Researcher says “cultural expression starts in early childhood”

One of the ethical standards for psychologists is to provide culturally sensitive services. Multicultural Guidelines have also been developed in the past (see below) after the ethics code was revised in 2002.

  • Guideline 1: Psychologists are encouraged to recognize that, as cultural beings, they may hold attitudes and beliefs that can detrimentally influence their perceptions of and interactions with individuals who are ethnically and racially different from themselves.
  • Guideline 2: Psychologists are encouraged to recognize the importance of multicultural sensitivity/responsiveness to, knowledge of and understanding about ethnically and racially different individuals.
  • Guideline 3: As educators, psychologists are encouraged to employ the constructs of multiculturalism and diversity in psychological education.
  • Guideline 4: Culturally sensitive psychological researchers are encouraged to recognize the importance of conducting culture-centered and ethical psychological research among persons from ethnic, linguistic, and racial minority backgrounds.
  • Guideline 5: Psychologists are encouraged to apply culturally appropriate skills in clinical and other applied psychological practices.
  • Guideline 6: Psychologists are encouraged to use organizational change processes to support culturally informed organizational (policy) development and practice.

diversityGiven the growing diversity of the population, it’s more important than ever before to be “culturally competent.” Culturally competency has been defined as a system that acknowledges the importance of and incorporates culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural difference, expansion of cultural knowledge, and adaptation of interventions to meet the culturally unique needs at all levels of service (Whaley & Davis, 2007). During a session (chaired by Shamin Ladhani, PsyD) titled Culturally Sensitivity in Health: Health Psychology’s Role, Health Beliefs, and Assessment (held on Saturday morning), the presenters discussed key components of being culturally sensitive in a health care setting and outlined practical approaches to meeting the needs of a diverse population.

Tips to be more culturally sensitive may include:

  • Understanding communication methods
  •  Recognizing and responding to language barriers
  •  Clarifying cultural identification
  • Identifying religious and spiritual beliefs
  • Managing your own biases and prejudice
  • Being aware of your body language and privilege

diversity2All of these aspects of cultural sensitivity are important. The panel also highlighted that we need to be careful about not recognizing variation and diversity within ethnic groups. For example, Gurung noted that Latino might include individuals who are Mexican-American, Puerto Rican, Cuban or Dominican. Each of these groups has its own traditions, beliefs and rituals that may affect how you work with members to address their needs. According to Regan Gurung, PhD, “cultural expression is a developmental process that starts in early childhood.” Given the developmental nature of cultural expression, you can imagine that for anyone different from someone else could have a different world view on causes and coping for a particular concern.

On Loneliness

lonelinessI don’t want to be a downer after reading about all of the exciting and innovative presentations but I cannot help the pull to highlight a session I attended on loneliness. I think that part of my draw, as well as my conflict, is that loneliness is such a universal experience.

Dr. Rebecca Curtis started the panel discussion by sharing a couple of case examples that highlighted the struggle with loneliness when there is a conflict between seeking others out and avoiding them. Dr. Curtis described characteristics of this type of loneliness as being related to perfectionism — that an individual desires being in relation with another yet simultaneously devalues others by having high standards for the relationship.

Dr. Rebecca Curtis

Dr. Rebecca Curtis

In helping to further expand the concept of loneliness, Dr. Ben Mijuskovic added:

The fear of loneliness is the ultimate universal drive in human beings, in all we feel, think, say and do … loneliness is the prime motivator in all our passions, thoughts and actions. The opposite of loneliness is intimacy, a desire for empathic unity with another self-conscious being, whether divine, human or sentient.

Dr. Mijuskovic went on to criticize behaviorism’s view that loneliness is passively caused by external conditions — environmental, cultural, situational and even chemical imbalances in the brain, in which he argues that the DSM is compatible with this approach since all of these external conditions are transient and avoidable.

On loneliness and the DSM, Dr. Mijuskkovic added:

The DSM analytically dissects, classifies, reduces and vivisects the emotions into separate “diagnoses” and thus fails to “see” the whole interplay of the emotions and its concomitant developing dynamic. Therefore, the DSM fails to include the “diagnosis” of loneliness because it has misunderstood the dynamic presence and force of loneliness by tearing it into lifeless pieces; it has separated the original constitutive members and transformed them into dead parts.

