Theoretical Orientation
- Cognitive behavioural
- Theories and frameworks underlying traditional CBT and 3rd wave
- Structure my conceptualizations in terms of presenting problems and diagnoses, precipitating factors, maintaining mechanisms and their origins
If I get a case vignette with a list of symptoms and am asked how I would assess/conceptualize/treat what steps do I go through mentally?
- Consider differentials including other disorders and medical conditions
- Consider cultural factors and how they might relate to or change the interpretation of symptoms
- Determine what assessment strategy would be most appropriate (consider aim of assessment, referral question)
- Always include psychosocial history, semi structured diagnostic interview and/or psych testing, self report measures.
- Conceptualization: focus on maintaining mechanisms, look to literature to inform it
- Consider evidence based treatments
- Feedback, collaboration with client on conceptualization
- Agreement to therapy
- What therapy looks like
Cultural considerations for working with indigenous clients
- Of course I have a lot to learn in this area, and I haven’t had the opportunity to work with indigenous clients
- BUT I have done workshops and a few of the major takeaways I had from a workshop I did on working with indigenous clients were
To recognize the role of historical/intergenerational trauma, and how that may lead to higher levels of distrust, may have to work harder to built that trust
Also a lot of issues related to identity tied in with this, so much has been lost in terms of culture and traditions, historical experiences with residential schools, the 60s scoop etc, can contribute difficulties with identity, feeling lost about who they are and what it means to be indigenous
“jagged worldviews colliding” leroy little bear (maybe don’t include)
Also: Indigenous ways of knowing and understanding of mental health and wellbeing might be different
-> Ideas of wellness focus less on symptoms and more on outcomes related to purpose, belonging
-> Eurocentric ideas not necessarily “better” indigenous knowledge passed down, just because doesn’t have RCT doesn’t mean it isn’t important/worthwhile
Don’t forget strengths
- Community based, inclusive
- wholistic way of knowing and doing (view the interconnectedness of things)
- Connection to land and water
- Belief of time as circular
- Beliefs about aging and elders
- Spirituality, fine line between physical and spiritual world
Finally, there is a lot of variability within groups, so keep these things in mind but don’t make assumptions
Approach to diversity more generally
- Approach it with humility
- Recognize that I am part of the dominant culture and this affects my perceptions and experiences,
- Educate myself about other cultures, but also recognize the diversity within cultures is immense and it’s important not to make assumptions
- Address culture and diversity factors with all my clients
- In my conceptualization I take time to think about how cultural and diversity factors might be influencing my client’s experience, my experience of them, their experience of me, and their understanding and ways of coping with their difficulties. Throughout therapy I keep this in mind.
- Intersectional factors**
o Example of case - Recognize that I will make mistakes, it’s important to stay open and keep learning
- Goals for internship are to keep working on building competency in this area
o Encouraged to that diversity and indigenous interculturalism and reconciliation are part of your programs core values and didactic training opportunities like: Manitoba Indigenous Cultural Safety Training
What types of things would you consider when doing an assessment with an indigenous client?
- Reflect on our assumptions (acknowledge systemic racism exists) what stereotypes do I have?
- Different indigenous people are in different places in terms of their identity
- Assumption that Eurocentric ways of knowing are “right” indigenous knowledge has been passed down through generations, just because doesn’t have an RCT behind it, doesn’t mean it’s less valuable
What are the guidelines to conducting a “culturally sensitive” assessment
- Start with a self assessment
- Assess preferred language and obtain an interpreter if needed
- Spending time developing rapport, trust (maybe an extra assessment session)
- Need to understand contemporary and social issues that impact the person
- Misuse of standardized tests among culturally diverse clients (look at the norms used etc)
- Use ‘cross cultural skills’ in interpreting results from measures (e.g., consider how culture could impact results)
- Multi-method assessment is best
- Cultural interpretations and understanding of their symptoms/problems might be different from how we conceptualize it
- Facilitating choice and empowerment
