Compressed CC614 Lecture Notes Wk. 1-MIDTERM PDF

1 Week 1 Monday, August 26th, 2024 Dr. Adames ___________________________________________ Office hours→ Monday 4pm & by appt. Recommended book → ethics in psychotherapy and counseling What is Psychology - It is the scientific study of behavior and mental processes - Behavior: -...

1 Week 1 Monday, August 26th, 2024 Dr. Adames ___________________________________________ Office hours→ Monday 4pm & by appt. Recommended book → ethics in psychotherapy and counseling What is Psychology - It is the scientific study of behavior and mental processes - Behavior: - observable Actions of a person or animal, anything that is visible/observable to the naked eye - Where do we do this → MSE - Mind: everything that the person experiences that we cannot see, internal processes that they will report to us that we cannot see with the naked eye - Thought feelings, sensation, perceptions, memories, dreams, motives, and other subjective experiences - Emotions vs. Feelings (NOT THE SAME) - Emotions: are internal, subjective raw experiences that we are having (cooking up the food) - Feelings are: the language that we try to imperfectly try to put on our internal subjective raw experiences to - (combination of seasoning, texture etc, the food “product” and what the other person is eating/taking in) - Feelings - the story or the words that we use to help us communicate our internal subjectivity with each other in an imperfect way - Science: - An objective way to answer questions based on observable facts, data and well described methods  2 - ***What is the Goal of Psychology (DEPC) (on exam) - Describe → Help the client describe what they're feeling, describe the problem, describe what clients are reporting to us (their symptoms, which are internal subjective experiences), - Signs are things that we are able to see with our naked eye → external - Symptoms= what clients are reporting to us, that we cannot see. It's their internal subjective experiences. - Also describing Reason for referral - Also describing onset → When did the symptoms start? - Acute onset → started all of a sudden - Progressive onset→ Starts out slowly then becomes more noticeable - What is the course of the symptoms? - 4 courses of sx: either symptoms get better, worse, same, or fluctuate - Explain → Conceptualize the case, explain the signs and the symptoms according to the theory, the theory is helping you explain what you are describing - Predict → Looking through the DSM and literature, what would happen if this person does or does not get said treatment? - What kind of intervention does the person need - Control → Treat the client - What are we trying to DEPC? ⇒ behavior and mental processes - These are the same goals of therapy → DEPC What is Psychotherapy? - Psychotherapy is: - A culturally based healing practice - Healers in different times & space  3 - Therapy is an emotional healing endeavor/journey/process - It entails curiosity and attunement to - Ourselves - And our clients - Relationships that entail a meeting of minds and hearts → it's also an emotional experience → a corrective emotional experience - Quality therapy is when the therapist can keep mind in mind, and heart in heart → need to be genuinely curious of what the client is going through and need to be aware of ethics Why do people come into therapy? - To manage signs and symptoms - To address a problem - To look for answers - To let it out; to feel less alone - When they're having difficulties or are in pain If client and therapists collude in pretending the client has come for a different reason, therapy is over before it starts. “Never look for a psychological explanation unless every effort to find a cultural, [societal, and systemic] one has been exhausted” - Margaret Mead (quoting her mentor, Ogburn Cartesian philosophy, → the mind is in isolation and because the mind developed in isolation, what's important is what's happening in the person's mind → - very individualistic way of thinking, not entirely true - We need to also consider context, because if we miss context we miss a huge portion of the story - we need to consider the context in which the mind is developing - Analogy: We are interested in the soil, water, etc, not just the seed EVERYTHING IS IMPORTANT! What is culture? - “Highly variable systems of meaning which are learned and shared by a people or an identifiable segment of the population  4 - Culture is not genetic, it's something we are born into - Culture represents designs and ways of life that are normally transmitted from one generation to another” - Objective culture: - Buildings, road, tools - Subjective culture: - Social norms, beliefs, values, roles Culture is “what we do around here” → it's a way of life that we learn from others and pass down to others What is Culture → falicov, 1983, 2014 “Culture is those sets of shared worldviews, meanings, and adaptive behaviors derived from simultaneous membership and participation in a variety of contexts, such as language, rural, urban, or suburban settings, race, ethnicity, and SES status, age [sex] , gender, [sexual orientation] religion, nationality, employment, education, occupation, political ideology, and stage of acculturation etc. ^^^^^^ NOT true for us Culture → how we think and do things Nationality → country where we come from Ethnicity → group with common geographical and cultural traditions Race → how we are grouped based on phenotype; - socially made up category - race doesn't exist; it's not biological; it's not real All of these are their own separate categories, they are different; not the same Where did Race come from??? - English wanted to colonize the Irish  5 - The English created a policy, to describe the Irish as a race/different group or category because they wanted to clarify that they were less than the English - The Irish began to believe that they were less than them, and also helped the English control them - Racism → when a person is treated less than because of racial superiority - Eurocentrism → when a person is treated less than because of ethnic