Presentation on theme: "Increasing Cultural Competence in Clinical Practice"— Presentation transcript:
1Increasing Cultural Competence in Clinical Practice Lillian Comas-Díaz, PhDExecutive Director, Transcultural Mental Health Institute Clinical Professor of Psychiatry and Behavioral Sciences The George Washington University School of MedicineFrederick M. Jacobsen, MD, MPHMedical Director, Transcultural Mental Health InstituteClinical Professor of Psychiatry and Behavioral Sciences The George Washington University School of MedicineWorld Federation of Mental HealthOctober 30, 2007
3Clinical realities are negotiated by therapists and clients not merely in terms of cognitive models, but in terms of cultural frames deeply invested with personal, ethnic, racial, gender, spiritual, sexual orientation, and class meanings.
5Race matters in healing African American patients rate their visits to African American practitioners as more participatory than those in race discordant dyads.Cooper-Patrick et. al. JAMA, 1999
6Cutural Competence can promote resilience through: Enhanced optimismImproved regulation of attachment behaviorPositive self conceptActive coping styleImproved ability to convert helplessness into learned helpfulnessBetter acceptance of social support/altruismImproved ability to disclose emotionsJacobsen and Comas-Díaz, 2007
7APA Multicultural Guidelines Commitment to cultural awareness and knowledge of self and other.Guideline 1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves.Guideline 2: Psychologists are encouraged to recognize the importance of multicultural sensitivity/responsiveness, knowledge and understanding about ethnically and racially different individuals.
8Diversity: Relationship between Self and other Diversity variables bear unconscious dimensions which tend to emerge during the multicultural encounterVirtually every therapeutic (human) encounter is multicultural in nature.
9Strategies to increase multicultural awareness and knowledge Identify and challenge internalized privilege and oppressionCommit to ongoing self reflectionChange automatic in-group and out-group perceptionsIncrease contact with people of color of equal social statusTransform “us and them” into “us”Expand your cultural horizons
10APA Multicultural Guidelines PracticeGuideline 5: Psychologists strive to apply culturally appropriate skills in clinical and other applied psychological practices.There are three core areas in this guideline:Client in contextCulturally appropriate assessmentBroad range of interventions
11Explanatory Model of Distress What do you call your distress (problem)?What do you think your problem does?What do you think the natural course of your problem is?What do you fear?Why do you think this problem has occurred?How do you think the distress should be treated?How do you want me to help you?Who do you turn to for help?Who should be involved in decision making?Adapted from Kleinman, 1993
12The challenge of multicultural practice 1. Exciting, gratifying, and challenging2. Complicated strain in the mental health practitioner3. More opportunities for projections based on race and ethnicity.4. These projections are embedded in the therapeutic relationship.5. Potentially missed empathic opportunities
13Ethnocultural Transference and Countertransference 1. Cultural and racial differences may have a catalytic effect on the development of transference leading to a more rapid revelation of core problems.- racial differences can represent trust and mistrust issues within the development of a therapeutic alliance.2. References to the race or culture of the therapist have been identified as the first sign of a developing transferential relationshipComas-Díaz and Jacobsen, 1991
14INTER-ETHNIC CULTURAL TRANSFERENCE Overcompliance and friendlinessDenial of ethnicity and cultureMistrust and suspiciousnessHostilityAmbivalenceComas-Díaz and Jacobsen, 1991
15INTRA-ETHNIC CULTURAL TRANSFERENCE The Omniscient/omnipotent TherapistThe TraitorThe Folk Hero/HeroineThe Auto-racistThe AmbivalentComas-Díaz and Jacobsen, 1991
16INTER-ETHNIC CULTURAL COUNTERTRANSFERENCE Denial of cultural differences: "All patients are the same”GuiltPityAggressionAmbivalenceThe Clinical Anthropologist's SyndromeComas-Díaz and Jacobsen, 1991
17INTRA-ETHNIC CULTURAL COUNTERTRANSFERENCE OveridentificationUs against themDistancingCultural myopiaAmbivalenceAngerSurvivor's guiltHope alternating with despairComas-Díaz and Jacobsen, 1991
18Culturally Competent Practitioners Conduct self- reflection and assessmentManage the dynamics of differenceIncorporate cultural knowledge into interactions with clients to develop multicultural skillsAdapt to clients’ cultural contextsValue diversity
19Some strategies to develop multicultural competence skills Identify Cultural identity developmental stagesUse Explanatory model of distressExamine Cultural transference/countertransferenceDevelop Cultural empathyAcquire Multicultural communication skills
21Course objectivesApply the APA multicultural guidelines to improve psychological practiceIdentify the effect of culture on practiceImplement strategies to compare worldviews ofclients and psychologistsDiscuss the usefulness of developmental models andtheories on psychological practiceAdjust psychological practice to provide culturally competent servicesBecome familiar with resources available to practitioners on cultural competencemenopause and expectation for pregnancyMay want SSRI or NTP rather than other antidepressantthere are many examples of culture-bound uses of psychoactive medication or whose function/use varies tremendously in different cultural contexts: coca leaves in the tea - by Peruvian indians vs addictionmany foreign born immigrants disdain the use of psychtropics in themselves or their loved ones *S marry not Prozacin the mainstream culture, most patients want quick-fixesexplanation of long-term nature crucial from the beginning with EC translocated have to work doubly hard to encourage maintenance of the regimin
22Complex therapist expectations from culturally diverse individuals Integration of clients’ active and non- directive expectations from therapists.Patients of color expect their psychological practitioner to have diverse roles such as counselor, teacher, guide, folk healer, advisor, advocate, witness, consultant, coach, therapist, and others.