Training Therapists to Be Culturally Sensitive with Asian American Women Clients

SUMMARY

We describe here a developmental sequence of three key training experiences that contribute to developing cultural sensitivity for clinicians who are not of Asian heritage and are working with Asian American women. The sequence reflects and illustrates our guiding assumptions for developing multicultural sensitivity, including an emphasis on cultural self-awareness and a reflexive approach to knowledge acquisition and clinical practice. Effects of these training experiences are illustrated through three case examples of therapy with Asian American women written by an African American male and two European American female therapists at different stages in their training.     

A Moral Framework for Multicultural Education in Healthcare

The goal of this paper is two-fold. First, I begin by reviewing several of themajor points of emphasis among health educatorsas they begin to incorporate multiculturalissues into healthcare education. I thenconsider the role of moral relativism, which iscurrently being endorsed by some healtheducators, as the foundation for resolvingcross-cultural conflicts in healthcare. Iargue that moral relativism is ultimatelyinconsistent with the stated goals inmulticultural curricular proposals and fails toprovide an effective framework for consideringmoral conflicts in cross-cultural settings. Instead, I propose that those methods seekingto establish a common morality, built uponmutually shared values, offer the mostpromising means of resolving cross-culturalconflicts. This leads to my second goal, tocompare recent work in moral pragmatism withwhat is now widely known in bioethics as moral``principlism.' I argue that while proponentsof principlism and pragmatism each seek toestablish a common foundation for moraldeliberation, they fail to appreciatesignificant similarities between theirrespective approaches. Instead of offeringtwo completely unique and independent methodsof moral deliberation, I suggest thatprinciplism and pragmatism embrace commonthemes that point us in a positive direction,providing an effective framework useful forconsidering cross-cultural conflicts inhealthcare.     

Higher attention bias for fear at 8 months of age is associated with better socioemotional competencies during toddlerhood

BackgroundIn previous studies, an attention bias for signals of fear and threat has been related to socioemotional problems, such as anxiety symptoms, and socioemotional competencies, such as altruistic behaviors in children, adolescents and adults. However, previous studies lack evidence about these relations among infants and toddlers.AimsOur aim was to study the association between the individual variance in attention bias for faces and, specifically, fearful faces during infancy and socioemotional problems and competencies during toddlerhood.Study design and subjectsThe study sample was comprised of 245 children (112 girls). We explored attentional face and fear biases at the age of 8 months using eye tracking and the face-distractor paradigm with neutral, happy and fearful faces and a scrambled-face control stimulus. Socioemotional problems and competencies were reported by parents with the Brief Infant and Toddler Social Emotional Assessment (BITSEA) when children were 24 months old.Outcome measures and resultsA higher attentional fear bias at 8 months of age was related to higher levels of socioemotional competence at 24 months of age (β = .18, p = .008), when infants’ sex and temperamental affectivity, maternal age, education and depressive symptoms were controlled. We found no significant association between attentional face or fear bias and socioemotional problems.ConclusionsWe found that the heightened attention bias for fearful faces was related to positive outcomes in early socioemotional development. Longitudinal study designs are needed to explore the changes in the relation between the attention bias for fear or threat and socioemotional development during early childhood.     

Cross-Cultural Supervision in Marriage and Family Therapy

The purpose of this study was to gain an understanding of the various cultural factors that influence the supervisor-trainee relationship when at least one of these individuals is a member of an ethnic minority group in the United States. Marriage and Family Therapy supervisors and students were asked to compare and contrast their experiences working with ethnic minority and white persons. Findings indicate that both supervisors and students express great value in cross-cultural supervisory experiences, but report that these opportunities are very limited.     

Understanding Thai Families: A Cultural Context for Therapists Using a Structural Approach

This article describes six cultural influences that affect Thai families: religious beliefs, rural and urban considerations, family relationships, societal values, masculine and feminine roles, and sexuality. A case study of a Thai family struggling with these issues and interventions from a structural therapy perspective is presented.     

Diagnosing Deficits in “Basic Trust” in Multiracial and Multicultural Groups: Individual or Social Psychopathology?

Deficiencies in basic trust frequently undermine the efficacy of group therapy in multiracial and multicultural groups. It is necessary to distinguish trust deficits caused by individual psychopathology, societal attitudes (cultural pathology), or a combination of both. A typology for classifying self-disclosure problems in multicultural and multiracial groups is presented, and illustrated with case material: Mode A, Good enough trust, allows patient self-disclosure in multicultural groups; Mode B, Low level of cultural paranoia and high level of functional paranoia; Mode C, Culturally paranoid individual can self-disclose in culturally homogeneous group but mistrusts outsiders; Mode D, Confluent paranoid has high levels of both functional and cultural paranoia. For Modes C and D, it is crucial that experiences of bias be acknowledged and empathized with first before patients will be able to achieve good enough trust to risk self-disclosure. The ethnic composition of the group must be attended to in the placement of these patients. Hospital (inpatient) groups are especially likely to have problems with basic trust. The role of the leader in demonstrating empathy, tolerance, racial sensitivity, and appropriate self-disclosure is emphasized. Cultural awareness training, a personal group therapy experience for the therapist, and the use of co-therapists are recommended as ways of minimizing negative countertransference or cultural bias on the part of the leader.     