superiority Culture, race, ethnicity, & differences in psychology - 1960s & 70s - Studying psychological phenomena as they apply to distant ethnic groups - Dr. White and his book “even the rat is white” (racism in psychology) - Created black psychology → Psychology that's by and for the people, accessible to the people and is focused on people's strengths - Prior to this psych created by white hetero men and applied to everyone and focused on pathology, and information was gate kept; it was written in a way that people needed a degree to read and understand it - “Towards a black psychology” famous piece written by him, written in a magazine so that it would be accessible to the common people - 1980s - Dr. Janet Helms - Acculturation - Ethnic-racial identity models - 1990s - Expanded focus on diverse minority groups (eg biracial, multiracial, LGBTQI+, elderly ability) - 2000’s - Guidelines - Cultural lens applied to different subfields within psychology  6 WEEK 3 Monday, September 9th What is Evidence-Based Practice in Psychology? (EBPP) - We are training for this in this program - → interventions that are supported by scientific evidence - we let empirical literature guide our practice - EBPP consists of 3: - 1) Evidence - Evidence = Best available research evidence - Evidence is more expansive and broad than when we think about empirical - Page 208 table in textbook; this topic is on the exam - Empirical studies → EST and EVT (these 2 are the same) - Very prescriptive and has clear borders, more reductionist approach - Double-blind study → neither the researcher nor participants know what the study is about. Helps reduce biases that could happen in the study - Include random selection (everyone in the population has an equal chance of being included in the study) and random assignment (those recruited for study are randomly assigned to treatment group or control group) - EST and EVT follow this process^^^^ - EST and EVT does not necessarily always include POC, mostly college pop. used for this sample - EBP - Does not necessarily have to go through a double-blind random assignment, and random selection process because it's not interested in just looking at what works only if it goes through this process, also interested in other things that work  7 - More expansive and more culturally embracing way of bringing other sources to say that outcome is working - ie) latina client says she goes to curandera aside from therapy. The curandera approach is not empirically supported, but she reports that it helps her - It could include EST and EVT, but it could include something more too (more flexible?) - (WORD PROBLEMS on the exam about the difference between EST & EVT and EBT) - 2) Clinical expertise - Resources including practitioners' expertise & competence - Expertise/competence is NOT achieved simply because you are a member of that group!!! - Expertise means you know the history and interventions that are out there; you are informed - Consider multiple contexts about an individual - 3) Client characteristics - Client characteristics, race, ethnicity, gender, SES, acculturation, cultural values EBPP: Evidence for who? - Best available research evidence - LEBP: Latinx evidence-based - Research methods: sampling concerns - Resources including practitioners' expertise & competence - LEBP: Latinx evidence-based → - Formal training - LMH certificate - The racial identity of the provider - Client characteristics: race, ethnicity, gender, SES, acculturation, cultural values  8 - LEBP: Latinx evidence-based → - Cultural foundations - Sociohistorical - Community psychology Cultural competence: 3 Key ingredients (Sue, 1998) Cultural humility and cultural competence are not the same - Competence → Means “i know enough to not do any harm” It does not mean you need to know it all. It does not mean you are an expert - Humility → is good in theory, in the sense that you recognize that you don't know everything → but ultimately it's lazy because you're coming in with “i know nothing, you guide me” approach 1. Scientific Mindedness a. Favor hypothesis formulation over clinical interpretations i. Hypothesis= checking with person about where the behavior is coming from (An educated guess, supported by past literature/research) 2. Dynamic Sizing a. Knowing when to: i. Generalize and know when to individualize 1. i.e) hallucinations → is it psychogenic vs. cultural hallucinations → need to contextualize a. Consult with people of that culture to see if it's a common bx or experience from that culture. If it is a unique behavior, then you need to explore more about psychogenic etiologies ii. Avoid errors in thinking → To avoid cognitive biases 1. Type 1 error (false positive) → i.e) A behavior is cultural when it is  9 2. Type 2 error (false negative) → A behavior is general when it is culturally specific 3. Culture-specific elements a. Self-awareness b. Knowledge c. Specific intervention skills and techniques Multicultural Tripartite Model (Sue,1998) (3 main ingredients) - Awareness - Of own biases - Own power - Power = Having the resources and having access to create reality, and then making other people respond to that reality as if that were their own/true - What is reality/real? - Need to have two or more people agree on a phenomenon, then that, reality is co-created - What about hallucinations? - Create the reality with the person who is hallucinating - Invite the psychosis in therapy, enter the client's world/reality BECAUSE WHO ARE WE TO SAY THAT WHAT THEY ARE SAYING IS NOT REAL - Who has power? (typically) - Able-bodied, rich, Christian cisgender, WHITE men → these are the people that create reality through laws and policies - We get punished if we break rules that create this reality, if we break the social contract  10 - Own Privilege - People who have unearned advantages - We should not buy into imposter syndrome - Own racial/ethnic identity - Knowledge - Knowledge of Specific population - Skills - Specific skills, interventions, techniques  11 WEEK 3 reading Falicov (2014) Chapter 1: MECA → A Meeting Place for Culture in Therapy - Crossing