Cognitive Behavioral Therapy for Aboriginal Patients: Cultural Modification and Implementation

This article discusses the cultural modifications and implementation of Cognitive Behavioral Therapy for Aboriginal patients. It explores the barriers that may arise due to cultural differences and suggests innovative ideas to modify the therapy to suit the cultural traditions, preferences, and inhibitions of the patient. The article also discusses the effectiveness of these modifications and the positive outcomes they can have.

Running head: COGNITIVE BEHAVIORAL THERAPY
COGNITIVE BEHAVIORAL THERAPY
Name of the student:
Name of the university:
Author note:

1
COGNITIVE BEHAVIORAL THERAPY
Client background:
Ben is a 65-year-old Aboriginal man who is the eldest of the family comprising of four
sons with their wives and children. He is a strong follower of the aboriginal traditions and
cultures and is not fond of the western culture of professionalism, healthcare, education and
many others. He is aware of the historical turmoil that the period of colonization had affected the
mental and physical health of his ancestors and how it had affected their wealth and resources
resulting in very poor living conditions. Therefore, he is not very fond of the western culture.
From the last few days, he had been having symptoms of cardiac disorders and his excess
reliance on alcohol and tobacco had been contributing to these symptoms. However, he believes
strongly that smoking tobacco is part of their cultural traditions and he cannot overcome such
traditions. His sons have requested him to visit the health clinic to get help regarding his
substance abuse disorder so that his chances of becoming affected by cardiac disorders become
less. He has never considered this to be of a concerning factor and does not believe that this
habits and behavior can hardly cause any harm. However, he has just visited the ward to keep the
request of the sons and can change his behavior for his sons.
The patient is attended by a western healthcare professional, who has proposed cognitive
behavioral therapy for the modification of the behavior of the patient. The professional in this
case cannot apply the "one treatment method for all" mode of technique for the cognitive
behavioral therapy with the client. This is because of a number of factors. The patient does not
trust the western mode of treatments, maintain strong native traditions that do not align with
western healthcare and the patient does not himself want to be treated. These will be the barriers
in the therapy. Therefore, the professional needs to modify the therapy in different ways so that it
can help in the successful treatment of the client (Lee et al., 2015).

2
COGNITIVE BEHAVIORAL THERAPY
Cultural modification of the intervention:
A number of innovative ideas can be developed for the modification of the therapy in
ways by which it suits the cultural traditions, preferences and inhibitions of the patient. The
different new incorporations that should be done would be setting the therapy sessions in open
green areas that would be free from regular rushes of patients probably in the garden or areas
beside lakes. The second modification that should be done is allocating two extra sessions for
developing a rapport with the patient following which the therapy sessions would be started.
Extra 15 minutes would be allocated for his session every day for better rapport building. The
third modification would be engaging an aboriginal healthcare expert along with the non-native
professional as these would help in trust building of the patient over the system (Benett et al.,
2016). The fourth modification would be showing video clips of other aboriginal patients who
had hot help through this therapy and making them talk socially with such patients. These would
help in developing the trust of the patient and increasing his compliance with the treatment
therapy.
Implementation of the intervention:
The first intervention would be the setting of the therapy sessions with the patient in areas
that would be away from the healthcare centre in the midst of nature especially beside lakes,
fields or in parks. The cultural preferences and traditions of the aboriginals state that they are
nature lovers and want to remain in close connection with nature as well as prefer living with the
natural resources beings close to nature as possible (Rowan et al., 2014). Therefore, this
modification would make the patient feel closer to nature and he can easily connect to the nature
and his roots of culture. Conducting the assessments within the four walls and closed door in the

3
COGNITIVE BEHAVIORAL THERAPY
clinics would have given him the impression that he is treated under the western medical system.
Therefore, this cultural modification is indeed helpful.
The second important modification that needs to be done is the allocation of extra time
for about 15 minutes before the beginning of therapy sessions as well as the allocation of two
extra sessions to the patient before initiation of the cognitive behavioral therapy. Researchers are
of the opinion that aboriginal people are introvert by nature and they cannot disclose specific
important information about their personal lives unless they are comfortable with the
communicators (Leske et al., 2016). Moreover, they also do not want to reveal important
information to western health care professionals, as they believe that the professionals might
become judgmental and disrespect their culture. Therefore, more the time the professionals
allocate for rapport building, the better will be chances of compliance of the client with the
professionals. In the first two sessions, the professional would be empathizing with the situations
of the aboriginals, as the client in the case believes that they have been oppressed of their rights
and have gone through severe turmoil throughout the periods of colonization. Therefore,
empathizing with the situation and developing rapport through informal discussions will help the
client to develop a bond and relationship with the professional resulting in better outcomes
(Wagner et al., 2017).
The third intervention that the professional would implement is the allocation of the
aboriginal healthcare expert in the discussion with the patient when the western healthcare
professional is applying the therapy to the patient. The presence of the aboriginal healthcare
workers would help in easing the conversation with the patient helping him to relate with
different aboriginal manners of thinking and style of working procedures (Newton et al., 2015).
When the client will see that the session is being carried on by procedures that align with the

