Nov 20 & 25 Lecture Flashcards
what is feminist therapy video
field of psychology does lots of harm to certain groups of people - especially those who are targeted in multiple ways
ie. due to race, class, gender, sexuality, size, ability
in 1960s - women psychologists infused feminism and psychology
^ goal is to subvert the patriarchy and advance equality and social justice for people of all genders/backgrounds
^ way to be able to see systems that are impacting your lives, relationships and ultimately mental health
key tenets of feminist theory video
- de-expert
- reframe
- de-pathologize
- advocacy
de-expert: key tenets of feminist theory video
therapists are here to collaborate with clients
there to co-discover their truth
doing this together, pulling from patient before adding anything from themselves
they’re always equal (regardless of things like age gaps)
reframe: key tenets of feminist theory video
intrapersonal view > societal view
^ recognize society’s role in health and wellness
intrapersonal view = deficiency related, you’re at the root of your prroblems
societal view = how has society/oppression/injustice affected your mental health?
de-pathologize: key tenets of feminist theory video
start to question the DSM-5
why do we have to use labels anyways? who does the DSM-5 serve?
the key factors that help with client outcomes aren’t dependent on diagnosis - regardless of diagnosis, outcomes are dependent on the client-therapist relationship
reading on feminist therapy - what’s the primary goal?
empowerment
seeing self as ‘active agent in personal, interpersonal, and political contexts’
^ links to self-determination theory
reading on feminist therapy - empirical evidence…
empirical evidence > different parts have promising evidence (esp impact of increasing client empowerment)
overall, little research on treatment outcomes when therapist incorporates feminist therapy orientation into whatever evidence-based treatment is being conducted
MORE WORK NEEDED
liberation psychology
purpose is to “change people so they can change the world”
promote indigenous cultural healing and activism/emancipation into mainstream therapy
nonreligious and non-denomenational, but leans into spirituality present among oppressed communities
^ values of interconnectedness, solidarity, transformation
radical humility & empathy
purpose of liberation psychology
to change people so they can change the world
liberation psychology promotes…
indigenous cultural healing
activism/emancipation into mainstream therapy
liberation psychology is nonreligious and non-denominational, but…
leans into spirituality present among oppressed communities
values of interconnectedness, solidarity, transformation
liberation psychology - radical humility & empathy
OPEN conversations about POSITIONALITY and POWER DIFFERENTIALS in life and between therapist and client
help develop CLIENT CRITICAL CONSCIOUSNESS and accompany clients as they connect with cultural strengths and work toward personal and collective liberation
summary: feminist and liberation therapy
broad theoretical orientations (approaches to therapeutic process)
not incompatible with ‘mainstream’ evidence-based practices, but these practices will likely require more adaptation to be more inclusive of systemic-level influences
both focused on power, privilege and oppression as contributors to struggling
reconnecting with various aspects of identity, becoming aware of inequalities, narratives, and taking concrete action are proposed as healing mechanisms
evidence-based psychosocial interventions for ethnic minority youth: the 10 year update - INCLUSION CRITERIA
- representation: at least 75% of participants were ethnic minorities
- OR effects evaluated using subgroup analyses with subset of ethnic minorities
- OR evaluated whether ethnic minority status moderated the outcome(s)
65 studies included
evidence-based psychosocial interventions for ethnic minority youth: the 10 year update - DESIGN AND METHODS INCLUSION CRITERIA
- group design: study involved a randomized controlled design
- independent variable: intervention was manualized or logical equivalent
- population: specified problems based on clearly delineated/exclusion criteria
- dependent variable: reliable and valid measures used to ascertain outcomes
evidence-based psychosocial interventions for ethnic minority youth: the 10 year update - of the 65 studies identified…
27 studies focused on Hispanic/Latino youth
19 studies focused on African American youth
1 study focused on Asian American youth
18 studies focused on multiethnic youth
NONe focused on Native American youth
MORE HIGH-QUALITY RESEARCH NEEDED
how many well-established programs exist among Ethnic-Minority Youth?
only FOUR
the 4 well-established programs among ethnic minority youth
- cognitive and behavioural interventions for anxiety in latinx children (caveat: if no consideration given to cultural-contextual factors, program compromised)
- multisystemic therapy (MST) for disruptive behaviours among black adolescents
- family-based interventions for disruptive behaviours among Latinx children & teens
- family-based interventions for substance use problems among Latinx children & teens
what is MST?
