Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 181

The American Psychological Association has developed guidelines for adapting therapy to meet the needs of children and families from multicultural backgrounds. In order to provide culturally adapted treatment, psychologists must develop an appreciation for, understanding of, and willingness to learn about clients’ social–cultural histories, identities, and values (APA, 2017b).

At the heart of the APA multicultural guidelines is the notion that a child’s identity is shaped by multiple ecological systems. Each child views herself as a member of a family, peer group, school, neighborhood, and community. The child’s identity is also formed by her educational background, ethnicity, gender, immigration status, income, religion, sexual identity, and social–cultural values. Identity is constantly changing, depending on the child’s age, experiences, and the broader social–political context in which she lives (Bronfenbrenner, 1979, 2005).

Psychologists use the term intersectionality to describe the way these social–cultural factors interact to shape children’s identity and either promote or hinder their development (Rosenthal, 2017). Instead of examining each factor individually, psychologists try to understand how identities intersect to affect children’s outcomes in either an adaptive or maladaptive way (Figure 4.6).

Most research has focused on the manner in which social–cultural dimensions of identity interact to limit children’s access to high-quality mental health care. For example, African American and Latino children with depression are less likely to receive adequate, evidence-based treatment than non-Latino White children. This ethnic disparity in treatment is partially explained by cultural differences in parents’ attitudes toward treatment. On average, ethnic minority parents have greater concerns about stigma or the effectiveness of psychotherapy than non-Latino White parents and are less likely to seek services for their children. Ethnic minority parents may also be reluctant to pursue treatment if they speak a language different than the therapist or if they perceive the therapist as being insensitive to their social–cultural background and experiences (Comas-Diaz & Brown, 2018).

Ethnic minority children who also live in poverty are even less likely to receive treatment. African American and Latino, low-income families face additional logistical barriers to treatment—barriers that may not limit middle- or high-SES minority families. These barriers include the cost of therapy, finding access to childcare and transportation to attend sessions, securing time off work, and obtaining high-quality mental health services in their community (Cummings, Ji, Lally, & Druss, 2019).

Figure 4.6 ■ Intersectionality

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Note: Intersectionality refers to the way social–cultural factors interact to shape children’s identity over time and promote or hinder development (American Psychological Association, 2017b).

Ethnicity and SES can interact to place children at greater risk for other psychological problems. For example, behavior therapy with parents is one of the most effective treatments for children who are oppositional and defiant toward adults. However, participation in behavior therapy is poor among low-income, ethnic minority parents. Even when services are provided at a convenient location, and parents are offered free transportation and childcare, less than one-third of parents who are eligible actually participate in treatment. Parents typically report a lack of time and high levels of stress as the main reasons for not taking advantage of these services (Gross, Breitenstein, Eisbach, Hoppe, & Harrison, 2015).

Recently, researchers have tried to use families’ social–cultural backgrounds to increase participation in therapy and enhance the effectiveness of treatment. Culturally adapted treatment involves modifying evidence-based psychotherapy to fit families’ social–cultural context. Therapists listen to families’ backgrounds and immediate needs to make treatment practical and relevant given their current strengths and challenges (Pina, Polo, & Huey, 2019).