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“From Awareness to practice“An Introduction to Cultural Competency in Counselling & Psychotherapy Facilitator - RavindJeawon
Overview of Day • 1: Introduction of topic with some theory, video & self reflection • 2: Speaker - Akidwa (national network for migrant women living in Ireland) • Lunch 1-2pm • 3: Speaker – Thomas McCann – Traveller Counselling Service • 4: Further theory & Discussion • 5: Speaker – Abeer Younis – Palestinian/Israeli Artist • Finish 5pm
Workshop Materials • www.talktherapy.ie • https://talktherapy.ie/service-information/cultural-competency-workshop-materials/ • Also shortly IACP website
What is Culture? • “Culture…is that complex whole which includes knowledge, belief, art, morals, custom & any other capabilities and habits acquired by man as a member of society” (Tyler - British Anthropologist - 1870) • “Culture consists of derivatives of experience, more or less organized, learned or created by the individuals of a population, including those images or encodements and their interpretations (meanings) transmitted from past generations, from contemporaries or formed by individuals themselves.’’ (T Schwartz - 1992) • ‘’….the set of attitudes, values, beliefs and behaviors shared by a group of people but different for each individual, communicated from one generation to the next.” (Matsumoto - 1996)
Diversity in all clients! Counselor Client *Race/Ethnicity/Culture * Sexuality * Gender * Status * Religion/Spirituality * Socioeconomic status * Age * Language * Health/Disability
All counseling is cross-cultural in nature often placing an emphasis on human diversity in all its many forms, Culturally competent counselors are multi-culturally literate human beings developing awareness, knowledge andskillsin order to work effectively with people from diverse backgrounds Being able to “sit & work with” cultural experiences & perspectives that may challenge our own & thus emerge in the therapeutic relationship. Meeting the client where they are at but understanding where we are at ! BASIC CONCEPTS OF MULTICULTURAL COUNSELING
What type of reactions or emotions am I feeling as I engage on material on multicultural counselling. Why am I feeling this way? What could it mean? Does having a different point of view mean I am resisting the material? List reasons to support & challenge your stance. In what ways may these emotions affect my ability to understand the worldview of clients who differ from me? How could this affect my work? Keep in mind today...
Presenter Bio • Founder of Talk Therapy Dublin a counselling practice based out of Dublin 6W. • Postgraduate Diploma in Integrative Counselling and Psychotherapy from University College Cork, conferred after 4 years with Turning Point Institute. • Primarily Client work but also personal & family experiences have developed a specific interest in Culturally Sensitive Counselling . • Additional Cultural Competence Training at the Nafsiyat Intercultural Therapy centre in London. Prior to Psychotherapy • Thirteen year career in the corporate sector having received a Bachelor’s Degree in Business (BBS) from Trinity College Dublin. • Spent time working in Geneva Switzerland and the United Kingdom as well as all across both the Republic & Northern Ireland. • Still involved in business linked to residential property in Dublin. • 10 years of experience volunteering with vulnerable people of all age groups • Youth advocacy for Foróigeand more recently involved advocating for vulnerable people affected by the housing crisis in Dublin.
Wade & Bernstein (1991) found that culturally sensitive counselling affected therapeutic process more than ethnicity of the therapist. To develop cultural competence we must be conscious of our assumptions and start to appreciate that culture is not a ‘thing’ a person has, a “type” or “category” they fall into Culture may better understood as something people ‘do’ rather than ‘have’ (Markus, 2008). A therapist’s sensitivity to their client’s culture involves sensitivity to their clients’ construct systems, while at the same time being astutely aware of their own construing processes. Cultural Competency in Psychotherapy?
What is Intercultural Therapy? • It takes into account the whole being of the patient – not only the individual concepts and constructs as presented to the therapist, but also the patient’s communal life experience in the world – both past and present. The very fact of being from another culture involves both conscious and unconscious assumptions, both in the patient and the therapist. “I believe that for the successful outcome of therapy it is essential to address these conscious and unconscious assumptions from the beginning”. • Jafar Kareem, co-founder of Nafsiyat Intercultural Therapy Centre 1978
Hazel Chu – Green Party TD – Barrow Street Protests. EU – MIDS survey showed Ireland, Austria & Finland worst for racially motivated violence as well as hate motivated harassment. Less than one third report – Dundrum incident racial? Omission of fadas by public & private companies – GDPR – rights of people to have inaccurate personal data corrected – Complaints against HSE., Bank of Ireland Love Island – Yewande Biala - 2019 & Samira Mighty 2018 Where are we at?
