Class 3: Anti-Oppressive Practice in Clinical Settings

Class 3: Anti-Oppressive Practice in Clinical Settings August 27, 2012 Reclaiming Futures Anti-Oppressive Practice Training 2012

Objectives for Today • To understand how privilege and oppression appear in clinical settings. • To learn tools to constructively challenge dominant power structures and arrangements in clinical settings. • To promote liberation, strengths and empowerment in clinical settings.

From Last Session…. • Briefly discuss examples of organizations that work to improve the power of clients.

Core Competencies • Describe threats to anti-oppressive practice in clinical settings. • Apply tool to identify quality of anti-oppressive practice components in current setting. • Describe common “tresspasses” that occur in clinical settings. • Describe and apply a “liberation” lens in clinical settings. • Apply methods to advance evolution of clinical practices from an AOP perspective.

Overview of Today • Explore evolution of cultural competence to anti-oppressive frames and AOP-related threats in clinical settings. • Discuss AOP-specific counseling/intervention models and skills including liberation frameworks. • Use tool to reflect on strengths/needs regarding AOP elements in local clinical settings.

Reflecting on Pre-Work for Today • Do your clinical services have information available about ethnic/racial or gender-related success rates? • If yes, how do you assess the rate you found? If not, why does this not occur? • What did you learn as you explored this question?

Brief History of Cultural Competence in Clinical Work • Increasing acknowledgement of diversity in the last 30 years • Minor shifts in “appreciating difference” • Growing awareness of disparities • Increasing grounding in clinical ethics that attention to “cultural competence” important • Tendency to place focus on practitioner responsibility for shift – rather than balance action with larger organization and community changes

Definition of Cultural Competence • A set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in a cross-cultural situation. Operationally defined, cultural competency is the integration and transformation of knowledge about individuals and groups into specific standards, policies, practices and attitudes used in appropriate cultural settings to increase the quality of health care therapy improving or producing better health outcomes (Cross, Bazron, Dennis and Issacs, 1989).

Contrast with an AOP Foci… • A clear theoretical and value base that promotes egalitarianism and power-sharing; • An understanding of one’s social location and how it informs relationships and practice behaviors; • A challenge to existing social relationships in which powerful groups maintain power and influence over less powerful groups; and • Specific practice behaviors and relationships that minimize power imbalances and promote equity and empowerment for users of service. - Larson, 2008

Acknowledging Whiteness in the Dominant Discourse of Treatment • Majority of human development and human behavior theory not grounded in diversity • Need for acknowledging that this has created a hegemonic discourse which permeates all human (and related) services – rendering other perspectives less valuable, dysfunctional or invisible. • Rich literature exists to describe: diverse ideas about identity development and strengths across the human community, impact of racism on human functioning (including trauma response and intergenerational loss & phenomenon of racial micro-aggression), and diverse perspectives on social and health-related behavior but all is seldom integrated into our traditional practice with youth.

Common Threats to AOP Practice in Clinical Settings • Labeling • Micro-Aggression • Unacknowledged realities of the trauma of racism to aggravate and/or exacerbate other issues facing clients • Unexamined/underutilized cultural strengths/resilience • Lack of reflexivity in practitioner stance (lack of self-awareness, fear of issue, unexamined privilege)

Labeling Theory • Understanding of deviance as social rather than psychological phenomenon. • Deviance is not an inherent property of any specific behaviors or persons. Rather it is a model of social definition. • Deviance is thus created through a process of interaction in which moral meanings are assigned to specific behaviors or attributes. Persons who engage in these behaviors or possess these attributes are then selectively chosen and labeled as deviant.

Labeling Theory (Continued) • Social audience is a critical variable in labeling theory. • Social audience, not the individual actor, that determines if a specific behavior is deviant. • The process of creating and applying moral meanings (good, bad, normal, deviant) is a moral enterprise conducted by moral entrepreneurs – people who create and enforce rules, selectively label behaviors and persons as deviant. • Highly valued realms of culture (psychiatry, law, religion) are responsible for the creation, definition and control of deviant types and stereotypes.

Labeling Theory (Continued) • Labeling theorists are concerned with the processes and consequences of labeling • When negative and pathologizing labels are effectively applied, the label impacts all social relations as the labeled person is moved from a normal position in society to a deviant role. • The role carries with it a special status and role expectations the leveled person is expected to fulfill the role requirements of a “patient” or a “prisoner.” • Often these role expectations become a self-fulfilling prophecy for both the individual and the social audience.

