & Clarkin, 1990), and clinician characteristics such as ethnicity, gender, and age are likely to be used by clients to make rapid appraisals about clinician credibility and empathy. The ability to conduct assessment and treatment in the primary language of the client rather than through translators greatly enhances the therapeutic alliance (Chin, 1993).

On a simple level, Asian American clients' perception of the therapists' capacity to understand the uniqueness of the Asian American psychological experience may facilitate early rapport building. Perceived similarity is also likely to assist in the client's development of trust and rapport, liking for the clinician, openness to being influenced in the treatment context, motivation to commit to working in treatment, and the willingness to make changes that may be initially difficult or painful (Shiang, Kjellander, Huang, & Bogumill, 1998). On a more psychodynamic level, the introduction of race and culture into the therapeutic relationship is likely to invoke a number of transference themes such as self-image, race, social class, identity, and so on. Chin (1993) considers four variations of transference themes concerning Asian American clients:

1. Hierarchical transference (i.e., the therapeutic relationship being colored by Asian emphasis on filial piety and respect for authority)

2. Racial transference (i.e., the therapeutic relationship being affected by power inequalities among the races in the larger American sociocultural context)

3. Self-object transference (i.e., the therapeutic relationship being colored by ethnic self-identification of the client and therapist)

4. Pre-Oedipal transference (i.e., the therapeutic relationship being colored by the dominance of mother-son themes in the Buddhist tradition).

Each of the above-listed transference themes are colored by the individual issues that the client brings to treatment. For example, in a case example of a

24-year-old American-born Chinese woman struggling with issues of autonomy and cultural and personal identity, Yee (1993) discusses both the negative and positive aspects of racial and ethnic transference. In this case, the fact that the clinician was also Chinese American contributed to an initial negative transference, as the client was angry toward her mother and her older sisters and viewed the clinician as a part of the system that oppressed her. On the other hand, the fact that the clinician was also Chinese American assisted in the corrective same-gender relationship that did not involve rejection of the client's Chinese American heritage. Clinicians working with Asian American clients should be alert to the possible interaction of cultural factors with transference and countertransference.

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  • markus
    What is ascribed credibiltity?
    6 years ago

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