Cultural Aspects of Ethics in Psychotherapy

Alireza Rashtbari, Omid Saed



Background and Aim: Changes such as globalization and migration, which have been widespread at international level in recent years, have led to increased cultural interactions and the transformation of existing communities into multi-cultural communities. In such a situation, awareness of the cultures governing the various communities, the role of culture in diagnosis, treatment, and symptoms of mental disorders, as well as awareness of the impact of therapist's and client's culture on the therapeutic process is necessary. The purpose of the present article is to study the cultural aspects of ethics in different countries such as East Asia, India, Middle Eastern countries, European countries, the United States of America and Africa.

Materials and Methods: In the present narrative review paper, a systematic study was conducted for full-accessible English papers at 2005 to 2015 years time period using "culture", "ethics", "psychotherapy", "cutularal differences" keywords on PubMed, Science Direct and Google Scholar databases. Of total 116 obtained papers, 24 related papers were studied and analyzed.

Findings: The cultural differences between different communities are such that ignoring them could lead to a decline in therapeutic performance of therapist and poor treating outcome. Literature review showed that the APA's ethics code forces psychologists to have knowledge and awareness of cultural, individual, and Mutual respect for the fundamental rights, dignity and authority of all human beings.

Ethical Considerations: Integrity and honesty in reporting, documenting and citing of resources were observed,

Conclusion: The results show that although the therapist may not be familiar with all cultures, the therapist's awareness of his own cultural context, as well as the understanding and acceptance of his cultural differences with the clients, could have contribution in effective advancement of the therapeutic process and improving the quality of the treatment. In addition, there is an extensive need to determine ethical codes proportional to culture of various communities.


Cite this article as: Rashtbari A, Saed O. Cultural Aspects of Ethics in Psychotherapy: A Review. Med Ethics J. 2018; 12(43):e7.


Culture; Ethics; Psychotherapy; Cutularal Differnces

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Sumari M, Jalal FH. Cultural issues in counseling: An international perspective. Counseling, Psychotherapy and Health 2008; 4(1): 24-34.

Hall GCN. Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting and Clinical Psychology 2001; 69(3): 502-510.

Gallardo ME, Johnson J, Parham TA, Carter JA. Ethics and multiculturalism: Advancing cultural and clinical responsiveness. Professional Psychology: Research and Practice 2009; 40(5): 425-435.

Hoop JG, DiPasquale T, Hernandez JM, Roberts LW. Ethics and culture in mental health care. Ethics & Behavior 2008; 18(4): 353-372.

M.Leach M, Harbin JJ. Psychological ethics codes: A comparison of twenty-four countries. International Journal of Psychology 1997; 32(3): 181-192.

Barnett JE, Bivings N. Culturally sensitive treatment and ethical practice. The Maryland Psychologist 2002; 48(2): 8-10.

American Psychological Association. Revision of ethical standard 3.04 of the “ Ethical Principles of Psychologists and Code of Conduct” (2002, as amended 2010). American Psychologist 2016; 71: 900-905.

Sue S. In search of cultural competence in psychotherapy and counseling. American Psychologist 1998; 53(4): 440-448.

Schoen AA. Culturally Sensitive Counseling for Asian Americans Pacific Islanders. Journal of Instructional Psychology 2005; 32(3): 253-258.

Leong FT, Lee SH. A cultural accommodation model for cross-cultural psychotherapy: Illustrated with the case of Asian Americans. Psychotherapy: Theory, Research, Practice, Training 2006; 43(4): 410-423.

Kwan K-LK. The ethical practice of counseling in Asia: an introduction to the special issue of Asian Journal of Counselling. Asian Journal of Counselling 2003; 10(1): 1-10.

Jim J, Pistrang N. Culture and the therapeutic relationship: Perspectives from Chinese clients. Psychotherapy Research 2007; 17(4): 461-473.

LaFromboise TD, Trimble JE, Mohatt GV. Counseling intervention and American Indian tradition: An integrative approach. The Counseling Psychologist 1990; 18(4): 628-654.

Inman AG, Howard EE, Beaumont RL, Walker JA. Cultural transmission: Influence of contextual factors in asian indian immigrant parents' experiences. Journal of Counseling Psychology 2007; 54(1): 93-100.

Timmins F, Neill F, Murphy M, Begley T, Sheaf G. Spiritual care competence for contemporary nursing practice: A quantitative exploration of the guidance provided by fundamental nursing textbooks. Nurse Education in Practice 2015; 15(6): 485-491.

Tiew LH, Creedy DK. Development and preliminary validation of a composite Spiritual Care-Giving Scale. International Journal of Nursing Studies 2012; 49(6): 682-690.

Mueller PS, Plevak DJ, Rummans TA. Religious involvement, spirituality, and medicine: implications for clinical practice. Mayo Clinic Proceedings 2001; 76(12): 1225-1235.

