Cultural Competence in Eating Disorder Treatment: Beyond the Symptom

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Cultural Competence in Eating Disorder Treatment
Beyond the Symptom

• Dr. Daniela E. SchreierLicensed Clinical
  Psychologist222 Merchandise Mart Plaza Suite
  432 Room 4107 Chicago, Il 60654
• Mailing Address 233 East Wacker Dr Suite 1607
  Chicago, IL 60601
• Phone [phone] E-mail drschreier_at_drschreier.
  com
• Websites
• http//drschreier.comhttp//chicagowalkandtalk.co
  m
• http//thecolorsoftherainbow.com

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Philosophy A shared path

• Tell me and I will forget
• Show me and I may not remember
• Involve me and I will understand.
• - Native American Proverb

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Prologue Culture Eating Disorders

• The gift I give to myself is valuing and
  allowing myself to be my primary
  relationship.The prize I give to myself is the
  gift of loving myself. I am whole. I am complete.
  I am perfect. -- Joy Miller, 1989
• Necessary exploration for clinicians and clients
  Knowing all part of the puzzle of your identity
  will assist you to know yourself on a deeper
  level.

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Goals

• Develop culturally competent practice
• What does this mean?
• Not this is what you do when you work with Group
  X
• Not I dont know how to work with group X so I
  will refer this person out
• Instead- knowing what you dont know and how to
  know it.
• Knowing who you are and what you bring to the
  process

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Cultural Competent Practice Is

• Knowing how to think about the clinical issues
  involved in working with people from a diversity
  of backgrounds and life experiences
• Knowing how to think about what you might
  represent to this person
• Knowing how to think about what this person
  represents to you.
• A road map

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Cultural Assessment Why?

• In order to understand the foreground of a
  person, you need to have deep understanding and
  insight into their cultural background

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Culture

• Influences development across the lifespan
  (Paludi, 2002), our values, thoughts
• Includes Sex, gender, (race), ethnicity, SES,
  sexual orientation, national origin,
  religious/spiritual orientation, disabilities and
  how they effect the life cycle development and
  the development of health and dysfunction

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Feminist-Multicultural Lens (Brown, 1994
Kaschak, 1992 Root, 1992)

• Culture may be defined as a framework of values
  and beliefs, a means to organize experience. It
  includes the rules by which interpersonal events
  are perceived. Even private thought is conducted
  in socially constructed language, and thus,
  cannot be purely personal and self-contained.
• The culture of the society in which one is raised
  and lives defines what can and cannot be
  conscious or, viewed slightly different, what
  must remain unconscious. (Kaschak, 1992, p. 30)
• Culture defines How we are allowed to deal with
  distress, anxiety, depression, stress is also
  culturally determined

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Multiculturalism Assessment of Eating
Disturbances

• Did formerly not consider the impact of culture
  on cognitive social emotional physiological,
  psychological development of children
  adolescents adults
• Critique on research/ theories Androcentrism
  Gendercentrism Ethnocentrism Heterocentrism
  (Paludi, 2002)

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Introducing AddressingHays (2001) Model of
Addressing Diversity

• Goes beyond how to treat group X model
• Attends to the many complexities of each persons
  identity (clients therapists researcher)
• Creates a paradigm for understanding the matrix
  of diversity and difference

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Terms Target Group Versus Minority Group
Majority Versus Dominant

• Minority Group Target Group Non-majority
  population including gender ethnicity racial
  religious sexual orientation, etc. Target group
  is the more accurate term because many target
  groups are no longer minorities but outnumber
  the majority group which well call the
  dominant group in this course Examples are
  women Hispanic Americans in certain parts of the
  countries
• Majority Group Dominant Group
• People also learn to be Caucasian, socially
  privileged, male, heterosexual, able-bodied, etc.
• Each of these identities also goes through
  processes of awareness and transformation
• Brannon and Plecks work on white male identity
  development
• Helms and Carters work on white racial
  identity development

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Multicultural Assessment Model Axis VI (Adopted
from Hays, 2008, p. 18)

• Target Groups
• Child, Adolescent, Elders
• People with developmental/
• acquired disabilities
• People with disabilities acquired later in life
• Religious target groups
• Ethnic target groups
• People of lower status due to
• class, education, occupation,
• income, rural or urban
• habitat, (family name)

• Cultural Influences
• Age generational influences
• Developmental disabilities
• Disabilities Acquired later in life
• Religion spiritual
• orientation
• Ethnic and racial identity
• Socioeconomic status (SES)