therapists work in the home, school and community
are on call 24/7 to provide caregivers with tools they need to transform the lives of troubled youth
research demonstrates that MST reduces criminal activity and other undesirable behaviour
MST reduces…
criminal activity and other undesirable behaviour
MST ecological model
sees the child as inside a big environment
child is surrounded by:
- family
- peers
- school
- neighbourhood
- community/culture
cultural adaptation
program modifications that are culturally sensitive
tailored to a cultural group’s traditional world views
cultural adaptation requires…
- moving beyond changing surface structure to CHANGING DEEP STRUCTURE
- understanding CULTURAL NUANCE
- CULTURAL COMPETENCE
cultural adaptation: can adapt…
program content
or program delivery
sources of misfit model looks at…
- sources of mismatch
- program validation group(s)
- current consumer group
- actual or potential mismatch effect
sources of misfit model: sources of misfit
group characteristics:
a) language
b) ethnicity
c) SES
d) urban-rural context
program delivery staff:
a) type of staff
b) staff cultural competence
admin/community factors:
a) community consultation
b) community readiness
sources of misfit model: actual or potential mismatch effects
- consumer inability to understand program content
- conflicts in beliefs, values, norms
- insufficient social resources and culturally different life experiences
- lesser or different program delivery skills and perspectives
- limited awareness of/insensitivity to cultural issues
- absence of community “buy in”, community resistance, low participation
why are mental health services under-utilized in black populations?
- FINANCIAL (but still under-utilize when insurance covers)
- CULTURAL BARRIERS (stigma, seen as weakness, prohibition on sharing)
- STIGMA OF MENTAL ILLNESS
- ALTERNATIVE RESOURCES (church, primary care)
- LACK OF INFO or KNOWLEDGE
- MISTRUST OF MENTAL HEALTH CARE SYSTEM
- FEW BLACK PRACTITIONERS (4% psychologists in US)
standing in the gap - distance between clinicians and clients
distance between clinic and clients:
- diagnosis and symptom focus
- lack of focus/lack of therapist understanding of structural factors impacting client
- lack of self disclosure
standing in the gap - cultural relevance
“as we enter a new decade on research and especially practice concerning Black youth, it appears there still remains a GAP BETWEEN the PHILOSOPHICAL PRESCRIPTIVE on the one hand (what theory and research says) and the PRACTICE on the other (what practice does)”
“what does it mean to incorporate culture in the clinical context? what should be said or done differently to move traditional practice from a typically monocultural, mainstream framework toward a culturally relevant framework?”
more practice recommendations
- assess clients’ and their caregivers’ experience with racial stressors, racial socialization practices, and racial identity
- assess spiritual beliefs
- be cautious that various ethnic and cultural groups exist within the greater Black racial categorization - you don’t want to stereotype
- explore common barriers to session attendance
goals tailoring treatments
- increase engagement
- decrease drop-out
- increase satisfaction
- increase relevance
- increase treatment effectiveness
- address specific issues
cultural relevance
- LINGUISTIC STYLE
a) storytelling
b) call & response
c) signification - art of insult when speaking humorously, sarcasm come backs, jokes
- SPIRITUALITY and RELIGION
- HUMAN CONNECTION
a) genuineness, culturally grounded
- MOVEMENT - communication tool
- RACIAL/CULTURAL SOCIALIZATION
Africentric treatments: application of Nguzo Saba Principles
- umoja (unity)
- kujichagulia (self-determination)
- ujima (collective work and responsibility)
- ujamaa (cooperative economics)
- nia (purpose)
- kuumba (creativity)
- imani (faith)
Nguzo Saba Principles: umoja
unity
to strive for unity in family, community and race
Nguzo Saba Principles: kujichagulia
self-determination
to define ourselves, create for ourselves, and speak for ourselves
Nguzo Saba Principles: ujima
collective work and responsibility
to build and maintain our community together
and make our sisters’ and brothers’ problems our problems
and to solve them together
Nguzo Saba Principles: ujamaa
cooperative economics
to build and maintain our own businesses and to profit from them together
Nguzo Saba Principles: nia
purpose
to make our collective vocation the building and developing of our community
Nguzo Saba Principles: kuumba
creativity
to do always as much as we can and in the ways we can to leave our community more beautiful and beneficial than we inherited it
Nguzo Saba Principles: imani
faith
to believe with all out heart in our people, our parents, our leaders and the righteousness and victory of our struggle
afrocentric worldview
values, beliefs and behaviour of people of African descent
- spirituality
- collectivism (cooperation)
- time orientation
^equal importance of past, present, future - time flexibility - orality
- sensitivity to affect and emotional cues
- verve and rhythm, creative behaviour
- balance and harmony with nature (balance of mental, physical, spiritual states)
TF-CBT
trauma-focused CBT
- short term evidence-based trauma treatment
- cognitive behavioural strategies to address PTSD and trauma-related depressive and anxiety symptoms & behaviour problems
- 9 intervention components - PRACTICE
CBT triangle
triangle in the middle: TRIGGERING EVENT
3 boxes surrounding it:
1. THOUGHTS
2. BEHAVIOURS
3. EMOTIONS
CBT triangle: thoughts
- words you tell yourself
- internal dialogue
eg. “I’m never going to be good enough”
CBT triangle: behaviours
- your actions
- what you do
eg. procrastination, comparing yourself to others, avoiding
