community psychology and treatments for depression based on ethnicity

Community Psychology Treatments 1

Community Psychology and Treatments for Depression Based on Ethnicity

Angela Cichosz and Liliana Gomez

Professor Megan Pietrucha

PSY 328 Clinical & Counseling Psychology

Community Psychology and Treatments for Depression Based on Ethnicity


Depression occurs at a similar rate across all ethnic and racial groups, yet not all groups

receive equal treatment for the condition; community psychology aims to lessen this discrepancy

(Fortuna, Alegria, & Gao, 2010). As the largest minority group in the United States, Hispanics

face new challenges as they assimilate and adapt to a new culture (Grames, 2006). An increasing

issue therapists address with Hispanic clients is low retention rates in treatment for depression

and similar mental health issues (Fortuna, Alegria, & Gao, 2010). Due to a mismatch in the

therapist-client relationship and other factors related to cultural values, many Hispanics do not

continue their psychotherapy treatments for depression. One of the goals of community

psychology is to alter the inequality in therapeutic treatment of groups from different cultural

backgrounds. As will be discussed shortly, community psychology does not have a universal

definition, but rather a collection of various definitions that captures what community

psychology refers to and its effects on different social or minority groups in society.

Specifically, community psychology has evolved to treat the mental health needs of a diverse

population of social, ethnic, and other minority groups.

According to Duffy and Wong (2003), no agreement for a single definition of community

psychology exists. Yet, there are several definitions which could possibly lead to a conflict if no

consensus emerges among professionals in the field. For instance, Heller et al. (2008) defined

community psychology as the study of the effects of social and environmental factors on human

behavior from the individual, group, organizational, and societal viewpoints. Likewise,

Rappaport (1977) stated that community psychology is a way of finding alternatives to cope with

deviations from the norm, and a way to help clients be different without risking psychological

harm from criticism. Zax and Specter (1974) defined community psychology as an approach to

behavioral problems that focuses on environmental factors as well as ways these problems can be


treated. Adding more perspective to the definition, Duffy and Wong (2003) defined community

psychology as a focus on institutions, issues, and other areas that impact social groups and the

individual.

During the late 1970s and early 1980s, community psychology experienced its greatest

period of popularity in the United States (Toro, 2005). At this time, community psychology’s

ideas were still fairly new but important because of relevant political issues. In 1983, American

psychologists found interest in community psychology ideas, so many became members of the

APA’s Division 27 in community psychology. Further into the 1980s, community psychology in

the U.S. began to separate from the APA (Toro, 2005).The separation resulted from a desire to

attract more non-psychologists to the field. Community psychology emphasized clinical practice

issues over all other issues. Recognition soon emerged that the term “psychology” no longer fit

with how community psychologists practiced their techniques. After breaking apart from the

APA, the field of community psychology began to shape its separate identity with a new name,

the Society for Community Research and Action (SCRA) (Toro, 2005). It was incorporated as an

independent professional society, and it held its first Biennial Conference on Community

Research and Action in 1987 in South Carolina.

Tracing back to the 1960s, community psychology’s history was rooted in social and

political issues. In the 1960s, reforms and movements such as the civil rights movements were a

fight for equality from minorities, women, and other less privileged groups in society (Duffy &

Wong, 2003). Combined with foreign economic competition, the threat of nuclear war from the

Soviet Union, and the space race, psychologists were encouraged to participate in societal issues.

Furthermore, John F. Kennedy’s election led to more interest in institutionalization, mental

health, and the general availability of human services. The passage of the Community Mental


Health Act of 1963 allowed funds to be used for the creation of local mental health centers.

Services provided in the centers included outpatient, emergency, and educational services. After

John F. Kennedy’s assassination, Lyndon B. Johnson led the War on Poverty through his Great

Society Program (Duffy & Wong, 2003).

Being his first time leading the War on Poverty, Lyndon B. Johnson mentioned his plan

in his State of the Union address (Duffy & Wong, 2003). In the 1964 Annual report of the

President’s Council of Economic Advisors, Johnson stated we had the power to control poverty.

Approximately $11 billion per year would have brought all low income families up to an income

of $3,000, which had been the standard for decent living at that time. The majority of people

would have paid enough taxes to support the necessary financial aid to fund low income families.

Yet, this “solution” would not have dealt with the root of the issue. In reality, Americans desired

to achieve the American dream without aid from welfare. Although it would have been more

difficult, the poorest families would have had a better outcome if they had earned the additional

money without help from the taxpayers (Duffy & Wong, 2003). A few years later, the

Swampscott Conference of May 1965 in Swampscott, Massachusetts was held. The Swampscott

Conference was commonly known as the birth of community psychology (Duffy & Wong,

2003). The first conference was attended by clinical psychologists who sought to create political

and social changes. Their discussions led them to change the focus from treatment to prevention

strategies and also to include a more ecological perspective, meaning the inclusion of an

individual in the environment (Duffy & Wong, 2003, as cited in Bennet et al., 1966).

