What is Clinical Practice? - NY Coalition for Asian American Mental

Report
WHAT IS CLINICAL PRACTICE?
THE INTERRELATIONSHIP
BETWEEN CULTURES, THEORIES
AND APPROACHES
Irene Chung,
LCSW, PhD
Associate Prof.
Silberman
School of
Social Work at
Hunter College
WHAT IS CLINICAL PRACTICE?
The process of helping individuals and
families through the “professional use of self
and application of clinical knowledge and
skills to restore, maintain, and enhance the
biological, psychological, social, and spiritual
functioning of our clients” (Council on Social
Work Education, 2009).
WHAT ARE CLINICAL THEORIES?
Bodies of knowledge in behavioral sciences
that offer insights to human nature and
behavior.
They inform the practitioners’ assessment of
their clients’ thoughts, feelings and behavior
as well as therapeutic interventions .
CULTURAL MEANINGS EMBEDDED IN
CLINICAL CONCEPTS AND THEORIES
 Clinical theories are generally infused with cultural
meanings when theorists, influenced by their
background and social times, emphasize and de emphasize certain foci in their theoretical
elucidation.
 The predominant influences of Euro -American values
on clinical theories tend to deviate from collectivistic
world views.
CULTURAL MEANINGS EMBEDDED IN
CLINICAL CONCEPTS AND THEORIES
Examples:
 Maslow’s “hierarchy” of human needs
 Self-actualization versus social needs.
 Mahler’s childhood development of “separation and
individuation”
 Emphasis on the child’s autonomy, self-sufficiency and self
expression versus prolonged bonding with caretakers and
development of keen awareness of the needs of other.
 Somatization as an ego defense
 Dichotomous view of mind and body in Western medicine versus the
belief that emotions and bodily changes are interrelated through the
circulation of qi or prana in Chinese and Ayurvedic medicines.
CULTURAL MEANINGS EMBEDDED IN
TRADITIONAL COUNSELING APPROACHES
 “The talking cure” and “insight-oriented counseling”
as influenced by Euro-American values and
communication style:
- Practitioner maintains a “blank screen” to
facilitate the client’s free association of thoughts and
feelings, and re-enactment of transference toward the
practitioner;
- Direct probing and interpretation of the client’s
thoughts and feelings.
- Empathy offered in affective and professional
terminology.
CULTURAL MEANINGS EMBEDDED IN
CASE MANAGEMENT PRACTICE
 Use of agency protocol in the exploration of the
client’s presenting problems and background.
 Clear delineation of the practitioner’s role and
responsibilities.
 Minimization of the practitioner’s self disclosure of
personal information, thoughts and feelings to
maintain professional boundaries.
CULTURAL DISSONANCE IN USING WESTERN
APPROACHES WITH ASIAN CLIENTS
 Asian values:
- Introspection and articulation of personal
feelings are considered to be ego-centric and
detrimental to one’s health and harmonious
relationship with others.
- Being thrifty with words and intuitive to
other’s needs and feelings in interpersonal
communication are virtues under the teachings of
Confucianism, Buddhism, Hinduism and Taoism.
- Interpersonal relationships are defined by
mutuality and reciprocity between individuals.
CULTURAL DISSONANCE IN USING WESTERN
APPROACHES WITH ASIAN CLIENTS
 Asian communication style: indirect and high
context
 Asian cultural norms: disclosure of personal and
familial information to individuals outside of the
kinship network is deemed inappropriate.
 Asian languages: limited vocabulary in
conversational lexicons to describe or explore
feelings; affective lexicons are generally somatic
complaints or metaphorical expressions of
feelings.
COMMON PRACTICE DILEMMAS
If we adhere to the Western clinical model:
 What do we do when Asian clients seem reluctant or evasive
to disclose their feelings or minimize them in regard to their
presenting problem?
 How much do we help Asian clients articulate their thoughts
and feelings?
 Should we ask “intrusive” questions, and if so, how?
 How do we communicate empathy?
 How much do we do for our Asian clients?
 How should we respond if Asian clients ask us for “advice”?
 What do we do when Asian clients bring us gifts?
 What do we do when Asian clients inquire about our personal
background?
A CLINICAL PERSPECTIVE OF CULTURAL
DIFFERENCES
 Cultural values and norms are culture -specific
“constructs of well-being and distress” that often
influence and shape individuals’ subjective
experiences.
 There are adaptive purposes underlying the cultural
values associated with the Asian
interdependent/collectivistic and the Western
individualistic world views.
THE INTERRELATIONSHIP BET WEEN
CULTURES, CLINICAL THEORY AND
APPROACHES
Euro-American Practice Model:
Clinical Theories

