Culture, Prejudice and Reflective Practice

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Culture, Prejudice and Reflective Practice

Post by Ruthie »

Reflecting on difference, culture and prejudice
An awareness of the impact of culture and our own attitudes and prejudices is really important in any area of clinical work, across all populations. Cultural issues can sometimes be overlooked or attributed to other factors, so we need to keep them in mind. We cannot provide appropriate help unless we acknowledge difference, as therapy relies on a shared understanding of a person's life experiences.

Being aware of our own culture and background is really important as it helps us understand how we are shaped by what we have experienced. Even within cultures, we all have different attitudes and beliefs based on our experiences and this will impact on the way we relate to people both professionally and in our personal life. It can be a real challenge to remain aware of how our own culture may impact on clients and the outcome of therapy.

It is important to ask ourselves what values we work from and what kind of clinical psychology we want to be able to offer. The values of justice, human rights, empowerment, agency and a commitment to understanding and challenging social inequalities are important in our work with all sections of the community but are perhaps even more magnified when working with refugees and asylum seekers. We also need to be mindful of issues of difference and power in our relationships.

- There are some reflections and discussion on this forum thread about facing our own prejudices.
- A very useful special issue of Clinical Psychology about reflective practice
- Two more links relevant to reflective practice (courtesy of guest23): 'White privilege' and C. Butlers ‘Homoworld’ (see pp.15-17). 'Homoworld' was made into a film in 2009 and as far as I know is available on DVD for free from its producer.

Being aware of the cultural background, attitudes and beliefs of people we work with
An awareness of cultural and political issues relevant to people you work with is also really important, and may be particularly pertinent when working with asylum seekers and refugees. You can develop this by asking the person you are working with, you don't have to know everything beforehand. Being aware that there are differences is a good start. It is also useful to think about theories from your undergraduate degree that may be relevant, such as considering the different social identities (e.g. national/religious/ethnic identity) a person has and whether they were in the minority or majority in any of those groups in their home country. This may play some role in their life decisions after immigration.

Think about how eurocentric ways of working may be adapted to work with the client group. Multi-agency working and building links with voluntary organisations can be really important in this field. That comes with its own challenges though e.g. a clash of organisational cultures for example.

There are some really helpful websites like Amnesty International and the Medical Foundation for the Care of Victims of Torture where you can find info on particular countries, politics, and conflicts. The Health for Asylum Seekers and Refugees website provides practical, health, social and cultural information for health professionals and volunteers working with asylum seekers and refugees. It also allows you to translate appointment details into 32 different languages (edit: this doesn't appear to be working at the moment - 19/08/2010).

It is important to be aware that some things we take for granted are considered rude or not allowed in other cultures. E.g. making eye contact, shaking hands, drinking alcohol, listening to music. Therapy is a very western concept so it is crucial to check out your client's understanding of mental health issues and therapy and there might be a lot of explaining to do in order to gain informed consent. It may be helpful to work from within a social constructionist approach and it may be appropriate to use systemic and narrative methods. Often the detached introspection of individual therapies such as CBT can feel alien. Endings can be poignant when working with people who have lost everything and may have become very attached to their therapist. Therefore, endings can be incredibly hard both for the client and the therapist and so it is useful to think about attachment theory.

There are a minefield of issues around working with interpreters that need to be considered carefully (there is a specific wiki on working with interpreters here). Therapeutic work can be tricky to do through an interpreter, especially where there aren't the words in the client's language to translate directly. It is important to get an interpreter that is not from the other side of a political conflict than your client. Confidentiality can also be a big issue if there is only a small community of people in the local area from that country and this may mean that people are very resistant to having an interpreter. Some clients may insist on a partner or family member interpreting, but this may not be appropriate for a number of reasons. As a comprimise, it may be worth thinking about sourcing an interpreter from further away. When working with interpreters, it is important to brief them before and after a session. They may not be prepared for what's coming so check out how much therapy work they've been involved in interpreting for. If all they've done is escort people to the benefits office, the GP and the dentist they may be in for quite a shock when faced with the issues that come up in this type of therapy.

Have a think about how culture, mental health services and evidence based practice interface, are they compatible? Guidelines such as NICE may not take sufficient account of the diversity which exists in the populations we are supposed to serve. Does the NICE guideline for PTSD for example (which would be highly relevant for this population) address socio-political factors?

In terms of how we as a profession can best meet the needs of asylum seekers and refugees, one of the most important things is critically analysing the way we formulate and provide interventions. Do we take enough account of the relevant political, historical, social, religious and spiritual (and other) contexts of people's lives? Does a community psychology approach have more to offer and are we as clinical psychologists in a position to offer this? Are we in a position to tackle human rights abuses and social inequalities that contribute to the onset and maintenance of many of the difficulties that asylum seekers and refugees face? Lots of difficult questions.

It's probably also useful to have a look at some of the trauma literature, especially Judith Herman's work. Have a think about self-care given that you may come across some really quite horrific stories working with asylum seekers and refugees, and how you might manage this through supervision.

Other useful websites:

References that you might find helpful:

Berry, J.W. et al. (1989). Acculturation attitudes in plural societies. Applied Psychology: An International Review, 38, 185-206.

Division of Clinical Psychology (1998). Briefing paper number 16: Services to black and minority ethnic people. (You can download this here)

Ellis, A. (1980). Psychotherapy and aesthetic values: A response to A.E. Bergin's 'Psychotherapy and religious values'. Journal of Consulting and Clinical Psychology, 48, 635-639.

Kazarian, S.S. & Evans, D.R. (1998). Cultural clinical psychology: Theory, research and practice. NY: Oxford University Press.

Patel, N. et al. (2000). Clinical psychology, 'race' and culture: A training manual. Leicester: British Psychological Society.

Sharfranske, E.P. & Maloney, H.N. (1990). Clinical Psychologists' religious and spritual orientations in their practice of psychotherapy. Psychotherapy, 27, 72-78.

With thanks to astra, Ruthie, magrat, Lil_Angel, and ilikeblueskies for their contributions to this wiki.

Note: If you have a suggestion about how to improve or add to this wiki please post it here. If you want to discuss this post please post a new thread in the forum.

Last updated by h2eau on 19/08/10
Content checked by a qualified Clinical Psychologist on 03/07/10
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Re: Culture, Prejudice and Reflective Practice

Post by FoxInTheSnow »

Thanks for a massively useful wiki here Ruthie- for some reason this one's evaded my attention before (I'm wondering if that's something to do with wanting to avoid the idea of having prejudices), but seems to have 'unblocked' an area that I was finding it difficult to reflect on for interview prep. The forum thread you link to at the top is really helpful too!

Re: Culture, Prejudice and Reflective Practice

Post by nxa153 »

A very thoughtful and thought-provoking wiki! as i am thinking and feeling very blocked about my clinical interview tomorrow this has not only reminded me that i am capable of thoughts and ideas but of a client i worked with who was a refugee and where there was some suggestion of ptsd and we used an interpreter. and his response to the routine outcomes questionnaire something about 'im not crazy those questions are for crazy people' i recall an embarassed looking interpreter and me momentarily lost for words.
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