CBT triangle: emotions
how you feel
eg. frustrated, hopeless, sad
TF-CBT traditionally does NOT address…
- racial trauma
- cultural factors that may influence engagement and persistence in treatment
adding ERS to TF-CBT can…
- help youth PROCESS and COPE with racially charged traumatic experiences
- help with MANAGEMENT of racialized stressors that may ADD to IMPAIRMENT and COMPOUND upon ‘general’ trauma experiences
- improve TREATMENT ENGAGEMENT by increasing cultural relevance
PRACTICE - first part
part of TF-CBT
PRAC: Coping skills
- Psycho-education and parenting
- Relaxation
- Affective expression and modulation
- Cognitive coping
PRACTICE - second part
part of TF-CBT
T:
- Trauma narrative and processing
ICE:
- In vivo exposure
- Conjoint sessions
- Enhancing safety
summary - treatment in black populations
think about barriers to access and engagement in treatment
afrocentric principles (afrocentric worldview, Nguza Saba)
integration of ERS into existing mental health treatments
^ no great data on these yet, but is hopefully coming
CBT with Latino populations
- PROVIDING POSITIVE REINFORCEMENT
^ helping parents praise positive behaviours
- SHAME vs GUILT
^ addressing cognition in adolescents regarding family
- UNDERSTANDING CONTEXT OF IMMIGRATION
^ educational experiences
^ rules and consequences
^ family conflict
family based CBT for Latino families
- empower parents
- pleasant activity planning
- discuss rule setting and expectations
empower parents: family based CBT for Latino families
teach them skills
discuss feelings of failure
pleasant activity planning: family based CBT for Latino families
using family
increasing trust in family
discuss rule setting and expectations: family based CBT for Latino families
explicate rule setting - giving authority to parents
help teens form expectations in context of family
meta analysis of culturally adapted substance use interventions for Latinx adolescents - QUESTION
what is the effectiveness of culturally adapted treatments for Latino adolescents made to treat substance use?
meta analysis of culturally adapted substance use interventions for Latinx adolescents - STUDY CHARACTERISTICS 1
analyzed findings from 10 studies of interventions intended to prevent/reduce substance use in Latinx adolescents
7 studies were randomized controlled trails
3 studies were quasi-experimental design studies
meta analysis of culturally adapted substance use interventions for Latinx adolescents - STUDY CHARACTERISTICS 2
10% of interventions were delivered to a group of adolescents
30% were one-on-one
control group was non-adapted version 40%, attention/placebo 10%
70% addressed substanced use through education or skills training
40% included parents
half in school settings
mean sessions = 12
mean duration = 12 weeks
meta analysis of culturally adapted substance use interventions for Latinx adolescents - CHARACTERISTICS OF CULTURAL ADAPTATIONS
- CULTURAL VALUES
- CONTENT
- LANGUAGE
- DELIVERY
cultural values: characteristics of cultural adaptations
incorporating cultural values to intervention context
ie. respeto, familismo
90% did this
content: characteristics of cultural adaptations
making changes to intervention content
ie. using actors of colour, telenovelas
60% did this
language: characteristics of cultural adaptations
providing the intervention in English and Spanish
40% did this
delivery: characteristics of cultural adaptations
changing the nature of the therapeutic service delivery
ie. family members are included in the recruitment, engagement, or retention of participants
20% did this
meta analysis of culturally adapted substance use interventions for Latinx adolescents - RESULTS
- very small effect at POST-TEST (right when intervention ends) - Latinx teens in culturally adapted interventions generally did ONLY VERY SLIGHTLY BETTER than control groups
^ G = .06
- effect of intervention at LATER FOLLOW-UP - POSITIVE EFFECT of culturally-adapted intervention on substance use outcomes
^ G = .26
underutilization of care in Asian populations - cultural barriers
- privacy
- avoidance of shame and stigma
- reliance on other sources of help
- individual versus collectivist goals
- acculturation
- model minority myth
even compared to other minoritized groups, Asian populations…
utilize mental health care FAR LESS and have LESS POSITIVE ATTITUDES towards seeking psychological help
school-based mental health prevention at a high school…
AA youth less likely to utilize SBMH compared to other ethnic minority youth
East Asian groups often clash in values…
with Western models of psychotherapy
ie. Western models often emphasize the EXPLORATION OF EMOTION as a solution to problems, which often doesn’t align with EAA practices
EAAs with stronger internalized model minority beliefs…
also have less positive help-seeking attitudes
EAA cultural values
- avoidance of shame
- hierarchical relationship
- deference to authority
- collectivism - keeping things within the family
- emotional self-control
- conformity to norms
- filial piety
- humility
- family recognition through achievement
south asian youth and families - mental illness seen as…
a “moral failure” or “characterological weakness”
south asian cultural values…
COLLECTIVISM and CONFORMITY
COURTESY STIGMA: family members can become victims of the same devaluation experienced by the individual with the mental illness due to their association
south asian groups - collectivist values are associated with…
higher stigmatizing attitudes
south asian youth/families are more likely to present with…
somatic complaints
south asian youth/families: more culturally acceptable to…
seek spiritual remedies like:
prayer
complementary/holistic medicine
what does literature say about effectiveness of psychology tx with Asian groups?
