Publicado
2022-12-13

Competencia cultural en psicoterapia: un imperativo ético

Cultural competence in psychotherapy: an ethical imperative

DOI: https://doi.org/10.15332/22563067.8206
Natalia Salinas-Oñate
Abner Silva González
Patricia Santibáñez Fernández

Resumen (es)

Este artículo presenta una revisión del concepto de competencia cultural (CC) en psicoterapia, considerando los aspectos históricos que han propiciado su aparición y su actual relevancia para la psicología clínica aplicada. Se examina el concepto de cultura y los principales enfoques en CC. Se revisa críticamente el complejo desafío en la operacionalización de esta competencia, examinando algunas propuestas actuales, y reflexionando en torno a la relevancia de articular psicología cultural y clínica en la formación de psicólogos. La presente revisión, permite relevar un tema que éticamente es primordial para asegurar que los tratamientos psicológicos sean justos y pertinentes para grupos culturalmente diversos, en un país multicultural como Chile.

Palabras clave (es): Competencia cultural, psicoterapia, cultura, salud de las minorías, Chile

Resumen (en)

This article presents a review of the concept of cultural competence (CC) in psychotherapy, considering historical aspects that have favored its appearance and its current relevance for applied clinical psychology. The concept of culture and the main approaches in CC are examined. The complex challenge in the operationalization of this competence is critically reviewed, examining some current proposals, and reflecting on the relevance of articulating cultural and clinical psychology in the training of psychologists. This review accounts for a topic that is ethically primordial to ensure fair and relevant treatments to culturally diverse groups in a multicultural country such as Chile.

Palabras clave (en): Cultural competence, psychotherapy, culture, minority health, Chile

Referencias

Aggarwal, N. K., Nicasio, A. V., DeSilva, R., Boiler, M., & Lewis-Fernández, R. (2013). Barriers to Implementing the DSM-5 Cultural Formulation Interview: A Qualitative Study. Culture, Medicine and Psychiatry, 37(3), 505–533. https://doi.org/10.1007/s11013-013-9325-z

Alarcón-Muñoz, A. M., & Vidal-Herrera, A. C. (2005). Dimensiones culturales en el proceso de atención primaria infantil: perspectivas de las madres. Salud Pública de México, 47(6), 440–446. https://doi.org/10.1590/s0036-36342005000600008

American Psychiatric Association. (2013). Resource Document on Cultural Psychiatry as a Specific Field of Study Relevant to the Assessment.

American Psychological Association. (2003). Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists. American Psychologist, 58(5), 377–402. https://doi.org/10.1037/0003-066X.58.5.377

Anderson, K. N., Bautista, C. L., & Hope, D. A. (2019). Therapeutic alliance, cultural competence and minority status in premature termination of psychotherapy. American Journal of Orthopsychiatry, 89(1), 104–114. https://doi.org/10.1037/ort0000342

Bernal, G., Jiménez-Chafey, M. I., & Domenech Rodríguez, M. M. (2009). Cultural Adaptation of Treatments: A Resource for Considering Culture in Evidence-Based Practice. Professional Psychology: Research and Practice, 40(4), 361–368. https://doi.org/10.1037/a0016401

Bernales, M., Cabieses, B., McIntyre, A. M., & Chepo, M. (2017). Challenges in the health care of international migrants in Chile. Revista Peruana de Medicina Experimental y Salud Publica, 34(2), 167–175. https://doi.org/10.17843/rpmesp.2017.342.2510

Bernales, M., Pedrero, V., Obach, A., & Pérez, C. (2015). Competencia Cultural en Salud: una necesidad urgente en trabajadores de la salud. Revista médica de Chile, 143(3), 401–402. https://doi.org/10.4067/s0034-98872015000300018

Betancourt, H., & López, S. R. (1993). The study of culture, ethnicity, and race in american psychology. American Psychologist, 48(6), 629–637. https://doi.org/10.1037/0003-066X.48.6.629

Betancourt, H. (2015). Investigación sobre cultura y diversidad en psicología: Una mirada desde el modelo integrador. Psykhe, 24(2). https://doi.org/10.7764/psykhe.24.2.974

Carreño, A., Blukacz, A., Cabieses, B., & Jazanovich, D. (2020). “No one seems ready to hear what I’ve seen:” Mental health care for refugees and asylum seekers in Chile. Salud Colectiva, 16, 1–16. https://doi.org/10.18294/SC.2020.3035

Chu, J., Leino, A., Pflum, S., & Sue, S. (2016). A model for the theoretical basis of cultural competency to guide psychotherapy. Professional Psychology: Research and Practice, 47(1), 18–29. https://doi.org/10.1037/pro0000055

Cross, T. L., Bazron, B. J., Dennis, K. W., & Isaacs, M. R. (1989). Culturally Competent System of Care: A Monograph on Effective Services for Minority Children Who Are Severely Emotionally Disturbed. National Technical Assistance Center for Children’s Mental Health, Georgetown University Child Development Center.