cultural borders - By putting Stress and strengths tied to migration, culture change and sociopolitical ecologies at the center of the clinical practice encounter, rather than simply viewing it as an “Add on” to treatment, we are better able to serve our clients and meet their needs - “Clinical practice as a cultural and sociopolitical encounter” - Be aware of how theoretical positions, sociopolitical perspectives, and professional values can inform the clinical encounter - Also the idea of “cultural countertransference” → how the values acquired from the cultures and contexts of one's family affect the practice; and how the clients’ and therapists’ perceptions of each other’s cultures and sociopolitical contexts - Affects the therapeutic relationship and can directly impact the outcome of therapy - You need to be subjective when working with people of different, race, classes, ethnicity - Most cultural competence approaches focus on learning the values of various ethnic cultures as belonging to other people - Including culture and context into theory, assessment, treatment planning and the therapeutic relationship is CHALLENGING - At the societal level, there may be brief generalizations about norms and values, however, they need to be refined, nullified and or rejected when looking at the individual level - Following Stereotypes could hamper rather than facilitate clinical work - “The Place of culture and context in clinical practice: a spectrum of choice” - The practitioner and family need to explore the connections between the presenting problem and culture and context issues in a collaborative way - Some view: - Culture as central or tangential - Culture as a background - Culture as foreground - How clinicians may approach the relationship between culture and therapy:  12 - The universalist - “This position maintains that families are more alike than different. A universal position emphasizes similarities rather than differences in both intrapsychic and interpersonal processes.” - Universalist assumptions underlie most psychological concepts and assumptions - Regard culture as tangential to therapy and not necessary - Of course there are many similarities across cultures, and it's good to appreciate dome level of smaness between groups HOWEVER, this stance also leads to ethnocentriscm ( measuring or judging one's own culture against another culture and can lead to judging someone else's culture negatively. Ethnocentrism is also the belief that one's own cultural rules are the best and often better than another culture's rules.) - The particularist - At the other extreme is the particularist position, which states that all individuals and families are more different than they are alike. - From a particularist perspective “no generalizations can be made about the relationship between a family and the larger culture, and therefore each individual's predicament is a product of his or her personal history and the interior of the family.” - “No focus on multicultural training is necessary” - The ethnic focused - “The third position stresses predictable diversity of thoughts, feelings, and behavior, as well as of customs and rituals, among different ethnic groups - Limitation: “ethnic-focused generalizations tend to portray culture as static and stable rather than as changing and unstable” - “The ethnic-focused approach advocates "cultural literacy" through education of the practitioner about specific features of the culture, grounded in a view of the client as "other." - The multidimensional ecological comparative - Integrates all 3 positions above and goes beyond them - “This framework maintains that it is possible and desirable to integrate cultural awareness at every step in the process of  13 learning to observe, conceptualize, and work therapeutically, regardless of theoretical orientation” - Culture discussed in the context of a specific issue rather than in - the abstract - Every clinical encounter is really an encounter between the practitioner's, the client's, and the supervisor's cultural and personal life maps, - ‘The clinician's maps are further affected and organized by personal values, views, and preferences acquired in his or her family of origin and through life experiences’ - - Definition of culture: - Culture is those sets of shared world views, meanings, and adaptive behaviors derived from simultaneous membership and participation in a variety of contexts, such as language; rural* urban or suburban setting; race, ethnicity, and socioeconomic status; age, gender, gender identity, sexual orientation and sexual variance, religion, disability, nationality; employment, education and occupation, political ideology, stage of migration/acculturation, partaking of similar historical moments and ideologies. (Falicov, 1983, pp. xiv—xv) - “Since individuals and families partake of and combine features of several contexts, it is necessary for practitioners to consider membership in all of the relevant contexts simultaneously” - “Exploration of cultures and contexts should also include the critical examination of practitioners' racist, sexist, or classist views” ECOLOGICAL NICHE  14 - Borderlands give rise to internal inconsistencies and contradictions as well as to commonalities and resonances among groups and individuals - The idea of cultural borderlands - “The process Of investigating one's personal and theoretical ecological niche helps therapists and supervisors get in touch with their cultural ideologies as well as areas of privilege and areas in which they,have either experienced "otherness" or need to acknowledge their own racism.” - Don't make generalizations that describe some culture-specific aspect of a collective identity - Honor individual differences by probing the person's interpretations or exceptions to these cultural generalizations - Knowing and not knowing stances - Ethnic focused position believe that we should know as many details about a partiuculkrta cutlurre when in reality it is okay to not know because you come from a place of curiosity, which cna help encourage further dialogue - A