14 results
EPA guidance on cultural competence training
- Part of
- Meryam Schouler-Ocak, Iris T. Graef-Calliess, Ilaria Tarricone, Adil Qureshi, Marianne C. Kastrup, Dinesh Bhugra
-
- Journal:
- European Psychiatry / Volume 30 / Issue 3 / March 2015
- Published online by Cambridge University Press:
- 16 April 2020, pp. 431-440
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- Article
- Export citation
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The stress of migration as well as social factors and changes related to the receiving society may lead to the manifestation of psychiatric disorders in vulnerable individuals after migration. The diversity of cultures, ethnicities, races and reasons for migration poses a challenge for those seeking to understand how illness is experienced by immigrants whose backgrounds differ significantly from their clinicians. Cultural competence represents good clinical practice and can be defined as such that a clinician regards each patient in the context of the patient's own culture as well as from the perspective of the clinician's cultural values and prejudices. The EPA Guidance on cultural competence training outlines some of the key issues related to cultural competence and how to deal with these. It points out that cultural competence represents a comprehensive response to the mental health care needs of immigrant patients and requires knowledge, skills and attitudes which can improve the effectiveness of psychiatric treatment. To reach these aims, both individual and organizational competence are needed, as well as teaching competence in terms of educational leadership. The WPA Guidance on Mental Health and Mental Health Care for Migrants and the EPA Guidance on Mental Health Care for Migrants list a series of recommendations for policy makers, service providers and clinicians; these are aimed at improving mental health care for immigrants. The authors of this paper would like to underline these recommendations and, focusing on cultural competency and training, believe that they will be of positive value.
Beneficial uses of dandelion herb (Taraxacum officinale) in poultry nutrition
- S. QURESHI, S. ADIL, M.E. ABD EL-HACK, M. ALAGAWANY, M.R. FARAG
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- Journal:
- World's Poultry Science Journal / Volume 73 / Issue 3 / September 2017
- Published online by Cambridge University Press:
- 03 July 2017, pp. 591-602
- Print publication:
- September 2017
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- Article
- Export citation
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Dandelion or Taraxacum officinale is a well-known medicinal plant that grows naturally in Europe, North and South America and Asia. Dandelion is a source of various nutrients and biologically active substances and its root and leaves contain vitamins (A, K, C and B-complex), minerals (calcium, magnesium, potassium, zinc and iron), micronutrients, fibre, lecithin and choline. The various parts of the plant have a long history of use as an herbal remedy; roots of this herb are firstly considered for enhancing digestion. Also, the roots are generally used for as liver tonic by stimulating bile production and removing toxins and re-establishing hydration and electrolyte balance. Dandelion leaves could be used successfully as digestive stimulant and diuretic. Moreover, dandelion leaves were reported to improve growth and productive performance of poultry. Several beneficial effects have been reported on intestinal mucosa regarding architecture of villi, villus height/ crypt depth ratio as well as cellular infiltration. Dandelion has many properties like immunomodulator, digestive stimulant, prebiotic, insulin stimulant, anti-inflammation, antiangiogenic, antineoplastic and demulcent. Furthermore, dandelion treats indigestion and hepatitis B infection as well as enhances metabolise androgenic hormones. Because of the scarcity of in vivo studies on dandelion, further investigations are needed to confirm its benefits and efficacy.
11 - Barriers to the intercultural therapeutic relationship and how to overcome them
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- By Adil Qureshi, Hospital Universitari Vall d'Hebron, Barcelona, Spain, Rachel Tribe, University of East London, London, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 51-56
-
- Chapter
- Export citation
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Summary
A considerable body of research shows that ethnic minorities and immigrants have lower levels of health service use relative to White or mainstream populations (Institute of Medicine, 2002), and once entering into treatment, have poorer adherence and end it sooner. These results are in part due to barriers related to access to mental health services, poor awareness of mental health services and stigma surrounding their use, lack of services in the patient's mother tongue, cultural insensitivity (Sue, 2003), distrust of service providers (Watkins et al, 1989) and problems in the therapeutic relationship (Griffith, 1977; Welch, 2003; Qureshi, 2005; Comas-Diaz, 2006; Qureshi & Collazos, 2011).
