Diversity In Practice - Western State Hospital Internship Program

May 05 2018

Friday Factoids Catch-Up: Toward Cultural Competence: Understanding Historical/Generational Trauma of African Americans

Historical trauma is relevant to examine regarding African Americans because those who never experienced the traumatic stressor themselves, such as children and descendants of people who experienced race-based genocide/slavery, can still exhibit signs and symptoms of trauma. In the United States alone, African Americans have experienced over 350 years of oppression, generations of discrimination, slavery, colonialism, imperialism, racism, race-based segregation and poverty (Ross, n.d.).

In addition, African Americans currently are exposed to frequent and even multiple daily microaggressions, which are defined as, “Events involving discrimination, racism, and daily hassles that are targeted at individuals from diverse racial and ethnic groups” (Michaels, 2010). “Racial microaggressions are brief and commonplace, and include daily verbal, behavioral, or environmental indignities, whether intentional or unintentional, that communicate hostile, derogatory, or negative racial slights and insults toward people of color,” (Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, & Esquilin, 2007). The impact of historical and generational trauma can affect people of color such that internal impressions/views of self begin to skew, and negative behavior and emotions such as anger, hatred, and aggression become self-inflicted, as well as imposed on members of one’s own group (Ross, n.d.).

Stigma related to mental illness also impacts views on mental health and help-seeking behaviors because African Americans who received services, as well as those with no prior experience with mental health services, associated these supports with embarrassment and shame (Thompson, Bazile & Akbar 2004). The researchers also found that African American participants in mental health services have mistrust around mental health practitioners, and that it may be challenging for psychologists and psychotherapists to be free of the attitudes and the beliefs of the larger society, especially due to stereotypes.

Asbury, Walker, Belgrave, Maholmes, and Green (1994) found that perceptions of provider competence, self-esteem, emotional support, and attitudes toward seeking services were significant predictors of seeking service. In addition, racial similarity, perception of provider competence, and perceptions of the service process determined continued participation. Pole, Gone, and Kulkarni, (2008) and Sue (1998) found that overall, African-Americans attended average to fewer sessions (underutilize services), as well as terminated from services earlier than European Americans.

When conducting psychological interventions with African Americans it is important to be mindful of their cultural beliefs, as well as current oppression (stereotypes) faced by this population, and to be culturally sensitive to the issues and experiences that the African-American community has historically confronted, and continues to experience (Ross, n.d.). When conducting psychological treatment with people of color, it is important to be mindful of the historical and generational trauma African Americans have faced, as well as keeping in mind how internal oppression can impact their views on mental health and help-seeking behaviors.

References
Asbury, C. A., Walker, S., Belgrave, F. Z., Maholmes, Green, L. (1994). Psychosocial, cultural, and accessibility factors associated with participation of African Americans in rehabilitation. Rehabilitation Psychology, 39, 113-121.

Michaels, C. (2010). Historical trauma and microagressions: A framework for culturally- based practice. Children, Youth & Family Consortium’s Children’s Mental Health Program. Retrieved from http://www.cmh.umn.edu/ereview/Oct10.html

Pole, N., Gone, J. P., & Kulkarni, M. (2008). Posttraumatic Stress Disorder Among Ethnoracial Minorities in the United States. Clinical Psychology: Science & Practice, 15(1), 35-61. doi:10.1111/j.1468-2850.2008.00109.x

Ross, K. (n. d). Impacts of historical trauma on African Americans and its effects on help-seeking behaviors. Presentation. Missouri Psychological Association.

Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271-286.

Sue, S. (1998). In search of cultural competence in psychotherapy and counseling. American Psychologist, 53(4), 440-448.

Thompson, V. L., Bazile, A. & Akbar, M.D. (2004). African American’s Perceptions of Psychotherapy and Psychotherapists. Professional Psychology: Research and Practice, 35, 19-26.

Katy Roth, M.A., CRC
WKPIC Doctoral Intern

May 05 2018

Friday Factoids Catchup: Toward Cultural Competence: Understanding Historical/Generational Trauma for Native Americans

Native Americans have been facing psychological consequences of genocide for over 400 years. Due to colonization and military attacks, Native Americans have been subjected to one of the most systemic and brutal ethnic cleansing operations in history. They were relocated to penal colonies, neglected, starved, forbidden to practice their religious beliefs, and their children were taken away from them and reeducated so that much of their language, culture and kinship patterns were lost (Whitbeck, Adams, Hoyt, & Chen, 2004). In addition, the researchers note that the threats of their lives and cultures being obliterated has become progressive, increasing as each generation passes away. One elder noted, “I feel bad about it. Tears come down. That is how I feel. I feel weak. I feel weak about how we are losing our grandchildren.”