combination of knowing and not knowing is needed - Weaving back and forth between these stances—one informed by cultural guesses and the other guided by curiosity - “The clinician must be comfortable with an ever-present "double discourse"—an ability to see the universal human similarities that unite us beyond color,. class, ethnicity, and gender, while simultaneously recognizing and respecting culture-specific differences that exist due to color, class, ethnicity, and gender.” STRENGTHS BASED ORIENTATION - “I focus on their resilient responses and underline the importance of working with their many strengths. Among these are strong family and community bonds and sys-tems of help, healthy maintenance Of cultural rituals, capacity for hard work, and pride in good parenting.” - “Relational resilience” lens How do we assess racial identity? MECA key generic domains - Migration and acculturation - Ecological context - Family organization - Family life cycle MECA Framework: Key Generic Domains  15 Migration-Acculturation: Examines the impact of migration and acculturation on families. Ecological Context: Considers the family's social and cultural environment. Family Organization: Explores diversity in family structure and values. Family Life Cycle: Examines cultural variations in developmental stages and transitions.  16 WEEK 4 Monday, September 16th 2024 Cultural Adaptation: Culturally Adapted Treatment (CAT) - The systemic modification of an evidence-based treatment or intervention protocol to consider language, culture, and context in such a way that it is going to be compatible with the client’s cultural patterns, meaning and values (Bernal, Jimenez -chafay … 2009) Note: most behavioral health can be culturally adapted Why is it important to culturally adapt treatment interventions? - Improves engagement - To promote retention - If they come in do they stay? - To increase RELEVANCE - Addressing specific risk and protective factors - Addressing symptoms clusters specific to ethnic and cultural groups (e.g. acculturative stress) - To ensure a culturally competent process - Because you are intentional about considering culture in treatment - To improve treatment outcome - Which are our clients feeling better - Adheres to professional ethics - AKA ‘Do no harm’ - Respect for Peoples Rights and Dignity - Justice → for the person and their community  17 Culturally Adapted Psychotherapies (CAP) Ways to culturally adapt treatment? Match client and therapist on race and ethnicity ○ Though there is no evidence to support this ○ No ethnic group benefits from this other than East Asian populations (Japanese, Korean, etc.) because of “saving face” ○ Although most groups don't benefit from this, when we are matched with a therapist with the same background, it impacts retention positively because premature termination is decreased → it increases retention … the frequency of it (the frequency of number of sessions is 1) Providing treatment in the client's preferred or native language Incorporating traditional cultural values into treatment Ecological Validity framework (EVF): → 8 dimensions of adaptation – one model of Tx. Adaptation (Bernal, bonilla, & Bellido, 1995)  18 Is Culturally Adapted Interventions Enough? If yes, why; if not what's missing? Evidence-Based → Adaptation → Intervention created and vetted by The People → (so now we have several therapies created for Latinos) 1. Dichos therapy a. Talking about it, without talking about it b. Personalismo → balance, harmony, how do we take the relationship back to a harmonious state i. Such as small talk 2. Parenting Training Groups: a. Abriendo Puertas: opening doors. Created in Spanish first and then translated to english 3. CREAR-CE (adames & chavez-dueñas, 2017) 4. H.E.A.R.T framework 5. Psychology of Radical Healing  19 Culturally Adapted Interventions is not enough! “Knowledge and science must come from the people, otherwise were repackaging oppressive ideologies, practices and interventions” - Adames - We have to create interventions for the people Cultural Interventions Lecture From Therapies to Therapists - Making the shift – by being: → - Humble - Respectful - Having an open approach - Ethical → → What is Y(our) clinical stance - “It is much more important for us to know what sort of a patient has a disease [disorder] than what sort of disease [disorder] patient has” - The person needs to be more important rather than the disorder “Healing is therapeutic, but not all therapy is healing” (Parham, 2002) ~We need to know ourselves and the lens that we are coming in with Effective Therapists- Psychotherapy research - What are the pieces we need to develop and nurture as therapists? (6 things according to research for positive outcomes) 1. Providing a flexible etiology of a client's distress a. Trying to understand what causing, maintaining, or exacerbating the client's distress b. Etiology → what's the cause or contributing factors that are causing something c. “Being multilingual and multi-exploratory” → can't just rely on a single theory to understand the client  20 2. Treatment plan congruent with etiology provided to the clients a. Co-create the treatment plan with the client i. Because when someone feels like they are a part of something, they are more likely to follow through with it and believe it 3. Being aware of the client's demographics a. We want to know the social groups the client belongs to b. Think of whom the client is, their identity → who do we say we are? Who am I? i. Identity is 4 things: 1. the “i that i say that i am” + 2. “the i that others see” + 3. the “i” that I want other people to see + 4. “the i that nobody knows” ii. When the four “i” statements overlap → this is identity iii. It's dangerous and unethical to only focus on the “i that i say that I am” 4. Not avoiding challenging content in therapy a. Because therapy may be the only place where they may feel free to talk about that topic b. When you can create a therapeutic culture in where they feel like they can talk about anything, it is really powerful for the client 5. Therapists being aware of