Some of these barriers lie beyond the purview of the busy mental health professional. The therapeutic relationship, however, is not only well within the control of the clinician, it is also one of the strongest predictors of positive therapeutic outcome (Horvath & Symonds, 1991; Jennings & Skovholt, 1999; Martin et al, 2000; Cruz & Pincus, 2002). The barriers can be understood to be related to sociorace and racism and cultural difference (Gregg & Saha, 2006). The impact of the last derives from the cultural encapsulation of the clinician (Wrenn, 1985), in which the clinician operates from the perspective of pig-headed ethnocentrism (as differentiated from quotidian ethnocentrism in which the clinician is aware that they experience the world from their own cultural perspective) (Rorty, 1987), assuming that their own take on reality is not only correct but also superior to that of the ethnic other. The power differential inherent in the clinical context (Rose, 1998), which can be exacerbated by institutional racism and the challenges inherent in immigration (Walls, 2004), can negatively affect the therapeutic relationship in various ways.
Intercultural communication
Communication style, both verbal and non-verbal, is culturally circumscribed (Singh et al, 1998; Morales et al, 1999; McDonagh, 2000; Skelton et al, 2001; Ulrey & Amason, 2001; Van Wieringen et al, 2002; Kapoor et al, 2003; Misra-Herbert, 2003). Normal and adequate communication is a function of cultural context. In the clinical encounter, too little or too much expression of emotion (either flat affect or lability), for example, is considered to be symptomatic. Yet it is reasonably well established that norms for the expression of emotion are by no means universal (Markus & Kitayama, 1991; Jenkins, 1996).
12 - How does intercultural interpretation work in the mental health setting?
-
- By Rachel Tribe, University of East London, London, UK, Adil Qureshi, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 57-60
-
- Chapter
- Export citation
-
Summary
Please ask yourself the following questions, then return to them after you have read this chapter, to see whether you wish to reconsider any of your responses:
• What exactly is intercultural interpretation in the mental health setting?
• What is expected of the interpreter?
• What is being interpreted or mediated in such an encounter?
• Each individual brings their own culture into a meeting, which is itself mediated by a number of factors at the micro- (individual) and macro- (cultural and contextual) level. Is it merely language that is being interpreted or is it something more complex, which includes culture, world views and explanatory health beliefs?
• Is it possible to work effectively with an interpreter to ensure that a patient's mental health needs are addressed appropriately and respectfully?
The challenges
There can be resistance to, or difficulties associated with, working through an interpreter, including feelings of threat and possible exposure experienced by all parties (Westermeyer, 1990). The overall and transferential dynamics within the meeting may be changed (Tribe & Thompson, 2009; Qureshi et al, 2011). Psychiatrists may feel a lack of experience in working through interpreters and may have concerns about how it will affect the meeting and about the accuracy of the interpreting. Patients may be very worried that their words and emotions may not be communicated adequately (Tribe & Raval, 2003). The interpreter may have concerns about working within a psychiatric setting (Razban, 2003). Lack of training and support for interpreters is a matter of concern. They may not be trained in mental health, nor be receiving support or clinical supervision, leaving them vulnerable to vicarious traumatisation (Doherty et al, 2010). We must not assume that a patient and interpreter who share a language will also share a culture. The latter is highly individualistic and there can be dangers in assuming any commonality of culture between interpreter and client. Language and culture interact in complex ways, and the interpreter may be negotiating between three world views: the patient's, the clinician's and their own (Drennan & Swartz, 1999).
