Global Perspectives on the Teaching and Learning of Intercultural Psychotherapy

  • Renato D. AlarcónEmail author


Globalisation, a process accelerated by massive world migration and increasingly sophisticated technology, has also generated a new set of population exchanges. Amongst other things, these circumstances bring a challenge to the field of mental health through the overwhelming need to provide care to immigrants, refugees and displaced individuals and families, including adequate psychotherapeutic support. It is in this context that intercultural psychotherapy, a set of principles that combine humanistic concerns and clear clinical indications, has become a decisive management component. The teaching and learning processes involved in this approach require solid theoretical bases, adequate curricular development, locations and cogent practical applications. The most salient feature of the intercultural psychotherapeutic encounter is the mutual recognition of cultural differences between patient and therapist, and a determined joint attempt to build a close and constructive therapeutic relationship. This chapter examines the challenges in the teaching and learning of intercultural psychotherapy worldwide, along with the strengths and weaknesses of its study and research initiatives, and positive results in theoretical, technical and practice areas. The intercultural approach can, indeed, be considered essential to all types of psychotherapy, a defining ingredient of the transactions shaping the “meeting of minds” represented by and reflected in the process. Intercultural psychotherapy must be part both of modern comprehensive training conceptions and of the philosophical basis of multidisciplinary teamwork in the field of mental healthcare.


Intercultural psychotherapy Cultural psychiatry Migration Psychotherapy education Psychiatric training Multidisciplinary teamwork 


  1. 1.
    McNeely IF, Wolberton L. Reinventing knowledge: from Alexandria to the internet. New York: Norton; 2010.Google Scholar
  2. 2.
    Bitterli U. Cultures in conflict. Encounters between European and non-European cultures, 1492–1800. Stanford: Stanford University Press; 1986.Google Scholar
  3. 3.
    Price RK, Shea BM, Mookherjee HN, editors. Social psychiatry across cultures. Studies from North America, Asia, Europe, and Africa. New York: Plenum Press; 1995.Google Scholar
  4. 4.
    Standal SW, Corsini RJ, editors. Critical incidents in psychotherapy. Englewood Cliffs: Prentice Hall; 1959.Google Scholar
  5. 5.
    Zeigler K, Camarota SA. Immigrant population hits record 42.1 million in second quarter of 2015. Center for Immigration Studies, April 2015 Report.Google Scholar
  6. 6.
    Draguns JG, Tanaka-Matsumi J. Assessment of psychopathology across and within cultures: issues and findings. Behav Res Ther. 2003;41:755–76.CrossRefGoogle Scholar
  7. 7.
    Negy C, editor. Cross-cultural psychotherapy: toward a critical understanding of diverse clients. 2nd ed. Reno: Bent Tress Press; 2008.Google Scholar
  8. 8.
    Kirmayer LJ. Psychotherapy and the cultural concept of the person. Transcult Psychiatry. 2007;44:232–57.CrossRefGoogle Scholar
  9. 9.
    Jacoby R. The repression of psychoanalysis. Otto Fenichel and the Politiucal Freudians. New York: Basic Books; 1983.Google Scholar
  10. 10.
    Bhugra D. Cultural identities and cultural congruency: a new model for evaluating mental distress in immigrants. Acta Psychiatr Scand. 2005;111:84–93.CrossRefGoogle Scholar
  11. 11.
    Wells LA, Frank JB. Psychopdynamic psychotherapy: from psychoanalytic arrogance to evidence-based modesty. In: Alarcón RD, Frank JB, editors. The psychotherapy of Hope. The legacy of persuasion and healing. Baltimore: Johns Hopkins University Press; 2012. p. 190–214.Google Scholar
  12. 12.
    Erim Y, Morawa E. Psychotherapy with immigrants and traumatized refugees. Psychother Psychosom Med Psychol. 2016;66:397–409.CrossRefGoogle Scholar
  13. 13.
    Waldman K, Rubalcava L. Psychotherapy with intercultural couples: a contemporary psychodynamic approach. Am J Psychother. 2005;59:227–45.CrossRefGoogle Scholar
  14. 14.
    Alarcón RD. Cultural psychiatry: a general perspective. In: Alarcón RD, editor. Cultural psychiatry. Basel: Karger; 2013. p. 1–14.CrossRefGoogle Scholar
  15. 15.