their own internal process a. What is triggered in us when clients speak to us? b. What draws me to one client more than another? Why do we dread one more than another 6. Therapeutic Alliance a. The quality of the relationship b. It's a felt sense ___________________________________________________________ 21  22 WEEK 5 Monday, September 23 Deconstructing Diversity variables in multiculturalism in therapies - The parable of the bling men and an elephant originated in the ancient Indian - We are all trying to address the same thing, we , may be touching the same thing but how we make sense of it may be different - We want to be on the same page with what we are discussing, otherwise we’lll get really lost Cultural Competence - Cultural sensitivity - An awareness and appreciation of human cultural sensitivity - Cultural Knowledge - The factual understanding of basic anthropological knowledge about cultural variation - Cultural Empathy - The ability and desire to connect emotionally with the patient’s cultural perspective → to see how they understand life - Emotions are raw experiences that you haven't processed, or put a label to them - We have to pay attention to what happening to the person as they talk about it - We will all fail at being empathic because we will never truly know what they are going through, we will never feel exactly what they are going through → but that doesn't mean we can't be there for the person - Cultural Guidance:  23 - Involves assessing whether and how a patient's problems are related to cultural factors and experiences, and suggesting therapeutic interventions that are based on cultural insights - Research: - STUDIES REPORT THAT CULTURALLY DIVERSE CLIENTS CONSIDER A THERAPIST'S CULTURAL RESPONSIVENESS AND UNDERSTANDING OF THEIR WORLDVIEW AS MORE RELEVANT THAN ETHNIC MATCHING Latino families in therapy → falicov book The Multidimensional Ecosystemic Comparative Approach (MECA) - Cultural borderlands: - Edges of officially or unofficially recognized cultural groups - Examples: - Argentine who is also Jewish - Us citizen vs undocumented citizen - Gay Asian American male - Black lesbian Cuban who has a disability We need to consider ALL the groups that the person belongs to - → to have a better understanding of the client Socio Cultural Profile Socio-cultural category Membership Dominant, subordinate, mixed level privilege Race “White” Mixed level Ethnicity Mexican-American Class Low-income Subordinate Gender Female Mixed level Religion Catholic Sexual/affectionate orientation  24 ability/disability status SCP: Key Lessons-5 Research Finding 1. Identity is multidimensional a. Made up of a number of socio-cultural factors 2. Identify is dynamic and fluid a. These factors may interact to enhance compromise or neutralize each other 3. Identity is connected to context 4. Identity is connected to power and privilege 5. The SCP promotes comfortable dialogue Ecosystemic - Considers interactions with outside systems, institutions, and agencies - Schools - Political arena - Community - DYFS - Social clubs - Courts - Access to resources, entitlement, powerlessness Comparative - Similarities and differences are treated comparatively so that their relativism becomes apparent - Mexico vs. Puerto Rican vs. Cubans - Migration - Political status - Host perception - Lesbian vs. gay vs. bisexual  25 Therapists as Cultural Architects & Systemic Advocates - Latina/o Skills - Identification Stage Model - (Gallardo, 2012) L-SISM - Identify core issues that are facilitative in the therapeutic process - Not a linear mode and not exhaustive (does not cover everything) - Therapy is complex and aspects of the L-SISM will be implemented at different times depending on the needs of the client - Grounded with a culturally explanatory model (CEM; kelenman et al 1978) - Used this model to build the identification stage model Cultural Explanatory Model (CEM) - (CEM → using culture to explain a person’s presenting problems ) - Health professional who adhere to a biomedical model base their work on: - Empirical studies (know what this means) - Empircal study is: “a research method that relies on direct observation and experimentation to gather data” - Hard to carry out these studies, but it is the only way we can tell if A is causing B - Observable - Measurable - Objective - Individualistic  26 - Absolute - Often use linear logic - Lay individuals use cultural explanations to describe their existence: - Vague - Dynamic - Have Emotional Meaning - Embedded in a Person's sociocultural context - CEMS help us understand the multitude of ways individuals: - Conceptualize an illness - Its causes (etiology) - e.g) que cosas causa el yeyo? Que no causa el yeyo? - Signs and symptoms - e.g) cuales son los sintomas corporales del yeyo? - Modes of prevention and diagnosis - e.g) come se previene el yeyo? - Treatment - e.g) cuales son los tratamienties para el yeyo? - Prognosis - Expectation of their role as a patient and the role of the treatment provider - → como te puedo ayudar yo con el yeyo? - Make sense of what it is, gather data from how they are feeling and what that looks like for them or other people → then decipher what it is - Be as open-ended as possible when gathering data → don't put words in their mouth by bringing up suggestions L-SISM → 6 steps  27 (Gallardo, 2012) 1. Connecting with the client a. The relationship is always more important than the task at hand (i.e billing) i. Personalismo (AKA taking care of each other/harmony/balance) b. Self-disclosure i. Have to be very careful, your client is not your friend. Must be very intentional with why you are disclosing, and know the intention behind it 1. Ask where those questions are coming from if they ask about you/point something out about you a. e.g) “I will answer, but I think that it’s more important to understand together what the motivation behind that question is” c. Environmental context i. E.g. doing therapy outside the therapy room d. Assessing the clients cultural strengths & existing resources i. Helps validate clients e. VALIDATE before you attempt challenge, question, or