Culturally sensitive therapy with ultra-orthodox patients: the strategic employment of religious idioms of distress.

The article deals with the problem of administering therapy in multicultural settings where the therapist and the patient hold divergent explanatory models in regard to the patient's symptoms. Different conceptualizations of the universal structure of symbolic healing stress the importance of therapist-patient compatibility for therapeutic success. In order to reach this compatibility, strategic therapists seek to join the patients' explanatory models and employ metaphors and symbols derived from their cultural world. From a psychodynamic perspective, strategic techniques are often presented as superficial treatments limited to the symptomatic level. In order to deal with this argument, we present a case study of an ultra-orthodox patient with a major depressive episode and describe the treatment which was based on a strategic, culturally sensitive approach. We use the case to discuss theoretical issues arising in the context of multicultural therapy such as the translatability of culturally divergent idioms of distress and the possibility to bring about significant, nonsymptomatic changes through strategic employment of culturally congruent metaphors and symbols.