Postpartum Depression Among Women With Disabilities: A Multicultural Counseling Perspective

Postpartum depression is an important mental health problem for women, and women with disabilities are at greater risk than are women without disabilities. This article explores the disability‐specific contextual, environmental, social, and systemic causes of postpartum depression from an ecological perspective. I aim to help counselors develop a nonpathologizing, multicultural counseling–rooted approach and to prepare counselors to work effectively with this unique population. Implications of multicultural counseling tenets and advocacy are also examined for best practices. La depresión posparto es un problema de salud mental importante para las mujeres, y el riesgo es mayor para las mujeres con discapacidades que para las mujeres sin discapacidades. Este artículo explora las causas contextuales, sociales, del entorno y sistémicas de la depresión posparto relacionadas con la discapacidad desde una perspectiva ecológica. Mi objetivo es ayudar a los consejeros a desarrollar un enfoque no patológico basado en la consejería multicultural y preparar a los consejeros para trabajar de forma efectiva con esta población singular. También se examinan las implicaciones de los principios de la consejería multicultural y la defensoría para las prácticas recomendadas.     

The Association Between Implicit Racial Bias and Mindfulness in Mental Health Practitioners

The mental health research literature on implicit bias is limited (Boysen, 2009), and little is known about how factors that are associated with self‐perceived multicultural counseling awareness, such as mindfulness, relate to implicit racial bias in practicing mental health professionals. Using a correlational research design, we examined the association between mental health practitioners' implicit bias, self‐perceived multicultural counseling competence, facets of dispositional mindfulness, and mindfulness practices. A total of 137 mental health professionals completed an online questionnaire. Results revealed a negative relationship between the observing component of dispositional mindfulness and the implicit racial preference associating White and “good” words. In addition, results indicated that the frequency of engaging in mindfulness practices negatively predicted implicit racial preference associating White and good. Implications for counselor training, practice, and future research are discussed.     

Racial and cultural in-betweenness meet in the consulting room: the case of ‘Anna’

An upper-middle-class black woman, who grew up adapting to a white-dominated environment, entered the consulting room of a multicultural ‘white-passing’ analyst, and here unique emotional experiences were reflected in dream images of racial disorganization, internal racism, and identity confusion. While sorting through the analysand’s internal dynamics, the external world erupted in May 2020 with the murder of George Floyd, catapulting both analysand and analyst (and the nation) into a transformative confrontation with their mutual, deep-seated woundings of American racial and cultural inequities. The analysand’s racial complexity directly impacted the analyst’s ‘white-passing’ privilege, bringing into question established classifications of American whiteness. Overlapping dynamics and experiences as ‘in-betweeners’ and ‘outsiders’ – a black woman subsumed by a white-dominated society and an immigrant refugee acculturated to American life – provided a common exilic ground for mutual understanding and mirroring. The analyst explores the racial and multicultural straddling that served as a lens into the analysand’s fragmented racial identity during the eruption of American racial unrest.     

Psychoanalytic supervision in the new millennium: On pressing needs and impressing possibilities

Having now completed its first century, psychoanalytic supervision has been and continues to be regarded as the cornerstone of psychoanalytic education; it is the primary means by which (1) psychoanalytic ideology becomes translated into practical product, and (2) budding analytic practitioners develop and grow in their therapeutic skills and professional identity. The supreme significance of supervision in contributing to the “making” of the competent psychoanalytic practitioner now seems a widely accepted given, even axiomatic. But as its second century gets underway, what have we learned from psychoanalytic supervision's first 100 years? What are its most pressing needs and, in turn, impressing possibilities at this time? And what needs to most change if psychoanalytic supervision is to most profitably advance in the years and decades ahead? In this paper, I would like to consider those questions, giving focus to five needs that seem to most require attention now: (1) making the practice of psychoanalytic treatment an increasingly competency-based, concretized learning affair; (2) enhancing the efficacy of supervisors through competency-based practice and training in psychoanalytic supervision; (3) more effectively incorporating existing technology and emerging technological advances into supervision and using them to enhance the psychoanalytic learning process; (4) better attending to matters of difference and diversity, and striving to seamlessly integrate them into the conceptualization and conduct of the psychoanalytic supervision experience; and (5) vigorously researching the psychoanalytic supervision process and working to establish an evidence base for supervisory practice.