comfort WEEK 6 Monday, September 30th 2. Assessment a. Gather data and information, analyze it/make sense of it, and use that info to guide your understanding of the client b. Asess: i. Generation status ii. Ethnic identity When we measure ethnic identity, we also measure acculturation and vice versa iii. Level of acculturation  28 iv. Language usage Leading wherever the client goes Monitor when they switch to Spanish and when they switch to English Emotional language is our first language a. Difference between emotional language and cognitive language Therapy is an emotional relationship, it's an emotional enterprise, so we need to help them be emotional We can encourage the client to speak their language even if we don't understand that language → say it in your language then process those emotions/that experience in English v. Trauma assessment Trauma is when we experience or when we witness an event in where we perceive/believe that our life or the other person is in danger a. It’s not the event itself that causes trauma, it's how that person metabolizes it vi. Assess Environment vii. Racial identity (Adames & chaves-Duenas, 2017) Race is not identity Race is a social construct, it is a category that was created by a group of people → race used to be a word for category → by the Irish viii. Contextual factors ix. Historical Past events (e.g, slavery, recession) Past and current history of oppression POC 3. Facilitating awareness a. Liberation psychology  29 i. If we simply heal our clients in the “room”, without intervening in the environment that created the distress to begin with, how much have we really accomplished? ii. Basically → helping people become aware that they are not the problem iii. Externalizing & locating the problems(s) 1. Depathologize client & presenting problems 2. Separate what is individual specific from the environment 4. Setting goals a. Understand and assess your own process variables in therapy when working with Latinxs i. What are our assumptions and biases that we are not questioning? This will impact the Tx plan that we are creating and implementing b. Incorporate level of education, SES, language, etc. when identifying goals for therapy i. The contextual understanding of the client is paramount!!→ understand their beliefs, religion, etc. because this will impact our understanding of the client and our interactions with them in therapy c. Collaboration is critical i. When someone feels and knows that they helped create something, they are more likely to take care of it, there's more ownership → client may think “i feel like i contributed to this” d. Remember Maslow’s hierarchy of needs → address the immediate concern first e. Expand your role as a provider i. Be comfortable wearing different hats, and advocate for your client → because we are supposed to help without hurting SMART goals i. Specific 1. What are you trying to achieve? What are your hopes? ii. Measurable 1. How will we know when you've achieved it? iii. Attainable  30 1. Goals should be challenging and reasonable to achieve iv. Relevant 1. This is about getting real and honest and ensuring what you want is healthy and worthwhile for you. Does it align with your values? a. Don't copy and paste textbook treatment plans, make them specific to the client! v. Time-bound 1. Goals need a target date→ motivates to focus and achieve what you want - Tx Goals → the “what” (the overarching goal) - Tx Objectives the “How” (the small doable steps needed to get there) 5. Taking Actions & Instigating Change - As therapists, get out and get connected: - Increase cultural empathy and understanding of context - Understand the research and culturally adapt intervention to address client's concerns when needed - Involve family and community when appropriate - Become a social advocate/Cultural broker for clients  31 6. Feedback and accountability How can we get feedback and keep ourselves accountable: - Assessing one's credibility - Understand how to measure “success” in a Latinx-specific context - Examine congruence between goals and outcomes achieved within the context of the client - Assess your own role in creating change → understand what is helpful and what is not CREAR-CE A Treatment Approach Culturally Responsive and Racially Conscious Ecosystemic Treatment Approach - Spanish verb - To form, to create, to build anew Phase 1: BUILD (knowledge of a racially conscious self) Phase 2: how can we LEARN about the groups we are working with Phase 3: how can we use this info to create culturally responsive and racially conscious interventions → DELIVER  32 Phase 1: Build - Preparing to liberate self & Helping others heal - Healing and Liberating Yourself is connected with - Self-knowledge and Awareness - Emotional engagement White racial identity development model (helms, 2008) C-REIL framework Effective culturally competent treatment requires: flexibility in order to address the complexity of human behavior R/CID model The cultural and racial self: Planful action in ethnic & racial identity You can do this for yourself BUT also when you are working with someone and helping them understand  33 - Conceptual level → when we learn and do stuff → we increase our fund of knowledge - Emotional Level → emotionally process the knowledge/stuff - Behavioral Level → when we are out and interacting with people in the community - Skills level → when we are using our skills in a therapeutic setting Cannot do this in isolation, it takes time and requires talking with others, modeling, and mentoring from others who may be more advanced than you Phase 1: Build → Preparing to Liberate Self & Helping others health - Knowing the multicultural literature - Knowing history and its contemporary impact - Knowing your areas of - Power - Privilege - Knowing your stimulus value - e.g.) skin color, gender, gender expression, gender identity, office decor) - Put your privilege to work - Constantly assess if you're doing this - Ask others for feedback - Become involved and advocate  34 - The more you know → the less you know - Be humble! Client expectations from