Society for the Study of Psychiatry and Culture 40th Annual Meeting Toronto, Ontario - "Towards a Cultural Psychotherapy of Empowerment" - "Five Situations": Reply to Martín La Roche (original) (raw)

Culture and psychotherapy in a creolizing world

Transcultural psychiatry, 2006

call creolization the meeting, interference, shock, harmonies and disharmonies between the cultures of the world. .. [it] has the following characteristics: the lightening speed of interaction among its elements; the awareness of awareness: thus provoked in us; the reevaluation of the various elements brought into contact (for creolization has no presupposed scale of values); unforeseeable results. Creolization is not a simple cross breeding that would produce easily anticipated results.' (Edouard Glissant, 1997) The practice of psychotherapy depends on a fund of tacit knowledge shared by patient and clinician (Frank, 1973). Intercultural work challenges this shared 'assumptive world' and poses problems of translation and positioning, working across and between systems of meaning and structures of power that underpin the therapeutic alliance and the process of change. The encounter of patient and clinician from two different cultures is not simply a matter of confrontation or exchange between static systems of beliefs and values. Once viewed as self-contained worlds of meaning, cultures are now seen as systems of knowledge and practicesustained by cognitive models, interpersonal interactions, and social institutions-that provide individuals with conceptual tools for selfunderstanding and rhetorical possibilities for self-presentation and social positioning. Moreover, cultural worlds are open-systems, shaped by forces of migration, globalization, and hybridization (Hannerz, 1996; Papastergiadis, 2000). This flux destabilizes old values, identities and ways of life

Culturally Responsive Clinical Psychology and Psychiatry: An Ecosocial Approach

Cultural Clinical Psychology and PTSD, 2019

Cultural clinical psychology and psychiatry aim to address the mental health needs of diverse communities by integrating attention to cultural differences in knowledge, social institutions, identities, and practices. These differences affect mental health by influencing the causes and mechanisms of psychopathology, shaping illness experience and expression, and guiding processes of coping, adaptation, healing and recovery. Various theoretical models, borrowed from social sciences, have been used to understand the interaction of culture and mental health and the nature of psychiatric disorders. These models reflect the cultural assumptions of psychiatry itself and becoming aware of some of these tacit assumptions is essential to open up a space for intercultural work. In this chapter, we will advance an ecosocial approach to culture in mental health in terms of “culturally responsive care.” This aims to identify crucial dimensions of culture and social context relevant to the lived experience of mental health problems and apply that to understanding to clinical assessment and interventions.

Training Clinicians in Cultural Psychiatry: A Canadian Perspective

Academic Psychiatry, 2008

The authors summarize the pedagogical approaches and curriculum used in the training of clinicians in cultural psychiatry at the Division of Social and Transcultural Psychiatry, McGill University. We reviewed available published and unpublished reports on the history and development of training in cultural psychiatry at McGill to identify the main orientations, teaching methods, curriculum, and course content. Student evaluations of teaching were reviewed. The training strategies and curriculum are related to the larger social context of Canadian society including the history of migration, current demography, and policies of multiculturalism. The McGill program includes core teaching, clinical rotations, an intensive summer program, and annual Advanced Study Institutes. The interdisciplinary training setting emphasizes general knowledge rather than specific ethnocultural groups, including: understanding the cultural assumptions implicit in psychiatric theory and practice; exploring the clinician's personal and professional identity and social position; evidence-based conceptual frameworks for understanding the interaction of culture and psychopathology; learning to use an expanded version of the cultural formulation in DSM-IV for diagnostic assessment and treatment planning; and developing skills for working with interpreters and culture-brokers, who mediate and interpret the cultural meaning and assumptions of patient and clinician. An approach to cultural psychiatry grounded in basic social science perspectives and in trainees' appreciation of their own background can prepare clinicians to respond effectively to the changing configurations of culture, ethnicity, and identity in contemporary health care settings.

Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture

Psychotherapy: Theory, Research, Practice, Training, 2006

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman's (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor's (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups.

Training Child and Adolescent Psychiatrists to Be Culturally Competent

Child and Adolescent Psychiatric Clinics of North America, 2010

Cultural competence is the ability of health care professionals to communicate with and effectively provide high-quality care to patients from diverse sociocultural backgrounds. Aspects of diversity include-but go beyond-race, ethnicity, gender, sexual orientation, religion, and country of origin. 1 In response to the increasing diversity of many industrialized societies, educational efforts have been aimed at educating medical trainees to address the needs of a heterogeneous patient population. It is imperative that the child and adolescent psychiatric community prepare for the changing world to provide appropriate, accessible, and quality clinical care. The first step toward this goal is to understand the role of culture and cultural competence in clinical care. As the field of cultural competence has evolved, the goal has moved from educating clinicians in the categorical approach-that of becoming skilled at knowledge, attitudes, and practices of a particular cultural group of patients-to a focus on the development of a set of skills and framework. This culturally competent therapeutic stance is an orientation that places medicine and patients in a social, cultural, and historical context. The overall aim is the open acknowledgment of the dignity and autonomy of, and delivery of high-quality medical care to all members of society, regardless of gender, race, ethnicity, religion, sexual orientation, language, geographic origin, or socioeconomic background. 2

Culturally competent psychotherapy

Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2003

To provide effective psychotherapy for culturally different patients, therapists need to attain cultural competence, which can be divided broadly into the 2 intersecting dimensions of generic and specific cultural competencies. Generic cultural competence includes the knowledge and skill set necessary to work effectively in any cross-cultural therapeutic encounter. For each phase of psychotherapy--preengagement, engagement, assessment and feedback, treatment, and termination--we discuss clinically relevant generic cultural issues under the following headings: therapist, patient, family or group, and technique. Specific cultural competence enables therapists to work effectively with a specific ethnocultural community and also affects each phase of psychotherapy. A comprehensive assessment and treatment approach is required to consider the specific effects of culture on the patient. Cultural analysis (CA) elaborates the DSM-IV cultural formulation, tailoring it for psychotherapy; it i...

Families' and Practitioners' Use of Culture in Youth Mental Health Services: A Double-Edged Sword

Child & Youth Care Forum, 2022

Background Although the literature in medical anthropology and transcultural psychiatry has documented how cultural representations shape individual experiences and perceptions of psychosocial distress and its management, less attention has been given to what is actually meant when the concept of culture is used in professional practice, and how this may influence experience of care. Objective The objective of this article is to explore what understandings of culture circulate in youth mental health practitioners' and families' narratives, and to analyse how different operationalizations of the concept may affect experience of services. Methods This article draws upon the qualitative components of a larger mixed-methods research program on collaborative care in youth mental health. Semi-structured interviews were conducted in Montréal (Québec, Canada) with 39 parents, 48 youths and 29 practitioners about their experience of services, and with 26 practitioners about their experience of intercultural training. Data was analyzed using thematic and narrative approaches. Results Results show that families and practitioners use a multiplicity of understandings of the concept of culture in their discourses as a narrative strategy to mediate dialogue in clinical encounters, either by engaging in it, avoiding it, or refusing it. Conclusions The concept of culture and its use in the clinical realm can be seen a doubleedged sword, both as a tool to reify stereotypes and inequalities, and as a means to mobilize representations towards cultural safety and transformative practices. Minority families' experiences of services may be improved by providing intercultural training and a supportive work environment to clinicians.