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Multicultural Assessment Model (Adopted from
Hays, 2001, p. 16)

• Cultural Influences
• Sexual Orientation
• Indigenous heritage
• National origin
• Gender
• Schreier Added
• Bi-cultural Identity
• College Education

• Target Groups
• Gay, lesbian, bisexual
• People
• Indigenous, aboriginal, native people
• Refugees, immigrants
• (legal/illegal), inter. students
• Women, transgender people
• Bicultural people (Assess
• language spoken at home)
• 1st, 1.5 or 2nd generation
• American- Self-identified
• 1st, 2nd generation in college
• or high school

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Multicultural Assessment Model (Adopted from
Hays, 2001, p. 16)

• REFLECT If you are a member of more than one
  group you have a double, triple, fourfold,
  jeopardy, then the additive negative effect of
  oppression may manifest in your life,
  relationships, and self-perception or you may
  have developed resistance to parts or all of it

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What is stands for

• A Age related factors. Actual age and age
  cohort (generation)
• D Disability visible and invisible
  disabilities
• R Religion and spirituality
• E Ethnic identity race, culture (includes
  people of color as well as Caucasian, white
  ethnic)

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What it stands for

• S Socioeconomic Status current and former
  especially in childhood
• S Sexual orientation gay, lesbian, bisexual,
  heterosexual, asexual, kinky and mono -,
  polygamous, or celibate
• I Indigenous heritage First nations peoples
• N National identity immigrants, refugees,
  temporary residents, children of the same
• Gender biological sex, transgender, gender
  roles and stereotypes

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What does that all Mean

• A Age and generational influencesPeople are
  not simply the age they are age in context of
  personal, cultural, and world hx (also
  chronological versus developmental age) At
  different stages different developmental
  milestones are accomplished
• People are situated in their age cohort, i.e.,
  baby boomers, depression babies
• Thus we ask What does it mean for this person
  to be this age, in this context, at this time in
  the world, and to have been other ages at other
  specific times in the world and how did it impact
  the individuals development across the lifespan?

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Age and Generational Influences

• Answering these questions requires a knowledge of
  hx
• Specific culture
• Larger picture (country, world)

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Developmental Acquired Disabilities

• Some are born with disabilities developmental
• Some people loose their temporarily able-bodied
  status during life acquired
• Being a person with a disability means different
  things depending on

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Developmental Disability

• Whether its developmental or acquired note the
  importance of
• Cultural, social, hx contexts in which the
  person lives
• Politics of disability during the persons
  lifetime
• Impact of disability in functioning and on which
  domain
• Visible or invisible?

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Disabilities

• A language piece Speak of person with a
  disability. The person is not disabled. The
  person has a disability.
• Something to think about Is an eating
  disturbance a disability?

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R Religion and spirituality

• What is the place of religion and spirituality in
  this persons life? What is their religious
  identity?
• For some people, religious beliefs also create a
  culture? i.e., Jehovahs witness Islam or in
  former times Roman Catholicism when religious and
  political systems are merged
• Is this a minority religion or mainstream
  majority? Has that always been true for this
  person in her life (i.e., were they born in a
  Buddhist/Islam majority country and then moved
  here)?

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Religion and Identity

• Is religion or spiritual practice important in
  this persons identity?
• I.e. in the Pacific Northwest (where I moved
  from) many people are unaffiliated with organized
  religion
• This doesnt mean that spirituality is
  unimportant however
• How was the persons life/life experience/upbringi
  ng shaped by specific beliefs of their faith of
  origin

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E Ethnic Identity

• Ethnicity may include race such as
  African-American, Hispanic Americans, Asian
  Americans (typically considered as racial and
  ethnic categories) Italian American Irish
  American Polish American etc. (typically
  understood) to refer only to ethnic groups)
• People of self-identified mixed racial heritage
  (remember race is a social construct, not all
  people of mixed backgrounds will self-identify as
  such)
• White ethnicity (WASP, Irish, Italian, Armenian,
  etc. - Americans

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Race Ethnicity??

• Race is a social construct
• People of different racial groups are, at the
  level of genes, indistinguishable
• Different societies code race and ethnicity
  differently i.e., In America the one-drop
  rule.

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Race

• An arbitrary classification system of
  populations conceived in Europe, using actual or
  assumed genetic traits to classify populations of
  the world into a hierarchical order, with
  Europeans superior to all other (Christensen,
  1989).

