Community Psychology Treatments 1

Community Psychology and Treatments for Depression Based on Ethnicity

Angela Cichosz and Liliana Gomez Professor Megan Pietrucha PSY 328 Clinical & Counseling Psychology

Community Psychology Treatments 2 Community Psychology and Treatments for Depression Based on Ethnicity Depression occurs at a similar rate across all ethnic and racial groups, yet not all groups receive equal treatment for the condition; community psychology aims to lessen this discrepancy (Fortuna, Alegria, & Gao, 2010). As the largest minority group in the United States, Hispanics face new challenges as they assimilate and adapt to a new culture (Grames, 2006). An increasing issue therapists address with Hispanic clients is low retention rates in treatment for depression and similar mental health issues (Fortuna, Alegria, & Gao, 2010). Due to a mismatch in the therapist-client relationship and other factors related to cultural values, many Hispanics do not continue their psychotherapy treatments for depression. One of the goals of community psychology is to alter the inequality in therapeutic treatment of groups from different cultural backgrounds. As will be discussed shortly, community psychology does not have a universal definition, but rather a collection of various definitions that captures what community psychology refers to and its effects on different social or minority groups in society. Specifically, community psychology has evolved to treat the mental health needs of a diverse population of social, ethnic, and other minority groups. According to Duffy and Wong (2003), no agreement for a single definition of community psychology exists. Yet, there are several definitions which could possibly lead to a conflict if no consensus emerges among professionals in the field. For instance, Heller et al. (2008) defined community psychology as the study of the effects of social and environmental factors on human behavior from the individual, group, organizational, and societal viewpoints. Likewise, Rappaport (1977) stated that community psychology is a way of finding alternatives to cope with deviations from the norm, and a way to help clients be different without risking psychological harm from criticism. Zax and Specter (1974) defined community psychology as an approach to

Community Psychology Treatments 3 behavioral problems that focuses on environmental factors as well as ways these problems can be treated. Adding more perspective to the definition, Duffy and Wong (2003) defined community psychology as a focus on institutions, issues, and other areas that impact social groups and the individual. During the late 1970s and early 1980s, community psychology experienced its greatest period of popularity in the United States (Toro, 2005). At this time, community psychologys ideas were still fairly new but important because of relevant political issues. In 1983, American psychologists found interest in community psychology ideas, so many became members of the APAs Division 27 in community psychology. Further into the 1980s, community psychology in the U.S. began to separate from the APA (Toro, 2005).The separation resulted from a desire to attract more non-psychologists to the field. Community psychology emphasized clinical practice issues over all other issues. Recognition soon emerged that the term psychology no longer fit with how community psychologists practiced their techniques. After breaking apart from the APA, the field of community psychology began to shape its separate identity with a new name, the Society for Community Research and Action (SCRA) (Toro, 2005). It was incorporated as an independent professional society, and it held its first Biennial Conference on Community Research and Action in 1987 in South Carolina. Tracing back to the 1960s, community psychologys history was rooted in social and political issues. In the 1960s, reforms and movements such as the civil rights movements were a fight for equality from minorities, women, and other less privileged groups in society (Duffy & Wong, 2003). Combined with foreign economic competition, the threat of nuclear war from the Soviet Union, and the space race, psychologists were encouraged to participate in societal issues. Furthermore, John F. Kennedys election led to more interest in institutionalization, mental

Community Psychology Treatments 4 health, and the general availability of human services. The passage of the Community Mental Health Act of 1963 allowed funds to be used for the creation of local mental health centers. Services provided in the centers included outpatient, emergency, and educational services. After John F. Kennedys assassination, Lyndon B. Johnson led the War on Poverty through his Great Society Program (Duffy & Wong, 2003). Being his first time leading the War on Poverty, Lyndon B. Johnson mentioned his plan in his State of the Union address (Duffy & Wong, 2003). In the 1964 Annual report of the Presidents Council of Economic Advisors, Johnson stated we had the power to control poverty. Approximately $11 billion per year would have brought all low income families up to an income of $3,000, which had been the standard for decent living at that time. The majority of people would have paid enough taxes to support the necessary financial aid to fund low income families. Yet, this solution would not have dealt with the root of the issue. In reality, Americans desired to achieve the American dream without aid from welfare. Although it would have been more difficult, the poorest families would have had a better outcome if they had earned the additional money without help from the taxpayers (Duffy & Wong, 2003). A few years later, the Swampscott Conference of May 1965 in Swampscott, Massachusetts was held. The Swampscott Conference was commonly known as the birth of community psychology (Duffy & Wong, 2003). The first conference was attended by clinical psychologists who sought to create political and social changes. Their discussions led them to change the focus from treatment to prevention strategies and also to include a more ecological perspective, meaning the inclusion of an individual in the environment (Duffy & Wong, 2003, as cited in Bennet et al., 1966). Unlike other fields, community psychology considers the individual as a part of the larger context. In its application, community psychology has most commonly addressed societal issues

