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«The Mediating Effect of Acculturation on the Effectiveness of Culturally Adapted Cognitive Behavioral Therapy with Mexican Americans Suffering From ...»

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One of the main premises of the evolutionary/ecological perspective is that of culture as a way of life. This idea posits that “the way of life of a society…..consists of prescribed ways of behaving or norms of conduct, beliefs, values and skills along with the behavioral patterns and uniformities based on these categories (Gordon, 1964, p.32).

For example, the culture as a way of life idea is the basis for the culture of poverty argument (Lewis, 1966), which views culture in a deterministic way; one in which there is no hope for those in poverty because of ingrained cultural values and therefore, to intervene would be futile. This view contributes to seeing culture as a barrier to seeking services, a philosophy that was prevalent in social work literature for many years (Crist, 2002; Krakauer, Crenner & Fox, 2002; Torrez, 1998). To view culture through this lens would be to assume there is no reason to culturally adapt interventions for minority groups because it will not make a difference if their cultural values are different from

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they are not able to benefit from such interventions.

Ideational theories of culture clarify the process that is taking place when practitioners seek to culturally adapt interventions. According to this theoretical framework, cultures represent a system of ideas (Keesing, 1974). This theoretical framework includes three major sub-theories. The first, culture as cognitive systems, asserts that cultures are a system or organization of knowledge. The second, cultures as structural systems, has at its core the premise that cultures are shared symbolic systems created in the mind. The third, and the one that most effectively explains the interaction between practitioners and clients from minority groups, is culture as symbolic systems.

The culture as symbolic systems approach looks at cultures as being systems of shared symbols and meanings. Gertz (1973) suggests these symbols and meanings are shared by social actors and are used to interpret the reality of everyday life. One example that is relevant to this study is the meaning that Mexican Americans sometimes ascribe to mental illness (i.e. being crazy). If the individual holds a culturally derived meaning that being depressed is synonymous to being crazy, the stigma that is attached to this meaning may prevent them from seeking treatment from certain sources or even from seeking treatment. A cultural adaptation that is needed to address this is to explore with the client what their understanding is of mental illness and what sources of care are acceptable.

Thus practitioners must first understand the psychosocial frame of the client and then find some means to either change the frame or accommodate to the frame.

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understand culture or a given event, one must first understand internal models of reality;

(2) meanings are shared by people who have different conceptions of culture; (3) in order to understand cultural change and diversity, one must see that cultures exist within a social ecosystem (Keesing, 1974).

This approach sheds light on why it may be therapeutic for interventions to be culturally adapted for minority groups. Given the ideational theory of culture, culture is experienced as a series of symbols and meanings that are assigned to beliefs, practices and values by cultural groups. This raises the question of whether it is important for practitioners to provide interventions that are culturally relevant to minority groups by (a) becoming aware of these symbols and meanings, (b) exploring these symbols and meanings with their clients, (c) and culturally adapting interventions in order to engage and retain minority clients in treatment.

Culture as a Tool Kit As the study of culture evolved, Swidler (1986) developed a framework derived from the symbolic view of culture that includes three elements. The first involves looking at “culture as a ‘tool kit’ of symbols, stories, rituals, and world-views, which people may use in varying configurations to solve different kinds of problems” (p. 273). The second involves looking at culture as focusing on strategies of action. The third involves looking at culture as providing cultural components that are used to construct strategies of action rather than as defining ends of action. Swidler’s framework moves the study of culture

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embraces Swidler’s idea, one could propose that clients come to practitioners with their own “tool kit” of symbols, stories, rituals, and world-views. In turn, practitioners must learn ways to decipher these tool kits in order to work with their clients more effectively.

Culture as a Dynamic Process Lopez and Guarnaccia (2000) brought the study of culture a step forward with their notion that seeing culture as values, beliefs and practices has important limitations.

They argue that this definition of culture implies that culture lies within individuals (psychological nature of culture). These authors propose that culture should be seen as a product of the interaction of the psychological world and the social world. They add that culture should also be seen as a dynamic ongoing process that changes as the social world changes. And thirdly, they suggest that any viable definition of culture acknowledges that individuals participate in establishing their social worlds (Lopez & Guarnaccia, 2000).





This view propels the definition of culture away from being seen as something static that is possessed by individuals to a more dynamic construct that is constantly being influenced by what takes place in the environment.

Culture and the Helping Process Winkelman (2005) presents a set of approaches that provide a comprehensive view of the impact of culture on groups of people. The three major approaches he outlines are the Process-Stage Approach, the Strengths Perspective and the Cultural Systems Perspective. The Process-Stage Approach supports the cultural adaptation of

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development of intervention plans and termination are all based in culture. In this approach, cultural knowledge is seen as essential because “resolving problems requires an understanding of the client’s perspective on the putative problem and the realistic and acceptable solutions from the perspective of the individual and his/her social group” (p.

7). In other words, the client and his/her cultural group must consider solutions to be appropriate if plans to resolve problems are to prove successful.

The strengths perspective focuses on understanding the cultural dimensions of clients and their relationships and access to resources of the broader society in order to provide effective services. This approach moves away from the traditional social work approaches that focus on client dysfunction and looks at the client’s cultural system and its goals and values to build effective mutually respectful helping relationships (Winkelman, 2005). Similarly, the Cultural systems perspectives provide models for linking individuals and their behavior to adaptation to numerous environments. The psychocultural model is one example. This model was developed by Whiting and Whiting (1995) and considers the primary elements affecting culture to be history, environment, the cultural system, the child-rearing environment, innate needs and projective systems.