7 - On the role of culture and difference in evaluation, assessment and diagnosis
-
- By Adil Qureshi, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 31-35
-
- Chapter
- Export citation
-
Summary
Culture and difference are considered to have a potentially enormous impact on diagnosis and assessment of mental health and illness, to the extent that some investigators believe that the elevated rates of psychiatric illness in African–Caribbeans in the UK and Holland may be at least in part a function diagnostic error (Hickling et al, 1999; Mulder et al, 2006; Singh, 2009). Disparities in healthcare can arise from the effect of cultural and racial differences on interactions between patients and mental health services (Smedley et al, 2002; Gregg & Saha, 2006). The former has to do with differences in the explanation and expression of mental distress, and treatment expectations and adherence, whereas the latter has to do with noticing differential treatment of individuals on the basis of an arbitrary demographic characteristic (Qureshi et al, 2008).
Culture
Culture influences psychiatric diagnosis, especially where there are cultural differences. Psychiatric diagnosis as represented in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) systems is predicated on a derived etic or universalist perspective. This holds that mental disorders are real disease entities that exist independent of culture and context, although there are cultural variations in both their expression and explanation, as well as in what is deemed normative and functional (American Psychiatric Association, 1994; Bowers, 1998; Mezzich et al, 1999; Kirmayer, 2001). This accommodation of cultural variability, however, is challenging in that the diagnostic systems delimit symptomatology for particular disorders; despite the nod to cultural particularities, in terms of both what constitutes a symptom and how the symptom is related to the disorder, this does not allow for much deviation from Western norms.
The relationship between behaviour, symptom and disorder is complex and rather murky. A particular symptom of a particular disorder in one culture may be normative and functional in another. What is symptomatic of a particular mental disorder according to the DSM system may be symptomatic of a different disorder in another diagnostic system or culture. This is often asserted but rarely supported for culture-bound syndromes. Some symptoms may be indicative of nothing in particular in diagnostic terms. The overall argument is that culture circumscribes, at a very minimum, both expression and explanation of mental distress, and thus the application of standardised diagnostic criteria without taking culture into consideration can result in serious diagnostic error. How can this be?
5 - Are particular psychotherapeutic orientations indicated with specific ethnic minority groups?
-
- By Adil Qureshi, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 21-26
-
- Chapter
- Export citation
-
Summary
Matching the type of psychological intervention to specific conditions or symptom profiles is gaining increasing popularity, particularly in light of the emphasis on evidence-based medicine and managed care (Barlow, 2004). It may also be the case that cultural differences in the expression and expected management of distress are such that certain cultural groups may derive greater benefit from specific types of psychotherapeutic approach or orientation. This chapter explores these clinical options.
Cultural values and specific therapeutic approaches
Directive approaches
Prince (2004) has described his very unsuccessful experience of applying insight and non-directive therapeutic techniques with the Yoruba in Nigeria in the early 1960s. He concluded that, given the cultural values of the Yoruba, a focus on psychological self-awareness and on childhood experiences, utilising open-ended questions in which the patient is invited to take the lead, is simply inapplicable and, indeed, counterproductive. A number of multiculturalists follow the same notion, arguing that various non-Western groups prefer or derive greater benefit from directive types of therapy, because of characteristics – perhaps world views – specific to the culture in question (Lin & Cheung, 1999; Sue & Sue, 1999).
Many non-Western cultures prefer an action orientation, look to the clinician as the expert and consider the expression (and recognition) of emotion, if at all, to belong to the domain of close family members. Such may be the strength of these characteristics that, as Prince suggested, individuals will be inimical to exploration of insight and emotional processes, and will vastly prefer and benefit from directive approaches (Atkinson & Lowe, 1996; Sue & Sue, 1999; Kirmayer, 2007). Research shows that cognitive– behavioural therapy, with or without cultural adaptation, is effective with ethnic minority and immigrant patients (Miranda et al, 2003, 2005; Voss Horrell, 2008).
Relational approaches
Relational psychoanalysts have argued that their approach, with its thematisation of a ‘three-person model’ in which the clinician, patient and overall social context are all included, is particularly valuable for individuals from collectivist cultures, given the focus in these cultures on interpersonal relationships (Perez-Foster et al, 1996; Altman, 1999; Walls, 2004; Moran, 2006). Not only are such treatment orientations adaptable to other sorts of selves (there is a strong concordance between the relational and sociocentric self); also, the overt inclusion of the social context situates mental distress within the sociopolitical dynamics that affect patients.