Native Americans still are faced with daily reminders of this violent erasure of self and community, such as reservation living, encroachment on their reservation land, loss of language, loss of traditional practice, and loss of healing practices (Whitbeck, Adams, Hoyt, & Chen, 2004). The Indian Health Service (1995) noted that Native American alcoholism death rate was 5.5 times the national average. One can argue that this population is drinking as a means of coping with the historical and generational trauma, as well as the daily reminders of the trauma they experience. Whitbeck, Adams, Hoyt, and Chen, 2004 supported this theory, indicating that daily reminders of ethnic cleansing coupled with persistent discriminations are the keys to understanding historical trauma among Native people.

When conducting psychological treatment with this population it is important to be mindful of the historical and generational trauma Native Americans have faced, as well as keeping in mind the role their culture plays. Brave Heart and DeBruyn (1998) highlight that when conducting psychological treatment it is important to recognize that Native Americans incorporate spiritual empowerment and utilize traditional healing ceremonies, which have a natural therapeutic and cathartic effect for spiritual, physical and emotional healing. Many tribes need to conduct specific grief ceremonies, not only for recent deaths, but also historical traumas, including but not limited to the loss of sacred objects being repatriated, mourning for human remains of ancestors, loss of rights to raise children in their cultural norms, and loss of land. Bridging both evidence-based treatment (EBT) and culturally sensitive approaches in this population appears advantageous. Gone (2009) found, “Both in Northern Algonquian and other Native community contexts, the therapeutic emphasis often remains on healing rather than treatment.” McCabe (2007) supported this finding, indicating that Native healing goes beyond the meaning of distress and coping, to fostering a robust sense of well-being, a strong Aboriginal identification, cultural reclamation, purposeful living and spiritual well-being. Native Americans may not be fond of formal outcome assessment or therapeutic interventions, and find it a distraction from the provision of services ( (Gone, 2011).

References
Brave Heart, M., & DeBruyn, L. (1998). The American Indian holocaust: healing historical unresolved grief. American Indian & Alaska Native Mental Health Research: The Journal Of The National Center, 8(2), 56-78.

Gone, J. P. (2009). A Community-Based Treatment for Native American Historical Trauma: Prospects for Evidence-Based Practice. Journal Of Consulting & Clinical Psychology, 77(4), 751-762. doi:10.1037/a0015390

Gone J. P. (2011). The red road to wellness: Cultural reclamation in a Native First Nations community treatment center. American Journal of Community Psychology 47(1–2):187–202

Indian Health Service. (1995). Trends in Indian health. U.S. Department of Health and Human Services. Washington, DC.

McCabe, G. H. (2007). The healing path: A culture and community-derived indigenous therapy model. Psychotherapy: Theory, Research, Practice, Training, 44, 148– 160.

Whitbeck, L. B., Adams, G. W., Hoyt, D. R., & Chen, X. (2004). Conceptualizing and Measuring Historical Trauma Among American Indian People. American Journal Of Community Psychology, 33(3/4), 119-130.

Katy Roth, M.A., CRC
WKPIC Doctoral Intern

May 05 2018

Friday Factoid Catch-Up: Toward Cultural Competence: Historical/Generational Trauma Related to Japanese Americans

Historical trauma is relevant to examine regarding the Japanese population in the United States, because those who never experienced the traumatic stressor themselves, such as children and descendants, can still exhibit signs and symptoms of trauma. “During World War II, the United States confined 120,000 Japanese Americans in camps based solely on their Japanese heritage and two thirds of those forced to live in the camps were United States Citizens,” (Nagata, Kim, & Nguyen, 2015.) In addition, the researchers noted that even though the United States was also at war with Germany and Italy, neither German Americans nor Italian Americans were subjected to mass incarceration, like the Japanese Americans.

When conducting psychological treatment with this population it is important to be mindful of the historical and generational trauma Japanese individuals have faced, and to note that, “Even though the incarceration assaults on identity represented a cultural trauma, Japanese Americans did not process them as a collective group. Instead, the impacts were contained primarily at the individual trauma level, during and after the war,” (Nagata, Kim, & Nguyen, 2015.) In addition, the researchers stated, after the Japanese Americans experienced incarceration in camps, they attempted to cope by silence to repress the incarceration trauma for more than three decades. Laub and Auerhahn (1984) supported Nagata, Kim, and Nguyen (2015) and stated, “The more profound the outer silence exhibited by a Japanese individual, the more extensive was the inner impact of the event experienced (p. 154).”

