Short-Term Intercultural Psychotherapy: Ethnographic Inquiry

The contemporary clinical environment is marked by two pronounced trends. First, in response to a variety of social and economic factors, short-term psychotherapies are delivered with increasing frequency in many mental health settings. Second, because of the growing cultural, ethnic, and racial diversity of the clientele who seek mental health services, and of the clinicians who provide them, intercultural treatments have become a more common clinical occurrence. The challenges of brief psychotherapies and of intercultural treatments have been discussed in the clinical literature in recent years, but they have been addressed separately. Despite the historic convergence of these two phenomena, the problems specific to treatments that are both short-term and intercultural have received insufficient attention. This article examines theoretical and technical frameworks that are applicable to short-term intercultural treatments. After discussing difficulties that are common to such treatments, the article describes clinical approaches that allow therapists to conceptualize and explore the psychic and cultural worlds of clients whose cultural and linguistic backgrounds differ from theirs. Three short-term intercultural case vignettes are presented to illustrate these new approaches. Short-Term Psychotherapies As managed care makes ever deeper inroads in providing coverage for mental health services, therapists more frequently encounter clients who request brief psychotherapies because of the constraints of their mental health insurance plans. Short-term psychotherapies are also the rule in many institutional settings, including corporations and universities, where therapists commonly have a limited number of sessions to offer their clients. Even therapists who might prefer to provide their clients with open-ended, long-term treatments recognize that short-term treatments have become the norm across a variety of contemporary clinical settings. The limitations of brief treatments, and the comparative advantages and disadvantages of short-term and long-term treatments, have been widely discussed and are not reviewed here (compare Bolter, Levenson, & Alvarez, 1990; Hoyt, 1985; Koss & Shiang, 1994; Luborsky, Singer, & Luborsky, 1975; Orlinsky & Howard, 1986; Ursanoff & Dressler, 1977). For the purposes of this article, it should be noted that short-term psychotherapies have been found especially problematic in clinical work with clients whom psychotherapists categorize as "difficult." This category includes clients who are actively psychotic, clients with severe preoedipal pathologies, clients with histories of trauma and early object loss, and clients with serious physical illnesses (Messer & Warren, 1995). Of central importance to this article is that the category of difficult clients also includes international and ethnic minority clients. Short-Term Intercultural Psychotherapies The problems characteristic of brief psychological treatments are apt to multiply and deepen in short-term intercultural psychotherapies. Even when client and therapist share linguistic and cultural backgrounds, therapists sometimes find it difficult to make quick diagnostic assessments and to fully grasp their clients' concerns in a limited number of sessions. In brief intercultural treatments, the cultural and linguistic differences between therapist and client may inhibit their communication and mutual understanding profoundly, diminishing the possibility of accurate psychological evaluation and effective therapeutic intervention. When the usual pressures of working with clients from different cultural and linguistic backgrounds (compare Chin 1993; Ewalt & Mokuau, 1995; Kakar, 1990; Landrine, 1992; Littlewood, 1990; Roland, 1988, 1996; Sabin, 1975; Seeley, 2000) are heightened by limitations of time, the puzzles that commonly characterize intercultural clinical work can seem even more insoluble. …