Assessing for Acculturation Level may Matter in Mental Health Care
I recently conducted a training on the adaptation of cognitive behavior therapy (CBT) for diverse populations for a group of about eighty-five community mental health clinicians. The training was focused on equipping community mental health clinicians on how to adapt CBT for culturally diverse clients. I was in awe of the dynamic discourse that took place. The feeling of excitement and the energy in the room was undeniable. The clinicians seemed not only genuinely interested in the topic- but also excited. We began by going over general terms such as ethnicity, race, privilege, and humility.
I then realized that perhaps for some of the clinicians, it may have been one of the few times that they had an opportunity to engage in introspection of the self -in terms of diversity issues that may influence the therapeutic process. They seemed to be carried away by one of the exercises we did in which they were asked to identify diversity factors that may label them as belonging to a majority or minority group. All clinicians spoke English and shared that they identified as being part of the majority group in this matter. A handful of the clinicians shared that English was their second language, and one of these clinicians shared that their accent, associated with their native language often lead others to ask them if they were born outside of the U.S. or if they were raised elsewhere. They then shared about their journey via the process of acculturation.
Acculturation is a process in which an individual chooses the adopt the concept of cultural maintenance—that is to maintain their culture of origin (language, values, norms etc.) or they choose the concept of contact and participation, that is to integrate and adopt mainstream language, values and norms (Berry, 1992; Berry & Kim, 1988; Berry & Kim, 1980). The clinician shared that they had successfully integrated into the American culture after living in the U.S. for about seven years-yet they have worked with clients who have lived in the U.S. for over twenty years who still did not speak English. I noticed a tone of judgment in their voice and kindly nudged – asking them to elaborate. They shared that for this client to be most successful in the U.S. they should choose to integrate themselves more effectively into society and adopt the English language. We then had a larger room discussion of the pros and cons of the decision to adopt English as a second language vs. to retain their mother tongue.
The theory of acculturation outlines that being either high or low on cultural maintenance or contact and participation leads to four possible strategies of acculturation: a) integration, which is also known as biculturalism, b) assimilation, also known as the loss of the native culture, c) marginalization, defined as the loss of both the native and dominant culture and lastly, d) separation, defined as increased ethnocentrism of the native culture (Berry & Sam, 1997; Berry, 1992; Berry & Kim, 1988; Berry & Kim, 1980). Amongst these four strategies, research shows that individuals who adopt the strategy of integration have better mental health outcomes compared to those who choose separation (Berry, 2013; Lee, Sobal, & Frongillo, 2000; Rogler, Cortes, & Malgady, 1991). As we continued on this conversation, the clinician received feedbacked from other clinicians in the room such as, “as clinicians we need to respect our client’s choice, regardless if we agree with it or not” and, “I think that even if the client may do better in life if they choose to integrate, it is still their choice, and we must accept it”. The dialogue was rich, and we could have been there for hours! At the end of the day, we realized how much acculturation matters.
Further, we discussed the role of acculturative stress among our clients. Acculturative stress is defined as a stress reaction in response to the process of transitioning and adopting the norms, values and language of the dominant culture (Berry, 1997; Yakishko, 2010). In this process, migrant workers may experience an acculturative stress, a stress reaction in response to life events that are rooted in the experience of acculturation (Berry, 1997). This type of stress is different from general life stress and hassles because it is uniquely linked to migrant workers’ process of transitioning and adapting to their environment, such as linguistic limitations and loss of social status (Berry, 1997; Yakushko, 2010). Interestingly, Berry’s work has found that the greater the cultural difference, the greater level of acculturative stress (1997). This is important as acculturative stress has been found to be associated overall negative health issues such as poorer sleep quality, insomnia, and poorer self-reported physical health (Gonzalez-Guarda, Stafford, Nagy, Befus, & Conklin, 2021).
Needless to say that our conversation on the topic ran beyond the time allotted and we just had to move on. We agreed that at the end of the day, it is up to the client and as clinicians, we should support their self-determination. We also agreed that in some way, shape or form, acculturation matters- in terms of how the client may be experiencing and navigating the process of transitioning – or not, into the dominant culture. Another key take away from the dialogue was the power of assessment. Assessing our client’s level of acculturation may bring to light pertinent information related to their treatment plan. For more information on the matter, consider the Center for Substance Abuse and Treatment, Improving Cultural Competence (2014) manual, as it offers an excellent list of instruments to measure identity and acculturation.
Berry, J. (2013) Professor John Berry, Emeritus Professor of Psychology at Queen’s University, discusses cross-cultural psychology. Prof Berry was Visiting Academic at the Centre for Applied Cross-cultural Research, Victoria University of Wellington, in 2013. Retrieved from: https://www.youtube.com/watch?v=XAm0iqkZCKI
Berry, J. W. (1980). Acculturation as varieties of adaptation. In A. M. Padilla (Ed.). Acculturation: Theory, models, and some new findings (pp. 9 –25). Boulder, CO: Westview Press.
Berry, J. W. (1992). Acculturation and adaptation in a new society. International Migration, 30, 69 – 85. Berry, J. W. (2003). Conceptual approaches to acculturation. In K. M. Chun, P. B. Organista, & G. Marin (Eds.). Acculturation: Advances in theory, measurement, and applied research (pp. 17–37). Washington, DC: American Psychological Association.
Berry, J. W., & Kim, U. (1988). Acculturation and mental health. In P. R. Dasen, J. W. Berry, & N. Sartorius (Eds.), Health and cross-cultural psychology (pp. 207–236). Newbury Park, CA: Sage.
Berry, J. W., & Sam, D. L. (1997). Acculturation and adaptation. In J. W. Berry, M. H. Segall, & C. Kagitc ̧ibasi (Eds.), Handbook of crosscultural psychology (pp. 291–326). Needham Heights, MA: Allyn & Bacon.
Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46, 5–34. https://doi.org/10.1111/j.1464-0597.1997.tb01087.x
Center for Substance Abuse Treatment (US). Improving Cultural Competence. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 59.) Appendix B, Instruments To Measure Identity and Acculturation. Available from: https://www.ncbi.nlm.nih.gov/books/NBK248425/
Yakushko, O. (2010). Stress and coping strategies in the lives of recent immigrants: A grounded theory model. International Journal for the Advancement of Counselling, 32, 256–273.
Yoon, E., Chang, C. T., Kim, S., Clawson, A., Cleary, S. E., Hansen, M., … & Gomes, A. M. ( 2013). A meta-analysis of acculturation/enculturation and mental health. Journal of counseling psychology, 60(1), 15.