Unlike other fields, community psychology considers the individual as a part of the larger

context. In its application, community psychology has most commonly addressed societal issues

such as marginalization, globalization, poverty, and social justice (Nelson & Prilleltensky, 2005).


Community psychologists have also had experience working with issues sensitive to ethnic

minorities, including colonization, racism, immigration, and cultural diversity. Other concerns

that it has dealt with includes sexism and gender power, heterosexism and the oppression of

members of the LGBT community, and people with disabilities. Traditionally, community

psychologists focused on issues such as psychiatric disabilities, mental health,

institutionalization, and community health. Disadvantaged families and environmental problems

such as global warming have also been considered (Nelson & Prilleltensky, 2005).

Based on decades of empirical research, the ways in which ethnic minorities view

treatment for mental health issues can be better understood. Minorities do not seek treatment for

mental illness as often as Caucasians do, though they do have a more positive attitude toward

treatment in general (Anglin, Alberti, Link & Phelan, 2008). In a recent study, Anglin et al.

(2008) examined different racial groups’ attitudes toward the severity of mental illness and the

perceived effectiveness of treatment. A group of African-Americans was compared to a group of

Caucasians on their beliefs in the study that used hypothetical scenarios of mentally ill people.

These scenarios, known as vignettes, were used to assess their perception of treatment in relation

to the severity of the different types of mental illness. The researchers found that African-

Americans were more likely than Caucasians to believe that mental health experts could help

people suffering from schizophrenia or depression, but they were also more likely to believe that

mental illness would improve without treatment (Anglin et al., 2008).

Within the Hispanic population, a greater risk exists for mental illnesses such as panic

attacks, generalized anxiety, and depression (Grames, 2006). Contributing factors such as

poverty acculturation levels lead to higher rates of mental illness. Some Hispanic groups are

shown to have lower rates of depression if they are recent immigrants, and this is thought to be


related to family support and the retention of cultural values. In addition to using diagnoses to

treat Hispanic patients, therapists must understand the cultural background of Hispanic clients

and how this affects the mental health state. Research suggests that Hispanics use psychotherapy

treatments significantly less than Caucasians because the treatment was designed to be used with

middle class Caucasians (Grames, 2006). Problems arise when mental health agencies train

therapists to treat all clients with the same set of techniques, regardless of any cultural values or

other issues that must be considered. The American Psychiatric Association recommends that

therapists seek to understand the client’s cultural identity, ask minority clients for their cultural

explanation of the mental illness, examine cultural factors in the client’s environment and their

effect on the client’s ability to function, understand the cultural view of the therapeutic

relationship, and culturally assess the client on an overall level in terms of diagnosis and

treatment (Grames, 2006).

While mental health problems affect all ethnic groups equally, inequality exists in the

way people of different ethnic backgrounds receive treatment (Fortuna, Alegria, & Gao, 2010).

Such factors that affect the retention rates of minorities in treatment are the client’s unfulfilled

expectations, a mismatch between the race of the client and therapist, and the low chance of

receiving mental health care from a specialist. Other factors include an inequality in treatments

available to minorities and a mistrust of the mental health system due to cultural beliefs.

Minorities, both African-Americans and Hispanics, had lower rates of adhering to prescribed

medications. This is attributed to having no health insurance, speaking Spanish only, not having

access to better quality healthcare, and being a member of a low socioeconomic status (SES)

group. (Fortuna, Alegria, & Gao, 2010).


González-Prendes, Hindo, & Pardo (2011) explored the case study of a Latino who

received cognitive behavioral therapy (CBT). Overall, culture encompasses the beliefs,

behaviors, and values shared across generations of a group of people over time. Accepted

behaviors in one culture may seem outside the norm to another culture. Multicultural competence

is considered an important skill for therapists to have in order for them to integrate their

therapeutic techniques with the cultural values of the client. For a stronger therapeutic alliance,

therapists working with clients of different cultural backgrounds need to be aware of the meaning

of these values. The purpose of using CBT is to alter the client’s automatic thought processes or

maladaptive thought patterns that could lead to potential unhealthy behaviors (González-Prendes

et al., 2011). The therapist working with the male Latino client uses a modified CBT treatment

for his depression that integrates the techniques of CBT while taking into consideration the

cultural values of the client. The therapist recognizes that the client has a collectivist view,

meaning family is more important than the individual, and that the client does not have a

supportive family in terms of seeking treatment. This view is referred to as familismo, the idea in

Latino culture that family values are placed over individual values. The client’s culture does not

value seeking treatment for mental health issues, and instead, believes that this should be dealt

with privately. A key factor that Hispanics look for in an effective therapist is the level of

personalismo (González-Prendes et al., 2011). Personalismo is defined as the amount of warmth,

empathy, and personal connectedness the therapist shows to the client in treatment. Therapists

who display high levels of personalismo make an additional effort to avoid staying overly

focused on paperwork and techniques. They show genuineness and friendliness that give an

impression of a strong quality therapist-client relationship. The Latino treated with CBT has


several successful sessions attributed to the integration of the client’s cultural values into his

treatment (González-Prendes et al., 2011).