10 - Benefits and limitations of the cultural formulation in intercultural work
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- By Francisco Collazos, Universitat Autònoma de Barcelona, Marcos González, Centre de Salut Mental d'Adults d'Horta, Barcelona, Spain, Adil Qureshi, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 47-50
-
- Chapter
- Export citation
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Summary
In 1991, the US National Institute of Mental Health supported the creation of the Group on Culture and Diagnosis. The main goal of this group was to advise the DSM-IV Task Force on how to make culture more central to DSM-IV (Mezzich, 1995). The Group even suggested the inclusion of a sixth axis devoted to cultural issues. This ambitious proposal had to be abandoned because of the strong criticisms received but, among the few suggestions finally accepted, the ‘cultural formulation’ was probably the most significant (Mezzich et al, 1999).
The cultural formulation is an operationalisation for clinicians of the process of cultural analysis as it relates to the clinical encounter that can be performed as part of the evaluation of every patient. From the outset, one of its specific aims was to provide a mechanism that would facilitate the application of a cultural perspective to the process of clinical interviewing and diagnostic formulation in psychiatry (Lewis-Fernàndez, 1996). The cultural formulation was meant to supplement the multi-axial diagnostic assessment and to address difficulties that may be encountered in applying DSM-IV criteria in a multicultural environment. The DSM cultural formulation consists of five components:
• assessing cultural identity
• cultural explanations of the illness
• cultural factors related to the psychosocial environment and levels of Functioning
• cultural elements of the clinician–patient relationship
• the overall influence of culture on diagnosis and care.
As explained by the Committee on Cultural Psychiatry of the Group for the Advancement of Psychiatry, the specific definitions, causal role and interrelations of constructs such as culture, immigration, ethnic identity and so forth are difficult to delineate, to the extent that these constructs are confounded or lost (Committee on Cultural Psychiatry, 2002). In addition, as some authors have pointed out (Alarcón, 1995; Bäärnhielm & Rosso, 2009), a key challenge in cultural psychiatry is the management of the nomothetic v. the idiographic. The cultural formulation seeks to aid clinicians in combining the more idiographic perspective of psychiatry and the DSM with the more nomothetic (Bäärnhielm & Rosso, 2009).
10 - Benefits and limitations of the cultural formulation in intercultural work
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- By Francisco Collazos, Associate Professor of Psychiatry, Universitat Autònoma de Barcelona, and Servei de Psiquiatriá, Hospital Universitari, Vall d'ebron, Barcelona, Spain, Marcos González, Adjunct Psychiatrist, Centre de Salut Mental d'dults d'orta, Barcelona, Spain, Adil Qureshi, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 47-50
-
- Chapter
- Export citation
-
Summary
In 1991, the US National Institute of Mental Health supported the creation of the Group on Culture and Diagnosis. The main goal of this group was to advise the DSM-IV Task Force on how to make culture more central to DSM-IV (Mezzich, 1995). The Group even suggested the inclusion of a sixth axis devoted to cultural issues. This ambitious proposal had to be abandoned because of the strong criticisms received but, among the few suggestions finally accepted, the ‘cultural formulation’ was probably the most significant (Mezzich et al, 1999).
The cultural formulation is an operationalisation for clinicians of the process of cultural analysis as it relates to the clinical encounter that can be performed as part of the evaluation of every patient. From the outset, one of its specific aims was to provide a mechanism that would facilitate the application of a cultural perspective to the process of clinical interviewing and diagnostic formulation in psychiatry (Lewis-Fernàndez, 1996). The cultural formulation was meant to supplement the multi-axial diagnostic assessment and to address difficulties that may be encountered in applying DSM-IV criteria in a multicultural environment. The DSM cultural formulation consists of five components:
• assessing cultural identity
• cultural explanations of the illness
• cultural factors related to the psychosocial environment and levels of functioning
• cultural elements of the clinician–patient relationship
• the overall influence of culture on diagnosis and care.
