Multicultural Therapy
When Lia Lee began having severe epileptic seizures as a young child, her family, Hmong refugees from Laos, faced distrust, miscommunication, and belittlement from her Western doctors in Merced, California. Lia’s doctors firmly believed that the Western way of doing things always led to the highest successes, and they became angry when her non-English speaking parents failed to remain medically compliant and failed to understand the “American” way of doing things. Despite a strict medicine regimen and constant supervision, Lia’s condition worsened and her doctors eventually made a report to child protective services, causing Lia to be removed from her home. No one had sought out a translator for Lia’s family during any of their hospital visits, nor did they ask the family what they believed to be the cause of Lia’s seizures. In Hmong culture, the spirit within the body is of utmost importance when it comes to health and ailments. Individuals hold good spirits, but can be invaded by bad spirits, dabs, which the Lee family believed to be causing Lia’s epilepsy. Medication and blood work not only went against the family’s values, but it was not the correct treatment for what was occurring within Lia.
Multiculturalism is a necessary aspect of talk therapy that addresses and understands the diverse and different racial, cultural, ethnic, gender, and other identities that clients possess. Multiculturalism also acknowledges how these different identities play a role in the ways that each individual client views the world, their problems, and their solutions to problems. Therapists who fail to acknowledge these diverse values and backgrounds and fail to incorporate cultural values into treatment run the risk of establishing a therapeutic relationship built on power imbalances and distrust. On the other hand, therapists who remain mindful of systems of oppression and privilege, incorporate culturally appropriate interventions within treatment, and allow their clients to guide treatment as an expert of their own experiences, help to create a safe and respectable environment for clients to process and work towards goals. Had Lia’s doctors incorporated a multiculturalistic approach into their practices, the Lee family may have been more likely to engage in medicinal compliance and treatment planning.
It was not until the Lee family was assigned a case manager, Jeanine, that their concerns and cultural values were heard. Working amongst a team of multiple doctors, nurses, social workers, CASAs, case managers, etc., Jeanine was the only individual who asked the Lee family what they believed to be the cause of Lia’s epilepsy and how it should be treated. While working with the Lee family, Jeanine learned that they viewed the cause of her seizures to generate from a dab that had infiltrated her body and that medication would not help her. Instead, it was necessary for a shaman to help trick the dab out of Lia’s body and to be guided elsewhere using gifts and sacrifices. Jeanine was also able to learn that the Lee family was confused by Lia’s medicine, as they were not able to read the instructions and did not know how to measure her doses. Jeanine helped the Lees administer the medication in a way that made the most sense to them and advocated to have certain medications taken away to help decrease the complexity of her medication regime.
Jeanine displayed characteristics of a multicultural therapist. In our own experiences, seeking out a multicultural therapist can help to provide us with the empathy, respect, and safety needed in order for us to be our best selves. Therapists who are firmly stuck in Westernized beliefs fail to acknowledge the benefits of human differences and how helpful it is to maintain our cultural beliefs when engaging in life changing events. When seeking a multicultural therapist, it may be helpful to look for a therapist who uses interventions that align with your values or can be adapted to fit within your values and beliefs. Therapists who may threaten or harm specific cultural beliefs are not engaging in multiculturalism and may harm the environment of safety within the therapeutic relationship. Additionally, these therapists are willing to learn from you about your experiences and values, but will not expect you to educate them on everything there is to know about your identity. Multicultural therapists are also in-tune to their own personal biases and are capable of stepping away from these biases in order to provide the best care. Finally, multicultural therapists understand the intersectionality of privilege and oppression and will be willing to act in the role of an advocate when necessary. Working as a team is important within therapy, and multiculturalism helps to prevent power imbalances within the therapeutic relationship.
If you are interested in learning more about Lia and her family, or about Hmong culture, Anne Fadiman’s The Spirit Catches You and You Fall Down provides extensive information on Hmong culture and multiculturalism in practice.
-Emily Hayes