The impact of the Caribbean culture on

the outcome of therapy

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Culture may be defined as the long-term behaviors, ideas, attitudes, and

traditions shared by a large group of people and communicated from one

generation to the next. It is in essence the lens through which a person sees

their world. What is completely healthy and normal in one culture may

subsequently be defined as unhealthy and abnormal in another.

Culture is what people think, value, and do to ensure their existence. As

each generation inherits a culture, modifications will be made, with basic

features left untouched such as language, religious, practices and government

systems.

Like a river, culture has many sources (Mosterin, 1992). There are at least

five tributaries that merge to make us who we are. We are first influenced by

our biology. Our genders, sexual preferences and socialization processes

produce several combinations of behaviour, which cut across national and

possibly international boundaries. Human beings however will naturally seek

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to adjust their behaviours to „fit‟ with the dictates of the world in which we

inhabit.

Our culture is influenced by our ecology. The various environments existing

worldwide will be hot or cold, tropical or temperate, mountainous or flat.

Understandably, persons living in Iceland will develop a different way of life

to those living in Hawaii.

Our national grouping will influence specific culture. Generally, inhabitants

of countries will share common language, style of government, mode of dress

etc., which may be vastly different from the variable in another country. For

example, the language and mode of dress in India is significantly different

from that of Spain.

Within a country there may be differences between regions, which may

contribute significantly to the national culture. For example, in the United

States of America, people living in California and Texas long the Mexican

border present cultural characteristics that are unique to that part of the

country (Vontress, 2001). Similarly, certain parts of Canada have French as

their first language eg. Quebec, while other parts have English as the first

language, eg. Ontario.

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In certain countries of the world, the racio-ethnic group into which

individuals are born and socialized plays a tremendous role in influencing

culture. In the USA, many African-Americans manifest a culture quite

different from the Caucasian-Americans. In Trinidad, the Indian and the

Negro population exhibit vastly differing beliefs, dress and traditions.

Although culture is a complex construct, it undoubtedly affects our entire

existence.

Anthropologists often describe culture as a system of shared meanings.

Because there are a variety of ways to define a cultural group (e.g., by

ethnicity, religion, geographic region, age group, sexual orientation, or

profession) so consequently, some persons consider themselves as having

multiple cultural identities.

Culture and society play critical roles in mental health, mental illness, and

mental health services. Understanding the wide-ranging roles of culture and

society enables the mental health professional to design and deliver services

that are more responsive to the needs of racial and ethnic minorities.

Psychologically speaking, major perceived cultural differences between

people can cause initial uncertainty, misunderstanding and fear. Culture is

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relevant, however, even in matches of very similar cultures, as in situations

where there is a good therapeutic fit or where the therapist over identifies

with the patient and makes unwarranted cultural assumptions (Moffic et al.,

1988).

With a seemingly endless range of cultural subgroups and individual

variations, culture is important because it bears upon what all people bring

to the therapeutic setting. It can account for variations in how clients

communicate their symptoms and which ones they report. More often than

not, culture influences whether persons seek help in the first place, what

types of help they seek, what coping skills and social supports they have, and

how much stigma they attach to mental illness. All cultures also feature

strengths, such as resilience and adaptive ways of coping, which may

safeguard some persons from developing certain mental disorders. Potential

clients will most likely carry this cultural diversity directly into the treatment

setting.

Culture is a concept not limited to clients. It also applies to the therapists

who treat them. Every group of professionals embodies a "culture" in the

sense that they too have a shared set of beliefs, norms, and values. This is as

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true for counselling professionals as it is for other professional groups such as

engineers and teachers. Any professional group's culture can be inferred from

the jargon they use, the terms of reference and emphasis in their writings,

and from their worldview.

Most therapists hold a worldview about the interrelationship between body,

mind, and environment informed by knowledge acquired through their

course of study. It also means that therapists view symptoms, diagnoses, and

treatments in ways that sometimes contradict their clients' views, especially

when the cultural backgrounds of the client and counsellor are different. This

divergence of viewpoints can create barriers to effective therapy.

Psychotherapy originated in the Judeo-Christian ambience of Central Europe

in the early twentieth century and evolved as a white, middle class

phenomenon primarily in North America. Counselling theories presently

emphasize the relational nature of therapeutic encounters and the

importance of interaction between counselor and client, which are both

likely to be more beneficial to the therapeutic needs of marginalized clients.