    Forsyth DM, Nash V. Behavioral and condition-specific approaches to psychotherapy. In: Alarcón RD, Frank JB, editors. The psychotherapy of Hope. The legacy of persuasion and healing. Baltimore: Johns Hopkins University Press; 2012. p. 215–37.Google Scholar
  16. 16.
    Alarcón RD, Frank JB, Williams M. Cultural dynamics in psychotherapy and cultural psychotherapies: ingredients, processes and outcomes. In: Alarcón RD, editor. Cultural psychiatry. Basel: Karger; 2013. p. 281–309.CrossRefGoogle Scholar
  17. 17.
    Mayer CH, Viviers R, Flotman AP, Schneider-Stengel D. Enhancing sense of coherence and mindfulness in an ecclesiastical, intercultural group training context. J Relig Health. 2016;55:2023–38. Scholar
  18. 18.
    Lewis-Fernández R, Aggarwal NK, Hinton L, Hinton DE, Kirmayer LJ, editors. DSM-5 handbook on the cultural formulation interview. Washington: American Psychiatric Publishing; 2016.Google Scholar
  19. 19.
    Boutin-Foster C, Foster JC, Konopasek L. Viewpoint: physician, know thyself: the professional culture of medicine as a framework for teaching cultural competence. Acad Med. 2008;83:106–11.CrossRefGoogle Scholar
  20. 20.
    Willen SS. In: Del Vecchio GM, Willen SS, Hannah SD, et al., editors. Pas de trois: medical interpreters, clinical dilemmas and the patient-provider-interpreter triad. New York: Russell Sage Foundation; 2011.Google Scholar
  21. 21.
    Truong A, Wu P, Diez-Barroso R, Coverdale J. What is the efficacy of teaching psychotherapy to psychiatry residents and medical students? Acad Psychiatry. 2015;39(5):575–9. Scholar
  22. 22.
    Kleinman AM. Patients and healers in the context of culture. Berkeley: University of California Press; 1980.Google Scholar
  23. 23.
    Winnicott DW. The maturational processes and the facilitating environment. Studies in the theory of emotional development. London: H. Karnac Books; 1990.Google Scholar
  24. 24.
    BenEzer G. Group counseling and psychotherapy across the cultural divide: the case of Ethiopian Jewish immigrants in Israel. Transcult Psychiatry. 2006;43:205–34.CrossRefGoogle Scholar
  25. 25.
    BenEzer G. From Winnicott’s potential space to mutual creative space: a principle for intercultural psychotherapy. Transcult Psychiatry. 2012;49:323–39. Scholar
  26. 26.
    Meurs P, Cluckers G. The desire for attachment with the culture of origin-migrant families in psychodynamic therapy. Prax Kinderpsychol Kinderpsychiatr. 1999;48:27–36.PubMedGoogle Scholar
  27. 27.
    Heinz A, Bermpohl F, Frank M. Construction and interpretation of self-related function and dysfunction in intercultural psychiatry. Eur Psychiatry. 2012;27(Suppl 2):S32–43. Scholar
  28. 28.
    Kovach JG, Dubin WR, Combs CJ. Psychotherapy training: residents’ perceptions and experiences. Acad Psychiatry. 2015;39:567–74. Scholar
  29. 29.
    McGowen KR, Miller MN, Floyd M, Miller B, Coyle B. Insights about psychotherapy training and curricular sequencing: portal of discovery. Acad Psychiatry. 2009;33(1):67–70. Scholar
  30. 30.
    von Lersner U, Baschin K, Wormeck I, Mösko MO. Guidelines for training in inter-/transcultural competence for psychotherapists. Psychother Psychosom Med Psychol. 2016;66:67–73. Scholar
  31. 31.
    Bagayogo IP, Interian A, Escobar JI. Transcultural aspects of somatic symptoms in the context of depressive disorders. In: Alarcón RD, editor. Cultural psychiatry. Basel: Karger; 2013. p. 64–74.CrossRefGoogle Scholar
  32. 32.
    Nadeem E, Lange JM, Edge D, Fongwa M, Belin T, Miranda J. Does stigma keep poor young immigrant and U.S.-born Black and Latina women from seeking mental health care? Psychiatr Serv. 2007;58:1547–54.CrossRefGoogle Scholar
  33. 33.