“Where are you really from?” • The continued experience of explaining a name – microagression. • Ravindra (sun lord) Jeevan (life) is a Hindi name tinted with the effects of colonialism . • Grew up in 1980s/1990s Dublin – school access issues – culture shock! • Catholic Mum, Hindu Father • Quaker Primary School, Jewish secondary school – • Work responsibilities in Northern Ireland for two companies • Filling out first census to working on census 2016. Mental Health Effect: . • Identity issues - Jason Sherlock (“Jayo”) - Baz Ashmawy (The Lost Muslim)
Diversity & practice • My private practice – consistently 40-45 % of clients born outside Ireland – changing Irish demographics. • Lack of coverage of ethnic diversity - 4 year of training – diversity focused on the “majority culture’s” priorities. Silence from minorities is typical in these group settings. • Minimizes concept of multi culturalism as the “ Fourth Force” in counselling/psychotherapy – institutionalized bias? • Very common factor is RESISTENCE to multicultural training • Demonstrated by Irish training course reading lists. • Explicitly mentioned in policy document “A Vision for Change”. Also in EAP document on Core Competencies. • An issue linked to being congruent, communicating empathy & an opportunity for all Therapists
Diversity in Psychotherapy – IACP Members Survey 2018 (1076 people) • 88% Born in Ireland • Over 75% identified as Female. • 65% aged between 46-65 years old. • 63% from Dublin/Leinster region. • Under 35’s more likely to work on cultural identity issues. • Only 6 % of membership – Why this minority group?? • 10% offer foreign language counselling • Depression, anxiety & relationship issues main presenting issues as reported by therapists surveyed. • Sexuality, gender & cultural identity much smaller…??? • What if looked at together under diversity? Are they linked to the above issues which are essentially constructs?
Competency & Ethical practice • Mental Health Reform 2014 - The mental health needs of people from black and minority ethnic (BME) communities, including the Traveller community, are a priority. • The Government’s mental health policy A Vision for Change recognizes that culturally appropriate services are important and recommends that: • Mental Health Services should be provided in a culturally sensitive manner. Training should be made available for mental health professionals in this regard and mental health services should be resourced to provide services to other ethnic groups including provision for interpreters (p41)
Enhance accessibility of services to service users from diverse ethnic, cultural and religious backgrounds Address health issues experienced by service users from diverse ethnic, cultural and religious backgrounds Ensure provision of high quality, culturally responsive services to service users from diverse ethnic, cultural and religious backgrounds Build an evidence base Strengthen partnership working to enhance intercultural health. HSE – Second National Intercultural Health Strategy 2018 - 2023
A question of Competency & Ethical practice BACP – Ethical Guidelines “facilitating a sense of self that is meaningful to the person(s) concerned within their personal and cultural context” IACP – Ethical Guidelines Code of Ethics – Principle 1 Respect • to respect clients' dignity and to give due regard to their moral and cultural values. • Not allow their service to clients to be diminished by factors such as age, class, culture… • Mandatory examination & training in the USA to be a licensed therapist
Recent 2016 census 17.3% of population born outside Ireland - 810,406 people. Increase of 43,636 people versus 2011 82.2% White Irish – other White Background 9.5% 535,475 non Irish nationals 1.6% decrease vs 2011 – effects of Dual Nationality & Integration Twelve nations accounted for 73.6% of this – USA, Brazil, France, Germany, India, Italy, Latvia, Lithuania, Poland, Romania, Spain and the UK Travelling Community – 30,987 – 0.7% population Ethnic Diversity in Ireland
Insert CSO Ethic Diversity in Ireland
What are the basic values, beliefs, and assumptions that characterize your society? Are these manifested in the practice of psychotherapy? What are the generic characteristics of counselling and psychotherapy - how may they act as barriers to the helping process? In what way may the cultural values of diverse populations affect the counselling process? What role may socioeconomic class issues play in the effective delivery of mental health services? What are issues that a mental health provider faces when working with clients whose first language is not English? In understanding some of your therapeutic assumptions, values, and approach, with which population (Asian, African, Polish, Travellers) do you anticipate having the greatest difficulty working? Why? Reflective Questions (Exercise)Derald Wing Sue, David Sue ( 2012) Counseling the Culturally Diverse: Theory and Practice, 6th edition
Variety of definitions but below are three key headings that are our key to our workshop for today Cultural Competence 1: Awareness Cultural Competence 2: Knowledge Cultural Competence 3: Skills What is Cultural CompetencyDerald Wing Sue, David Sue ( 2016) Counseling the Culturally Diverse: Theory and Practice, 7th edition
Move from being culturally unaware to aware, sensitive to our own cultural heritage and to valuing and respecting differences. Aware of our own biases & values and how they may affect clients & the therapeutic relationship (Example – Brazilian Client). Ability to “sit with” client differences– race, gender narratives, sexual orientation Differences not seen as negative or pathologized (e.g. Rogers initial reaction to homosexuality). Competency 1 - Awareness
Sensitivity to circumstances – (personal bias, sociopolitical influences, stage of racial awakening, sexual orientation, gender identity) This may dictate a referral of a client to members of their own sociodemographic group or a different therapist – e.g. Travellers Counselling Service. Honesty & awareness of our own racist, prejudiced, sexist and biased beliefs & feelings – use of supervision/personal therapy in this regard. Competency 1 - Awareness
