A recent article, published in the Archives of Scientific Psychology, describes how racial, ethnic, cultural, and national disparities in counseling and psychotherapy outcomes are inevitable, but eliminating global mental health disparities with indigenous healing is not. After describing the incongruence of exporting psychotherapy to other countries, Robinder Bedi, a psychologist and researcher from the University of British Columbia, suggests an integration of local indigenous practices with culturally competent psychotherapy practices to address mental health disparities.
“Although this [exporting psychotherapy cross-culturally] is generally done with good intentions to promote global mental health and to address differences in mental health across the world, these practices can be inconsistent with the societal values and collective beliefs of individuals in non-Western countries and can sometimes lead to more harm than good,” writes Bedi, “Instead, promoting traditional healers and indigenous healing practices and integrating them with culturally adapted counseling and psychotherapy is recommended to reduce international mental health disparities.”
The Lancet Commission on Global Mental Health and Sustainable Development recently published a report detailing plans to “scale up” mental health care across the globe. Simultaneously, the UK government hosted a Global Mental Health Ministerial Summit proposing to globally implement mental health policies. In contrast, Bedi argues that the notion of utilizing western psychotherapy with racial and ethnic minority individuals within Western countries as well as promoting its use to non-Western countries “has not received the careful deliberation that it deserves.” Bedi, among other mental health professionals, activists, and service users, challenges the cross-cultural applicability of Western mental health healing practices and calls for a more intentional approach to addressing global mental health disparities.
Psychotherapy is a cultural byproduct. In fact, Bedi suggests that psychotherapy might correctly be considered an indigenous mental healing practice of the West, “originally developed by and for Western individuals to address mental health concerns endemic in the Western world.”
“In light of the dominance of the medical (diagnose-and-treat) model of mental health disorders, there is burgeoning but oft-neglected research that has concluded that (a) counseling and psychotherapy are forms of healing indigenous to the West rather than universally valid practices, and (b) counseling and psychotherapy share important therapeutic systems and structures with all well-established indigenous healing approaches across the world.”
These universal structures share the following factors: a culturally approved healing setting (counseling office), a trusting and confiding relationship with the healer (a therapeutic alliance), a therapeutic rationale and conceptual framework (psychotherapeutic theory), and rituals and procedures that logically flow from the therapeutic rationale.
While others have critiqued the action of and intentions behind disseminating Western psychotherapies cross-culturally, Bedi’s article is unique in its proposal to integrate indigenous healing practices with culturally adapted counseling and psychotherapy.
Culturally adapted counseling and psychotherapy aims to “ensure all individuals, regardless of race, ethnicity, culture, or country, experience equal benefits from counseling and psychotherapy” and is ostensibly “backed by an abundance of North American and European research.” Yet, many studies, indicate just modest improvements and high dropout rates, albeit better outcomes than non-culturally adapted approaches.
Bedi raises concerns about the often unquestioned propagation of Western psychotherapeutic techniques such as the potential marginalization of indigenous systems of mental healing, a loss of local skills by ignoring traditional healing methods historically implemented to address mental well-being, and the insensitivity of reifying “colonial mentality as a hegemonic imposition of Western cultural and political interests.”
Bedi offers a format in which culturally adapted counseling and psychotherapy could be applied abroad, particularly when Western understandings have to some degree “permeated non-Western countries,” which could be measured by considering ethnic identity development and acculturation to the West prior to treatment. Alternative solutions to integrating traditional healing practices and psychotherapy are also outlined:
Alternative 1: Focusing on the preexisting cultural congruence of current Western methods. Rather than exporting psychological interventions based on Western evidence, identify what interventions are already most consistent with local cultural beliefs, avoiding the need to “convince” the culture of intervention efficacy. This approach should only be applied if locals determine indigenous healing methods as lacking.
Alternative 2: Collaboration with traditional healers as equals. This approach follows that “individuals will likely be best served by the integration of Western and indigenous methods in either a “common factors” or technical eclecticism manner…a fully cooperative model…blended into a well-integrated hybrid service.”
Alternative 3: Using traditional healers to provide culturally congruent psychological interventions. Traditional local healers incorporate and employ culturally appropriate psychotherapeutic interventions into indigenous healing practices, an approach that would require “scanning hundreds of bona fide counseling and psychotherapy approaches to see which ones are already most consistent with a particular culture and extrapolating its explanations and interventions to supplement not supplant local indigenous healing practices.”
Future research would be necessary to implement these alternatives. Bedi recommends research that assesses the discrepancy between those who strongly ethnically identify as un-Western with more Western-acculturated individuals to test treatment outcomes. Furthermore, conducting outcomes studies of various psychotherapeutic approaches throughout multiple countries is relevant to determine if outcomes shift when a country’s popular beliefs are disparate with the conceptual underpinnings of the approach.
Finally, Bedi encourages research that would test whether Western groups do better with counseling/psychotherapy and non-Western groups do better with their culturally congruent indigenous healing practice for the same issue under examination. However, this research is complicated by the issue of “how to decide a particular issue is commensurate if it is conceptualized differently by the two groups; that is the ‘issue’ should not be wholly defined in Western terms and through Western ideology necessarily.”
Bedi concludes clarifying that he is not suggesting one approach as inferior or superior to another in some universal capacity, but rather that “context matters considerably.” Further, his article is not meant as “blanket denouncement of the humble sharing of Western psychological knowledge,” but supports careful deliberation and consideration of appropriate healing approaches. Ultimately, Bedi, whose research largely focuses on cross-cultural and multi-cultural counseling, brings a focus to the intricacy of understanding mental distress, especially across cultures:
“As complicated as the question is when considering the disparate epistemologies, ontologies of mental distress (e.g. biomedical, spiritual supernatural, magical), and goals of intervention (transformative/growth vs. restorative/symptom removal) adopted in various cultures in various parts of the world, indigenous healing methods for overcoming impairing mental distress (what we would usually term “mental disorders” in the West) have been repeatedly found to be effective. An obstacle lies in who has the highest authority to determine the rules for establishing effectiveness.”
Bedi, R. P. (2018). Racial, ethnic, cultural, and national disparities in counseling and psychotherapy outcome are inevitable but eliminating global mental health disparities with indigenous healing is not. Archives of Scientific Psychology, 6(1), 96-104. http://dx.doi.org/10.1037/arc0000047 (Link)