As explained by the Committee on Cultural Psychiatry of the Group for the Advancement of Psychiatry, the specific definitions, causal role and interrelations of constructs such as culture, immigration, ethnic identity and so forth are difficult to delineate, to the extent that these constructs are confounded or lost (Committee on Cultural Psychiatry, 2002). In addition, as some authors have pointed out (Alarcón, 1995; Bäärnhielm & Rosso, 2009), a key challenge in cultural psychiatry is the management of the nomothetic v. the idiographic. The cultural formulation seeks to aid clinicians in combining the more idiographic perspective of psychiatry and the DSM with the more nomothetic (Bäärnhielm & Rosso, 2009).
5 - Are particular psychotherapeutic orientations indicated with specific ethnic minority groups?
-
- By Adil Qureshi, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 21-26
-
- Chapter
- Export citation
-
Summary
Matching the type of psychological intervention to specific conditions or symptom profiles is gaining increasing popularity, particularly in light of the emphasis on evidence-based medicine and managed care (Barlow, 2004). It may also be the case that cultural differences in the expression and expected management of distress are such that certain cultural groups may derive greater benefit from specific types of psychotherapeutic approach or orientation. This chapter explores these clinical options.
Cultural values and specific therapeutic approaches
Directive approaches
Prince (2004) has described his very unsuccessful experience of applying insight and non-directive therapeutic techniques with the Yoruba in Nigeria in the early 1960s. He concluded that, given the cultural values of the Yoruba, a focus on psychological self-awareness and on childhood experiences, utilising open-ended questions in which the patient is invited to take the lead, is simply inapplicable and, indeed, counterproductive. A number of multiculturalists follow the same notion, arguing that various non-Western groups prefer or derive greater benefit from directive types of therapy, because of characteristics – perhaps world views – specific to the culture in question (Lin & Cheung, 1999; Sue & Sue, 1999).
Many non-Western cultures prefer an action orientation, look to the clinician as the expert and consider the expression (and recognition) of emotion, if at all, to belong to the domain of close family members. Such may be the strength of these characteristics that, as Prince suggested, individuals will be inimical to exploration of insight and emotional processes, and will vastly prefer and benefit from directive approaches (Atkinson & Lowe, 1996; Sue & Sue, 1999; Kirmayer, 2007). Research shows that cognitive– behavioural therapy, with or without cultural adaptation, is effective with ethnic minority and immigrant patients (Miranda et al, 2003, 2005; Voss Horrell, 2008).
Relational approaches
Relational psychoanalysts have argued that their approach, with its thematisation of a ‘three-person model’ in which the clinician, patient and overall social context are all included, is particularly valuable for individuals from collectivist cultures, given the focus in these cultures on interpersonal relationships (Perez-Foster et al, 1996; Altman, 1999; Walls, 2004; Moran, 2006). Not only are such treatment orientations adaptable to other sorts of selves (there is a strong concordance between the relational and sociocentric self); also, the overt inclusion of the social context situates mental distress within the sociopolitical dynamics that affect patients.
7 - On the role of culture and difference in evaluation, assessment and diagnosis
-
- By Adil Qureshi, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 31-35
-
- Chapter
- Export citation
-
Summary
Culture and difference are considered to have a potentially enormous impact on diagnosis and assessment of mental health and illness, to the extent that some investigators believe that the elevated rates of psychiatric illness in African–Caribbeans in the UK and Holland may be at least in part a function diagnostic error (Hickling et al, 1999; Mulder et al, 2006; Singh, 2009). Disparities in healthcare can arise from the effect of cultural and racial differences on interactions between patients and mental health services (Smedley et al, 2002; Gregg & Saha, 2006). The former has to do with differences in the explanation and expression of mental distress, and treatment expectations and adherence, whereas the latter has to do with noticing differential treatment of individuals on the basis of an arbitrary demographic characteristic (Qureshi et al, 2008).