de Haan, A. M., Boon, A. E., de Jong, J. T. V. M., & Vermeiren, R. R. J. M. (2018). A review of mental health treatment dropout by ethnic minority youth. Transcultural Psychiatry, 55(1), 3–30. https://doi.org/10.1177/1363461517731702

Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (Eds.). (2010). The heart and soul of change: Delivering what works in therapy (2nd ed.). American Psychological Association. https://doi.org/10.1037/12075-000

Espinosa-Duque, D., & Krause, M. (2020). El desafío de integrar teoría, investigación y práctica clínica en psicoterapia. CES Psicología, 13(3), 1–9. https://doi.org/10.21615/cesp.13.3.15

Flynn, P. M., Betancourt, H., Emerson, N. D., Nunez, E. I., & Nance, C. M. (2019). Health Professional Cultural Competence Reduces the Psychological and Behavioral Impact of Negative Healthcare Encounters. Cultural Diversity and Ethnic Minority Psychology, November. https://doi.org/10.1037/cdp0000295

Fung, K., Andermann, L., Zaretsky, A., & Lo, H. T. (2008). An integrative approach to cultural competence in the psychiatric curriculum. En Academic Psychiatry (Vol. 32, Número 4, pp. 272–282). https://doi.org/10.1176/appi.ap.32.4.272

Fung, K., & Dennis, C. L. (2010). Postpartum depression among immigrant women. En Current Opinion in Psychiatry (Vol. 23, Número 4, pp. 342–348). https://doi.org/10.1097/YCO.0b013e32833ad721

Fung, K., Lo, H. T., Srivastava, R., & Andermann, L. (2012). Organizational cultural competence consultation to a mental health institution. Transcultural Psychiatry. https://doi.org/10.1177/1363461512439740

Fung, K., & Lo, T. (2017). An Integrative Clinical Approach to Cultural Competent Psychotherapy. Journal of Contemporary Psychotherapy, 47(2), 65–73. https://doi.org/10.1007/s10879-016-9341-8

Gainsbury, S. M. (2017). Cultural Competence in the Treatment of Addictions: Theory, Practice and Evidence. Clinical Psychology & Psychotherapy, 24(4), 987–1001. https://doi.org/10.1002/cpp.2062

Hall, G., Iwamasa, G., & Smith, J. (2003). Ethical principles of the psychology profession and ethnic minority issues. En Handbook of professional ethics for psychologists: Issues, questions, and controversies (pp. 301–318).

Huey, S. J., Tilley, J. L., Jones, E. O., & Smith, C. A. (2014). The contribution of cultural competence to evidence-based care for ethnically diverse populations. Annual Review of Clinical Psychology, 10, 305–338. https://doi.org/10.1146/annurev-clinpsy-032813-153729

Kirmayer, L. J. (2012). Rethinking cultural competence. Transcultural Psychiatry. https://doi.org/10.1177/1363461512444673

Koç, V., & Kafa, G. (2018). Cross-Cultural Research on Psychotherapy: The Need for a Change. Journal of Cross-Cultural Psychology, 50(1), 100–115. https://doi.org/10.1177/0022022118806577

López, S. R., Ribas, A. C., Sheinbaum, T., Santos, M. M., Benalcázar, A., Garro, L., & Kopelowicz, A. (2020). Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence. Transcultural Psychiatry, 57(4), 594–609. https://doi.org/10.1177/1363461520909599

Ministerio de Salud. (2017). Plan Nacional de Salud Mental 2017-2025.

Ministerio de Salud. (2018). Encuesta Nacional de Salud 2016-2017. Segunda entrega de resultados.

Moleiro, C., Freire, J., Pinto, N., & Roberto, S. (2018). Integrating diversity into therapy processes: The role of individual and cultural diversity competences in promoting equality of care. Counselling and Psychotherapy Research, 18(2), 190–198. https://doi.org/10.1002/capr.12157

Moodley, R., & Palmer, S. (2014). Race, culture and psychotherapy: Critical perspectives in multicultural practice. R. Routled.