culturally and racially diverse individuals Clients of Color expect their therapists to have diverse roles: - Counselor - Teacher - Guide - Folk healer - Advisor - Advocate - Witness - Consultant, therapist, and others - We need to be what our clients want us to be → of course within our scope of practice and ethics The exam is heavily on ch. 9 in the textbook —------------------------------------------------------------------  35 WEEK 7 Monday, October 7th, 2024 We Gon’ Be Alright The Psychology of Radical Healing for Communities of Color “Liberation psychology articulates the impact of oppression and the importance of striving for justice to liberate from oppression.” The context of racism in the United States - By 2040, the United States will become a majority, “minority” country where POC will become the numeric majority - Power is having the resources to create reality - Scientific Racism → Using the narrative that POC are less than, less intelligent, born defective, etc. Draconian Immigration Laws - Deportations and slander against immigrants and asylum refugees - i.e) Haitians with TPS are being demonized in order to maintain the status quo of White power - Separation of babies from their mothers - “Anti-immigrant rhetoric is as American as apple pie” Muslim bans → Decision was upheld by the U.S. Supreme Court - Trump Racial health disparities - Black maternity death → It's dangerous for black women to be pregnant, the chances of them dying during childbirth is astronomically higher - Black infant mortality rate is higher - Access to health insurance is scarce or of low quality for immigrants and marginalized communities - The pandemic made everything worse  36 - Called “the big equalizer” because people thought it would finally make people see the health disparities - But it mostly only affected POC - Because People of Color were the ones who were out there being the essential workers - Anti-Asian sentiments during Covid → increased hate crimes Mass Incarceration - An increase of 500% of black and brown folks incarcerated - Reagan administration shifted the economy → Reaganomics → gave the rich tax breaks, and the idea that it would trickle down, but it failed because it created financial disparities - Led many people to sell drugs, which is illegal, led to mass incarceration - Crack cocaine discrepancy - If you were caught with crack, it was a different felony than if you were caught with cocaine - Those using crack got higher sentences than those with cocaine, this differentiated those buying (richer vs poor) - “distribution of just 5 grams of crack carries a minimum 5-year federal prison sentence, while distribution of 500 grams of powder cocaine carries the same 5-year mandatory minimum sentence.” - “ President Ronald Reagan signed into law the Anti-Drug Abuse Act of 1986, which established a racially discriminatory 100:1 sentencing disparity between crack and powder cocaine. As a result of this legislation, for example, possession of 5 grams of crack cocaine, which was disproportionately consumed by African Americans, triggered an automatic five-year jail sentence — whereas 500 grams of powder cocaine, which was mostly consumed by richer, White demographics, merited the same punishment. Police Brutality - BLM movement began 2013 - POC are victims of police brutality Ethnic Studies and Book bans  37 - Predominantly books from queer and brown/black authors - The first ethnic study group that was banned through law was in Arizona → Mexican American studies - This comes and goes in ways → banning is now new - They attempted to erase our culture, values, and wisdom - JEDI (justice, equity, diversity and inclusion) and DEI (diversity equity and inclusion) - This racial awakening was big during 2020, but no one advertises or talked about it before, no more funds - This scared those with power - This collective group affects elections Need to put a spotlight on: A White Supremacy Culture - It's a culture, not an individual - When it's in the culture we can fix policies - Whiteness is baked into everything around us - Aims to affect anyone who is not white, hetero, a male, or with privilege (WHMP) - WHPM = White heterosexual male privilege - WHIMP-ness is embedded in the culture Racism and Discrimination harm the Physical health of POC - Make them more suscetible to common cold - Hypertension - Cardiovascular disease - Breast cancer - Higher ealry mortality rates Racism had devastating effects on The Mental Health of POC - High risk for depression - High risk for anxiety - Racism can be understood as a chronic stressor - Has potential to produce trauma  38 Ethno-Racial Trauma - Ethno because racial trauma could be affected by ethnicity - It is → The individual and collective psychological distress and fear of danger that results from experiencing or witnessing several things - Discrimination - Threats of harm - Violence - Intimidation - Directed at ethno-racial minoritized groups - This form of trauma stems from a legacy of oppressive laws, policies and practices Ethno-racial trauma is a more collectivistic view of trauma Mainstream treatment Approaches to therapy - Focus on the individual - The person and inside that persons mind, based on cartesian philosophy - Neglect History and context - They do not incorporate that history aspect - Even the way that colleges are set up, each has their own department, theres no communication between them, and knowledge is gate kept - Do not address power, privilege, oppression - Just put everything under the umbrella term of “diversity” - Power (those with the resources to create reality) and privilege are not the same thing - (privilege is unearned advantages), - oppression = power imbalance → and the group with more power uses it to create a reality that dehumanizes, wounds, and hurts another group  39 - Systemic oppression → when there are laws and policies that are put in place to hurt, wound, and denigrate a group of people - More at a government level - Institutional oppression → oppression within an organization, when an organized group that has policies, procedures, mechanisms, that