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Due to globalization, refugee and migration flows the composition of populations constantly changes: At least 21% of the population in Germany has a migration background. Further, the need for psychotherapeutic care in this population group is presumably at least as high as in patients without a migration background. Hence, transcultural encounters in psychosocial care increase. However, higher dropout rates and poorer outcomes in therapies with culturally diverse patients hint to a poor fit between the local therapy offers and this patient group. In line with that, transcultural competencies in insufficiently included both in psychotherapy training and in standard care. Thus, the need for an improvement of transcultural competencies in psychotherapy is obvious. Initially, in this dissertation it was investigated whether there are differences in patient groups of different cultures. Subsequently, possibilities of improving and measuring transcultural competencies were investigated to address those differences.
In study 1, illness representations of Iranian and German patients with mental disorders as well as subclinical samples of the general population were compared. Results showed that Iranian patients reported a higher amount of emotional representation, coherence and supernatural causes. As illness representations of the patient influence planning and process of therapy, cultural differences need to be considered in therapy with culturally diverse patients. For this purpose, transcultural competencies in psychotherapists are necessary.
This is why in study 2 a web-based training program to improve transcultural competencies in psychotherapists was developed and a randomized controlled trial (RCT) to evaluate its effectiveness was presented. The program is based on the conception of transcultural competencies by Sue et al. (1992). It consists of six modules with texts and practical exercises. The modules cover content such as the role of cultural background, prejudices and discrimination as well as influences of migration and acculturation, and cultural aspects of clinical concept and diagnosis. Skills and knowledge concerning the work with culturally diverse patients shall be trained as well as participants' awareness regarding the importance of their cultural concepts for the therapeutic work. The aim of the RCT is the investigation of the general effectiveness of the training as well as the importance of its practical elements. This is why a design was chosen where three groups are compared: a training group, an education only group and a waiting control group.
To investigate the effectiveness of the training program, the Questionnaire on the
Transcultural Competencies in Psychotherapists (TCCP) was developed and validated in study 3. The inventory bases on the conception of transcultural competencies by Sue et al. (1992) as well as the General Factors of Psychotherapy (Grawe et al., 1994). It consists of 16 items loading on the subscales Skills, Challenges-Therapist and Challenges-Relationship. Reliability of the subscales was acceptable and factor structure was confirmed by a confirmatory factor analysis with good model fit. Correlations with the Big-Five-Inventory-10 (Rammstedt & John, 2007) as well as the Multicultural Counseling Inventory (Sodowsky et al., 1994) support the discriminant und convergent validity of the TCCP.
All in all the current dissertation shows that existing cultural differences in illness and concepts relevant to therapy between culturally different patients need to be addressed in psychotherapy. This can happen throughout the training of transcultural competencies in psychotherapists. In the future training like the one presented in this dissertation should be developed and provided nationwide. Especially in psychotherapeutic training workshops on the transcultural competencies should be common practice.