Knowledgeable and informed on a number of culturally diverse groups especially groups with whom therapist works with (example of therapist working with bereavement who has no direct experience). Knowledgeable about the sociopolitical system’s operation in Ireland with respect to the treatment of marginalized groups in society. Possess specific knowledge and understanding of the generic characteristics of counseling/psychotherapy Knowledge of institutional barriers that prevent some diverse clients from using mental health services. Competency 2 - Knowledge
Ability to generate a wide variety of verbal and nonverbal helping responses. Able to communicate (send & receive both verbal & non verbal) accurately & appropriately. Able to exercise institutional intervention skills on behalf of clients where appropriate. Able to anticipate the impact of their helping style and its limitations on culturally diverse clients. Able to play helping roles characterized by an active systemic focus (environmental interventions). Not restricted by conventional therapist mode of operation. (34 competencies D W Sue et al 1998) Competency 3 - Skills
American Psychological Association “The relationship between minority and dominant values and resultant conflict with the social environment experienced by minority members” The Irish Travelling Community Presenting Issue - Minority Stress
Introduction to the Tripartite Framework of Personal Identity Derald Wing Sue, David Sue ( 2016) Counseling the Culturally Diverse: Theory and Practice, 7th edition
The group dimension- Tripartite Framework of Personal Identity • Beware of the generic qualities of psychotherapy • Could a therapist avoid acknowledging the racial or cultural background of a client. • “there is only one race the human race ” • “we are all the same under the skin” • “we are all human beings at the end of the day” • “I have lots of experience working with diverse clients” • Paul McGrath with Tommy Tiernan
HSE - CIPC – National Evaluation Study - April 2018 • All 13 Counsellor/Therapists whom reported therapy type, recorded more than one type of therapy approach was employed with their clients. • Three therapeutic approaches accounted for the main forms of therapy utilised by participating Counsellor/Therapists (Person Centred, Cognitive Behavioural Therapy and Integrative Therapy) • All Counsellor/Therapists indicated that they utilised person centred therapy which was recorded for 89.9% (n = 71) clients.
Generally considered an evidence based variable in effective psychotherapy across modalities. Rogers (1957) Integrative Statement in a cross cultural context – what challenges might we face? Challenges - Language, Interpreters, Non verbal, communication The Therepeutic Relationship
Roger’s 1957 Core Conditions • Two persons are in psychological contact. • The first (the client) is in a state of incongruence, being vulnerable or anxious • The second person (therapist) is congruent or integrated in the relationship • The therapist experiences unconditional positive regard for the client. • The therapist experiences an empathetic understanding of the clients internal frame of reference and endeavors to communicate this experience to the client. • The communication to the client of the therapist’s empathic understanding and unconditional positive regard is to a minimal degree achieved.
What is Intercultural Therapy? “Any clinical encounter that does not take into account the client’s whole life experience and does not consider their race, culture, gender or social values, can only fragment that person.” (Jafar Kareem, co-founder of Nafsiyat Intercultural Therapy Centre) • It helps greatly for psychotherapists to cultivate an awareness of how engulfed they are in their own cultural assumptions. • Recent Example of Couples Counsellor
Barriers to Multicultural Counselling & Therapy Cultural Issues in Professional Practice, ICHAS – level 7 course Dr. Alvina Grosu
Outline: • Generic Characteristics of Psychotherapy • Class Bound values • Culture Bound Values • Language Barriers • Generalisations & Stereotypes
Culture-bound valuesFocus on Individual • Not all cultures view individualism as a positive orientation; or as the the psychosocial unit of operation. • In many non-Western cultures, identity is not seen apart from the group orientation (collectivism). • The notion of atman in India defines itself as participating in unity with all things and not being limited by the temporal world. • Hsu (1971) states the Chinese language does not have a counterpart for the Western idea of “personality.” “Jen” – Chinese word meaning “man” (the concept also shared by the Japanese “jin”) – is positioned on the individual‟s connections with his fellow human beings. • The construct of self relies heavily on interpersonal transactions, which make the person‟s existence worthwhile. • In many cultures and subgroups, the psychosocial unit of operation tends to be the family, group, or collective society. • The greatest punitive measure to be taken out on an individual by the family is to be disowned. Derald Wing Sue, David Sue ( 2012) Counseling the Culturally Diverse: Theory and Practice, 6th edition
Culture-bound valuesFocus on Individual • In societies that emphasize collectivism, the most dominant affective element to follow a wrongful behaviour is shame, not guilt. • Guilt is an individual affect, whereas shame appears to be a group one (it reflects on the family or group). • “Counsellors and therapists who fail to recognize the importance of defining this difference between individualism and collectivism will create difficulties in therapy. • Risk of describing traditional Asian clients as being "dependent," "unable to make decisions on their own," and "lacking in maturity." Many of these judgments are based on the fact that many Asian clients do not see a decision-making process as an individual one. • Netflix documentary on three arranged marriages – (A Suitable girl) DeraldWing Sue, David Sue ( 2012) Counseling the Culturally Diverse: Theory and Practice, 6th edition