4
COGNITIVE BEHAVIORAL THERAPY
aboriginal medium of thinking and conducting different actions, he would feel connected with
the system. Moreover, the presence of an aboriginal person in the room will reduce his
uncomfortable situation and would help in making the patient comply with the therapy with
proper features that align with cultural traditions and receptions of the professional (Benson et
al., 2016).
The fourth intervention is the allocation of the video clips where native people and their
success with the cognitive behavioral therapy. This medium helps patients to feel that their
native community members had got immense help from the therapy and starts believing that the
approach would not affect their culture but would help in the development of health (Le Grande
et al., 2017). Moreover, the patient would be also able to communicate with such members of the
community and seek for their suggestion. This approach would help the patient to develop trust
in the western healthcare methods and would help them to comply on the methods without being
judgmental on the treatment outcomes.
The effectiveness of the cultural modification:
The modification of the cognitive behavioral therapy is important, as the handling of
native Aboriginal patients requires separate considerations in comparison to the non-indigenous
patients. They have different cultural traditions, preference and inhibition and following such
customs become extremely important for the healthcare professionals. Culturally competent
therapy help in developing trust and bonding with the patient as the patient feels that the
professionals are not judgmental about their traditions and that they are aware of their liking and
disliking. They feel that they are honoured and the power struggle between them do not persist.
In the case as well, the culturally modified interventions would help Ben to feel that

5
COGNITIVE BEHAVIORAL THERAPY
professionals genuinely respect their traditions and that they are not judgmental and in turn
helping him to overcome his disorders (Fernandez et al., 2015). Each of the modifications is
evidence-based and aligns with their cultural norms that would satisfy him. Hence, these
modifications are effective.
The outcome of the intervention:
The patient would feel closer to nature when the therapy session would be held in natural
surroundings. This would make him happier and he would feel comfortable. The building like
structures, the rooms and the wring system of the health clinics might be foreign to him and he
might not relate with them. Therefore, to help him overcome such barriers, the sessions are
arranged in open and this would help him to feel comfortable in the session. Another effective
outcome would be the development of a therapeutic relationship with the patient that would be
based on proper rapport building. More the rapport built with the patient, the patient will be more
comfortable (Bennett et al., 2014). This would increase chances of compliance of Ben with the
system and rely on the western healthcare system. Moreover, when the clients would notice that
similar members of the Aboriginal community have also been benefitted from this mode of
therapy, he would develop trust on the system and would believe that the professionals would not
provide culturally incompetent practices. These would have the positive outcome of developing
trust in Ben about the western healthcare centre that he previously disliked. This would ensure
the better outcome of the therapy on the substance abuse issues as well in the patient.

6
COGNITIVE BEHAVIORAL THERAPY
References:
Bennett, S. T., Flett, R. A., & Babbage, D. R. (2016). Considerations for culturally responsive
cognitive-behavioural therapy for Māori with depression. Journal of Pacific Rim
Psychology, 10.
Bennett‐Levy, J., Wilson, S., Nelson, J., Stirling, J., Ryan, K., Rotumah, D., ... & Beale, D.
(2014). Can CBT be effective for Aboriginal Australians? Perspectives of Aboriginal
practitioners trained in CBT. Australian Psychologist, 49(1), 1-7.
Bensonn, J., Thistlethwaite, J., & Moore, P. (2016). Mental Health Across Cultures: a practical
guide for health professionals. CRC Press.
Fernández‐Álvarez, H., Castañeiras, C., & Wyss, G. (2015). Commentary on Three Articles on
Self‐practice/Self‐reflection in Cognitive‐Behavioural Therapy. Australian
Psychologist, 50(5), 335-339.
Le Grande, M., Ski, C. F., Thompson, D. R., Scuffham, P., Kularatna, S., Jackson, A. C., &
Brown, A. (2017). Social and emotional well-being assessment instruments for use with
Indigenous Australians: A critical review. Social Science & Medicine, 187, 164-173.
Lee, N. K. (2015). Cognitive behavioural therapies for substance use problems. Textbook of
Addiction Treatment: International Perspectives, 793-809.
Leske, S., Harris, M. G., Charlson, F. J., Ferrari, A. J., Baxter, A. J., Logan, J. M., ... &
Whiteford, H. (2016). Systematic review of interventions for Indigenous adults with
mental and substance use disorders in Australia, Canada, New Zealand and the United
States. Australian & New Zealand Journal of Psychiatry, 50(11), 1040-1054.

7
COGNITIVE BEHAVIORAL THERAPY
Newton, D., Day, A., Gillies, C., & Fernandez, E. (2015). A review of Evidence‐Based
Evaluation of Measures for Assessing Social and Emotional Well‐Being in I ndigenous A
ustralians. Australian Psychologist, 50(1), 40-50.
Rowan, M., Poole, N., Shea, B., Gone, J. P., Mykota, D., Farag, M., ... & Dell, C. (2014).
Cultural interventions to treat addictions in Indigenous populations: findings from a
scoping study. Substance Abuse Treatment, Prevention, and Policy, 9(1), 34.
Wagner, B., Fitzpatrick, J., Symons, M., Jirikowic, T., Cross, D., & Latimer, J. (2017). The
development of a culturally appropriate school based intervention for Australian
Aboriginal children living in remote communities: A formative evaluation of the Alert
Program® intervention. Australian occupational therapy journal, 64(3), 243-252.