Conceptualizing Culturally Competent Therapy with Amish Communities

Date of Submission


Degree Type


Degree Name

Doctor of Psychology (PsyD)



Department Chair

Robert A. DiTomasso, Ph.D., ABPP

First Advisor

Takako Suzuki, Ph.D., Chairperson

Second Advisor

Stephanie Felgoise, Ph.D., ABPP

Third Advisor

Andrew Warren, M.D.


Although the Amish have traditionally cared for those with mental health concerns within the privacy of their own homes, families and communities, Amish communities are tentatively exploring professional mental health treatment services. Despite these changes, no formal inquiry regarding how to provide culturally sensitive mental health treatment to Amish clients
has been carried out. The current qualitative study was designed to increase an understanding of how professional mental health treatment providers, who work with Amish clients, build trust and conceptualize cultural competence when working with people from this cultural group.
Therapists participated in semi-structured interviews designed to elicit their descriptions of cultural adaptations involved with assessment, diagnosis and treatment of Amish clients, as well as factors that relate to therapeutic alliance, cross-cultural communication, knowledge and awareness of Amish culture. Using grounded theory, a team of doctoral level psychology students participated in analysis of the data. Through this analysis, the researcher identified 1,200 unique concepts, 13 main themes and over 120 subthemes. Main themes identified included:„The Amish View of Mental Health and Mental Health Treatment‟; „Building the Bridge of Trust‟ ; „Qualities of Trusted Therapists‟; „Factors Related to Accessing Treatment‟; „Culturally Adapted Treatment”; „Spiritual Integration in Therapy‟; „Culturally Adapted Treatment and Theoretical Orientation‟; „Special Topics Related to Adapted Treatment‟; „Dealing with Abuse in Amish Communities‟; „Cross Cultural Communication‟; „Building Relationship,‟„Assessment‟ and „Cross Cultural Counter-Transference.‟ Analysis of the themes and subthemes that emerged from these interviews provided preliminary answers to questions about the ways in
which treatment is adapted to serve the unique needs of Amish communities. These results were interpreted and placed within the context of existing literature, towards the goal of developing a theory of culturally competent treatment for Amish communities. A model of culturally adapted
treatment, focused on the development of culturally specific awareness, knowledge and skills was provided as a means of understanding and summarizing this study‟s findings.

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