Culturally Grounded Perspective Marsiglia and Kulis (2009) bring together decades of work in the study of culture with their discussion on culturally grounded social work. These authors broaden the

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of life as reflected in its language, values and norms of behavior” (p.3). More specifically, culture is presented by these authors as being “an identifiable grouping of shared values, traditions, norms, and customs that guide how people think and behave in a community” (p. 25). In addition, they highlight a paradox: culture can present barriers for minorities if not understood, but on the other hand, can be “a source of strength and inspiration that helps people cope with the daily stressors they face” (p. 3). In addition, they propose that the study of culture is a multi-dimensional phenomenon that must be understood within its context, history, geographic location, as well as, the intersectionality of culture with social class, ethnicity, religion, language, gender, sexual orientation, age, and ability status. With this in mind, the authors propose that the way to provide effective interventions is to use the culturally grounded perspective. The culturally grounded perspective takes the study of culture from an abstract concept to outlining very specific tasks that must be accomplished in order to increase the effectiveness of social work interventions. Marsiglia and Kulis present the work of Sue (1998) as they outline the components of the culturally grounded perspective. The three

major components of the culturally grounded perspective are:

1. Hypothesis testing: the use of cultural knowledge about groups in a tentative, exploratory fashion without arriving at any definitive or premature conclusions about clients or their cultures (remember social context and intersectionality).

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3. Culturally specific expertise: the ability to work effectively with individuals from a particular culture and the possession of skills and abilities to develop rapport, to have a strong client-worker alliance, and to achieve the desired outcomes when working with members of that group (i.e. becoming a bicultural practitioner) (p. 178).

An understanding of the components of the culturally grounded perspective leads to an awareness that the cultural adaptation of interventions is essential in becoming an effective practitioner. This contemporary approach is the basis for understanding the cultural adaption process and the impetus for this dissertation study.

THE CONTEXT OF MEXICAN AMERICAN CULTURE

U.S. Mainstream American Culture For decades the United States/American culture was described as a melting pot of various cultures, but very little was written outlining any of its specific cultural characteristics. In recent years, however, authors describe cultural values such as individualism, autonomy, competition, future orientation, and mastery of the environment as being prominent in the Anglo-American culture, which is the largest group comprising American culture (Atkinson, Morten, Sue, 1998; Kim, 2007; Sue & Sue, 2003; Triandis, 1988). The term Anglo-American is used for individuals from British descent, while the term European American is used to identify individuals of Dutch, German, or Irish descent (or from other European countries).

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(2005) describes such traits as individualism, separateness, self-determination, independence, self-actualization, personal achievement and success, identity rooted in sexuality and work, egalitarian gender roles and material orientation. In fact, Brammer (2004) asserts that the Puritan work ethic still permeates much of the “white” culture.

Brammer adds that Anglo Americans tend to view any show of emotion as a lack of personal strength, focus on the nuclear family, and view themselves as dominant in their relationship to the natural world.

Individualism is one of the traits that sets Anglo-Americans and others who embrace the values of the mainstream culture apart from most other minority groups, who tend to be collectivist in nature (Triandis, 1988). Individualism is defined as emotional independence from groups, lack of attention to the view of others, little concern for family and relatives and tendencies towards competition (Hofstede, 1980; Triandis, McCusker, & Hui, 1990). Collectivists, on the other hand, tend to see the self as an aspect of a group and value interdependence. Collectivists emphasize the goals and needs of the group, over individual goals and needs (Gudykunst, Yoon, & Nishida, 1987).

Kirschner (1990) presents an analysis of three Anglo-American values in contemporary psychoanalytic developmental psychology. In her discourse, she discusses self-reliance, self-direction and verbal expression as being Anglo-American characteristics. Kirschner states the definition of self-reliance as being “to not depend upon another for care or for the regulation of one’s self-esteem” (p. 842). The definition

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accord with these inner beliefs and feelings, rather than in compliance with some external standard with another person’s wishes” (p. 846). In regards to dealing with difficult situations, Anglo-Americans are said to view showing emotions as a lack of personal strength and believing that issues and struggles are within the self (Brammer, 2004). In other words, everyone has the capacity to overcome any problem by individual effort.

As is true when exploring any cultural group, the Anglo-American culture should not be described as being all inclusive and absolute. Croll (2007) cautions that socioeconomic factors should always be considered when describing the AngloAmerican culture, as income and education may play a role in how some people experience and demonstrate cultural characteristics. In addition, it is important to note that geographic location may also play a role on how Anglo-Americans express their culture. For example, McGill and Pearce (1982) describe four major regions of the United States: East, Midwest, West and Appalachia. The Eastern Anglo-American is described as placing a high value on control of their emotional life and on high achievement. In addition, self-actualization is of utmost importance to the eastern AngloAmerican, as well as, public service. Bartzell (1979) describes the eastern AngloAmerican as being motivated by living up to past family standards.

The Midwestern Anglo-American is described as a close-knit, agrarian, who has more of a small town, rural culture. The Midwestern Anglo-American places a high value on being productive and doing their duty. Hard work and productivity are seen as tied to

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and unlike themselves. Failure is defined as maintaining too much contact with or living too close to their children or family. The Anglo-American in the Appalachian region (e.g.



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