Since Hispanics have become the fastest growing minority, Ellison, Finch, Hindo, and

Pardo (2011) conducted a study to determine the relationship between religious involvement and

mental health outcomes in Hispanics. Research suggests that Mexican-Americans are at least as

religious as the general U.S. population or perhaps more religious. The stresses of acculturation,

discrimination, and poverty have frequently been cited as having an impact on mental health

outcomes. However, experts now believe that the level of religious involvement of an individual

has an impact on mental health outcomes as well (Ellison et al., 2011). The attendance frequency

of religious services is inversely correlated with depressive symptoms in Hispanics, meaning the

more services that are attended, the less depressive symptoms there will be. Non-organized

involvement is also inversely correlated with depressive symptoms, and researchers attribute this

to the sense of meaning and purpose individuals gain from it (Ellison et al., 2011).

Through researching the necessity of multicultural perspectives in education and

counseling, and advocating for multiculturalism in the therapy setting, Sue, Arredondo, and

McDavis (1992) allow therapists to understand the need to be culturally aware and unbiased.

Because immigration rates have increased, the United States has become more diverse than ever.

It is necessary to have the skills to work with documented immigrants, undocumented

immigrants, and other minorities who have a different cultural background (Sue, Arredondo, &

McDavis, 1992). Another important factor counselors need to take into consideration is the way

therapists attempt to apply the same treatment to all clients without tailoring it to the individual.

Applying Western therapeutic techniques to clients from various ethnic backgrounds and

cultures has not been very effective (Sue, Arredondo, & McDavis, 1992).


Despite the numerous advances in the field of community psychology, an important

question remains unanswered. Now that the field of community psychology has been established

as a significant discipline, many experts, including Toro (2005), ask the question, where do we

go from here? Community psychology is experiencing a crisis because there is not a definite

direction for the continuation of the field. Toro (2005) suggests that the field should attempt an

expansion in order to include more people that could benefit from the expertise of community

psychologists. Division 27 of the APA hit its peak membership of 1,800 members in 1983, which

included APA members, non-APA members, and students. Thus, not only does the field of

community psychology promote diversity, but the APA does as well. Membership in community

psychology organizations has also grown significantly. Specifically, there are approximately 200

members in Australia and New Zealand, 100 in Canada, 250 in Europe, 400 in Latin America,

and 400 in Japan. Adding the current 1,350 international members from all the regions to the

1,000 already in SCRA equates to more than 2,000 members. Another important aspect of the

SCRA was that it was one of the most diverse divisions in the APA with 23% of its APA

members identifying as an ethnic minority (Toro, 2005). If non-APA members and students were

to be added, then it would be even more diversified. As a way to expand community psychology

further, Toro (2005) suggests expanding internationally, moving outside the academic setting,

increasing the participation of students and early career professionals, and continuing to include

ethnic minorities. Having defined itself as an advocate for the less fortunate, the field of

community psychology can go virtually anywhere from here.


References

Anglin, D. M., Alberti, P. M., Link, B. G., & Phelan, J. C. (2008). Racial differences in beliefs

about the effectiveness and necessity of mental health treatment. American Journal of

Community Psychology, 42(1/2), 17-24.

Duffy, K.G. & Wong, F.Y. (2003). Community psychology. Boston: Allyn and Bacon.

Ellison, C. G., Finch, B. K., Ryan, D., & Salinas, J. J. (2009). Religious involvement and

depressive symptoms among Mexican-origin adults in California. Journal of Community

Psychology, 37(2), 171-193. doi:10.1002/jcop.20287

Fortuna, L. R., Alegria, M., & Gao, S. (2010). Retention in depression treatment among ethnic

and racial minority groups in the United States. Depression & Anxiety (1091-4269),

27(5), 485-494. doi:10.1002/da.20685

González-Prendes, A., Hindo, C., & Pardo, Y. (2011). Cultural values integration in cognitive-

behavioral therapy for a Latino with depression. Clinical Case Studies, 10(5), 376-394.

doi:10.1177/1534650111427075

Grames, H. A. (2006). Depression, anxiety, and ataque de nervios: The primary mental health

care model in a Latino population. Journal Of Systemic Therapies, 25(3), 58-72.

doi:10.1521/jsyt.2006.25.3.58

Nelson, G.B., Prilleltensky, I. (2005). Community psychology: In pursuit of liberation and well-

being. New York: Palgrave Macmillian.

Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and

standards: A call to the profession. Journal of Multicultural Counseling and

Development, 20(2), 64-88. doi:10.1002/j.2161-1912.1992.tb00563.x


Toro, P. (2005). Community Psychology: where do we go from here? American Journal of

Community Psychology, 35 (1-2), 9-6. doi:10.1007/s10464-005-1883-y

community psychology and treatments for depression based on ethnicity

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