African-Americans born in the USA differ greatly in culture from their

African or their Caribbean counterparts. In fact, there are distinct differences

even among Negroes hailing from various islands in the Caribbean.

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Each culture brings with it its own and often incongruent perception of

power, authority, interpersonal boundaries and family dynamics (Tsui,

Schultz & Chen, 1988). All persons manifest varying levels of ethnic or racial

bias. However, the therapist‟s and client‟s awareness of their own prejudices

can minimize resistance and promote treatment goals (Addison 1977).

There are blind spots that each counsellor brings to the therapeutic setting

which, if left undetected, can result in negative therapeutic outcomes. Some

of these blind spots are: the issues of individuality, insight, intimacy and self-

expression.

As therapists it is important to understand the client‟s view of the individual

and of family. Western culture is typically very individual-centered while

many other cultures such as Asian, African-American or Caribbean are

family-oriented. This individualism that many of us have inherent to

ourselves is seen as a encumbrance to others who come from non-Western

cultures. In these cultures they view life from a group orientation.

For example, in the Japanese culture, the word „I‟ is rarely used in

communication. Another example of this orientation is how we speak to one

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another. We greet one another, by asking how are you? In group-oriented

cultures, they ask, „How is your family?‟ Counsellors who neglect this reality

will face difficulties when counseling people from such cultures.

A basic assertion of psychotherapy is that to receive insight into one‟s

problems and issues is good. When it comes to someone from a different

culture the same is not always true. Many cultural groups do not value this

method of self-exploration. In fact, many Asian elders believe that thinking

too much about something can cause problems. Lum (1982) discovered that

many such Asians believe that in order to achieve mental health one must

avoid “morbid thoughts.” They suggest that when they encounter feelings of

frustration, anger, depression or anxiety the best remedy is simply “don‟t

think about it.”

Similarly, many persons who seek counseling from a different culture do not

appreciate the value of insight, simply because their problems are practical.

We will often hear questions like, “I need to get a job,” or “How am I going

to afford my children‟s school fee?” before we get to emotional or spiritual

issues. Their response to our probing for insight might be “I don‟t have time

to think about those things. My life is just too hectic. In these instances, we

may as counselors refer them to the organizations that can assist them in

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these difficulties.

Therapy is established through talking and expressing oneself, yet different

cultures talk in different ways. Often clients who come from Asian and

Indian cultures do not value verbal expression as much as Westerners do.

Ways of speaking and communicating are vertical, that is, adults or one who

has higher standing and reputation initiates the conversation. Similarly, we

may push our clients to be more assertive and yet this may push them to do

something that goes against their family and community beliefs. There are

many cultural groups in which restraint of strong feelings is highly esteemed.

For example, traditional Asian cultures emphasize that maturity and wisdom

are associated with one‟s ability to control emotions and feelings.

Many non-Western cultures prefer a depth of friendship before sharing at a

deeper level. The Western traditional counseling process, where deep sharing

soon encouraged can seem wrong to those of different backgrounds where

one does not open up to those they do not know well.

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Caribbean culture is characteristically linked to the approaches to survival

taken by her peoples.

The major ethnic groups of the region are namely the East Indians, Africans,

and Europeans peoples, which have maintained connections with their

ancestral heritage in most instances. European traditions account in many

respects for the official expression of culture, but are often supplemented by

ethnic identity, especially with relation to the majority having African

tendencies.

The characterization of the region can be most clearly identified through the

European colonial legacies of the specific countries seen as follows: Haiti,

Dominican Republic, Cuba, and Puerto Rico for example, are to the French

and Spanish what Jamaica and Trinidad & Tobago are to the British. These

territories constitute the largest islands as well as populations, and therefore

have the largest respective impact on the region's culture.

Haiti singularly holds the critical mass of Afro-Caribbeans in the region.

Cuba holds the critical mass of European descendants, in particular Spanish,

population. Culturally this has resulted in a continuum of cultural

manifestations ranging from overwhelming African cultural presence in Haiti

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and Jamaica to a predominantly Spanish influence in Cuba, the Dominican

Republic and Puerto Rico.

