Problems associated with culture contact in the psychotherapeutic setting: disparity of expectations between the western-trained therapist and the non-western patient.

Observations made in this paper are based on work with a group of lower-class French-speaking North Africans receiving treatment at a Community Mental Health Centre in Jaffo. Experience with this group revealed a fundamental disparity between patients' and therapists' expectations from therapy. Patients generally expect tangible, quick relief and regard themselves as passive recipients of a procedure: therapists hope for some form of participation on the patients' part and view treatment as a slow process. Patients' expectations appeared to derive from basic features of their personalities. It is hypothesized that members of this group are 'psychologically undifferentiated': thus, among other things, they have poorly-developed identities, lack self-direction and stereotype themselves as subordinate beings, acted upon by authority figures. The present approach differs from the usual attitude adopted towards patients of this kind since it argues that it is possible to foster independence amongst them. It is proposed that this can be done only if the patient is regarded as an active participant in the therapeutic experience and if one uses the clinical situation as a fundamental learning experience. On a more general level, it is speculated that the observations and analysis presented here are not specific to the ethnic group dealt with, but are applicable to any disadvantaged lower-class group.