Thread by @DrJulietteM

Calling all therapists!

PSA: You are responsible for providing culturally-relevant treatment to your clients. What does this look like?

A thread...

1/15

Overall, this involves *explicitly* addressing clinician-client cultural differences, discrimination, stigma, and perceptions of mental health care early in therapy. This is critical to creating a healing space.

2/15

Have any of you ever described yourself as racially "color-blind"? Well, this philosophy is actually harmful. "Color-blindness" creates a barrier to understanding different cultures and cultural dynamics, which is essential to delivering quality MH care to BIPOC.

3/15

In therapy, all of the societal and cultural forces that have shaped the therapist and the client come into play. The therapist's awareness of these forces and how they impact therapy is critical. Ex, cultural mistrust & cultural norms re: authority, family roles.

4/15

Clients have to feel comfortable discussing how these forces impact their mental health and the therapeutic relationship. It is the therapist's role to set the stage and provide a safe space where these discussions are welcomed.

5/15

Therapists have to make it explicitly clear that conversations about culture and identity are on the table - meaning the therapist usually has to start the conversation!
"What aspects of your identity are most important to you?"
"Do your identities impact your MH?"

6/15

To have productive conversations, the therapist has to have awareness of their own culture and prejudices, have knowledge about their client's culture/identities, and recognize how current & historical dynamics impact symptoms, diagnosis and the therapy relationship.

7/15

This is often referred to as Cultural Competence. This term is losing favor because "competence" implies achieving something. Some like the term Cultural Humility. Not sure I think this is better, but I would love to hear your thoughts!

8/15

Cultural competence = balancing generalized, group-specific cultural knowledge with an understanding of how a client connects with their culture, and how their culture impacts their mental health.
"What does your culture mean to you? How does it impact your life?"

9/15

Cultural competence requires flexibility, perspective-taking and genuine curiosity, grounded in cultural awareness and knowledge. Non-judgment and humility are A MUST. Check out Stanley Sue's work for more on this.

10/15

We all carry stereotypes into our everyday encounters with others. Stereotypes are “heuristics” or mental shortcuts that allow us to make decisions under high uncertainty and time constraints. WE ALL USE THEM.

11/15

The clinical encounter can be an uncertain process. Clinicians must take in and weigh a great deal of information (some of which may be conflicting), while also deciding what further information to collect, all during a novel interpersonal interaction.

12/15

Add significant (& possibly anxiety-provoking) cultural differences between the clinician and client, and the resulting cognitive load brings biases and stereotypes to the forefront. A foundation of culturally-relevant awareness, knowledge and skills is thus ESSENTIAL.

13/15

So, it makes sense why we'd want to be culturally competent, right? Unfortunately we need more research on what kind of training works and how this affects therapist and client outcomes.

14/15

My goal is to better understand what kind of education and training enables clinicians to effectively serve BIPOC clients. Of course this thread just scratches the surface. I'm really interested in your all's experiences and questions!

15/15

Please share resources, articles, videos, etc. on culturally competent/relevant/sensitive/adapted MH treatment here!