Jamaica accommodates the large majority of Afro-Caribbeans in the English

speaking West Indies. To this extent the language, food, ideologies, and

ethnic tempo of Jamaica are similar in character to many parts of Africa from

which enslaved Africans were brought. The cultural artifacts (visual and

performance, material and non-material) produced in Jamaica are the

embodiment of African retentions and in many cases symbolize a struggle to

achieve liberation from systemic oppression. Resistance for this reason is seen

as a major motivating source of cultural expression. Populations of marooned

Africans also still inhabit the island. Trinidad & Tobago is chiefly known

through the music of Calypso and the creation of the steel pan. This nation

state along with Guyana holds the critical mass of East Indians in the

Caribbean. This factor has given both Trinidad and Tobago and Guyana

greater identity with Asian cultural practices especially with respect to food,

religion and the subsequent worldview this inculcates.

African retentions are particularly evident in the ideas of celebration and

worship, and artistic expressions. Jonkanoo exists in the Bahamas, Santaria in

Cuba, Vodun in Haiti, and Rastafari in Jamaica are some examples. Some of

these forms have been transferred from the Caribbean to the world such as

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Rastafari philosophy, Reggae Music, steel pan, Jerk cooking and regional

rums and spices.

The emergence of creole languages is perhaps one of the more clearly

identifiable cultural forms to have emerged in the Caribbean space explicitly

preserving African, European, Asian ideas/ words in the common everyday

popular expression.

The concept of underdevelopment is often presented in discourses on the

Caribbean. This concept lingers as a cultural baggage because of the

ideological power play that has been perceived as being wrought on the

modern Caribbean experience.

Men in the Caribbean, as contrasted with women, are considered to be

stronger, more dominant and expected to be more active sexually. Men are

expected to be the providers, while women seek someone to be responsible

for them.

The Caribbean person sees marriage as a status symbol, but does not believe

it should restrict the „natural‟ tendencies of men and women (Waithe, 1993).

As a strategy for survival, Caribbean men and women commonly migrate to

North America and the UK in an effort to „better themselves‟, leaving their

children in the care of relatives and friends.

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Sexual and physical abuse, in the form of men battering their women and

children, is high in the Caribbean – and socially accepted in many Caribbean

countries.

Gender is a central risk factor in Caribbean societies. Almost all children in

Jamaica and Saint Lucia, for example, are born out of wedlock, which means

that many fathers are absent from the lives of their children. [The

exclusionary nature of Caribbean „fathering‟, dates back to slavery when men

were not permitted to play the role of spouse and father.] At the same time,

social norms promote sexual prowess and multi-fathering of children among

men. These norms have important intergenerational effects. Children of

absent fathers are more likely to do poorly in school. Men‟s inability to

provide economic support means that women often raise children on their

own, leading to greater levels of poverty and vulnerability among these

women and their children.

Emotional immaturity is evident among some Caribbean men and women

where adults are still „attached‟ to parents (especially mothers) rather than to

their partner or spouse. This is particularly harmful when there are children

in the relationship.

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The Caribbean parent will typically believe that as long as their children‟s

financial well-being is taken care of, they are secure. There is therefore not

much concern about the emotional and psychological well-being of the child

in a dysfunctional, abusive family. The incidence of rage among young people

is extremely high: 40 percent of school-going CARICOM students reported

feelings of rage.

The proportion of Caribbean adolescent males who carry firearms is

extremely high. One-fifth of students had carried a weapon to school in the

30 days previous to the survey and nearly as many had been in a fight using

weapons. Gang violence is also high in the Caribbean, with 20 percent of

male students and 12 percent of female students at one point having belonged

to a gang. Young people in disadvantaged situations are often forced to find

work and have few options except informal sector work, drug trade, or

prostitution. Young girls in some countries – often at the encouragement of

their mothers – will engage in opportunistic sex to relieve poverty and

contribute to the household income. Childbearing is still used a strategy for

gaining economic support in countries like Jamaica.

The stigma and discrimination meted out to persons who have contracted

HIV or AIDS is very much a part of the Caribbean society.

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The pastoral counsellor in the Caribbean who will counsel persons in the

area of sexuality must be aware that he will be coming up against traditional

views which have always seen the pastor as one who should not be

discussing sexuality. He will also have to face the growing dissatisfaction that

men in the society appear to have for the church and religion in particular.

