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Providing Culturally Relevant Services
Rachael Hall, LCPCRama 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-inValidated and
UnderstoodHelps the therapeutic
relationshipAccomplished/optimisticEnhance client’s outlookPositive treatment
outcome
Understanding clientIncrease confidence in
skillsJob satisfactionPrevent burnoutPositive treatment
outcome
Conventional Psychotherapeutic interventions…
culturally appropriate????
Things to consider…-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)
More things to consider…- 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 ApproachesBeing a “culturally sensitive” therapist
Culturally sensitive therapy
Culture as the main focus of the therapy
(Cardemil, 2008)
Culturally sensitive therapist
•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
Culturally sensitive therapy
•Adapting empirically supported therapies to meet cultural diversity
•Requires cultural competency and focus on culturally relevant issues
•Make it “make sense”
Culture as the central focus of therapy
•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)
ParaprofessionalsInterpreterTranslatorCounselorCase workerculture brokeroutreach workerCommunity advocate
(Egli, 1987)
Group discussions…
Case Scenario 1Profound Acceptance
Case Scenario 2Withholding Judgment
Case Scenario 3Honoring spiritual/Religious beliefs
Case Scenario 4Receiving gifts
Case Scenario 5Self disclosure
Case Scenario 6Attending important ceremonies
Case Scenario 7Participating in ceremonies related to healing
Case Scenario 8Knowledge and understanding of the history
of where client came from
Case Scenario 9Strengths-based
References-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; 576-585-Cravens, R.E. et al (1991): Clinical Issues in Mental Health Service Delivery to Refugees; American Psychologist, American Psychological Association Vol 46 No 6; 642-648-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. 262-303). New York: Wiley-Cardemil, Esteban V. (2008). Commentary: Culturally Sensitive Treatments: Need for an Organizing Framework. Culture Psychology. (can be found at: http://cap.sagepub.com/content/14/3/357)-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, 1276-1281.-Westermey~ J. (1986). Migration and psychopathology. In C. L. Williams & J. Westermeyer (Eds.), Refugee mental health in resettlement coun‘-tries (pp. 113-130). Washington, DC: Hemisphere.-Egli, E. (1987). The role of bilingual workers without professional mental health training in mental health services for refugees (Contract No. 278-85-0024CH). Washington, DC: National Institute of Mental Health.