Adult Dominicans in therapy: Psychotherapists' perceptions of cultural treatment issues

Carolee Ellen Iltis (2002)

The population of Dominicans residing in the metropolitan New York City area has increased dramatically in recent years, yet literature is scarce concerning information about psychotherapy treatment issues for them. Because knowledge of multicultural issues is crucial in culturally sensitive treatment, this qualitative study explores how adults from the Dominican Republic present in psychotherapy as perceived by the psychotherapists who treat them. Twenty psychotherapists in the metropolitan New York City area were interviewed (psychologists, social workers, psychiatrists, and doctoral students in clinical psychology). Most of the therapists were Hispanic, including four Dominicans, and they described their experience working with over 2,800 Dominican clients, primarily of low socioeconomic background. The methodology and research design are presented within a qualitative framework guided by grounded theory methodology, with the goal of creating a conceptual ordering of data. Analysis of the findings indicates that Dominicans in therapy are both similar to and different from other Hispanics. Dominicans also present very differently in therapy depending on many factors such as socioeconomic status, social class, level of education, acculturation, area of origin in the Dominican Republic, stage of migration, generation in the US, immigration status, psychopathology, source of referral, and socialization to therapy. Implications of the findings of this exploratory study are wide-ranging for psychotherapy with primarily low socioeconomic and unsocialized clients in the New York City area. Selected examples include the discussion of: (1) commonalities with other Hispanics, including Caribbean Hispanics; (2) Dominican issues (strong wish to preserve Dominican identity, frequency of somatic presentation); (3) general cultural practices (family and respect, corporal punishment of children); (4) full spiritual belief system (and possible reluctance to share nontraditional beliefs); (5) behavior in therapy (offense at rejection of gifts and expectation of touching or hugging the therapist); (6) beliefs about therapy and the therapist (stigma of mental illness and expectation of a "quick fix" and therapist transparency); and (7) practical consequences (attendance issues and discontinuities in treatment resulting from Dominicans' frequent travel to the Dominican Republic).