Having grown up in Bermuda and traveled to various countries in the Caribbean, I have always had a love of Caribbean culture and customs. From the reggae/dancehall music and traditional dishes to the unique accents and dialects, Caribbean life has always been a fascination of mine. When I began my PhD program in clinical psychology in 2012, I knew that I wanted to focus much of my research and clinical work on Caribbean populations.
Research has shown that individuals from Caribbean countries are migrating to the United States in increasing frequency [1]. In an effort to provide culturally responsive and competent services, it is important to be mindful of certain factors when working with this population.
1. Diversity
Although I have already used the term “Caribbean” several times, it is important to note that the Caribbean community is not by any means a homogenous group. In fact, the Caribbean consists of various countries in the Caribbean Sea, stretching from the Bahamas in the north to the coast of South America.
The Caribbean community consists of larger islands, such as Cuba, Jamaica, Puerto Rico, Haiti, and the Dominican Republic, as well as smaller islands, like St. Lucia, Barbados, Trinidad, and Tobago. Each island presents with cultural differences and varies in terms of racial demographics, geographic landscape, and historical legacies of slavery [2].
When working with individuals from the Caribbean, it is essential to inquire about the specific country of origin. If you can, do a little extra research about the island to discover the history and customs. An appreciation of the broad diversity and uniqueness of the Caribbean will go a long way in establishing rapport and maintaining a strong therapeutic alliance.
2. Stigma
For decades, researchers and scholars have discussed the prevalence of the stigma associated with mental health within the Caribbean. Individuals dealing with mental health concerns may be shunned and viewed as weak [3]. The fact that psychological distress and mental illness are often viewed as indicators of moral weakness presents a major barrier to treatment in many Caribbean countries.
Many Caribbean children are socialized and taught to “be strong” and “move on” from distress. Thus, talking to a service provider or receiving mental health assistance is frowned upon. It is often more socially acceptable to seek help from a religious leader, and individuals may be encouraged to “pray about it.”
The stigma surrounding mental health treatment, coupled with deeply ingrained cultural values of resiliency, self-reliance, and self-silencing [4] can contribute to resistance to mental health services.
In both my personal and professional life, I have witnessed the cultural stigma tied to mental health treatment. When speaking with Caribbean friends, there is a shame and secrecy tied to depression and anxiety, for example. When working with Caribbean clients, I have observed them fearfully peering around the corner, worried about being seen leaving my office.
Educating Caribbean clients about the benefits of counseling, informing them of confidentiality (and its limits), and normalizing their experiences will help to reduce the negative stigma associated with seeking professional help.
3. Cultural Mistrust
Another factor that is important to consider when working with Caribbean clients is the notion of “cultural mistrust.” This topic was the subject of my dissertation (https://www.omicsonline.org/open-access/cultural-mistrust-conspiracy-theories-and-attitudes-towards-hiv-testing-among-african-americans-2155-6113-1000602.php?aid=77185 ) and so much of my work in graduate school. It can be an important variable to consider when working with any minority group.
The notion that Blacks (and other minority populations) have developed “paranoid-like behaviors” due to past and present experiences with racism and oppression was espoused by Grier and Cobb (1968) in their classic book Black Rage. As research on the cultural influences on mental health has evolved, the notion of cultural paranoia has been reconceptualized as cultural mistrust, and many clinicians and researchers have adopted this idea as a fundamental aspect of the Black experience [5].
Research has shown that cultural mistrust may help to explain why Blacks underutilize some mental health facilities [6], and various authors have asserted that mistrust, in general, may play a crucial role in the counseling process and in Black clients’ attitudes towards White therapists [7].
Within Caribbean communities, cultural stereotyping of mental health services can result in a reluctance to seek professional counseling or, in more extreme cases, total avoidance of mental health treatment [8], [9].
Feelings of cultural mistrust are typically deeply ingrained and transmitted from one generation to the next through socialization practices (e.g., conveying cautions or warnings about certain racial groups). Thus, it is important for clinicians of all racial backgrounds to be sensitive to a Caribbean client’s lived experiences and to build sincere and genuine rapport.
