Value Differences Impinging the Interview

At least in the United States, most immigrant groups come from less developed countries or rural/small town communities where, what are called "traditional" values still have strong influence. These values are described as consisting of greater emphasis on family ties (as well as subservience of the individual to the will or benefit of the family or community), more strictly defined gender roles and beliefs in folk explanations for natural phenomena. (This is not an exhaustive list of the characteristics of traditional societies.) Not all minority/ethnic group members will subscribe to these values to the same degree; in fact, some may be in frank rebellion against these, may seem not to subscribe to them at all, or may appear completely acculturated to the 20th-century North American style (if such a thing can be characterized). The point is that, regardless of the apparent degree of acculturation, these values and their emotional and behavioral manifestation continue to effect many individuals at some level. The clinician should be aware of these traditional values (they tend to be similar around the world), particularly how they affect family relationships. For example, the notion of respect for elders and the sharp divisions between what men and women do are very noticeable, at least in the cultural group that I work with. For example, there may seem to be excessive concern about caring for a sick family member at home or keeping an elderly parent at home rather than in a nursing home. Or within the nuclear family, the husband may appear to rule, the wife seem subservient, and the children supposed to be very respectful of, or even dominated by, both. The clinician should not only be mindful and respectful of these attitudes but should exercise caution in interpreting them as problematic, although they can certainly be that. Interventions to attempt to change tradition-based values should also be considered with care.

Related to this area of traditional values is the important principle of autonomy of the individual in society and in health care. This principle is one of the basic principles underlying decision making in medical ethics. It has, however, been criticized as being in conflict with traditional values of decision making as guided equally if not more by family needs, wishes, and expectations. In the mental health arena we see this issue arising in terms of apparent excessive dependence on family. It is important that the clinician not be too quick to consider dependency as pathologic, although it can certainly be so. Too great an emphasis on pushing the patient to decide a personal issue on their own, to fulfill their own needs by declaring their freedom from a seemingly oppressive relationship, or to unburden themselves of a tiring obligation may push the person into more acute and perhaps unresolvable conflict, or worse still may not be a solution at all. One must be careful not to impose one's culturally determined notions about self-autonomy upon others. On a more practical level, this issue plays out in determining whether to speak to family and, whether to be directive with the patient about adherence to or need for therapy, and around the question of advice giving in psychotherapy.

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