Dr. Ben Mijuskovic

Dr. Ben Mijuskovic

So much of this talk and presentation resonated to the core with my understanding of loneliness in my clinical work. After reflecting on the talk for a bit, I cannot help but see many of the parallels with a larger process of our work as psychologists, and also why the room for this talk was quite full. Each year, thousands of us gather at an annual convention with like-minded individuals in a way to avoid our experience of loneliness in our work, and increase our intimacy and connections with those who we truly believe have the capacity to understand what it is that each of us does. While loneliness can stem from the urge for perfection, I would also argue that loneliness, especially for psychologists doing the work, can also arise from personal insight and self-awareness. Perhaps it is because we are reflective clinicians and have a harder time connecting with those we encounter in everyday life outside of the office, in particular, those who struggle with self-awareness and do not value interpersonal connection.

While this talk focused on understanding loneliness in clinical work with patients/clients, I would be curious to hear your thoughts on the loneliness and isolation of our work as clinicians. If you are willing, please share your experiences in the comments.

Sessions to See: Making the Most of the Last Day

at APA 2014

at APA 2014

Convention is winding down and many people are preparing for the last day of sessions before heading home. After a busy three days of activities, most people are ready to skip out on sessions to sleep in or go to the airport to beat the afternoon madness.

However, the convention still offers lots of exciting and interesting sessions. Plus, it’s a great time to visit the bookstore to make your purchases. As the convention comes to a close, below are some sessions that may be interesting to see if you’re still wondering, “What session should I go to?”

8AM

Therapist Self-Care – A Lifespan Perspective: Evidence-based Expressive Writing as a Tool

CC Room 145A (1 hour, 50 minutes)

The session will cover empirical studies of expressive writing, an experiential portion involving expressive writing, and discussion.

How Do Psychologists with Privilege Respond to the Stigmatized Others?

CC 209A (50 minutes)

The session will focus on individual, cultural and contextual barriers and assets, as well as training implications for working with culturally stigmatized others.

9AM

Integrating Individual, Family and Systems- Focused Interventions: A Video Illustration

CC 101 (50 minutes)

The session will illustrate the interdependent nature of individual-, family- and systems-based interventions in a program focusing on family-based treatment of adolescent substance abuse and delinquency.

Taking a Stand? Sport Psychology, Media and GLBT Athletes in Sochi

CC 158 (1 hour, 50 minutes)

The session will focus on the experiences of GLBT athletes competing in the 2014 Olympic Games in Sochi.

Autism Spectrum Disorder and the Criminal Justice System

CC 209A (50 minutes)

The session will present on overview of ASD by a psychologist and a parent of a child with autism who is also a former judge.

10AM

Children’s Resilience in the Context of Military Deployment and Their Aftermath

CC 204C (1 hour, 50 minutes)

The session will discuss how scientific knowledge about resilience can provide the evidence base for programs to support and enhance the resilience of military-connected families.

11AM

Influence of Culture and Context on Family: School Partnerships

CC 209A (1 hour, 50 minutes)

The session will explore various influences of culture and context on the development and implementation of family-school partnerships.

12PM

Global Violence Toward Women: Interventions and Strategies for Change

CC 152A (1 hour, 50 minutes)

The session will explore global violence toward women through an examination of sexual assault and rape in Africa, domestic violence and international sex trafficking, emphasizing treatment methods and interventions.

1PM

Interprofessional Training: Preparing Psychology Students for the Changing Health Care Market

CC 154B (50 minutes)

The session will showcase an interprofessional training program for psychology graduate students and interns to address changes in health care.

Healthy Food Choices and Safety: Can You Have It All?

That was the question that stuck with me most after leaving the paper session “Influences on Healthy Eating Decisions.”

163118519According to the research led by Anthony G. Salerno, PhD, feeling safe may encourage people to eat larger amounts of unhealthy foods, outside of their awareness. “Feelings of safety increase people’s perception that they are protected from danger, which consequently decreases their sensitivity to harmful behaviors,” he said. Unhealthy eating is one of them, and can lead to harmful consequences. When people feel safe, they are less sensitive to these harmful consequences and are more likely to consume unhealthy foods, which can lead to weight gain and obesity.

This implies that our environment can play a crucial role in our determination of adhering to a healthy eating pattern. However, does that mean that you should move to an unsafe neighborhood to shed the pounds more easily? I’d say not so fast.