Culture
Culture influences psychiatric diagnosis, especially where there are cultural differences. Psychiatric diagnosis as represented in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and International Classification of Diseases (ICD) systems is predicated on a derived etic or universalist perspective. This holds that mental disorders are real disease entities that exist independent of culture and context, although there are cultural variations in both their expression and explanation, as well as in what is deemed normative and functional (American Psychiatric Association, 1994; Bowers, 1998; Mezzich et al, 1999; Kirmayer, 2001). This accommodation of cultural variability, however, is challenging in that the diagnostic systems delimit symptomatology for particular disorders; despite the nod to cultural particularities, in terms of both what constitutes a symptom and how the symptom is related to the disorder, this does not allow for much deviation from Western norms.
The relationship between behaviour, symptom and disorder is complex and rather murky. A particular symptom of a particular disorder in one culture may be normative and functional in another. What is symptomatic of a particular mental disorder according to the DSM system may be symptomatic of a different disorder in another diagnostic system or culture. This is often asserted but rarely supported for culture-bound syndromes. Some symptoms may be indicative of nothing in particular in diagnostic terms. The overall argument is that culture circumscribes, at a very minimum, both expression and explanation of mental distress, and thus the application of standardised diagnostic criteria without taking culture into consideration can result in serious diagnostic error. How can this be?
12 - How does intercultural interpretation work in the mental health setting?
-
- By Rachel Tribe, Professor of Applied Psychology, School of Psychology, University of East London, London, UK, Adil Qureshi, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, Barcelona, Spain
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 57-60
-
- Chapter
- Export citation
-
Summary
Please ask yourself the following questions, then return to them after you have read this chapter, to see whether you wish to reconsider any of your responses:
• What exactly is intercultural interpretation in the mental health setting?
• What is expected of the interpreter?
• What is being interpreted or mediated in such an encounter?
• Each individual brings their own culture into a meeting, which is itself mediated by a number of factors at the micro- (individual) and macro- (cultural and contextual) level. Is it merely language that is being interpreted or is it something more complex, which includes culture, world views and explanatory health beliefs?
• Is it possible to work effectively with an interpreter to ensure that a patient's mental health needs are addressed appropriately and respectfully?
The challenges
There can be resistance to, or difficulties associated with, working through an interpreter, including feelings of threat and possible exposure experienced by all parties (Westermeyer, 1990). The overall and transferential dynamics within the meeting may be changed (Tribe & Thompson, 2009; Qureshi et al, 2011). Psychiatrists may feel a lack of experience in working through interpreters and may have concerns about how it will affect the meeting and about the accuracy of the interpreting. Patients may be very worried that their words and emotions may not be communicated adequately (Tribe & Raval, 2003). The interpreter may have concerns about working within a psychiatric setting (Razban, 2003). Lack of training and support for interpreters is a matter of concern. They may not be trained in mental health, nor be receiving support or clinical supervision, leaving them vulnerable to vicarious traumatisation (Doherty et al, 2010). We must not assume that a patient and interpreter who share a language will also share a culture. The latter is highly individualistic and there can be dangers in assuming any commonality of culture between interpreter and client. Language and culture interact in complex ways, and the interpreter may be negotiating between three world views: the patient', the clinician's and their own (Drennan & Swartz, 1999).
11 - Barriers to the intercultural therapeutic relationship and how to overcome them
-
- By Adil Qureshi, Psychologist, Servei de Psiquiatriá, Hospital Universitari Vall d'ebron, Barcelona, Spain, Rachel Tribe, Professor of Applied Psychology, School of Psychology, University of East London, London, UK
- Edited by Kamaldeep Bhui
-
- Book:
- Elements of Culture and Mental Health
- Published online:
- 01 January 2018
- Print publication:
- 01 January 2013, pp 51-56
-
- Chapter
- Export citation
-
Summary
A considerable body of research shows that ethnic minorities and immigrants have lower levels of health service use relative to White or mainstream populations (Institute of Medicine, 2002), and once entering into treatment, have poorer adherence and end it sooner. These results are in part due to barriers related to access to mental health services, poor awareness of mental health services and stigma surrounding their use, lack of services in the patient's mother tongue, cultural insensitivity (Sue, 2003), distrust of service providers (Watkins et al, 1989) and problems in the therapeutic relationship (Griffith, 1977; Welch, 2003; Qureshi, 2005; Comas-Diaz, 2006; Qureshi & Collazos, 2011).
