How can psychotherapists improve their practice with service users from minoritised ethnicities? An application of the Declarative-Procedural-Reflective (DPR) model of clinical skill development

Many white psychotherapists may lack the skills required to work effectively with service users from minoritised ethnicities. This article proposes that the nature of this skills deficit can be understood through applying the Declarative-Procedural-Reflective (DPR) model of therapist skill development. The DPR model has been used in a range of psychotherapeutic contexts, and it provides a systematic account of how therapists from all modalities develop and can improve their skills. Adapting this model to white therapists’ skills in working with service users from minoritised ethnicities allows the identification of specific areas of skills deficit, and therefore clear recommendations as to how to address those deficits. The application of the DPR model to this context suggests that there are clear areas of skills deficit in terms of knowledge base, the practical skills of carrying out therapy, and the ability of therapists to reflect on their work with service users from minoritised ethnicities. I conclude by making a number of suggestions as to how those deficits could be addressed, both by individual therapists and at a systemic level. Key learning aims (1) To explore why some white psychotherapists find it more difficult to work effectively with service users from minoritised ethnicities. (2) To conceptualise difficulties in working with service users from minoritised ethnicities as an issue of clinical skill, knowledge and attitude development, where therapists’ skills can be improved if specific deficits are appropriately addressed. (3) To use the structure of the DPR model to better understand how deficits in therapists’ skills, knowledge and reflective ability may have an impact on their work with service users from minoritised ethnicities. This allows the identification of specific areas of deficit, and therefore clear recommendations as to how to address those deficits. (4) This is primarily addressed at CBT therapists, but the points raised in this article apply to all schools of therapy.

Navigating Privilege and Colorism

Discussions about cultural responsiveness for mental health practitioners often perpetuate colonizing frameworks. By centering White therapists’ awareness of power and privilege when working with people of color, dominant paradigms in the field can overlook the experiences of practitioners of color and the relational dynamics of engaging shared racial/cultural backgrounds. Interrogations of Whiteness are necessary to prevent harm in the predominantly White fields of the creative arts therapies, yet this discussion should not overshadow discussions about the experiences of practitioners of color who encounter issues of colorism and citizenship in working with communities of color. This self-reflexive essay describes how a Black Dominican-Haitian woman art therapist, who was raised in the United States (U.S.), recognized a need to explore her own political awareness while working with female participants at a youth organization in the Dominican Republic (D.R.). The author discusses the use of art to critically interrogate issues of colorism, citizenship, and privilege that arise during her time in the D.R. Recommendations are presented to support arts therapists of color to engage their perceptions of citizenship and colorism while providing mental health services to communities of color.

An Assets-Based Approach to Co-Producing a Culturally Adapted Family Intervention (CaFI) with African Caribbeans Diagnosed with Schizophrenia and Their Families

Objective: To determine how to improve the cultural appropriateness and accept­ability of an extant evidence-based model of family intervention (FI), a form of ‘talking treatment,’ for use with African Caribbean service users diagnosed with schizophrenia and their families.Design: Community partnered participa­tory research (CPPR) using four focus groups comprising 31 key stakeholders.Setting: Community locations and National Health Service (NHS) mental health care settings in northwest England, UK.Participants: African Caribbean service us­ers (n=10), family members, caregivers and advocates (n=14) and health care profes­sionals (n=7).Results: According to participants, com­ponents of the extant model of FI were valid but required additional items (such as racism and discrimination and different models of mental health and illness) to im­prove cultural appropriateness. Additionally, emphasis was placed on developing a new ethos of delivery, which participants called ‘shared learning.’ This approach explicitly acknowledges that power imbalances are likely to be magnified where delivery of interventions involves White therapists and Black clients. In this context, therapists’ cultural competence was regarded as funda­mental for successful therapeutic engage­ment and outcomes.Conclusions: Despite being labelled ‘hard-to-reach’ by mainstream mental health services and under-represented in research, our experience suggests that, given the opportunity, members of the African Carib­bean community were highly motivated to engage in all aspects of research. Participat­ing in research related to schizophrenia, a highly stigmatized condition, suggests CPPR approaches might prove fruitful in developing interventions to address other health conditions that disproportionately affect members of this community.Ethn Dis. 2018;28(Suppl 2): 485-492; doi:10.18865/ed.28.S2.485.

Significant Influence of Participation in Ethnic-Specific Programs on Clinical Diagnosis for Asian Americans

Asian American clients ( N = 1528) in the Los Angeles County mental health system who were seen at ethnic-specific (Asian) clinics by Asian therapists were diagnosed with significantly lower percentages of psychotic disorders and other major psychiatric disorders and significantly higher percentages of nonpsychiatric disorders than were Asian clients who were seen by Asian and white therapists at mainstream clinics.