Community Psychology Treatments 5 such as marginalization, globalization, poverty, and social justice (Nelson & Prilleltensky, 2005). Community psychologists have also had experience working with issues sensitive to ethnic minorities, including colonization, racism, immigration, and cultural diversity. Other concerns that it has dealt with includes sexism and gender power, heterosexism and the oppression of members of the LGBT community, and people with disabilities. Traditionally, community psychologists focused on issues such as psychiatric disabilities, mental health, institutionalization, and community health. Disadvantaged families and environmental problems such as global warming have also been considered (Nelson & Prilleltensky, 2005). Based on decades of empirical research, the ways in which ethnic minorities view treatment for mental health issues can be better understood. Minorities do not seek treatment for mental illness as often as Caucasians do, though they do have a more positive attitude toward treatment in general (Anglin, Alberti, Link & Phelan, 2008). In a recent study, Anglin et al. (2008) examined different racial groups attitudes toward the severity of mental illness and the perceived effectiveness of treatment. A group of African-Americans was compared to a group of Caucasians on their beliefs in the study that used hypothetical scenarios of mentally ill people. These scenarios, known as vignettes, were used to assess their perception of treatment in relation to the severity of the different types of mental illness. The researchers found that AfricanAmericans were more likely than Caucasians to believe that mental health experts could help people suffering from schizophrenia or depression, but they were also more likely to believe that mental illness would improve without treatment (Anglin et al., 2008). Within the Hispanic population, a greater risk exists for mental illnesses such as panic attacks, generalized anxiety, and depression (Grames, 2006). Contributing factors such as poverty acculturation levels lead to higher rates of mental illness. Some Hispanic groups are

Community Psychology Treatments 6 shown to have lower rates of depression if they are recent immigrants, and this is thought to be related to family support and the retention of cultural values. In addition to using diagnoses to treat Hispanic patients, therapists must understand the cultural background of Hispanic clients and how this affects the mental health state. Research suggests that Hispanics use psychotherapy treatments significantly less than Caucasians because the treatment was designed to be used with middle class Caucasians (Grames, 2006). Problems arise when mental health agencies train therapists to treat all clients with the same set of techniques, regardless of any cultural values or other issues that must be considered. The American Psychiatric Association recommends that therapists seek to understand the clients cultural identity, ask minority clients for their cultural explanation of the mental illness, examine cultural factors in the clients environment and their effect on the clients ability to function, understand the cultural view of the therapeutic relationship, and culturally assess the client on an overall level in terms of diagnosis and treatment (Grames, 2006). While mental health problems affect all ethnic groups equally, inequality exists in the way people of different ethnic backgrounds receive treatment (Fortuna, Alegria, & Gao, 2010). Such factors that affect the retention rates of minorities in treatment are the clients unfulfilled expectations, a mismatch between the race of the client and therapist, and the low chance of receiving mental health care from a specialist. Other factors include an inequality in treatments available to minorities and a mistrust of the mental health system due to cultural beliefs. Minorities, both African-Americans and Hispanics, had lower rates of adhering to prescribed medications. This is attributed to having no health insurance, speaking Spanish only, not having access to better quality healthcare, and being a member of a low socioeconomic status (SES) group. (Fortuna, Alegria, & Gao, 2010).

Community Psychology Treatments 7

Gonzlez-Prendes, Hindo, & Pardo (2011) explored the case study of a Latino who

received cognitive behavioral therapy (CBT). Overall, culture encompasses the beliefs, behaviors, and values shared across generations of a group of people over time. Accepted behaviors in one culture may seem outside the norm to another culture. Multicultural competence is considered an important skill for therapists to have in order for them to integrate their therapeutic techniques with the cultural values of the client. For a stronger therapeutic alliance, therapists working with clients of different cultural backgrounds need to be aware of the meaning of these values. The purpose of using CBT is to alter the clients automatic thought processes or maladaptive thought patterns that could lead to potential unhealthy behaviors (Gonzlez-Prendes
et al., 2011). The therapist working with the male Latino client uses a modified CBT treatment

for his depression that integrates the techniques of CBT while taking into consideration the cultural values of the client. The therapist recognizes that the client has a collectivist view, meaning family is more important than the individual, and that the client does not have a supportive family in terms of seeking treatment. This view is referred to as familismo, the idea in Latino culture that family values are placed over individual values. The clients culture does not value seeking treatment for mental health issues, and instead, believes that this should be dealt with privately. A key factor that Hispanics look for in an effective therapist is the level of personalismo (Gonzlez-Prendes et al., 2011). Personalismo is defined as the amount of warmth, empathy, and personal connectedness the therapist shows to the client in treatment. Therapists who display high levels of personalismo make an additional effort to avoid staying overly focused on paperwork and techniques. They show genuineness and friendliness that give an impression of a strong quality therapist-client relationship. The Latino treated with CBT has

