Cultural Intelligence for Mental Health Professionals

I spoke recently at the 4^th WA TRANSCULTURAL MENTAL HEALTH & 2^nd Australasian REFUGEE HEALTH CONFERENCE 2013 in Perth.  My workshop, Increasing your Cultural Intelligence,  followed the opening keynote by Professor Fred Bemak titled; Critical Dimensions in Transforming and Understanding Responsive Transcultural Mental Health. So Fred, too, was focusing on cultural intelligence and how to be effective in situations of cultural diversity.

Professor Bemak spoke about delivering mental health services in other countries or with other cultures where we may be dealing with people with different cultural value dimensions.  He challenged practitioners to consider their practices from the perspective of their clients who may not share Western values.  He asked - are our therapies, strategies and practice management standards universal?     

• He touched on the Individualism / Collectivism dimension and pointed out that Western medical responses focus on the individual but in a collective society family, and often extended family, is critical to the recovery of the individual.  He suggested we focus on the group, family and community not just the single client or patient and pointed out that at times that may mean having family members in the treatment alongside the client.
• Fred reminded us that the concept of internal locus of control is a western concept and many of our clients are not working from this perspective.  Therefore they may not see themselves as having as much agency and control as we who are from Western backgrounds may see them.
• He pointed out that credibility can be both ascribed & achieved and suggested we never bank on ascribed credibility as shown through qualifications, instead relationships or what you do and how you are in person may be more powerful.
• Perspectives on time mean some cultures have less orientation towards time management, diarizing and punctuality.  Fred spoke of one clinic that had replaced specific times for appointments with morning sessions or afternoon sessions.
• Independence is another Western concept and judgments are made about what is “normal” based on Western standards – Professor Bemak asked, “Why don't we have independent syndrome”?
• He pointed out that our code of ethics is also drawn from a Western way of thinking and draws specific boundaries in our relationships with clients but suggested that we may experience a clash between our ethical code and connection and relationship.  In many cultures, Fred suggested, we will enhance the connection / relationship by attending family events such as weddings and funerals. 
• In our processes Fred suggested we may need to increase our tolerance for ambiguity and in many situations learn to sit with the chaos we encounter and talk with people where we find them.  Therapy happens in different places and in different ways.  He reminded us that our Western cause and effect thinking may not be universal instead our clients may have more circular ways of thinking which will be expressed in what may seem as unfocused narrative.  We need to learn to sit with different styles of expression including silence.  The silence may express many things –resistance, anger, or respect.  Don’t assume a meaning.  Learn to sit with silence.
• Religious and spiritual beliefs will often be the first reference point for clients suffering from mental health problems –indeed mental health interventions are often the last intervention of choice for the client group we are dealing with and we may need to recognize use of folk or supernatural explanations for events.

These are just some of the challenges that the opening keynote provided and it was a great springboard for the discussions in my workshop that followed.

As stated in the opening speech of the conference:  Mental health is everybody's business no matter what language you speak or where you have come from and the challenge for mental health practitioners is to deliver their services in a culturally intelligent way. 

“A Senegalese poet said ‘in the end we will conserve only what we love. We love only what we understand, and we will understand only what we are taught.’ We must learn about other cultures in order to understand, in order to love, and in order to preserve our common world heritage.”

—Yo Yo Ma, White House Conference on Culture and Diplomacy

Comments

[Steph Schwarz]

Hi Trisha,
Thank you so much for taking the time to summarise Fred Bemak's presentation. I have recently moved to Africa and am wrestling with ethics, understanding my new legal context and cultural norms. His remarks that report are very helpful as I work out what to keep with me to maintain professional work and what aspects of my practice would be helpful to reshape to be effective in my new community. I love your website and often refer to it to my colleagues. Keep up the great work!
Stephanie

[Trisha Carter]

Thanks Steph,
I'm glad the article was helpful. Fred also commented on other aspects of ethics -the one I mentioned above was around boundaries and personal involvement in life events in a collective society. Other aspects included boundaries around self revelation, Fred said in many cultures he finds if he shares some of his struggles and experiences it helps the clients to open up more. I am aware of some cultures though where to reveal struggles would be to lose face and credibility so it's a case of knowing the culture you are dealing with.
He also spoke about ethical issues around touching which might be a big no-no in American culture but is very relevant and needed to bring comfort and healing in some of the African cultures he had been working in. The other ethical issue was payment - he has bartered his services for cooking and other services to ensure people get the help they need with the dignity of having paid in some way.

Even our ethics are so culturally bound and yet we feel they are so important that we don't review them or feel that they should be above review -it was certainly an interesting presentation.
Thank you for your kind comments -so glad I can help!
Trisha