Aliyousefi H, Shirani M. Individual and environment health in Islamic-Iranian culture. Medical Ethics Journal 2009; 3(9): 47-72. [Persian]

Abbasi M, Shamsi Gooshki E, Movahedi H, Saffari S. Spiritual Care at the End of Life (Systematic Review). Medical Ethics Journal 2015; 9(30): 99-133. [Persian]

Hajiesmaeili MR, Abbasi M, Safaiepour L, Fani M, Abdoljabari M, Hosseini SM, et al. Spiritual Health Concept in Iranian Society: Evolutionary Concept Analysis and Narrative Review. Medical Ethics Journal 2016; 10(35): 77-115. [Persian]

Triandis HC. Cross-cultural studies of individualism and collectivism. Nebraska Symposium on Motivation 1989; 37: 41-133.

Rhee E, Uleman JS, Lee HK, Roman RJ. Spontaneous self-descriptions and ethnic identities in individualistic and collectivistic cultures. J Pers Soc Psychol 1995;69(1): 142-152.

Bar S. Iran: Cultural Values, Self images and Negotiation Behavior. Israel: Herzliya Conference Series on the Balance of Israel’s National Security; 2004.

Khodayarifard M, Rehm LP, Khodayarifard S. Psychotherapy in Iran: A case study of cognitive behavioral family therapy for Mrs. A. Journal of Clinical Psychology 2007; 63(8): 745-753.

Tavakoli M. Content and Style of Advice in Iran and Canada/Le Contenu et la style de conseil en Iran et Canada. Canadian Journal of Counselling and Psychotherapy (Online) 2013; 47(2): 299-311.

Broude L. Trans-Cultural psychotherapy: Psychotherapeutic Setting in Non-Western (Arabic) Culture. World Journal Psychotherapy 2011; 1(4): 30-35.

Boghosian S. Counseling and Psychotherapy with Clients of Middle Eastern Descent: A Qualitative Inquiry. Logan, Utah: Utah State University; 2011.

Fakhr El-Islam M. Arab culture and mental health care. Transcultural Psychiatry 2008; 45(4): 671-682.

Al-Krenawi A, Graham JR. Culturally sensitive social work practice with Arab clients in mental health settings. Health & Social Work 2000; 25(1): 9-22.

Dwairy M, Van Sickle TD. Western psychotherapy in traditional Arabic societies. Clinical Psychology Review 1996; 16(3): 231-249.

Wassenaar DR. A history of ethical codes in South African psychology: An insider's view. South African Journal of Psychology 1998; 28(3): 135-145.

Foxcroft CD. Ethical issues related to psychological testing in Africa: What I have learned (so far). Online Readings in Psychology and Culture 2011; 2(2): 7-23.

Williamson ME. The Reluctance of African-Americans to Engage in Therapy. Lincoln, Nebraska: University of Nebraska; 2014.

Johnston ER. South African clinical psychology’s response to cultural diversity, globalisation and multiculturalism: a review. South African Journal of Psychology 2015; 45(3): 374-385.

Hickson J, Christie GM. Research on cross-cultural counselling and psychotherapy: Implications for the South African context. South African Journal of Psychology 1989; 19(3): 162-171.

Boyd-Franklin N. Incorporating spirituality and religion into the treatment of African American clients. The Counseling Psychologist 2010; 38(7): 976-1000.

Baba MM. Cross-Cultural Issues in Comtemporary Counselling Practice: African Experience. British Journal of Research 2015; 2(1): 1-8.

Aviera A. Culturally sensitive and creative therapy with Latino clients. California Psychologist 2002; 35(4): 18-25.

Bernal G, Bonilla J, Bellido C. Ecological validity and cultural sensitivity for outcome research: Issues for the cultural adaptation and development of psychosocial treatments with Hispanics. Journal of Abnormal Child Psychology. 1995; 23(1): 67-82.

Neeleman J, Van Os J. Ethical issues in European psychiatry. European Psychiatry 1996; 11(1): 1-6.

Rhee E, Uleman JS, Lee HK. Variations in collectivism and individualism by ingroup and culture: Confirmatory factor analysis. Journal of Personality and Social Psychology 1996; 71(5): 1037-1054.

Forbes GB, Collinsworth LL, Zhao P, Kohlman S, LeClaire J. Relationships among individualism-collectivism, gender, and ingroup/ outgroup status, and responses to conflict: a study in China and the United States. Aggressive Behavior 2011; 37(4): 302-314.

Smith J. Removing barriers to therapy with MENTS. Keene, New Hampshire: Antioch University New England; 2011.

Pedersen PB. The cultural context of the American Counseling Association code of ethics. Journal of Counseling & Development 1997; 76(1): 23-28.

Sue S, Zane N. The role of culture and cultural techniques in psychotherapy: A critique and reformulation. American Psychologist 1987; 42(1): 37-45.

Sue DW. Culture-specific strategies in counseling: A conceptual framework. Professional Psychology: Research and Practice 1990; 21(6): 424-433.


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