A PARADIGM FOR CULTURALLY BASED CARE IN ETHNIC-MINORITY POPULATIONS

Health care practitioners are encouraged to ''know the cultures'' of t he multicultural client population they are serving in the United Stat es. The premise behind this injunction is that the use of culturally s ensitive techniques that are tailored to the cultural background of th e client would result in effective therapy and produce positive outcom es. However, as reflected in the plethora of terms used to describe th e application of this knowledge, it is not made explicit why culture w ould make a difference in therapy nor how it makes a difference, ultim ately, in the outcome. The intent of this paper is to highlight one of the fundamental sources of variation in cultural beliefs that affect individual mental health. We propose a model that penetrates to the co re of why culture makes a difference in how problems are perceived and appropriate responses defined. Humans have three basic needs: safety and security, integrity, and a sense of belonging. Yet each culture un iquely frames each of these needs and prescribes the sanctioned means to achieve them. In our struggle to define culturally competent or cul turally based care, this fundamental aspect is often overlooked. Inste ad, the Western worldview, structure, and definitions are used as the template to assess dysfunction, diagnose a disorder, and prescribe app ropriate care. The theoretical underpinnings of indigenous concepts of self and symbolic interactionism are integrated to clarify these cult ural misconceptions and to construct a new paradigm for providing effe ctive and acceptable mental health care.