Rachael Hall, LCPC Rama Deen, LCSW Tidwell Social Work Services and Consulting

Objectives To learn or deepen understanding of what culturally relevant services are How culturally relevant services affect the treatment process and impact overall treatment outcome Gain better insight into the value of the therapeutic relationship (what it looks like/how to develop it) Better understand the importance of peer support in the healing process How to identify and build on client's strengths to promote healing and return to “pre-morbid level of functioning”

What are the challenges?? Pre-resettlement Post-resettlement Fragmentation Instability language barriers severe staff shortages (Cravens et al, 1991) frequent misdiagnosis inappropriate use of interpreters and paraprofessionals culturally inappropriate treatment methods

Why is this important? Client Therapist Client buy-in Validated and Understood Helps the therapeutic relationship Accomplished/optimistic Enhance client’s outlook Positive treatment outcome Understanding client Increase confidence in skills Job satisfaction Prevent burnout Positive treatment outcome

Conventional Psychotherapeutic interventions… culturally appropriate????

- Treatment approaches used by Mainstream Mental Health Providers - Client expectations regarding the duration, frequency and nature of treatment - Therapist knowledge or appreciation of culturally sanctioned healing practices within refugee communities - The nature of settings in which difficulties arise (Cravens et al, 1991)

- linguistic challenges - -Lack of expertise in cross-cultural diagnostic skills - Limitations related to diagnostic issues - – misdiagnosis of pathology (Cravens et al, 1991)

More things to consider cont… – misdiagnosis of pathology - Somatization - Suspiciousness and paranoia - Psychosis - PTSD-related symptoms - Evaluating for Organic impairment (Cravens et al, 1991; Mollica & Lavelle, 1988; Kinzie et al., 1982; Westermeyer, 1986).

So what does work????

3 Therapeutic Approaches Being a “culturally sensitive” therapist Culturally sensitive therapy Culture as the main focus of the therapy (Cardemil, 2008)

Focus is on being “culturally sensitive” with regard to client Ability to understand and develop a strong therapeutic relationship with client A general awareness and understanding of issues of difference, power, and marginalization

Adapting empirically supported therapies to meet cultural diversity Requires cultural competency and focus on culturally relevant issues Make it “make sense”

Culturally-centered therapy Using culture as the guiding principal to promote the development of well-being Requires therapist to be well versed in the culture and heritage AND to be culturally sensitive Focus is less on resolving pathology; more on developmental well-being (Cardemil, 2008)

Paraprofessionals Interpreter Translator Counselor Case worker culture broker outreach worker Community advocate (Egli, 1987)

Group discussions…

Case Scenario 1 Profound Acceptance

Case Scenario 2 Withholding Judgment

Case Scenario 3 Honoring spiritual/Religious beliefs

Case Scenario 4 Receiving gifts

Case Scenario 5 Self disclosure

Case Scenario 6 Attending important ceremonies

Case Scenario 7 Participating in ceremonies related to healing

Case Scenario 8 Knowledge and understanding of the history of where client came from

Case Scenario 9 Strengths-based

- Murray, K.E. et al (2010): Review of Refugee Mental Health Interventions Following Resettlement; Best Practices and Recommendations; American Journal of Orthopsychiatry Vol 80 No 4; Cravens, R.E. et al (1991): Clinical Issues in Mental Health Service Delivery to Refugees; American Psychologist, American Psychological Association Vol 46 No 6; Mollica, R. E, & Lavelle, J. P. (1988). The trauma of mass violence and torture: An overview of the psychiatric care of the Southeast Asian refugee. In L. Comas-Diaz & E. H. Griffith (Eds.), Clinical guidelines in cross-cultural mental health (pp ). New York: Wiley -Cardemil, Esteban V. (2008). Commentary: Culturally Sensitive Treatments: Need for an Organizing Framework. Culture Psychology. (can be found at: -Kinzie, J. D., Manson, S. M., Do, T V., Nguyen, T T., Bui, A., & Than, N. E (1982). Development and validation of a Vietnamese-language depression rating scale. American Journal of Psychiatry, 137, Westermey~ J. (1986). Migration and psychopathology. In C. L. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement coun‘-tries (pp ). Washington, DC: Hemisphere. -Egli, E. (1987). The role of bilingual workers without professional mental health training in mental health services for refugees (Contract No CH). Washington, DC: National Institute of Mental Health.