Many of us find it difficult to share our feelings with a complete stranger, especially when this stranger is probing our lives and emotions by asking personal questions. This is often true of survivors of motor vehicle accidents or other traumatic events, who might be assigned to an array of health professionals, including chiropractors, physiotherapists, massage therapists and psychotherapists.
At first, clients are usually focused on the physical aftermath of the accident, the particular injuries sustained and the resulting pain, which may be keeping them from their pre-accident activities. Many clients pay little attention to how the event has affected their emotional and psychological well-being, which can be further complicated by their cultural background, age and educational attainment.Psychotherapy is largely a Western practice that might be considered foreign or even bizarre in many cultures. Following a referral for psychotherapy, the client may protest, “I am in pain and want to feel better, but I’m not crazy, so why do you want me to see a psychotherapist?”
Sometimes clients are unaware of the connection between their pain and their emotional state, and don’t realize that psychotherapy can provide tools to combat negative emotional states. Often they don’t know what to expect from psychotherapy. One client opened up to me right away, partly because his wife had explained to him that I would be asking a lot of questions about his emotional state and he should tell me how he had been affected by his accident and exactly how he was feeling. In this case, the wife had performed an essential role in recognizing her husband’s uncertainties and explaining what to expect, which helped set the tone for our sessions together.
Cultural Background
Perhaps the most important demographic variable is the client’s cultural background. Individuals from collectivist cultures, including Asia and parts of the Caribbean, for example, may be accustomed to sharing their feelings and concerns only within their family unit. As one client put it, “I leave all my emotions at home and keep my problems in the family.”Values promoting sharing, putting others’ needs before your own, and family obligations often characterize individuals from collectivist cultures. A Punjabi-speaking client who had been born and raised in India always seemed rushed and unwilling to spend much time with me. During our third session together, I offered to book our session a little earlier so she could feel less hurried. She explained that our session was not the problem; instead, it was the fact that she felt guilty burdening her son with her weekly appointments and keeping him waiting in the reception area.
Age Group
Especially for older clients, psychotherapy can be an unfamiliar concept that they are reluctant to engage in. Explaining how they can benefit from the therapist’s care and outlining some goals for treatment may provide the necessary framework that older clients will appreciate.
Clients under 40 are often able to express their thoughts and feelings more easily than older clients. However, although self-expression is encouraged in therapy, certain goals must be attained within a specified number of sessions, so staying focused is paramount for treatment success. During the first of 10 sessions, a younger client – who had been referred for psychotherapy to help her manage chronic pain after an injury – talked exclusively about relationship issues with her spouse. I had to purposefully redirect her to the focus of our sessions together: managing her chronic pain condition.The therapist’s age can also contribute to the client’s comfort or willingness to take part in the therapeutic relationship. Younger clients seem to open up to me more easily than older clients, perhaps because we are close to the same age. For some clients, being a similar age to the therapist can create a more comfortable atmosphere and foster a sense of relatedness.
Educational Achievement
Health professionals may find that clients with greater educational achievement approach rehabilitation with “checklist” tactics, asking questions, seeking clarifications, and making special requests or wanting additional services. Sometimes my better-educated clients have wanted to know the rationales behind measures of anxiety and depression I am administering, or the length of time the measure is reliable for. These are good questions, because some measures of mood are valid for only a week or two, as our emotional states are constantly changing.
Clients who do not ask many questions or respond as much as we would like them to are not necessarily resistant, uncooperative or lacking interest. Sometimes they simply don’t know the meaning of certain terms used in therapy, especially if they have had less formal education or if English is not their first language. I tend to score measures of emotional well-being in the presence of clients so I can explain the results and any unclear concepts. If the scores do not reflect how clients tell me they are feeling, I ask them if they know why this may be the case. At this point they often admit not understanding some of the terms involved.Every individual is unique and should be treated as such throughout the rehabilitative process. However, certain core demographic variables should not be ignored when referring clients or designing treatment goals for them. A therapist who is culturally and demographically aware should be able to work sensitively and successfully with clients of different ages and from different backgrounds.