    Ong YL, Yap HL. Do intercultural factors play a role in exacerbating psychiatric symptoms? Singap Med J. 2013;54:e16–7.CrossRefGoogle Scholar
  34. 34.
    Seeley KM. Short-term intercultural psychotherapy: ethnographic inquiry. Soc Work. 2004;49:121–30.CrossRefGoogle Scholar
  35. 35.
    Pocreu JB, Martins-Borges L. Co-therapy in intercultural clinical psychology. Sante Ment Que. 2013;38:227–42.CrossRefGoogle Scholar
  36. 36.
    Leising D. Applying principles of intercultural communication to personality disorder therapy. Psychol Psychother. 2008;81:261–72.CrossRefGoogle Scholar
  37. 37.
    Arpin J. Masters of their conditions II: intercultural theatre, narration and stage work with patients and healers. Transcult Psychiatry. 2008;45:355–78. Scholar
  38. 38.
    Ulrey KL, Amason P. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety. Health Commun. 2001;13:449–63.CrossRefGoogle Scholar
  39. 39.
    El-Awad U, Fathi A, Petermann F, Reinelt T. Promoting mental health in unaccompanied refugee minors: recommendations for primary support programs. Brain Sci. 2017;7:E146. Scholar
  40. 40.
    Schouler-Ocak M, Graef-Calliess IT, Tarricone I, Qureshi A, Kastrup MC, Bhugra D. EPA guidance on cultural competence training. Eur Psychiatry. 2015;30:431–40. Scholar
  41. 41.
    Pew Research Center. Attitudes about aging: a global perspective. Population change in the U.S. and the world from 1950 to 2050, 30 Jan 2014. Accessed 17 Nov 2016.
  42. 42.
    Garcia-Naranjo Morales A. The Peruvian migration phenomenon. Lima: Gender and Development Program, Centro de Asesoría Laboral del Perú; Sept 2007.Google Scholar
  43. 43.
    Urzúa MA, Boudon Torrealba S, Caqueo-Urizar A. Salud mental y estrategias de aculturación en inmigrantes colombianos y peruanos en el Norte de Chile. Acta Col Psychol. 2017;20:80–9. Scholar
  44. 44.
    Dalgard OS, Thapa SB, Hauff E, et al. Immigration, lack of control and psychological distress: findings from the Oslo Health Study. Scand J Psychol. 2006;47:551–8.CrossRefGoogle Scholar
  45. 45.
    Missine S, Bracke P. Depressive symptoms among immigrants and ethnic minorities: a population based study in 23 European countries. Soc Psychiatry Psychiatr Epidemiol. 2012;47:97–109.CrossRefGoogle Scholar
  46. 46.
    Minas H, Tsutsumi A, Izutsu T, et al. Comprehensive SDG goals and targets for non-communicable diseases and mental health. Int J Ment Health Syst. 2015;9:12–5.CrossRefGoogle Scholar
  47. 47.
    Taylor PJ, Gooding P, Wood AM, et al. The role of defeat and entrapment in depression, anxiety and suicide. Psychol Bull. 2011;137:391–420.CrossRefGoogle Scholar
  48. 48.
    Akkaya-Kalayci T, Popow C, Waldhör T, Winkler D, Özlü-Erkilic Z. Psychiatric emergencies of minors with and without migration background. Neuropsychiatrie. 2017;31:1–7. Scholar
  49. 49.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition (DSM-5). Washington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  50. 50.
    Gadamer HG. Truth and method. 2nd ed. London: Sheed and Ward; 1989.Google Scholar
  51. 51.
    Qureshi A. Dialogical relationship and cultural imagination: a hermeneutic approach to intercultural psychotherapy. Am J Psychother. 2005;59:119–35.CrossRefGoogle Scholar
  52. 52.
    Markowitz JC, editor. Interpersonal psychotherapy. Washington: American Psychiatric Press; 1998.Google Scholar
  53. 53.
    Wenk-Ansohn M, Gurris N. Intercultural encounters in counselling and psychotherapy – communication with the help of interpreters. Torture. 2011;21:182–5.PubMedGoogle Scholar
  54. 54.
    De Figueiredo JM, Gostoli S. Culture and demoralization in psychotherapy. In: Alarcón RD (Editor), Cultural psychiatry. Basel: Karger, 2013, pp. 75–87.Google Scholar
  55. 55.