In many cases, the lack of communication about the interment created a sense of foreboding for the Sansei as they grew older, and ultimately increased the curiosity about the camps, as well as heightened their sense of parental trauma (Nagata, 1991). A participant described the topic of internment as a forbidden topic that family tiptoed around, like a family scandal. It is important when conducting therapy with Japanese individuals to explore the role of this silence, not only on an individual level but a familial level, and to explore the client’s interpretation of that silence. In addition, this population may experience lower levels of self-esteem and identity issues stemming from the historical trauma, which may need to be considered in current psychological treatment. According to Nagata (1991), after the camps, many Nisei felt particularly pressured to demonstrate their worth after being rejected by their country, and their Sansei children were also expected to be the best and acquire the respect of others. Further, while Sansei today have more opportunities accessible to them than their Nisei parents, the camp experience of their parents may continue to affect their sense of ethnic identity, resulting in issues of identity.

Narrative Therapy may be beneficial when working with this population because it will allow the therapist to evaluate the stories of the client and can serve several functions in clinical practice: (1) to “make the latent manifest,” (2) to “help construct a unifying narrative, “and (3) to “reconstruct a more useful and coherent interpretation of past events and future projects than the client’s present narrative” (Polkinghorne, 1988, p. 178). Family therapy is also advantageous for this population because, “The focus of the family work is to unburden relationships by encouraging dialogues among family members whereby protected, hidden, and even unconscious conflicts of loyalty, obligations, myths, and legends can surface and be examined” (Miyoshi, 1980, p. 41).

References
Laub, D. & Auerhahn, N.C. (1984). Reverberations of genocide: Its expression in the consciousness and unconsciousness of post-Holocaust generations. In S. A. Lueland P. Marcus (eds.), Psychoanalytic reflections on the Holocaust (pp. 151-167). New York: KTAV Publishing House.

Miyoshi, N. (1980). Identity crisis of the Sansei and the American concentration camp. Pacific Citizen, December 19-26, 91, pp. 41-42, 50, 55.

Nagata, D. K. (1991). Transgenerational Impact of The Japanese- American Internment: Clinical Issues in Working With Children of Former Internees. Psychotherapy, 28(1), 121-128.

Nagata, D. K., Kim, J. J., & Nguyen, T. U. (2015). Processing Cultural Trauma: Intergenerational Effects of the Japanese American Incarceration. Journal Of Social Issues, 71(2), 356-370. doi:10.1111/josi.12115

Polkinghorne, D. E. (1988). Narrative knowing and the human sciences. New York: State University of New York Press.

Katy Roth, M.A., CRC
WKPIC Doctoral Intern

January 01 2017

Friday Factoids Catch-Up: Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) has been a hot topic for some time now and more and more children are being diagnosed with ADHD than ever before. Lunau (2014) quoted Enrico Gnaulati by writing that an ADHD diagnosis is “as prevalent as the common cold.” If this is the case, how do we, as clinicians, respond to this phenomena?

Lunau noted that more than one in ten children are diagnosed, typically, boys. (Lunau 2015) In her research, she look at various states and how each approached the diagnosis and subsequent treatment of ADHD. She brought forward information regarding North Carolina and California to elucidate the vast differences how one can approach ADHD. She noted a 16 % diagnosis rate for children in North Carolina, whereas California has a 6%; she also discovered that children in North Carolina were 50% more likely to receive medications as treatment for ADHD symptoms. Lunau looked to the work of Hinshaw and Scheffler (reference information not provided in Lunau’s work) who explore the multiple variables that may impact these statistics, including demographics cultural influences, and health care policy. Ultimately, they discovered that school policy has the largest impact.

Specifically, school mandates in North Carolina for higher test scores may have impacted the perceived need for some children to receive additional services and, in some cases, children receiving academic based services are not included in the test score average (Lunau, 2015).

So, given the significant difference between the incidences of ADHD across state, are we witnessing an epidemic or a cultural phenomena that carries with it a secondary gain of medication management to attempt to manage behaviors or increase school testing scores. Taking a step back and looking at ADHD from a global perspective, Lunau noted other countries are not experiencing a similar increase in the onset of ADHD in their children and briefly explored how other factors may mimic ADHD symptoms, like sleep deprivation. Though briefly mentioned, Lunau indicated the need for further exploration into how ADHD is assessed and diagnosed.