Community Psychology Treatments 8 several successful sessions attributed to the integration of the clients cultural values into his treatment (Gonzlez-Prendes et al., 2011). Since Hispanics have become the fastest growing minority, Ellison, Finch, Hindo, and Pardo (2011) conducted a study to determine the relationship between religious involvement and mental health outcomes in Hispanics. Research suggests that Mexican-Americans are at least as religious as the general U.S. population or perhaps more religious. The stresses of acculturation, discrimination, and poverty have frequently been cited as having an impact on mental health outcomes. However, experts now believe that the level of religious involvement of an individual has an impact on mental health outcomes as well (Ellison et al., 2011). The attendance frequency of religious services is inversely correlated with depressive symptoms in Hispanics, meaning the more services that are attended, the less depressive symptoms there will be. Non-organized involvement is also inversely correlated with depressive symptoms, and researchers attribute this to the sense of meaning and purpose individuals gain from it (Ellison et al., 2011). Through researching the necessity of multicultural perspectives in education and counseling, and advocating for multiculturalism in the therapy setting, Sue, Arredondo, and McDavis (1992) allow therapists to understand the need to be culturally aware and unbiased. Because immigration rates have increased, the United States has become more diverse than ever. It is necessary to have the skills to work with documented immigrants, undocumented immigrants, and other minorities who have a different cultural background (Sue, Arredondo, & McDavis, 1992). Another important factor counselors need to take into consideration is the way therapists attempt to apply the same treatment to all clients without tailoring it to the individual. Applying Western therapeutic techniques to clients from various ethnic backgrounds and cultures has not been very effective (Sue, Arredondo, & McDavis, 1992).

Community Psychology Treatments 9 Despite the numerous advances in the field of community psychology, an important question remains unanswered. Now that the field of community psychology has been established as a significant discipline, many experts, including Toro (2005), ask the question, where do we go from here? Community psychology is experiencing a crisis because there is not a definite direction for the continuation of the field. Toro (2005) suggests that the field should attempt an expansion in order to include more people that could benefit from the expertise of community psychologists. Division 27 of the APA hit its peak membership of 1,800 members in 1983, which included APA members, non-APA members, and students. Thus, not only does the field of community psychology promote diversity, but the APA does as well. Membership in community psychology organizations has also grown significantly. Specifically, there are approximately 200 members in Australia and New Zealand, 100 in Canada, 250 in Europe, 400 in Latin America, and 400 in Japan. Adding the current 1,350 international members from all the regions to the 1,000 already in SCRA equates to more than 2,000 members. Another important aspect of the SCRA was that it was one of the most diverse divisions in the APA with 23% of its APA members identifying as an ethnic minority (Toro, 2005). If non-APA members and students were to be added, then it would be even more diversified. As a way to expand community psychology further, Toro (2005) suggests expanding internationally, moving outside the academic setting, increasing the participation of students and early career professionals, and continuing to include ethnic minorities. Having defined itself as an advocate for the less fortunate, the field of community psychology can go virtually anywhere from here.

Community Psychology Treatments 10 References Anglin, D. M., Alberti, P. M., Link, B. G., & Phelan, J. C. (2008). Racial differences in beliefs about the effectiveness and necessity of mental health treatment. American Journal of Community Psychology, 42(1/2), 17-24. Duffy, K.G. & Wong, F.Y. (2003). Community psychology. Boston: Allyn and Bacon. Ellison, C. G., Finch, B. K., Ryan, D., & Salinas, J. J. (2009). Religious involvement and depressive symptoms among Mexican-origin adults in California. Journal of Community Psychology, 37(2), 171-193. doi:10.1002/jcop.20287 Fortuna, L. R., Alegria, M., & Gao, S. (2010). Retention in depression treatment among ethnic and racial minority groups in the United States. Depression & Anxiety (1091-4269), 27(5), 485-494. doi:10.1002/da.20685 Gonzlez-Prendes, A., Hindo, C., & Pardo, Y. (2011). Cultural values integration in cognitivebehavioral therapy for a Latino with depression. Clinical Case Studies, 10(5), 376-394. doi:10.1177/1534650111427075 Grames, H. A. (2006). Depression, anxiety, and ataque de nervios: The primary mental health care model in a Latino population. Journal Of Systemic Therapies, 25(3), 58-72. doi:10.1521/jsyt.2006.25.3.58 Nelson, G.B., Prilleltensky, I. (2005). Community psychology: In pursuit of liberation and wellbeing. New York: Palgrave Macmillian. Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Multicultural Counseling and Development, 20(2), 64-88. doi:10.1002/j.2161-1912.1992.tb00563.x

Community Psychology Treatments 11 Toro, P. (2005). Community Psychology: where do we go from here? American Journal of Community Psychology, 35 (1-2), 9-6. doi:10.1007/s10464-005-1883-y