    Thornicroft G, Patel V. Including mental health among the new sustainable development goals. Br Med J. 2014;349:g5189.CrossRefGoogle Scholar
  56. 56.
    Slobodin O, de Jong JT. Mental health interventions for traumatized asylum seekers and refugees: what do we know about their efficacy? Int J Soc Psychiatry. 2015;61:17–26. Scholar
  57. 57.
    Penka S, Kluge U, Vardar A, Borde T, Ingleby D. The concept of “intercultural opening”: the development of an assessment tool for the appraisal of its current implementation in the mental health care system. Eur Psychiatry. 2012;(Suppl. 2):S63–9.
  58. 58.
    Schepker R. Institutionalized and individual crisis intervention between Youth Welfare and Adolescent Psychiatry, specified for unaccompanied minor refugees. Prax Kinderpsychol Kinderpsychiatr. 2017;66:47–58. Scholar
  59. 59.
    Bennegadi R. Clinical medical anthropology and immigrant’s mental health in France. Med Trop (Mars). 1996;56:445–52.Google Scholar
  60. 60.
    Uliaszek AA, Zinbarg RE. An examination of the higher order structure of psychopathology and its relationship to personality. J Personal Disord. 2016;30:157–76. Scholar
  61. 61.
    Quirk SE, Berk M, Chanen AM, Koivumaa-Honkanen H, Brennan-Olsen SL, Pasco JA, Williams LJ. Population prevalence of personality disorders and associations with physical health comorbidities and health care service utilization: a review. Pers Disord. 2016;7:136–46. Scholar
  62. 62.
    Schulz W, Shin MA, Schmid-Ott G. Attitudes towards psychotherapy in South Korea and Germany: a cross-cultural comparative study. Nervenarzt. 2018;89:51–7.CrossRefGoogle Scholar
  63. 63.
    Alarcón RD, Frank JB, Williams M. Cultural dynamics in psychotherapy and cultural psychotherapies: ingredients, processes and outcomes. In: Alarcón RD, Frank JB, editors. The psychotherapy of hope. The legacy of Persuasion and Healing. Baltimore: Johns Hopkins University Press; 2012. p. 281–309.Google Scholar
  64. 64.
    Berzoff J, Glanagan LM, Hertz P, editors. Inside out and outside in. Psychodynamic clinical theory and psychopathology in contemporary multicultural contexts. 2nd ed. Lanham: Jason Aronson; 2007.Google Scholar
  65. 65.
    Thornicroft G, Deb T, Henderson C. Community Mental Health Care worldwide: current status and further developments. World Psychiatry. 2016l;15:276–86.CrossRefGoogle Scholar
  66. 66.
    van Loon A, van Schaik DJ, Dekker JJ, Beekman AT. Effectiveness of an intercultural module added to the treatment guidelines for Moroccan and Turkish patients with depressive and anxiety disorders. BMC Psychiatry. 2011;11:13. Scholar
  67. 67.
    Kim MS, Derivois D. Mental issues of clinical research interviews in an intercultural context. Encéphale. 2013;39:360–6. Scholar
  68. 68.
    Bhugra D, Tasman A, Pathare S, Priebe S, Torous J, Arbuckle MR, Alarcón RD, et al. The WPA-Lancet Psychiatry Commission on the future of psychiatry. Lancet Psychiatry. 2017;4:775–818.CrossRefGoogle Scholar
  69. 69.
    Coler MS, Hafner LP. An intercultural assessment of the type, intensity and number of crisis precipitating factors in three cultures: United States, Brazil and Taiwan. Int J Nurs Stud. 1991;28:223–35.CrossRefGoogle Scholar
  70. 70.
    Georgiadou L. You look like them: drawing on counselling theory and practice to reflexively negotiate cultural differences in research relationships. Int J Adv Couns. 2016;38:358–68.CrossRefGoogle Scholar
  71. 71.
    Nance TA. Intercultural communication: finding common ground. J Obstet Gynecol Neonatal Nurs. 1995;24:249–55.CrossRefGoogle Scholar
  72. 72.
    Paré DA. Culture and meaning: expanding the metaphorical repertoire of family therapy. Fam Process. 1996;35:21–42.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Mayo Clinic College of MedicineRochesterUSA
  2. 2.Universidad Peruana Cayetano HerediaLimaPeru

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