aims to hurt, wound, and denigrate a group of people - At an institutional level - Cultural oppression - When there are symbols used to hurt people - Such as flags, - Interpersonal/personal oppression - When oppression is happening between people - Internalized opression - When an individual takes on the oppression around them I ]mplications to the Imbalance - We end creating a decontextualized conceptualization of the client - Develop an incomplete understanding of the lived experience of Clients of Color - Intervention may not fully address clients problems - Practive maintains the status quo Effective therapists– psychotherapy research - 6 common factors that we find in effective interventions See week 2, pg. 19 Theres an imbalance between - Centering healing from racial oppression and - Psychotherapy research  40 We are too focused on the symptoms rather than other factors that affect us - such as oppression and racism Healing Ethno racial trauma require Us to address - Sympotms of the trauma - Understanding people internally (mainstream approach) - Understanding symptoms of oppression - Understanding external influence→ what causes and maitains psychological distress - Breaking away from cartesian philosophy We need a RADICAL shift? What is radical: - Construct commonly used in political terms - Understood as a critical attitude or ideology that promotes the idea that complete change is necessary to reduce social problems Healing vs. coping - Is coping enough? is there something that we are not paying attention to? → help them HEAL instead of just cope Coping - Surviving - Critical consciousness not present - Critical consciousness is when people have a good understanding of how oppression works and how the system is meant to hurt people - Focus on individualism - Individual Eurocentric symptom reduction - Focuses alot on symptoms Coping is reactionary! → you are reacting after something happened Healing - Thriving (helping them to not just survive)  41 - Gaining critical consciousness about oppression - Focus on collectivism - Collective Multisystemic resistance and new realities - Helping them create a new reality about themselves - Helping people build resistance rather than resilience (coping) - Resilience is about becoming stronger in the broken places, fixing whats broken - With resistance → We need to focus on whats breaking us so that we don't become broken → We will be less likely to be broken and will then not have to focus on having to be resilient Radical Approach to Healing - Address power, privilege, and oppression - A collective approach to healing - Acknowledge and integrate history and context - Highlight the importance of collective resistance Integration: A Psychology of Radical Healing (PRH) - Liberation psychology - Articulates the impact of oppression and the importance of striving for justice to liberate from oppression - Its about helping people understand that what people are looking for is something they already have → but the system is trying to burn it down and stop us from using it - Black Psychology - Names the explicit Eurocentric assumptions of the field of mental health and detriments to Black communities - Calling for an African centered and strengths-based framework of mental health - Ethno- political psychology - Provides a specific liberatory framework for healing from racial trauma - Intersectionality  42 - Identifies ways that racism, sexism, heterosexism, transnegativity, classism, and other forms of oppression INTERSECT and produce interlocking forms of inequities - Its about the accidents, the trauma, that happens at the intersection of the factors above , what happens when they collide - intersectionality is not something that refers to celebrating diversity and how we are all different, diversity has become a buzzword Envisioning justice and liberation - what would justice look like for you? What would healing look like for you? Rather than merely helping them “cope” with that Helping people balance both sides → the interlocking systems of oppression and hate AND Envisioning justice and liberation - Having this balance and harmony between both - ***Being too heavily on either extreme can be detrimental to a person's health as well What will keep us in balance/ what will keep the radical healing afloat?  43 - It’s the five anchors above (critical consciousness, strength and resistance, emotional and social support, radical hope, cultural authenticity and self-knowledge) - Plus collectivism (in the image below) CRITICAL CONSCIOUSNESS - It's about how do we set ourselves free from the chains of WHMPness - It's about how we are getting free together, and that we are not replicating the hierarchical crap out there - We have to name it, AND FACE IT… in order to free ourselves Self-knowledge - Passing down wisdom, learning how ancestors navigated oppression to help us navigate our own oppression and pass it down to others Emotional and Social Support - Alone we are nothing, and together we can be absolutely everything - Together, anything is possible → help people find their people/support systems Strength and resistance  44 - Knowing that we have psychological strengths (7) RADICAL HOPE - It's a hope that's ACTIVE, it's not you just sitting around, it's you being engaged to create the change you want to see - Tomorrow may not be promised, but hoping that you will “Theory is not inherently healing, liberatory or revolutionary, it only fulfills this function only when we ask that it do so and direct our theorizing towards this end” - Hooks, 1992 “Thus, Keeping Radical Healing in Mind has no endpoint; instead, it is a practice that gains strength the more therapists and clients use and nurture it together in treatment” This will be on the exam ^^^ both articles  45 Goal for Therapists - “The field we want to transform has been worked on by history. Nonetheless, we must be inventive enough to continue to change it and build a new world. Take care and do not forget ideas are also weapons.….” subcomandante marcos quote Radical healing in psychotherapy paper will be on exam