The Rogerian concept of unconditional positive regard will be an important

pre-requisite in this area in the Caribbean.

The traditional hardships that Caribbean women often face, with men often

being absent, may cause the therapist to be less than objective in assessing

her, and possibly may even adopt her position. However, taking sides blinds

the counselor to the couple‟s interactions and lessens the possibility of

producing positive change in the situation.

The Caribbean counsellor will need to focus on helping women to build

their self-esteem, have self-respect, self-love and accept that they have power

to make choices which will be beneficial to them. Behaviour modification

techniques could be useful in helping to break negative thought and

behaviour patterns.

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The counselor should seek to maintain flexibility and an appreciation of

where each person is coming from, as well as what psychological factors may

have motivated the client‟s actions.

Caribbean men should be encouraged to reflect on the reasons behind their

seemingly promiscuous, irresponsible, and less than genuine behaviour in

relationships. Exploration of the possibility of their „acting out‟ what they

believe is expected of them by their peers and society, should prove fruitful.

Caribbean counsellors should be willing to promote maturity in relationships

and couples must be encouraged to keep their issues confidential unless

permission is obtained from their partner to share them.

Counsellors may have difficulty in convincing persons to share openly about

very personal problems. For example, in either sexually, incestuous or

physically abusive relationships, Caribbean persons will often not discuss

these problems outside of family, if at all.

The importance of treating families as one unit will be more crucial in the

Caribbean context. Many children and adolescents who are seen as being

„bad‟ are really reacting to family issues, which have affected them, and they

feel powerless to change. It will therefore be important to visit or counsel

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with as many family members as possible to better ascertain where the real

problems lie.

Caribbean Guidance Counsellors have a crucial role to play in helping

children and adolescents cope with themselves, their environment, and still

be able to succeed in school - with limited available resources. Teachers will

often end up supplementing the Guidance Counsellor‟s role, and so require

all the psychological support that can be given.

„Culture‟ affects every area of our lives whether we recognize it or not. The

culture of the therapist and the culture of the client will both need to be

identified and understood in order to more accurately determine what

therapy techniques and/or theories will best „fit‟ the presenting problem.

Clients can be helped or hindered, and even discouraged, because of a lack of

appreciation for the value of culture in the therapeutic relationship. It all

boils down to knowing who the client is and who they are outside of your

idea of who you think they are. It is essential that just as we prepare to know

the right techniques for each client, we must also do the necessary

preparation in know who our clients really are, from the viewpoint of their

cultural heritage. It is also essential that we know who we are and understand

our own selves, so that we can counsel with discernment and patience.

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Put simply, the writer George Bernard Shaw provided the core guideline to

cultural competence when he said: "Do not do unto others as you would that

they should do unto you. Their tastes may not be the same." Only then can

we expect not only a positive outcome in therapy, but change that is

observable, impacting and long-lasting.

REFERENCES

Kelly, James (2002) FindingourBlindSpots: Multicultural Counseling -

BonewellSpring

Psychotherapy in Scotland, Copyright © 2002-2004 Douglas McFadzean.

http://www.mcfadz.fsnet.co.uk/therapy/#outcome

U.S. Department of Health and Human Services, Office of the Surgeon

General, SAMHSA Mental Health: Culture, Race, and Ethnicity (2001) A
Supplement to Mental Health: A Report of the Surgeon General

Vontress, C. E. (2002). Culture and counseling. In W. J. Lonner, D. L. Dinnel,

S. A. Hayes, & D. N. Sattler (Eds.), Online Readings in Psychology and
Culture (Unit 10, Chapter 1), (http://www.wwu.edu/~culture), Center for
Cross-Cultural Research, Western Washington University, Bellingham,
Washington USA.

Waithe, Neilson A. (1993) Caribbean Sexuality. A Pastoral Counsellor looks

at Family patterns and the influences of Culture on Caribbean people. The
Moravian Church in America, Bethlehem PA.

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Waithe, Neilson A. (1995) Family Relationships. Caribbean Experiences. The
Moravian Church in America, Bethlehem PA.

Welcome To The Caribbean. Caribbean Culture. Retrieved from

http://www.welcometothecaribbean.com/culture.htm

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