Psychotherapy for Self-Stigma among Rural Clients

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Journal of Clinical Psychology (Impact Factor: 2.12). 05/2010; 66(5):524-36. DOI: 10.1002/jclp.20679
Source: PubMed


The stigma of mental disorders and psychological treatment afflicts rural clients more than most. This article provides practitioners with guidance in selecting and utilizing effective treatments for self-stigma in rural settings. We review both public stigma and self-stigma. Public stigma explains society's negative impact on individuals, while self-stigma describes an individual's internalization of public stigma. We review treatment principles and empirical research on psychotherapy for self-stigma rural settings. We finish with a case illustration of cognitive therapy with a rural client suffering from self-stigma.

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    • "Another potential problem with the use of translators is that of confidentiality within a small community where many of the community members are familiar with one another. Research demonstrates that those within closely connected communities may be afraid of having others within their community hear about the problems they are experiencing [23,24]. Since mental health is often a particularly stigmatizing topic, it is likely that this issue may be particularly salient in community mental health settings [9]. "
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    ABSTRACT: To meet federal requirements under Title VI of the Civil Rights Act, the state of California instituted policies requiring that comprehensive mental health services in native languages be made available to limited English proficiency (LEP) populations when concentrations exceed "threshold" levels. This paper builds on promising results from quantitative evaluations by reporting on qualitative interviews with Latino and Vietnamese LEP clients in mental health services (N = 20) to examine the awareness, impact, and implications of these threshold language policies. Results suggest that, while individuals are often not aware of the policies themselves, the language-related services they receive that are prompted by the policies are critical to treatment initiation and retention. Results also convey the complexities of using interpreters for sensitive psychological topics, and suggest that, for LEP individuals seeking mental health treatment, providers who speak their native languages are generally preferred. Access to language-appropriate services seems to be an important part of why LEP populations seek out mental health treatment. However, there are multiple variables that factor into the usage and usefulness of such services.
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    • "The rural practitioner knows that if she does not add the person to her current caseload (e.g., because she is going to be using time that would usually be assigned to clients to spend on advocacy efforts), the client will not receive services for what may be a substantial period of time, if the client is even willing to return at a later date. Given the well-documented stigma associated with receiving mental health care in rural areas (Larson & Corrigan, 2010; Pullman et al., 2010; Schank & Skovholt, 2006; Stamm et al., 2003), not accepting a client immediately may mean that the psychologist has lost the window of opportunity with this person. Thus, because rural practitioners are expected to be ready and able to see any client presenting with any issue at any point in time, the therapist may find it difficult to justify to clients or herself that time is better spent in advocacy efforts than in sessions with clients. "
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