A qualitative study of psychotherapists' approaches to cross-cultural assessment, diagnosis and treatment of posttraumatic stress disorder and major depressive disorder in KwaZulu-Natal, South Africa.

Abstract

Psychiatric illnesses are a reason for major concern for the health and welfare of people internationally and within the South Africa context (Slone et al., 2006; Stein et al). The rates of specific disorders such as Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD) are high within the South African context. This may be attributed to past human rights abuses, and current high rates of poverty, violence and trauma (Edwards, 2005). In South Africa, the process of psychological assessment, diagnosis and interventions can be challenging for psychologists specifically (Knight, 2004), due to the multicultural and multi-lingual contextual nature of the country. In this study, the relevant approaches used by psychotherapists, when assessing, diagnosing and intervening with clients from different ethno-cultural orientations were investigated from an interpretive paradigm in which a qualitative approach was used. Specific reference was given to the assessment, diagnosis and treatment of Major Depressive Disorder (MDD) and Posttraumatic Stress Disorder (PTSD) across cultures. Psychotherapists whom assess, diagnose and treat within private practice from various areas were selected to represent the broader KwaZulu-Natal area. Contextual factors are influential in determining multicultural assessment processes and the cultural competency of a clinician. Clinicians maintain that there is a need for different approaches to assessing, diagnosing and treating clients from different ethno-cultural orientations but also highlight that this is not sufficient in determining the approaches that may suit the needs of clients. The findings of this study highlight that the assessment, diagnosis and treatment of MDD and PTSD across cultures within the South African context is dependent on the clinician‟s perception and awareness of the relationship between culture and pathology. This will ultimately inform the clinician‟s understanding of the client‟s problems; the practical work done in relation to these problems; as well as how clients may respond to interventions used. The transition from the use of standard assessment and perception of cultural sensitivity to the use of multicultural assessment and development of cultural competency was prominent in this study. The need for attention to be given to the notion of clinician bias in developing and maintaining cultural competency in assessing, diagnosing and treating client‟s from multiple ethno-cultural orientations was highlighted in this study.