I caught up with Dr. Salerno this week, and here is what he had to say:

“While it obviously would not be a good idea for people to start seeking out harmful environments, I do think people may benefit from being mindful of the fact that just because they are in a safe environment, it does not mean that this protects them from their own unsafe behaviors. In general, it is of great importance to a person’s psychological well-being that they feel safe. However, people should also be mindful of the fact that feeling safe can sometimes increase our willingness to engage in behaviors with potentially harmful consequences (in this case the consumption of unhealthy food). So by simply being aware of the influence of safety on our behavior, we are more likely to undermine the undesirable consequences it has on us.”

122401671Stress is also linked to overeating, weight gain and obesity. The evidence that feeling safe may be a contributing factor when it comes to food choices and weight makes me wonder, where is the balance between the two when it comes to eating healthy? Constant stress can lead to suboptimal food choices, but so can the feeling of safety, according to Salerno. So does a golden mean between how we feel on a regular basis regarding our safety, and how much (as well as how healthy) we eat even exist?

While this may be more of a philosophical question, I think that it might be the intensity of the feelings that prompts the consumption of unhealthy foods. In other words, feeling very secure and at ease, as well as feeling very stressed, could be leading to overeating and weight gain. It is also important to recognize other behaviors and feelings that accompany feeling safe or stressed, which can also be contributors to unhealthy eating.

After all, eating is much more than merely satisfying hunger. We eat in response to a variety of emotions, both positive and negative. It is thus essential to recognize our feelings that trigger eating and overeating. Once eating triggers are identified, further steps can be taken to break the emotional eating habit and adopt a healthier eating pattern, which in turn can help reduce overweight and obesity.

Have more thoughts on this topic? Reply below. Dr. Salerno is also happy to answer questions via email. You can reach him at Anthony.salerno@uc.edu

Nicole Avena, PhD studies appetite and addiction at the NY Obesity Research Center, at Columbia University. You can learn more about her work at DrNicoleAvena.com. She can also be found on Twitter and Facebook, or on her Psychology Today blog.

How Can Psychologists Help Men and Boys?

463536557Five people were wounded overnight in shootings on Chicago’s West and South sides, according to a report in this morning’s Chicago Tribune. It’s a headline that appears almost daily in my city, and the victims, all men age 16 to 32, are among the most disadvantaged in the city – and frankly, in the country. Perhaps more importantly, this violence, and the stress and trauma that it leads to, is taking a serious toll on the health of men and boys in poor, urban communities throughout our nation, according to presenters at a symposium today.

At the session, members of APA’s working group on health disparities in boys and men discussed reasons why this population and other underserved groups of men have some of the worst health outcomes in the country.

Working group chair Wizdom Hammond, PhD, of the University of North Carolina at Chapel Hill pointed to several psychosocial factors that contribute to these health disparities, including a need among men to endorse and demonstrate traditional traits of masculinity, including toughness, self-reliance, confidence and aggression.

“It’s likely that the strains and conflicts associated with trying to live up to this masculine ideal is at least partly responsible for producing the kinds of health disadvantages we’re seeing,” Hammond said.

The researchers explained that, compared to women, males are more likely to take health behavioral risks, delay preventive health screenings and care-seeking for health problems, minimize their physical and mental health symptoms and signs of distress and have higher rates of substance abuse. These behaviors are even more widespread among men of low socioeconomic status, those who are ethnic and racial minorities, those who are gay or bisexual, and those who have been incarcerated.

Particularly when it comes to mental health, men and boys are socialized very early not to talk about their emotions around traumatic experiences, said presenter Waldo Johnson, PhD, of the University of Chicago.

“Therefore, they tend to suffer in silence,” he said.

The group is now finalizing an evidence-based report and a series of best practices and recommendations on the topic, for dissemination to psychologists and other health providers. One thing is clear, Johnson said:

“Any prevention or treatment program for this population must account for the unique circumstances of men and boys.”

Integrated Approaches Improve Care, Lower Costs

100614692Fifty years ago, the president of the American Pediatric Society dreamed of employing psychologists in pediatric centers. Today, that dream of integrating physical and mental health care is a reality, thanks in part to 2008’s Mental Health Parity Act and the 2010 Affordable Care Act, said presenters at an APA convention symposium on innovative care strategies for youth.

