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Cultures have varying notions about symptom expression and the treatment of mental health issues. Consequently, clients and psychotherapists may or may not share a similar worldview. In the psychotherapy literature there has been increased attention to these complex processes. This survey descriptive study aims to understand how therapists working with culturally diverse clients incorporate sensitivity to cultural differences. Fifteen culturally sensitive mental health care providers working with the Portuguese immigrant community were interviewed about their practices. Specifically, we investigated their understanding of the symptoms, causes and cures for agonias, a culture specific phenomenon. It was found that even though the providers are all Portuguese themselves, the meaning that they ascribed to agonias (anxiety and/or depression) was very different than the meaning ascribed to agonias by community members. The community member’s meanings ranged from indigestion to being on the brink of death. A cluster analysis revealed that clinicians who stated that agonias is anxiety, conducted cognitive behavioral therapy or psychopharmacology, and those that stated agonias had a depressive component tended to use family therapy or psychoanalysis.


This article was originally published in International Journal of Clinical and Health Psychology, 6(2): 441-454. © 2006 International Journal of Clinical and Health Psychology