meta analysis of 21 randomized control trials of mental health interventions including people of East or Southeast Asian descent
(very little research on South Asians)
on average, tx close to 1SD better than control
2 MODERATORS - what does literature say about effectiveness of psychology tx with Asian groups?
- treatments with most amount of CULTURAL TAILORING (ie. made for specific Asian subgroups) worked the best
^ followed by treatments generally tailored for minorities, and then by un-tailored treatments
- thought group might work better than individual treatment given context and collectivist beliefs, but INDIVIDUAL and GROUP TREATMENTS worked EQUALLY WELL
MODERATOR TAKEAWAY - what does literature say about effectiveness of psychology tx with Asian groups?
the more specific the cultural adaptation for specific Asian ethnicities, the better the treatment outcomes
regardless of group or individual therapy modality
intergenerational & historical trauma (treatment for Indigenous populations)
history of displacement, disenfranchisement, genocide
colonization
residential schools
forced assimilation
residential schools
family and community disruption
confusion of parenting and punitive institutional practice
impaired emotional response
physical and sexual abuse
loss of knowledge, language, tradition
systemic devaluing native identity
implications for interventions (treatment for Indigenous populations)
- need to establish TRUST
- reducing historical trauma response and increasing RE-ATTACHMENT TO HERITAGE cultural values
- discuss ETHNIC SIMILARITIES/DIFFS
- acculturation
- allow extended fam and other valued persons into therapy
- STRENGTHS-BASED
- respect silence
- honour and respect for culture
- EXAMINE HISTORICAL CONTEXT
- encourage physical health
- enhance coping
- reduce isolation and enhance connection
- PROMOTE POSITIVE CULTURAL IDENTITY & CONNECTIONS
- reduce generational divides
“what are the best practices for psychotherapy with Indigenous peoples in the US and Canada? a thorny question”
- very large diversity across NA indigenous people
- cookie cutter recommendations have some utility but aren’t a panacea
- very few RCTs and pre-post treatment studies of evidence based treatments
- mostly effective but mostly focused on substance abuse/alcohol use
- culturally adapted treatments exist, but are small in numbers
- important tools esp when adaptations are done at deeper level to align intervention with values and practices of group
- traditional healing and community-led cultural interventions are key
- process of implementation may be slow and support structures for these may vary
mindfulness based interventions INTRO
systemic review of 9 studies of mindfulness-based interventions for indigenous people
total n = 135 (very small)
mindfulness based interventions RESULTS etc
generally positive mental health effects
high feasibility
participants were satisfied with these programs and thought they helped them reconnect to their group’s traditional beliefs
culturally adapted digital interventions
large semi-recent increase in digital interventions
- convenient for users
- cheap
- flexible (may reduce mental health care access barriers)
- often ‘one size fits all’ but may benefit from cultural tailoring
impacts of culturally adapted digital mental health interventions SETUP
12 randomized studies (more included in broader view)
most involved ‘deep’/thorough cultural adaptation, including:
a) language translation
b) modification of audio/visual content
c) inclusion of culturally salient messaging
impacts of culturally adapted digital mental health interventions RESULTS
overall, effects of these interventions were LARGE and POSITIVE relative to controls
cultural adaptation of digital interventions is important and can be a good way to serve harder to reach minoritized populations
when working with people from marginalized backgrounds, be careful of…
ESSENTIALISM: idea that people inherently have specific attributes based on their cultural group membership
don’t assume - ask people about cultural identity, history, beliefs, values that may be impacting them
DSM-5 cultural formulation interview
some questions to guide work with people from marginalized backgrounds
“for you, what are the most important aspects of you background/identity?”
“are there any aspects of your background/identity that make a difference to your [problem]”
“are there any aspects of your background or identity that are causing other concerns or difficulties for you?”
