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Littleford’s article on, ‘How Psychotherapists Address Hypothetical Multiple Relationship Dilemmas with Asian American Clients’, is a very insightful article. In the article, Littleford starts by providing background information about the linkage between psychologists’ multicultural competence, and delivery of mental health care to people with diverse cultural values, norms, and beliefs, world perspectives, emotions, and behaviors. Multicultural competency assists psychotherapists to become aware of their biases and personal values that, might affect therapeutic relations between them and their clients (p.138). This way, the psychotherapists are able to deliver mental health care to clients from diverse cultural backgrounds, without allowing their own cultural perspectives or worldviews, affect the therapeutic relationships between them and their clients. From a personal perspective, the article’s background information is well structured to enable a reader understand the rationale of the study.
Thereafter, Littleford gives an analysis of previous studies conducted by other researchers, concerning the topic of discussion. Littleford cites that, over the last 30 years, the number of publications focusing on cultural competence has increased significantly (p.138). For instance, she cites the 2004 study by Liu, Sheu, and Williams, which found that, numerous researchers focus on defining, measuring, and increasing practitioners’ multicultural competencies (p.138). She also explores the definition of multiple relationships, in reference to psychologists, as provided by the 2002 APA Ethics Code (p. 138). Moreover, Littleford points out that, despite the importance of multicultural competencies among the psychotherapists, only a few researchers have concentrated on finding the empirical relationship between psychotherapists’ multicultural competence, and their behaviors (p.139). In addition, by looking at the previous studies conducted by researchers concerning multicultural competence, Littleford is able to discover that, much of the work on multiple relationships and culturally diverse groups have focused on rural communities, hence leaving out the urban communities, where Asian Americans are usually found (p.139). By giving an account of previous studies, Littleford helps the reader to understand what the researchers have so far managed to research, concerning multicultural competencies and multiple relationships, as well as understand the areas where more research need to be conducted. My personal evaluation of the first part of the article is that, Littleford provides a very good introduction of the selected topic, which allows a reader to be acquainted with the topic under discussion.
After the introduction, the hypotheses of the study are stated (p.144). Then, a brief explanation of the methodology of the study is given. This includes a description of the procedure used in data collection, the variables used in the study, and a description of the participants (p.144-147). I found the methodology part to be well organized, and appropriate for the selected topic of the study. Subsequently, Littleford gives a detailed explanation of the results of the study. She utilizes tables to present statistical results of the analyzed data from the study. Moreover, she uses statistical methods of measurement such as measures of diversion, for example, the mean, standard deviation, and variation; and measures of relationships such as correlation coefficient, to present the results. After the results, Littleford provides a detailed explanation of the major findings of the study, and their implications, and finally provides recommendations, based on the results of the study. I found the results, discussion, and recommendation parts to be very informative. The results are reliable and valid, given the fact that, Littleford does not just give a written narration of the results, but also provides statistical representation of the results. Moreover, the discussion is well articulated, and the recommendations provided are realistic. Generally, I found the article to be good.
Littleford’s article has enabled me to learn quite a number of things related to provision of mental health care to people of diverse cultural backgrounds. First, I have learnt that, clinicians should not depend on formal codes and rules; neither should they use their personal judgments, while responding to ethical dilemmas from their clients. Instead, clinicians should consider the cultural values, personal interests of their clients while offering medical care, in order to assist them avoid ethical dilemmas in their profession. Clinicians can achieve multicultural competence through multicultural training, and actual experience in working with clients from diverse cultural backgrounds (p.154). Even though many medical practitioners refrain from engaging in multiple relations with their clients, the only way that they can gain experience in working with diverse clients is through building multiple relations with their clients. Not all multiple relationships results into ethical violation. As long as the relationships do not cause harm to either of the parties, then they should be encouraged among the psychotherapists and other medical practitioners as well. Such relationships allows psychotherapist to interact with people of diverse cultural backgrounds, and learn more about the values, beliefs, behaviors, and worldviews, of different cultures.
In addition, I have learnt that, Asian Americans hold strong values for their culture. They value friendliness among community members, but they do not often open up to strangers/people outside their community. Therefore, for a psychotherapist to be able to offer mental health care to an Asian American, he/she needs to be familiar with their culture and worldviews, and interact with them frequently. For instance, a psychotherapist can disclose his/her marital status, family size, or individual status in the community, to Asian American clients, as they interact through multicultural relationships (p.139). This way, Asian Americans would be able to build trust in the psychotherapists, hence encouraging them to seek mental health care not only from the Asian American psychotherapists, but also from non-Asian American psychotherapists.
Moreover, Littleford’s article relates well with the ideas that we have learned in class. For instance, we learnt that, it is important for medical care practitioners to provide health care to all patients holistically. Holistic health care means that, medical care practitioners should not only consider the medical status of an individual while providing health care, they should also consider the spiritual and socio-cultural status of the patients. Holistic health care provision also entails considering the spiritual and social needs of the patients. This is based on the rationale that, the wellbeing of an individual is a collection of medical fitness (free from illnesses), physical fitness (free from disability), mental fitness, spiritual fulfillment, social wellbeing, and conformity to the cultural values, beliefs, and behaviors.
Additionally, the article supports the idea that, health care provision involves respect, and recognition of human diversity. One of the guiding principles of all medical practitioners/health care providers is that, they should respect the cultural values, beliefs, and behaviors of the patients. This is also depicted in Littleford’s article. It is clear that, we hold different beliefs, values, and worldviews. Mostly, these differences tend to influence our perceptions of different things, judgments, and even the way we perform our professions. In order to avoid biasness; because of our differences, we should learn to appreciate other people’s differences, endeavor to learn more about their cultures, and invest in positive multicultural relationships.
On the other hand, in the discussion section, Littleford states that, psychotherapists, as well as other medical practitioners, should engage in multicultural relationships with their clients, as one of the ways of helping clinicians become multicultural competence (p.154). This has evoked a very interesting ethical question to me: ‘should medical practitioners be discouraged from engaging in non-therapeutic relationships with their client?’ This is because, over the years, many of the ethical literatures that I have come across point out that, practitioners in the medical field should avoid engaging in non-therapeutic relationships with their clients. In fact, it is against the ethics of medical practitioners to develop personal relationships with their patients. In many cases, such relationships are viewed to be potentially harmful either to the patients or to the practitioners.
For instance, in a non-therapeutic relationship between a psychotherapist and a patient, the patient may influence the psychotherapist to administer the wrong treatment to him/her, especially where the treatment procedure may involve negative experiences such as pain. Instead, the psychotherapist may opt to administer a less painful treatment, which might not be the ultimate treatment for the patient’s condition, hence causing deterioration of the condition that the patient is suffering from.
Nevertheless, if the APA can be able to distinguish between healthy and harmful non-therapeutic relationships between psychotherapists and clients, then it can provide a guideline for the differences, to allow those psychotherapists who refrain from engaging in multicultural relationships due to fear of legal and professional sanctions, to identify, which non-therapeutic relationships they can engage in with their clients. In addition, if development of multicultural relationships between psychotherapists and their client will allow improvement of mental health care provision, due to development of multicultural competence among the psychotherapists, then health non-therapeutic relationships should be allowed.