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Race

• The myth of human races constitutes one of mans
  most damnable masses of misinformation, andhas
  led to wars, strife, murder and waste of natural
  resources (Calloway Harris, 1977).

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Race

• The idea that racial classifications correspond
  to a reality or collection of characteristics has
  not been demonstrated (Axelson, 1999)

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Evidence

• The human genetic code, or genome, is 99.9
  percent identical throughout the world

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Socioeconomic Status (SES)

• Social class great American invisible variable
• Because of possibility of upward/downward
  mobility , people in North America can and do
  change their social class status throughout their
  lifetimes
• A person has both a social class of origin, and
  the one they currently occupy, may have passed
  through others on their way to where they are now

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Social Class

• People who changed social class may hide their
  origins
• Social class maybe a combination of
• Money
• Education
• Attitudes and values
• Larger social context
• Context in which class is defined
• Class X ethnicity equation

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S Sexual Orientation

• Everyone has one
• Orientation the direction of ones desire. Its
  not a lifestyle.
• Mens orientations tend to be more fixed and
  stable
• Womens orientation tend to be less fixed, more
  fluid

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Sexuality

• People express their orientation in various
  configurations
• Monogamous
• Polygamous
• Celibate
• The new stigmatized sexual minority (by
  mainstream and LGB people) practitioners of
  kink.

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I Indigenous Heritage

• Indigenous peoples in North America, and in
  territories currently or formerly under US or
  European control have been oppressed or made the
  targets of genocide
• Understanding indigenous heritage means a
  thorough knowledge of the history of the
  relationship of indigenous to colonizing groups

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N National Origin

• Where someone comes from, and how they or their
  family got to the US
• On purpose
• In fear
• In chains
• Legal or undocumented
• When someones family came here
• In relationship to what attitude towards their
  particular immigrant group

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National Origin Issues

• How long ago s.o.s family came here
• Children/grandchildren of immigrants or refugees
  may have a different relationship to their
  national origin issues than those who came
  centuries ago
• Degree of attachment to country of origin Was/is
  the language of origin spoken at home, in
  worship, in cultural activities? Or was there
  shame around it? Is home visited or inaccessible?

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G Gender

• Gender is the initial and one of the most
  powerful organizers of human identity
• Challenging issues
• Transgender in all of its variations
• Intersex
• Challenging the binary notions of sex and gender
• Gender is NOT the same as biological sex

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G Gender

• Sex the body, biology
• Gender how does a person enact their
  relationship to that body and biology
• Gender is a social construct which changes with
  every other ADDRESS-ing variable

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Assumptions of Hays Model

• People do not have ONE identity
• Instead, our identity is constructed of various
  factors multiple identities
• Aspects of identity have different salience in
  different social contexts
• Observers will construct a persons identity
  differently than persons construct themselves

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Assumptions of the model

• Identity will emerge in the dialectical struggle
  between group memberships and individual sense of
  self, temperament, and context identity may
  construct differently depending upon a persons
  reference group e.g. being I am because we
  are is a different construction of identity than
  I am me.

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An example of the complexity of identity
construction

• Your own addressing model
• A
• D
• D
• R
• E
• S
• S
• I
• N
• G

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For Example.
Age
Sexuality
Gender
Social Class

Religion
Disability
Race
Psychologist
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Thank you

• Thank you for giving me some of your time time
  is very precious once gone it never comes back!
• As I break the messages that bind me, I become
  more loving and realize the possibility of my
  full potential. Joy Miller , 1989

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References

• Hays, P. A. (2008). Addressing cultural
  complexities in practice A framework for
  clinicians and counselors. Washington, DC
  American Psychological Association.
• Brown, L.S. (2004). Class handouts and lecture
  notes. Argosy University. Seattle, WA.
• Miller, J. (1989). Addictive relationships
  Reclaiming your boundaries. Deerfield Beach, FL
  Health Communications, Inc.
• Paludi, M. (2002). Human development in
  multicultural contexts A book of readings. Upper
  Saddle River, NJ Pearson Education Inc.

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Contacts

• Dr. Daniela E. SchreierLicensed Clinical
  Psychologist
• 222 Merchandise Mart Plaza Suite 432 Room 4107
  Chicago, Il 60654
• Mailing Address 233 East Wacker Dr Suite 1607
• Chicago, IL 60601
• Phone [phone]
• E-mail drschreier_at_drschreier.com
• Websites
• http//drschreier.comhttp//chicagowalkandtalk.co
  m
• http//thecolorsoftherainbow.com

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Peace and Harmony resides within you!