Adding the comfort of culture

A small health center in Lowell, Mass., has developed an expertise in treating a particular immigrant population: Cambodian clients who experienced the atrocities of the Khmer Rouge.

To make therapy relevant for these clients, the psychologists at the Lowell Community Health Center’s Metta Health Center use an innovative “co-counseling” model where an interpreter from the community — who understands the client’s culture and with whom the client may initially feel more comfortable — is much more involved in therapy than a standard interpreter.

“We’re guiding the therapy and the co-counselor is delivering it,” explains psychologist Nancy Colburn, PsyD, Metta’s site manager of behavioral health services. “When you use a co-counseling model, the Western therapist is not 100 percent in control of the therapy anymore.”

Unlike a standard session in which an interpreter translates the client’s words, a Cambodian co-counselor may have his or her own conversation with the client to ferret out a client’s concerns, which are then summarized for the Western co-counselor.

Using this framework makes sense, says Colburn. “What is therapeutic in therapy is the relationship with the therapist,” she says. “In this model, the client is able to have a direct relationship with two helpers — the bi-cultural worker as well as the Western therapist.”

The model also respects the Cambodian worldview and acknowledges that Western mental health concepts and frameworks might be hard for these clients to grasp. For instance, some Cambodians believe mental health problems are caused by spells and may seek a shaman’s services to cast them out, says Colburn.

“I don’t challenge people’s ideas about spells,” she says, “but if appropriate, I’ll offer another point of view and suggest other approaches they can take to dealing with their problems.”

While it might be difficult for some Western clinicians to share therapy this way, for therapy to be effective, “you have to let the interpreter be part of the healing relationship,” Colburn says. The federal Office of Minority Health thinks so too: In 2001, it cited the Metta Health Center and its parent program, the Lowell Community Health Center, as a “best practices” model.

—T. DeAngelis