Culturally Responsive Therapy
Hello, नमस्ते, হ্যালো, வணக்கம், నమస్తే, ନମସ୍କାର, سلام, ꯅꯥꯟꯗꯨ. …
The list will never end if all 121 languages of the diverse country of India are included. India, unlike other countries, is a melting pot consisting of different cultures. However, one main aspect that sets us apart while uniting us is our cultures. Compared to Westernized countries, India views mental health from a different perspective, mainly due to the different norms followed here. For instance, the concept of “boundaries” is not as relevant in Indian culture, and the idea of “knocking on your door” to enter does not always apply. While there is still a lot of taboo around it, the field of mental health is growing in India. To make it more culturally relevant, psychologists need to consider our rich culture and how we can incorporate it into therapeutic settings.
In this blog, we will explore two different cases that provide a significant understanding of why we should leverage cultural backgrounds to provide quality therapy outcomes.
Disclaimer: All names are purely invented; they are not intended to be based on actual people.
Ms.Rekha Shekhawat
Meet Ms. Rekha Shikhawat, a certified play therapist and clinical psychologist. She is currently working with a 10-year-old client named Bunty, helping him to open up. Bunty was brought to her with the following presenting problems:
Intense irritability and regular anger outbursts.
Severe temper tantrums, including hurling things or verbal or physical aggression
Difficulty in maintaining friendships at school due to fights with classmates.
Difficulty conversing with both of his parents.
Ms. Rekha, faced with the client's issues, aimed to gather a comprehensive case history. As Bunty was only 10 years old, Rekha wanted to approach him differently, which was with the obvious "play therapy" (this is considered to be a form of psychotherapy, which uses toys or any fun objects to communicate effectively).
Session 1:
During the first session, Rekha made the utmost effort to introduce the client to toys, puzzles, or anything recreational for a 10-year-old. But Bunty did not show any interest in them. To identify a different approach, she indulged him in "Talk Therapy" for a brief period. That was the game-changing point wherein Bunty had mentioned his interest in "Puppetry".
Session-2:
During the therapy sessions, the therapist gradually introduced the client to the “world of puppetry”. As the client's interest and focus grew, the therapist, Ms. Rekha, began using puppets to recreate the client's home and school environment. After several sessions of playing and reenacting scenarios, Ms. Rekha discovered that Bunty's parents were verbally and physically abusive to each other, which was contributing to Bunty's escalating anxiety and aggression.
Later Sessions:
In subsequent sessions, Rekha noticed that her client was repeatedly acting out scenarios with puppets representing his mother and father. These scenarios involved a lot of physical and verbal conflict. She decided it would be best to involve the client's parents to help them understand that their own aggression towards each other was mirrored in their son's unfriendly behavior and angry outbursts. Through psychoeducation (providing relevant information about the client's condition to help them cope better) and emotion tracking exercises(to improve understanding of emotions), along with counseling for the parents to improve their communication, Bunty's behavior improved significantly.
Ms.Afreen Firdose
Ms.Afreen is an equally talented Counseling psychologist, having a knack for “food’’ , she is not only a big food buff but also engages with her clients with “food language’’ or also famously known as “Culinary Linguistics’’ where appropriate. Her motto towards mental health and life is that- “just as “play’’ is the soul to a child’s life, so is “food’’ for an adult”.
Afreen is currently seeing her brand new client, “Mr.Ashwin Kaul’’ who himself is a huge chef from Mumbai. With a brief case history session, the following symptoms were highlighted:
Excessive anxiety while meeting new people, as he was always scared of embarrassing himself.
Experiences social distress especially during the work time periods.
Excessive blushing, sweating and palpitations.
As “food’’ was considered to be a common ground for both of them, Afreen wanted to converse in the “food language’’ to help the client and better their symptoms.
Session-1
The therapist made the therapy room as "non-judgmental" as possible. To do that, she started by addressing the elephant in the room: food and its significance to the client. The client slowly opened up about his passion for food, cooking, and other interesting hobbies. By the end of the session, the therapist knew that a common and safe ground had been established to move on to the next step of the session.
Session-2
Today was a D-day for the therapist and the client, as they would combine two main processes. The first one is "Food language" and "Systematic Desensitization" using VR (Virtual Reality). "Food language" is a tool the therapist uses to communicate with the client, where certain spices in food can represent specific "emotions." They also discussed whether the client would be comfortable with gradually being exposed to smaller and then larger crowds of people virtually using (VR), which could help them improve their condition.
Session-3
With proper breathing exercises, relaxation techniques, and creating a lot of the client’s comfort food, the therapist introduced a virtual reality "restaurant setting" to help reduce his anxiety. In the VR, the client was introduced to avatars who depicted the guests at his restaurants. Even though everything was virtual, the therapist ensured that the avatars could converse with the client to understand the specific trigger point. After a few days of observations, Afreen identified the main cause: the client was always nervous when presenting new dishes to guests, fearing that they would not like them.
Session-4 and terminations:
The therapist noticed significant changes in the client as the weeks passed. The client showed improvement, particularly after engaging in VR exercises, and was able to present himself better in front of new guests. Although there were challenging days at work, with the help of Ms. Afreen doing proper breathing exercises, the client's condition improved.
Therapy is not a hard and fast process, but rather a slow one. When done properly, using a creative and effective approach, therapists can create a safe space for their clients. This also helps in making the clients feel heard and understood, addressing their cultural concerns and worries.