In therapeutic interventions such as cognitive-behavioral therapy (CBT), clinicians can, for example, explore the impact of transgenerational traumas, such as racism and racial oppression. Genuine inquiry helps to build trusting relationships, which in turn helps to counterbalance feelings of mistrust.
4. Collectivistic Values
In general, Caribbean cultures espouse collectivist values as opposed to individualistic ones [10]. In the United States, a primarily individualistic culture, ties between individuals are often relatively loose; people are essentially looking after themselves and their immediate families.
However, in communities such as the Caribbean, individuals are often integrated into strong, cohesive groups consisting of parents, siblings, uncles, aunts, grandparents, neighbors, friends, friends of friends, friends of friends of friends, etc. With this communal focus often comes unquestioning loyalty. As such, self-disclosure to “others” (e.g., a therapist) is often perceived as a form of betrayal/disloyalty [3].
An understanding of the value of family, community, and in-group loyalty within Caribbean culture can help with the interpretation of body gestures, eye contact, silence, and interpersonal physical distance. Having this knowledge will undoubtedly affect the conceptualization of the client.
Within our field, multicultural competence is an ongoing process that requires us to constantly improve in areas of knowledge, attitudes and skills. We are ethically responsible for providing culturally appropriate services to our clients.
Of course, it is impossible to know everything about every culture, but it is possible to remain open and curious. As previously emphasized, the aforementioned factors by no means apply to all Caribbeans, but it is my hope that this post can shed light on some of the important points to consider when working with clients from this beautiful region.
References
[1] Thomas, K. J. A. (2012). Contemporary black Caribbean immigrants in the United States. In R. Capps & M. Fix (Eds.), Young children of Black Immigrants in America: Changing flows, changing faces (pp. 21–44). Washington, DC: Migration Policy Institute.
[2] Waters, C. (2004). Black Identities: West Indian immigrant dreams and American realities. Cambridge, MA: The Russell Sage Foundation and Harvard. University Press.
[3] Marwaha, S., & Livingston, G. (2002). Stigma, racism and choice: Why do depressed ethnic elders avoid psychiatrists? Journal of Affective Disorders, 72, 257–265.
[4] Ali, A., & Toner, B. B. (2001). Symptoms of depression among Caribbean women and Caribbean-Canadian women: An investigation of self-silencing and domains of meaning. Psychology of Women Quarterly, 25, 175–180.
[5] Whaley, A. L. (2001). Cultural mistrust and mental health services for African Americans: A review and meta-analysis. The Counseling Psychologist, 29(4), 513-531.
[6] Nickerson, K. J., Helms, J. E., & Terrell, F. (1994). Cultural mistrust, opinions about mental illness, and Black students’ attitudes toward seeking psychological help from counselors. Journal of Counseling Psychology, 41, 378-385.
[7] Townes, D. L., Cunningham, N. J., & Chavez-Korell, S. (2009). Reexamining the Relationships Between Racial Identity, Cultural Mistrust, Help-Seeking Attitudes, and Preference for a Black Counselor. Journal Of Counseling Psychology, 56(2), 330-336. doi:10.1037/a0015449
[8] Campbell, C., & McLean, C. (2002). Inter-ethnic comparisons in peoples’ accounts of local community participation: The context of health inequalities in England. Journal of Community and Applied Social Psychology, 12(1), 13–30.
[9] Campbell, C., Cornish, F., & McLean, C. (2004). Social capital, participation and the perpetuation of health inequalities: Obstacles to African-Caribbean participation in ‘partnerships’ to improve mental health. Ethnicity and Health, 9(3), 305–327.
[10] Henry, F. (1994). The Caribbean diaspora in Toronto: Learning to live, events and prediction of course of disorder in unipolar depressed patients. Canadian Journal of Behavioral Science, 21, 377–388.
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Do you have any suggestions or resources for working with individuals from Haiti and determining if there is a psychotic disorder present versus cultural/religious beliefs?