Oduola, S., Craig, T. K. J., Das-Munshi, J., Bourque, F., Gayer-Anderson, C., & Morgan, C. (2019). Compulsory admission at first presentation to services for psychosis: does ethnicity still matter? Findings from two population-based studies of first episode psychosis. Social Psychiatry and Psychiatric Epidemiology, 54(7), 871–881. https://doi.org/10.1007/s00127-019-01685-y

Pedrero, V., Bernales, M., Chepo, M., Manzi, J., Pérez, M., & Fernández, P. (2020). Development of an instrument to measure the cultural competence of health care workers. Revista de Saude Publica, 54, 1–10. https://doi.org/10.11606/S1518-8787.2020054001695

Pedrero, V., Bernales, M., & Pérez, C. (2018). Migración Y Competencia Cultural: Un Desafío Para Los Trabajadores De Salud. Revista Médica Clínica Las Condes, 29(3), 353–359. https://doi.org/10.1016/j.rmclc.2018.03.007

Pérez, C., Pedrero, V., Bernales, M., & Chepo, M. (2018). Competencia cultural: La necesidad de ir más allá de las diferencias raciales y étnicas. Atención Primaria, 50(9), 565–567. https://doi.org/10.1016/j.aprim.2017.12.007

Polanco, K., Vergara, C., & Santibáñez, P. (2019). La práctica y la vida hacen al terapeuta: comprendiendo y reconociendo resonancias. Revista Argentina de Clinica Psicologica, 28(3), 234–243. https://doi.org/10.24205/03276716.2019.1097

Ridley, C. R. (1985). Imperatives for ethnic and cultural relevance in psychology training programs. Professional Psychology: Research and Practice, , 16, 611– 622.

Rivas, K., Rojo, A., Zavala, A., & Santibáñez, P. (2020). Secuencia del uso de la resonancia: desde la historia invisible a la intervención. Redesdigital, 41, 31–48.

Rodríguez, D. M., & Niño, J. A. (2006). Marco comprensivo para el estudio de los procesos de formación de terapeutas. Diversitas, 2(1), 42–54.

Salinas-Oñate, N., Baeza-Rivera, M. J., Mellor, D., & Ossa, X. (2019). Beliefs about psychotherapy among adults in La Araucanía, Chile. Revista de Psicología, 28(1), 1–13. https://doi.org/10.5354/0719-0581.2019.53827

Salk, R. H., Hyde, J. S., & Abramson, L. Y. (2017). Gender differences in depression in representative national samples: Meta-analyses of diagnoses and symptoms. Psychological Bulletin, 143(8), 783–822. https://doi.org/10.1037/bul0000102

Schnyder, N., Panczak, R., Groth, N., & Schultze-Lutter, F. (2017). Association between mental health-related stigma and active help-seeking: Systematic review and meta-analysis. British Journal of Psychiatry, 210(04), 261–268. https://doi.org/10.1192/bjp.bp.116.189464

Servicio Jesuita a Migrantes. (2019). Población migrante en Chile.

Soto, A., Smith, T. B., Griner, D., Rodríguez, M. D., & Bernal, G. (2018). Cultural adaptations and therapist multicultural competence: Two meta-analytic reviews. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.22679

Sue, D. W., Ivey, A. E., & Pedersen, P. B. (1996). A theory of multicultural counseling and therapy. En D. W. Sue, A. E. Ivey, & P. B. Pedersen (Eds.), A theory of multicultural counseling and therapy. Thomson Brooks/Cole Publishing Co.

Sue, D. W., & Sue, D. (1990). Counseling the culturally different: Theory and practice. En Counseling the culturally different: Theory and practice (2nd ed.). John Wiley & Sons.

Sue, S., & Zane, N. (2009). The role of culture and cultural techniques in psychotherapy: A critique and reformulation. Asian American Journal of Psychology, S(1), 3–14. https://doi.org/10.1037/1948-1985.s.1.3

Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The Case for Cultural Competency in Psychotherapeutic Interventions. Annual Review of Psychology, 60(1), 525–548. https://doi.org/10.1146/annurev.psych.60.110707.163651

Sun, S., Hoyt, W. T., Brockberg, D., Lam, J., & Tiwari, D. (2016). Acculturation and Enculturation as Predictors of Psychological Help-Seeking Attitudes ( HSAs ) Among Racial and Ethnic Minorities : A Meta-Analytic Investigation. Journal of Counseling Psychology, 63(6), 617–632. https://doi.org/10.1037/cou0000172

Tehee, M., Isaacs, D., & Rodríguez, M. M. D. (2020). The elusive construct of cultural competence. En Handbook of Cultural Factors in Behavioral Health (pp. 11–24). Springer.

Triandis, H. C. (2002). Subjective Culture. Online Readings in Psychology and Culture, 2(2), 544–550. https://doi.org/10.9707/2307-0919.1021

Wampold, B. E. (2013). The good, the bad, and the ugly: A 50-year perspective on the outcome problem. Psychotherapy, 50(1), 16–24. https://doi.org/10.1037/a0030570

Watson, P., Raju, P., & Soklaridis, S. (2017). Teaching Not-Knowing: Strategies for Cultural Competence in Psychotherapy Supervision. Academic Psychiatry. https://doi.org/10.1007/s40596-016-0552-9

Cómo citar

Salinas-Oñate, N., Silva González , A., & Santibáñez Fernández, P. (2022). Competencia cultural en psicoterapia: un imperativo ético. Diversitas, 18(2). https://doi.org/10.15332/22563067.8206