When looking at the high rates of ADHD, we must also begin to consider how this diagnosis is treated. Is medication the ideal treatment? The CDC published a study (PR, 2015) which looked at the various types of treatment our children are exposed to. Results indicated 1 in 10 children, ages 4-17, diagnosed with ADHD received behavioral therapy, 3 in 10 received medication and therapy, and 1 in 10 received no treatment. When looking at preschool aged children, 1 in 4 received medication alone and 1 in 2 received both medication and therapy. This begs the question of whether or not we are over medicating our children so early in life. What are the long term implications of medication only interventions on the overall development of the child?

The CDC study highlighted that states which provided increased amounts of behavioral therapy also experienced lower rates of medication management for the treatment of ADHD, and vice versa. Bell and Efron (2015) briefly explored the impact of tri-cyclic antidepressants as a possible treatment for children with ADHD and noted tricyclic outperformed, in one trial, clonidine in the reduction of symptoms. The information in these three articles is obviously not exhausted, however, it does highlight the need for continued research in the assessment, diagnosis and treatment of ADHD and an active re-evaluation of how cultural/social influences can impact the national conversation of how we understand ADHD.

Bell, G., & Efron, D. (2015). Tricyclic antidepressants – third-line treatment for attention deficit hyperactivity disorder in school-aged children. Journal Of Paediatrics & Child Health, 51(12), 1232-1234. doi:10.1111/jpc.13031

Lunau, K. (2014). Giving ADHD a Rest. Maclean’s, 127(8), 48-50.

PR, N. (2015, April 1). CDC publishes first national study on use of behavioral therapy, medication and dietary supplements for ADHD in children. PR Newswire US.

Jennifer Roman, M.A.
WKPIC Doctoral Intern

January 01 2017

Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

The role of psychologists is changing as overall mental health service needs and service systems change. Separating medical health from mental health is not always so clear cut. With advances in the medical fields, psychologists must also embrace a new way of looking at overall mental health. Wahass (2005) noted that health was “seen as the absence of diseases or injury and their presence meant ill health.” This approach was suggestive of there being a solution to the malady. However, over time, the connection between the mind and body began to shift the traditional medical model (illness and its corresponding cure) to a more dynamic view, a biopsychosocial perspective on approaching maladies.

The biopsychosocial model integrates the biological, psychological and social factors that interact independently or in concert with each other to sustain a healthy or unhealthy status. (Wahass, 2005) This is particularly important to keep in mind as we encounter clients from culturally, linguistically, and socioeconomically diverse background. As psychologist we must have an awareness of and become champions of not only serving in a clinical role, but advocating for it as well. Our work is not limited to assigning diagnoses; rather, our responsibility to is act as a liaison between our clients and their communities.

Wahass identified several areas of focus, including clinical, health/medical, counseling, rehabilitation and community psychology. Many of the quotidian responsibilities may overlap; however, each has distinct demands and expectations, which not only allow for a more robust treatment of our clients presenting problems, they also encourage a more meaningful understanding of the person behind the list of concerns.

Chang, Ling and Hargreaves explored the relationship between scientist and practitioner and the effectiveness of graduate programs in preparing psychology students for the real life demands of the various roles psychologists assume. Results revealed that there is not one predominant stance, in part because depending on the setting (e.g. hospital, private practice, community bases setting, etc…) there are distinct demands on a psychologist.

As the approach to medical and mental health issues evolves, we must also look to our training program to ensure that developing clinicians are able to respond to the demands placed on psychologists in the real world.

Chang, K., I.-Ling, L., & Hargreaves, T. A. (2008). Scientist versus Practitioner-An abridged meta-analysis of the changing role of psychologists. Counselling Psychology Quarterly, 21(3), 267-291. doi:10.1080/09515070802479859

Wahass, S.H. (2005) The Role of Psychologists in Health Care Delivery. Journal of Family and Community Medicine, 12(2)), 63-70

Jennifer Roman, M.A.
WKPIC Doctoral Intern

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Category Archives: Diversity In Practice

Friday Factoids Catch-Up: Toward Cultural Competence: Understanding Historical/Generational Trauma of African Americans

Friday Factoids Catchup: Toward Cultural Competence: Understanding Historical/Generational Trauma for Native Americans

Friday Factoid Catch-Up: Toward Cultural Competence: Historical/Generational Trauma Related to Japanese Americans

Friday Factoids Catch-Up: Attention Deficit Hyperactivity Disorder (ADHD)

Friday Factoids Catch-Up: The Multiple Roles of a Psychologist

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