Labeling Theory (Continued) • Further, labeling theorists point out that these roles are stigmatized and are usually not reversable. • Thus, once labeled, a stigmatized person is rarely , if ever, allowed to resume a normal role or position in society. Note: The more powerful the person or system applying the label, and the less powerful the person receiving the label, the more dangerous and destructive this process may be.

Micr0-Aggressions • Racial microaggressions are brief and commonplace daily verbal, behavioral or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults towards people of color. • Perpetrators often unaware that they engage in such communications. • Seem to appear in three forms: microassaults, microinsults, and microinvalidation (see summary) Wing Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, & Esquilin, 2007

Trauma, Coping and Racism • Clients in treatment frequently have substantial, multiple and sustained losses • However there is a deeper level of loss to consider from an AOP perspective • Individual and community response to unyielding trauma of racism • Intergenerational transmission of trauma response • Coping and stress management – resilience in the face of racism

Why Strength-Based Approaches are Vital • Strength-based approaches involve deconstructing negative and confining labels and social expectations that deny or obscure people’s strengths. • Helper’s every action helps shape the client's understanding of self and the world, for better or worse, showing the great care must be taken in the helping relationship. • Highlights the importance of supporting a client’s development of self-esteem (recognition of one’s own strengths and worth) through behavior from the helper that is consistently respectful and affirming.

Liberation Psychology • Rooted in Paulo Friere’s pedagogy of the oppressed – concientization or critical consciousness to define process of personal and social transformation. • Believed that traditional models of education are instruments of oppression, reinforcing and maintaining social inequities. • Developed critical consciousness to teach individuals how to read their surrounding circumstances and to write their own reality. (Comas-Diaz, 2007)

Liberation Continued • Liberation paradigm states that to articulate the personal and communitarian liberation language, individuals and groups need to assume control to their lives, overcome their false conscience and achieve a critical consciousness of themselves. • Psychology of liberation seeks to work with people in context through strategies that enhance awareness of oppression and of the ideologies and structural inequality that have kept them subjugated and oppressed. • Collaborates with the oppressed in developing critical analysis and engaging in a transforming practice. • Resonates with African American psychology based on Black liberation psychology (also Afrocentrism). • Emerged from Latin American liberation theology.

AOP Counseling Foundations • Most interventions have been formed without centering distress as connected to identity and oppression • Critique of conventional approaches as individualized, localized (instead of socialized), blaming and implicating dysfunction instead of social causes • Rarely do we practice at the root cause level • Roles are infused with inequality, non-reciprocity and elitism • Spot this as it happens and commit to name it, own it, and undo it • This causes us to reflect on canons of professionalism in new and creative ways • Solidarity instead of distance, rigid boundaries & limited roles

AOP Counseling Practices (mostly from Mullaly, 2007; Baines, 2007) • Empowerment practices • Real building of power among clients & community • Consciousness raising • Pragmatic concerns • Crisis supports • Advocacy • Help with immediate needs • Referrals • Normalizing • Seeing their problems as not unique, but rather similar to others facing same problems • Collectivization • A primary value that recognizes people as social beings who depend on each other for primary & social needs • Is the antithesis of individualism – normalizes needs & collective solutions to problems • Redefining & Reframing • A consciousness raising activity to define private troubles as political issues, exposing the relationship between personal experience & structural domination

AOP “Therapeutic” Lens • Key tasks • Affirm and “own” experiences of oppression • Reject self-concept that flows from internalized oppression • Understand the reach of micro-aggressions and one’s response to it • Look for, and affirm the uniqueness of each individual and the injustices of their experience • Core role is to counteract damages, build strengths, build connections to others in same community, and build agency to create change, self-help and community power • Personal is political – refuse to understand distress solely at the individual level

Reflexivity in Practitioner Stance • Importance of developing practitioner education and ongoing support to see oppressive dimensions present in clinical settings (including willingness to see, understand and take action on their own privilege). • Importance of building climate of openness and “courageous conversations” to identify specific examples of heretofore unexamined potential for oppression and to explore/experiment with clinical practices that challenge and change this. • Strengthen connection to clinical focus on disparities reduction rather than merely execution of evidence-based practices.

Audit of Clinical Practice from an AOP Perspective • In this session, discuss what you learned regarding the AOP “index” for anti-oppressive practice in your clinical settings. • Discuss barriers and facilitators of progress – especially identification of key allies and levers for change • Discuss potential projects that could be derived from what was learned in this exercise for final project

Homework and Follow Up • Read articles relating to AOP relevance and issues in clinical practice.

For Next Class • Seek out any organizational diversity or cultural competence plans and bring examples to our next class. • If you can, please share them by sending to Cora who can assist us in sharing them. • Next class meeting on September 5, 2012

Class 3: Anti-Oppressive Practice in Clinical Settings