Culture-sensitive psychotraumatology

Although there is some evidence of the posttraumatic stress disorder (PTSD) construct's cross cultural validity, trauma-related disorders may vary across cultures, and the same may be true for treatments that address such conditions. Experienced therapists tailor psychotherapy to each patient's particular situation, to the nature of the patient's psychopathology, to the stage of therapy, and so on. In addition, culture-sensitive psychotherapists try to understand how culture enhances the meaning of their patient's life history, the cultural components of their illness and help-seeking behaviors, as well as their expectations with regard to treatment. We cannot take for granted that all treatment-seeking trauma survivors speak our language or share our cultural values. Therefore, we need to increase our cultural competencies. The authors of this article are clinicians and/or researchers from across the globe, working with trauma survivors in various settings. Each author focused on one or more specific cultural aspects of working with trauma survivors and highlighted the following aspects. As a result of culture-specific individual and collective meanings linked to trauma and trauma-related disorders survivors may be exposed to (self-)stigma in the aftermath of trauma. Patients who are reluctant to talk about their traumatic experiences may instead be willing to write or use other ways of accessing the painful memories such as drawing. In other cultures, community and family cohesion are crucial elements of recovery. While awareness of culture-specific aspects is important, we also need to beware of premature cultural stereotyping. When disseminating empirically supported psychotherapies for PTSD across cultures, a number of additional challenges need to be taken into account: many low and middle income countries have very limited resources available and suffer from a poor health infrastructure. In summary, culture-sensitive psychotraumatology means assuming an empathic and non-judgmental attitude, trying to understand each individual's cultural background. Cultural sensitivity is required to successfully treat trauma survivors. Empirically supported treatments may need to be modified depending on the patient’s cultural background. In addition to talking, patients may write or use other ways of accessing the traumatic memories such as painting, dancing, or singing. In low and middle income countries, dissemination of evidence-based treatments is frequently impeded by limited resources and poor health infrastructure. Beware of cultural stereotyping!尽管已有研究证实创伤后应激障碍（posttraumatic stress disorder, PTSD）的构念具备跨文化效度，但创伤相关障碍在不同文化背景下或存在异质性，针对此类病症的干预方案亦可能因文化而异。经验丰富的治疗师会根据患者的具体处境、精神病理特征以及治疗阶段等因素，定制个体化的心理治疗方案。此外，文化敏感型心理治疗师（culture-sensitive psychotherapists）会尝试理解文化如何塑造患者人生经历的意义、疾病与求助行为中的文化维度，以及患者对治疗的预期。我们不能想当然地认为所有寻求治疗的创伤幸存者都使用我们的语言，或是与我们拥有共同的文化价值观。因此，我们需提升自身的文化胜任力（cultural competencies）。本文作者均为来自全球各地的临床医师与/或研究人员，在不同场景中与创伤幸存者开展工作。每位作者均围绕与创伤幸存者工作中的某一或多个特定文化维度展开论述，并重点阐释了如下内容：由于创伤与创伤相关障碍存在文化特异性的个体与集体意义，创伤幸存者在创伤事件后可能会遭遇（自我）病耻感。不愿讲述创伤经历的患者，或许更愿意通过书写或其他方式触及痛苦的记忆，例如绘画。在其他文化背景中，社区与家庭凝聚力是康复过程的关键要素。尽管关注文化特异性维度至关重要，但我们也需警惕过早的文化刻板印象。在跨文化场景中推广针对PTSD的循证心理治疗（empirically supported psychotherapies）时，需考量诸多额外挑战：许多中低收入国家的可用资源极为有限，且卫生基础设施薄弱。综上，文化敏感型创伤心理学（psychotraumatology）意味着秉持共情与非评判的态度，尝试理解每一位个体的文化背景。要成功治愈创伤幸存者，需具备文化敏感性。循证治疗方案或许需根据患者的文化背景进行调整。除语言沟通外，患者还可通过书写或其他方式触及创伤记忆，例如绘画、舞蹈或歌唱。在中低收入国家，循证治疗方案的推广常因资源有限与卫生基础设施薄弱而受阻。警惕文化刻板印象！