It is a truth universally acknowledged that to practice in
any client-centred profession one must always consider the influence of culture
on the individual. An individual’s cultural context is such a unique and
integral part of their identity- shaping their opinions, approaches and understanding
of an activity and of you, as a person. After all, we are the products of the
circumstances we came from, our personal backgrounds and history are a major influence
on how we respond to people and what they ask of us.
Until next week,
Kaylee
Wegner, L., & Rhoda, A. (2015). The influence of cultural beliefs on the utilisation of rehabilitation
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Over my years as a student, I have worked with clients and
other team members from diverse cultural backgrounds. There is no switch that
flicks on in your brain when you encounter someone from a different culture
than yours, nothing that immediately triggers a new set of behaviours that is
in keeping with their beliefs, instead, over time you build up a repertoire of
mannerisms and considerations to include during interactions. This is unconscious,
a nod of greeting to an elderly male, a two-handed handshake, an “aunty” or “ma”
before an older woman’s name; all of which are picked up throughout life and
still will never be the perfect fit for every person, even of the same culture.
Culture itself is defined as “the customary beliefs, social forms, and material
traits of a racial, religious, or social group” and “the set of values,
conventions, or social practices associated with a particular field, activity,
or societal characteristic”[1].
To me, this means that all people have a set of beliefs, values and practices
that are unique to their context; this includes their religious background, the
society they form part of, and the racial group they belong to. Cultural context
differs so incredibly from person to person. Growing up in the same tax
bracket, neighbourhood and religious group as another, does not infer that you
will have the same cultural beliefs. Culture is ingrained in upbringing and
family, as well as intrinsically- it is what you identify with and as.
Being a member of the rainbow nation does not make me an
expert on culture. In fact, the cultural formulation component of our case
studies is one of the most difficult and soul-searching aspects of my case. It
results in me having to truly examine the life of my client, their family
dynamics and structure, their roles, and their beliefs. Once this is done, a
great amount of introspection occurs, to find out where our differences lie and
what influence this had on our therapeutic relationship. The therapeutic relationship
is certainly affected by culture. The way I talk, touch and approach my client
is all done with consideration to their cultural values. There are certain
actions that are appreciated across all cultures and these are largely based on
respect and common curtesy. What I’ve noticed during my fieldwork, is that
people appreciate your attempt to understand and get to know them. I have learnt to ask client’s how they would
like to be addressed, have made an attempt to include non-English first
language phrases in conversations, ask permission before physically handling a
client, gain more insight into a client’s activities of choice and how they
perform tasks (instead of assuming these are identical to mine), and ask direct
questions about their personal beliefs and values to allow for a deeper
understanding of their context. The client therefore feels respected and
understood, and as a therapist you are protecting yourself against unintentionally
offending the client. More so than unintentionally offending, is the need to identify
where you and the client clash culturally and how you can work around this
without harming the therapeutic relationship.
Currently, both of my clients are of completely different
cultural backgrounds to each other and to me. Client A is a male from an Islamic
cultural background whilst Client B is a female from a traditional isiZulu
background. During intervention with Client A, I must be mindful of his religious
beliefs and practices. A session I am planning to conduct with him next week
will involve preparing food, as I’m aware of his cultural background it is
therefore essential that the meal I aim to prepare with him is acceptable for
him to eat based on his religious beliefs. With this in mind, I will either use
Halal meat or no meat at all in the activity. Another cultural aspect to
consider in intervention with Client A is how his culture influences the way he
eats. When assessing the client, I noted that he ate slowly one handed and was
uncomfortable using his fork, I then considered introducing him to a hemi- fork
or plate guard that could make the process easier. However, upon discussing this
with the client, he rejected the idea, explaining that at home he doesn’t use
utensils to eat and his family eat all their meals with their hands. I could
have planned an elaborate treatment session to improve his hand functioning, but
this was unnecessary as the client’s cultural beliefs would’ve clashed with the
“problem” I had identified. Ironically, Client B was also observed eating with
her hands and I had to decide whether intervention was necessary. When I asked
her if she, too, came from a cultural background where eating with your hands
is encouraged, she stated it was not and explained that she would normally use
a fork but cannot form the correct grip at present. Here, I was able to intervene
because my intervention (a universal cuff and built-up-handle on spoon) were
culturally appropriate and would enable her to perform occupations as she would
normally.
When working with clients of diverse cultural backgrounds it
is also important to understand what their views are about their health, as this
will influence how they comply with treatment. Client B comes from a cultural
background where she would usually rely on traditional medicine
and healing to address any health problems and has done so in the past. However,
she is currently being treated using Western medicine and treatment approaches.
When we discussed her understanding about her diagnosis, medication and treatment
she admitted to being confused and having blind faith that the doctors knew
what they were doing. To some degree, this does impact on her compliance with
rehabilitation. The client is expecting Western medicine to perform miracles
and when progress is slow and she does not note obvious improvements, this
could lead to her rejecting the treatment, losing faith and seeking an alternative
approach. My role is to ensure that all of the interventions that I perform are
clear and understandable and to present information in a way that is not overwhelming
but a simplification of relevant information.
During future interventions, I also hope to include elements
of role fulfillment. Both of my clients have important roles within their households
and have particular beliefs about the duties associated with these roles. Client
B is a single mom who is dedicated to raising her children and has always been
hands-on in caring for them. In order to focus on her fulfilling this role
which is of huge significance to her, our interventions must focus on improving
her independence- as only once she can care for herself, can she care for
others. This shift of focus has been a challenging one, as it is frustrating
for her to have to relearn basic self-care whilst knowing that she is unable to
independently care for her children and fulfill her understanding of the role of
a mother. Similarly, I have planned to incorporate meal preparation into Client
A’s therapy as he is a father and wants to be able to perform the same tasks he
could previously around the home. He has mastered self -care and therefore is in
the position to progress to tasks based around care for others and the home. By
introducing meal preparation, I hope to encourage family-time around meals,
which is of importance to the client and will be a return to some of his familiar
roles.
So yes, it is a truth universally acknowledged that to
practice in any client-centred profession one must always consider the
influence of culture on the individual. Furthermore, we need to consider that
our individual cultures, as therapists, may align or may clash with some of our
clients’ beliefs. This is not the end of the world, but rather a learning
opportunity where we can grow through understanding and learn about adaptation
and the art of compromise. Culture is something to always consider, investigate
and incorporate into therapy, and may just contribute positively to the
strengthening of the therapeutic relationship.
Until next week,
Kaylee
Wegner, L., & Rhoda, A. (2015). The influence of cultural beliefs on the utilisation of rehabilitation
services in a rural South African context: Therapists’ perspective. African Journal of Disability, 4(1).
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