Research shows integrated care not only reduces health-care costs, but benefits families and children, said Joan Asarnow, PhD, of the University of California, Los Angeles, Geffen School of Medicine, who conducted a meta-analysis looking at integrated care.

“When we go in and provide integrated care, our kids are more likely to get better,” she said.

But challenges remain. For one, mental health parity is not always well enforced and only 4 percent of Americans know that health insurers are required to provide comparable coverage for mental and physical health care, according to an APA survey.

Further, disparities persist in mental health care: Minorities with mental health disorders are much less likely to receive mental health care — and appropriate care — than white populations, said Jeanne Miranda, PhD, of the University of California, Los Angeles. Minorities are also vastly underrepresented in the mental health care workforce.

To overcome such barriers and better integrated mental and physical health care, speaker Marc C. Atkins, PhD, of the University of Illinois at Chicago, called for expanding the mental health workforce, realigning mental health resources and developing a natural extension from prevention to intervention.

Tailoring interventions on a smaller scale is important, too, said W. Douglas Tynan, PhD, director of integrated care at APA who offered suggestions for those looking to integrate mental health care into existing primary-care clinics. “After you find out [the clinic’s] greatest need, develop a protocol and then develop a practice team,” he said.

Sharon G. Portwood, JD, PhD, of the University of North Carolina at Charlotte, said keeping prevention and wellness “at the forefront” of efforts is also key.

Psychologists have a key role to play in all of this work since many are experts in interventions that improve health outcomes, such as motivational interviewing, self-management training and problem-solving, said Terry Stancin, PhD, of MetroHealth Medical Center. “There’s a very important role we have to play in integrated-care settings,” she said.

Integrative Primary Care & Psychologists

integrative healthI attended a session Friday morning titled “Improving Outcomes for the Underserved: The Role of Integrated Primary Care.” The panel provided an overview of models of service delivery and highlighted key components to make integrative systems work effectively. I assume that this is an important topic for many psychologist and mental health professionals as the room was packed with standing room only (or floor seats for those who chose).

Why is this important to psychologists?

Health care reform and integrative primary care have been hot topics for several years. The Obama administration and Congress have played a major role in integrating mental health into primary care. The APA has also been involved in these discussions and highlighting the role of psychologists who work in primary care settings. You can visit the APA website for more information on health care reform and APA’s priorities (http://www.apa.org/health-reform/index.html).

Psychologists are experts in behavioral change. Therefore, it is imperative that they have a seat at the table when policymakers are discussing ways to improve mental and physical health. Psychologists have been working in integrated primary care settings for decades, providing behavioral health services. According to the APA, psychologists play a vital role in health promotion and disease prevention.

Roles of psychologists in integrative care include:

  • Psychologists possess the essential therapeutic skills for delivering treatment to substance abuse clients, including empathy, good listening skills and training in evidence-based methods known to curb addictive behaviors.
  • By assessing a client’s needs, abilities or behavior using a variety of methods, including psychometric tests, interviews and direct observation of behavior, psychologists help tobacco users quit smoking.
  • Psychologists have the ability to address factors associated with risky sexual behaviors and devise strategies for patients to meet their individual needs.
  • Psychologists possess the ability to devise and monitor appropriate programs of treatment, including therapy, counseling or advice, in collaboration with colleagues to assist adults and children in coping with the psychological factors associated with injury and violence.
  • Psychologists possess the skills necessary to assist patients in making behavioral changes to adopt physical activity to increase their mental well-being.
  • Psychologists can address both parent and infant anxiety before and during the immunization process and can develop materials and information on the behavioral aspect of immunization.

How is this important to meeting the needs of the underserved?

According to Dr. Dennis Freeman, under-served populations are the highest users of primary care services. “To improve cost and outcomes, we need to understand the impact of psychosocial factors,” he said. Given the shift in intgrative2health care reform to from traditional care to  community mental health centers, psychologists need to know how to be involved in these changes.

Whereas underserved populations over-use primary care and emergency room services, we know from the literature that they often under-utilize mental health services. Integrating mental and physical health care bridges a gap for psychologists to work with underserved groups. Dr. Freeman also noted “patients with mental disorders often have co-morbid medical conditions,” which may another reason why underserved seek medical care before seeking behavioral health services.