Most therapists are well-trained in the treatment of trauma, but what might be lacking is an appreciation of the need for cultural sensitivity in trauma therapy. Certainly, trained therapists value cultural competence, but it is not always simple to put this concept into practice when treating trauma. After all, trauma is complex, and we spend much of our time learning about the nuances of identifying triggers and physiological reactions to trauma, and helping clients to develop coping skills.
Underlying these trauma-specific skills is the need to be sensitive to a client’s culture. While there may be some features that are universally associated with trauma, the reality is that cultural factors can influence the way a person experiences and interprets trauma. What trauma means for a specific client may vary from the meaning you would assign to the event, and these meanings can vary based upon cultural norms and values. Proper trauma training for therapists on the complexities of treatment can help ensure a positive result. These complexities are discussed further below.
How Culture Affects Trauma Treatment
Client’s cultural values will influence their views related to seeking help, as well as their perception of the trauma they’ve experienced. Keep in mind that culture is more than simply race or ethnicity. It includes other factors, such as religion, socioeconomic status, area of residence, and sexual orientation.
Consider the following ways that culture can affect trauma treatment:
- Certain cultural or religious beliefs can influence the meaning a client assigns to trauma. Based on cultural values, a client may believe that their trauma has special meaning or is some sort of punishment.
- Culture may cause variations in the interpretation of trauma, which can also affect a client’s coping mechanisms and distress levels.
- Culture can dictate what constitutes an appropriate reaction to a traumatic event. While you may expect an intense reaction, some clients may show more subtle responses to trauma.
- Some cultural groups may distrust helping professionals or perceive that it is unacceptable to discuss emotions with someone outside of the family, which can influence relationship building.
Actionable Steps for Therapists
Understanding the nuances of culture is the first step toward becoming a culturally sensitive trauma therapist, but the second step requires therapists to put this knowledge into action. Some of the most important factors to consider include:
- The importance of relationship building: Some cultural groups may be reluctant to seek services because of their distrust of the mental health system. For example, research with communities of color has found that there is a reluctance to discuss problems, as well as a negative perception of mental health treatment, which can be a barrier to accessing mental health care.
Given the distrust and reluctance that may exist in some groups, it’s critical to put intentional effort into relationship and trust building. Of course, relationship building is important with all clients, but when a client comes from a cultural background that differs from that of the therapist, the therapist must learn about cultural norms related to communication. For instance, it’s important to consider word choice and body language and to communicate in a way that meets the client’s needs.
- Changes to the assessment process: Keep in mind that trauma reactions may present differently from culture-to-culture. If a client comes from a cultural background that differs in some way from the majority culture, their presentation and interpretation of trauma may be different from what you’d typically expect in trauma treatment.
As a part of your assessment process, it’s essential to ask the client what their trauma means to them, rather than imposing the dominant narrative on them. It’s also helpful to consider alternative presentations of trauma that may differ from the standard DSM diagnostic criteria. For example, some clients may present with somatic symptoms, which, absent a medical condition, could very well be related to the trauma.
- Psychoeducation: When clients come to trauma therapy distrustful of the process, or perhaps blaming themselves for bringing shame to their community, it can be helpful to engage in psychoeducation. Providing information about common responses to trauma can help clients to develop a stronger understanding of the treatment process.
Learning about typical trauma responses can also help to normalize the experience for clients who may feel as if they are somehow flawed or ostracized for demonstrating trauma-related symptoms.
- Treatment planning considerations: Finally, culturally competent care may involve making alterations to evidence-based trauma treatments in order to best serve clients. Some clients may not be comfortable talking about trauma, but they may be open to the idea of painting or writing. Additionally, taking part in traditional cultural practices, such as cooking a specific meal, can be helpful as part of a treatment plan, because these practices can help clients to restore their social connections.
Other treatment planning considerations include acknowledging the role of family and community leaders in the treatment process. Some clients may fare better when extended family is involved in their care, and others may thrive when religious leaders or other important members of their community are consulted.
Ultimately, culturally sensitive trauma-informed care requires the therapist to take the time to learn about the client’s cultural values, understand symptoms from the client’s perspective, and use assessment and intervention techniques that respect the client’s culture.
Bridge to Balance provides therapy services in three New Jersey locations, with a new office recently opened in Maine. We also provide professional training. Visit our webpage today to learn more about our therapy for trauma offerings.
Sources:
1)https://www.healthcaretoolbox.org/culturally-sensitive-trauma-informed-care
2)https://bmjopen.bmj.com/content/6/11/e012337.abstract
3)https://link.springer.com/chapter/10.1007/978-3-319-17335-1_11