Culture

Clinical Approaches
Cross-Cultural Practice Model:
Clinical Theories  changing socio-cultural values, universal
And culture-specific human needs, emotions and b ehavior

Clinical Practice
DE-CONSTRUCTING AND RE-CONSTRUCTING
CLINICAL CONCEPTS AND APPROACHES
Let’s start with the basic premise!
What are the therapeutic objectives in working
with clients across cultures and service
modalities?
 Support them through their life crisis and restore their
level of functioning
 Ameliorate their emotional distress and renew their
sense of hope in life
 Facilitate them in making lasting positive changes in
their life roles, coping mechanisms and relationship
with others.
DE-CONSTRUCTING AND RE-CONSTRUCTING
CLINICAL CONCEPTS AND APPROACHES: A
RELATIONAL FRAMEWORK
 From “talking cure” to “communication cure”.
 From “one-person” to “two-person” psychology: The
Relational Model that emphasizes
- Implicit therapeutic communication within the
helping relationship;
- Corrective experiences as interventions to modify the
client’s sense of self and others and coping
mechanisms;
- An egalitarian relationship characterized by
reciprocal dynamics and permeable boundaries
between the client and the practitioner.
RELATIONAL MODEL: THE CHANGE
PROCESS
 Different conceptualization of the client’s “change
process””
- Psychological growth can occur in a purposeful
relationship without delving into the client’s repressed
thoughts and feelings.
- Clients will be more inclined to reflect on their
issues and circumstances when they feel accepted,
supported and empowered in their interactions with
practitioners .
RELATIONAL MODEL: A CROSS-CULTURAL
PRACTICE FRAMEWORK
 Attunement to the client’s subjective experiences
and specific emotional needs: inclusion of culture as
a moderating factor in the helping process.
 Emphasis on authentic and spontaneous
interactions: development of professional yet
culturally relevant communication, relationship and
boundaries.
 Creative and purposeful use of self in engagement,
assessment and intervention with client.
EFFICACY OF RELATIONAL APPROACHES
 Studies have found that strong therapeutic
relationships are associated with positive treatment
outcomes (Martin, Ganke, & Davis, 2000; McCabe &
Priebe, 2004).
 Neurobiological and infant research findings indicate
that growth in the right brain structure (the realm of
affective and intuitive, mind-body communications)
is stimulated by non-verbal communications between
infant and care-taker. Implications: The nurturing
and interactive relational approaches in clinical
practice can have similar benefits (Schore & Schore,
2008).
RELATIONAL APPROACHES IN WORKING
WITH ASIAN CLIENTS
Opportunities:
 More effective engagement of clients who are not
familiar with or reluctant in the utilization of
counseling and social services.
Challenges:
 Management of permeable boundaries;
 Management of ethnocultural transference and
countertransference issues;
 Documentation of the efficacy of our work: building
an Asia-centric practice model.
THOUGHTS FOR FURTHER DISCUSSION
Theories are only as good as when we can
apply them in our practice with clients!
We can own our practice, broaden our skills
and approaches to make them meaningful to
our clients when we understand and
appreciate the pervasive cultural influences
embedded in theories and practice!
REFERENCES
 Chung, I. W. & Shibusawa, T. (2013). Contemporar y Clinical
Practice with Asian Immigrants: A Relational Framework with
Culturally Responsive Approaches. New York: Routledge.
 Martin, D., Garkse, J., & Davis, M. (2000). Relation of the
therapeutic alliance with outcome and other variables: A
meta-analytic review. Journal of Consulting Clinical
Psychology, 68, 438-450.
 McCabe, R. & Priebe, S. (2004). The therapeutic relationship
in the treatment of severe mental illness: A review of methods
and findings. International Journal of Social Psychiatr y, 50,
115-128.
 Schore, J. R. & Schore, A . N. (2008). Modern attachment
theory: The central role of af fect regulation in development
and treatment. Clinical Social Work Journal, 36, 9-20.

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