Title: Cultural Competence in Eating Disorder Treatment: Beyond the Symptom
1Cultural 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 312-804-0810 E-mail drschreier_at_drschreier.
com - Websites
- http//drschreier.comhttp//chicagowalkandtalk.co
m - http//thecolorsoftherainbow.com
2Philosophy 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
3Prologue 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.
4Goals
- 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
5Cultural 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
6Cultural Assessment Why?
- In order to understand the foreground of a
person, you need to have deep understanding and
insight into their cultural background
7Culture
- 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
8Feminist-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
9Multiculturalism 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)
10Introducing 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
11Terms 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
12Multicultural 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)
13Multicultural 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
14Multicultural 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
15What 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)
16What 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
17What 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?
18Age and Generational Influences
- Answering these questions requires a knowledge of
hx - Specific culture
- Larger picture (country, world)
19Developmental 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
20Developmental 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?
21Disabilities
- 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?
22R 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)?
23Religion 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
24E 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
25Race 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.
26Race
- 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).
27Race
- 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).
28Race
- The idea that racial classifications correspond
to a reality or collection of characteristics has
not been demonstrated (Axelson, 1999)
29Evidence
- The human genetic code, or genome, is 99.9
percent identical throughout the world
30Socioeconomic 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
31Social 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
32S 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
33Sexuality
- People express their orientation in various
configurations - Monogamous
- Polygamous
- Celibate
- The new stigmatized sexual minority (by
mainstream and LGB people) practitioners of
kink.
34I 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
35N 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
36National 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?
37G 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
38G 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
39Assumptions 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
40Assumptions 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.
41An example of the complexity of identity
construction
- Your own addressing model
- A
- D
- D
- R
- E
- S
- S
- I
- N
- G
42For Example.
Age
Sexuality
Gender
Social Class
Religion
Disability
Race
Psychologist
43Thank 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
44References
- 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.
45Contacts
- 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 312-804-0810
- E-mail drschreier_at_drschreier.com
- Websites
- http//drschreier.comhttp//chicagowalkandtalk.co
m - http//thecolorsoftherainbow.com
46Peace and Harmony resides within you!