Diagnosing Deficits in “Basic Trust” in Multiracial and Multicultural Groups: Individual or Social Psychopathology?

Abstract

Deficiencies in “basic trust” frequently undermine the efficacy of group therapy in multiracial and multicultural groups. It is necessary to distinguish trust deficits caused by individual psychopathology, societal attitudes (“cultural pathology”), or a combination of both. A typology for classifying self-disclosure problems in multicultural and multiracial groups is presented, and illustrated with case material: Mode A, “Good enough trust,” allows patient self-disclosure in multicultural groups; Mode B, Low level of cultural paranoia and high level of functional paranoia; Mode C, Culturally paranoid individual can self-disclose in culturally homogeneous group but mistrusts outsiders; Mode D, Confluent paranoid has high levels of both functional and cultural paranoia. For Modes C and D, it is crucial that experiences of bias be acknowledged and empathized with first before patients will be able to achieve good enough trust to risk self-disclosure. The ethnic composition of the group must be attended to in the placement of these patients. Hospital (inpatient) groups are especially likely to have problems with “basic trust.” The role of the leader in demonstrating empathy, tolerance, racial sensitivity, and appropriate self-disclosure is emphasized. Cultural awareness training, a personal group therapy experience for the therapist, and the use of co-therapists are recommended as ways of minimizing negative countertransference or cultural bias on the part of the leader.