Some of these barriers lie beyond the purview of the busy mental health professional. The therapeutic relationship, however, is not only well within the control of the clinician, it is also one of the strongest predictors of positive therapeutic outcome (Horvath & Symonds, 1991; Jennings & Skovholt, 1999; Martin et al, 2000; Cruz & Pincus, 2002). The barriers can be understood to be related to sociorace and racism and cultural difference (Gregg & Saha, 2006). The impact of the last derives from the cultural encapsulation of the clinician (Wrenn, 1985), in which the clinician operates from the perspective of pig-headed ethnocentrism (as differentiated from quotidian ethnocentrism in which the clinician is aware that they experience the world from their own cultural perspective) (Rorty, 1987), assuming that their own take on reality is not only correct but also superior to that of the ethnic other. The power differential inherent in the clinical context (Rose, 1998), which can be exacerbated by institutional racism and the challenges inherent in immigration (Walls, 2004), can negatively affect the therapeutic relationship in various ways.
Intercultural communication
Communication style, both verbal and non-verbal, is culturally circumscribed (Singh et al, 1998; Morales et al, 1999; McDonagh, 2000; Skelton et al, 2001; Ulrey & Amason, 2001; Van Wieringen et al, 2002; Kapoor et al, 2003; Misra-Herbert, 2003). Normal and adequate communication is a function of cultural context. In the clinical encounter, too little or too much expression of emotion (either flat affect or lability), for example, is considered to be symptomatic.
Contributors
-
- By Mohamed Agoub, Morton Beiser, Dinesh Bhugra, Kamaldeep Bhui, Tamsin Black, Miguel Casas, Prabha S. Chandra, Andrew Cheng, Francisco Collazos, Tom K. J. Craig, Nisha Dogra, Alexander Friedmann, Susham Gupta, Jannat el Harrak, David Holzer, Karen Iley, David Ingleby, Peter B. Jones, Gurvinder Kalra, Karim Khalid, James B. Kirkbride, I-Chao Liu, Carol Maggi, María del Mar Ramos, Driss Moussaoui, Priyadarshini Natarajan, James Nazroo, Man Kin Ng Roger, Norman Poole, Adil Qureshi, Hilda-Wara Revollo, Pablo Ronzoni, Pedro Ruiz, Ajit Shah, Laura Simich, Daya Somasundaram, Thomas Stompe, Rachel Tribe, Turner Stephen, Cristina Visiers, Wojteck Wojcik, Anna Yusim
- Edited by Dinesh Bhugra, Susham Gupta
-
- Book:
- Migration and Mental Health
- Published online:
- 04 February 2011
- Print publication:
- 02 December 2010, pp xii-xvi
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- Chapter
- Export citation
Chapter 19 - Intercultural mediation:
- from Section 4 - Management, services and training
- Edited by Dinesh Bhugra, Susham Gupta
-
- Book:
- Migration and Mental Health
- Published online:
- 04 February 2011
- Print publication:
- 02 December 2010, pp 245-260
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- Chapter
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Summary
One of the key factors in the process of migration is what the individuals carry with them and what they leave behind. Following the process of migration and then settling down in the new society, the individual may experience cultural bereavement, culture shock or culture conflict. Although grief is often associated with loss, the notion of cultural bereavement arises from an understanding of losses incurred and related to cultural values. This chapter describes in brief various theories related to bereavement. To understand culture shock and culture conflict, the role of acculturation and the processes related to it become very important. Acculturation is seen as the process in which individuals and groups from different cultures come into continuous contact with another culture. Racial and cultural congruity become important in understanding where an individual settles down and what kind of response they and their group generate amongs the larger society.