Researchers: Cultural Understanding Should Influence Counseling Methods

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Stephanie Lusk, left, and Teresia Paul presented research papers this spring at a conference in Thailand.

FAYETTEVILLE, Ark. – People suffering from mental illness and addiction in some nations may face great challenges in treatment and recovery because of societal attitudes, two University of Arkansas researchers are finding as they study counseling methods and the impact of culture on treatment internationally.

Stephanie Lusk and her doctoral student, Teresia Paul, are examining the mental illness and addiction counseling methods of several nations to develop best practices that can be shared across cultures. Each nation’s counselors must tailor treatment by considering the cultural experiences and attitudes of their clients, Lusk and Paul said.

“Our ultimate research goal is to look at what is working best and put ideas together to create a more holistic approach,” said Lusk, an assistant professor of rehabilitation education and research. “We are studying other nations to determine what is working in each country. All of us tend to work in silos and one country doesn’t know what another one is doing. We want to create a best practice model that incorporates culture, and we know we can’t simply apply U.S. or Western methods.”

Lusk and Paul spent 10 days in Nigeria in 2007, and Paul spent 10 days in Indonesia in 2008, meeting with people who provide treatment, including doctors, psychologists, church staff members and social workers.

Lusk and Paul also traveled to Bangkok, Thailand, in April of this year for the International Conference on Education, Psychology, and Society, where they presented research papers on the impact of addiction on the family, residential treatment, culture and self-esteem. Lusk also served as session chair during the conference. They hope to return to Bangkok to continue their research on the correlation between addiction, mental illness and culture.

In Nigeria and Indonesia, Lusk and Paul found a passion among service providers to help people with mental illness and addictions recover but, among the general public, the subject was taboo.

For example, many people in those countries believe that both mental illness and addiction are caused by a spiritual attack on the body, that the person committed a sin or did something else to cause this, they said.

“The stigma is such that people will sometimes drop a family member off blocks away from a hospital so they won’t be seen taking them there,” Paul said. “There is still a stigma in the United States but in these countries it’s worse. Some of the treatment facilities we visited reminded us of what was happening decades ago in the United States.”

Conditions are likely to improve with time, Lusk said, as young people with more progressive ideas about treatment begin to work in mental health counseling. Social customs and poverty also play a role in the systems overseas, she said.

“Some cultures require women to have permission from their parents or their husband to get treatment,” Lusk said. “There is also a lack of resources that hampers treatment. It’s only $300 (in Nigeria) for a six- to eight-week stay in a rehabilitation program but many people can’t afford that. It’s really disheartening that they can’t afford it when that seems so inexpensive to us.”

Lusk and Paul also found that practitioners tended to treat the illness itself without examining the patient’s behavior and environment.

“In the United States, we look at the home, social and family environments and include them as part of treatment,” said Lusk, who also researches and publishes about involving families in counseling when an individual has a mental illness or addiction.

“We’re more comprehensive but that may be related to the fact that more of the patients have insurance, money and resources,” she said.

Paul also has worked at a treatment facility for Native American youth in the United States. There, she added to the knowledge she gained in Nigeria and Indonesia about the need to learn about a patient’s cultural beliefs and connections with their cultural background before forming a treatment plan.

“That experience solidified what I had been learning about how important culture is in treatment,” Paul said. “We learn in the classroom that we have to appreciate different cultures and sometimes that means we are taught stereotypes. Some of the teens at this facility were very connected to their tribes and others didn’t know they were Native American until they came to the facility. A counselor can’t expect those teens to behave the way the traditional ones do. You have to meet them where they are and help them with their cultural identity.”

Lusk joined the faculty of the College of Education and Health Professions in 2012. She previously taught at North Carolina A&T State University, where she met Paul. Paul earned her master’s degree in rehabilitation counseling with a specialization in behavioral addictions at North Carolina A&T, and Lusk recruited her to come to the U of A to pursue a doctorate in rehabilitation education and research. She sand Lusk have worked together on their research for seven years.