Bilu Y, Witztum E
Department of Psychology, Hebrew University of Jerusalem, Israel.
Isr J Psychiatry Relat Sci. 1994;31(3):170-82; discussion 189-99.
The article deals with the problem of administering therapy in multicultural settings where the therapist and the patient hold divergent explanatory models in regard to the patient's symptoms. Different conceptualizations of the universal structure of symbolic healing stress the importance of therapist-patient compatibility for therapeutic success. In order to reach this compatibility, strategic therapists seek to join the patients' explanatory models and employ metaphors and symbols derived from their cultural world. From a psychodynamic perspective, strategic techniques are often presented as superficial treatments limited to the symptomatic level. In order to deal with this argument, we present a case study of an ultra-orthodox patient with a major depressive episode and describe the treatment which was based on a strategic, culturally sensitive approach. We use the case to discuss theoretical issues arising in the context of multicultural therapy such as the translatability of culturally divergent idioms of distress and the possibility to bring about significant, nonsymptomatic changes through strategic employment of culturally congruent metaphors and symbols.
本文探讨了在多元文化背景下进行治疗时所面临的问题，即在治疗师与患者对于患者症状持有不同解释模型的情况下如何开展治疗。关于象征性治疗的普遍结构的不同概念化强调了治疗师与患者之间的兼容性对于治疗成功的重要性。为了实现这种兼容性，策略性治疗师试图融入患者的解释模型，并运用源自他们文化世界的隐喻和符号。从心理动力学的角度来看，策略性技术常常被视为仅限于症状层面的表面治疗方法。为了回应这一观点，我们呈现了一个患有重度抑郁发作的极端正统派患者的案例研究，并描述了基于具有文化敏感性的策略性方法所进行的治疗。我们通过这个案例来讨论多元文化治疗背景下出现的理论问题，比如文化上不同的痛苦表达方式的可转换性，以及通过策略性地运用文化上相符的隐喻和符号来实现显著的、非症状性改变的可能性。
