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Anti-racist Teaching

Before we can ‘decolonise the curriculum’, we must understand the terminology and language used and be aware of the historical context of the development of clinical psychology. These resources are inspired by the valuable work of Dr Saafi Mousa and Dr Tansy Warrilow and have been adapted by the EDI team for the Leeds DClinPsychol Programme.

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Quick Top Tips

These tips will provide some ways in which to make your lectures more culturally competent and contribute to the work of anti-racism within your teaching. Please check with the strand leader or the programme  to consider whether your session needs to include consideration of all or some of these:

  • Discuss the specifics of research, including the communities involved, potential gaps in diversity, and the applicability of findings for different populations.
  • Incorporate discussions of the history and context of psychology as a profession into your lectures, highlighting the role of psychology in oppression and the ongoing need for progress in the field.
  • Consider the adaptation of therapeutic models or interventions for specific communities and share examples of practice where you have had experience in this area.
  • Incorporate first-person perspectives from individuals with personal experiences or through videos/documentaries to enhance trainee understanding of diversity issues.
  • Address issues of social and generational disparities, considering factors such as poverty that may impact certain communities.
  • Encourage collaborative learning by acknowledging that you do not have to have all the answers and promote self-directed learning and reflective tasks among trainees.
  • Include tasks that allow trainees to practice making adaptations or reflecting on diversity issues, such as case studies or self-reflection exercises.
  • Share creative approaches to addressing social inequalities in service delivery and engage trainees in thinking about incorporating diverse perspectives into their practice.
  • Provide resources and suggested reading on working cross-culturally or with diversity and include a variety of sources beyond academic texts to ensure diverse perspectives are represented in the learning materials.
  • Be understanding of mistakes or challenges that arise during the learning process and foster a supportive community of learning with trainees.
  • Encourage open dialogue and feedback to address any concerns or discomfort that may arise. It’s important to highlight that cultural attunement is a collective responsibility and that everyone has a role to play in it.

 

Reviewing your teaching

There are five broad ways in which we can contextualise teaching content and process

Refer to racial/ethnic/cultural difference within given context (i.e. client group, therapy model)

Account for background and identity of authors and clinicians of ideas/theories/approaches

Explore how ideas/theories/approaches can include or excludes different communities

Recognition of discrimination and/or oppression as trauma and impact of these explored

Include ideas/knowledge from a diverse and wide range of authors/clinicians

1. Racial, ethnic, and cultural difference in given context

It is important to acknowledge how difference is understood and experienced across the different aspects of psychology, specialisms, materials and research. The first step in doing so is to recognise issues of difference – or as is often the case, the lack thereof. This includes thinking about the benefits and strengths these differences bring. To consider this, you could include the following:

  • Which communities are more served by the given services and why that might be the case?
  • Who is excluded and who is regularly centred in the given context?
  • Who are the most and/or disproportionately affected by a given experience or represented in a given service/research?
  • How are research methods and content influenced by this, i.e., qualitative research mostly through White, Western lens; “norms” used in quantitative research are not applicable to other communities, racial bias and discrimination of authors/clinicians influencing interpretation.
  • Recognition and discussion of over-presentation and under-representation of communities in given context, i.e., people from racialised backgrounds are over-represented in psychosis and forensic services, but less likely to be offered primary care services or to be seen in eating disorders service.

 

2. Background and identity of the authors/clinicians

The faces and founders of psychology are overwhelmingly that of White men. One’s social identity, positioning and power influences the perception of others. For psychology this results in an almost homogenous group defining what is routinely considered normative psychological experience, thinking, behaviour and therapy.  It is not possible for any clinician to achieve true objectivity because perceptions, biases and positioning form the lens from which the world is viewed. It is therefore essential to apply an additional critical lens to all theory, assessment and therapy. The following is worth considering:

  • What are the social identities and intersections of the authors/clinicians?
  • What were the values and beliefs held by the authors/clinicians?
  • What are the likely biases and blind spot these authors/clinicians might have?
  • How might this be of disadvantage to certain groups of people and where do we see this manifest today?
  • What was the political context during the times this author/clinician was developing this work?
  • What communities does this author/clinician centre/focus on?

 

3. Inclusion and exclusion of communities

Theories and models are often centred on European and American, White, Western ideologies and experiences, thus psychology has long been considered for White people, by White people. To consider this, your teaching content could explore the following:

  • Who are these ideas/theories/approaches based on or developed for and who are excluded from them or who do they not apply to?
  • Who do they benefit and who do they disadvantage, i.e., who is required to mould themselves to the apparent “norms” of experiences and behaviour?
  • Is this idea/theory/model sensitive to different needs or adaptable to different communities?
  • Who is likely to be considered “mentally ill/abnormal/non-compliant/not psychologically minded” for presenting differently?
  • What was the political context during which these ideas/theories/models were developed?
  •  Is there a link between the development of x idea/theory and oppression?
  • What led to the development or was the function of these ideas/theories/approaches ? (e.g. much of the early work on intellect was a directly linked to the justification of racial segregation in schools).

 

4. Recognition of discrimination and oppression as trauma

Racial trauma (unlike other traumas) is often perceived as an internal process and viewed as an inability to cope or manage emotions (suggesting that people are paranoid or sensitive) rather than acknowledging the impact of external factors that perpetuate racism i.e., systems and institutions. Racism, directly or indirectly, macro or micro has a significant impact of physical, psychological, and emotional wellbeing. To consider this, the following could be included:

  • Routine consideration of racism and discrimination as traumatic experiences within a person’s context, including the explicit assessment and exploration of a person’s experience of being racialized and reflection on the potential for intergenerational trauma at a biological, psychological and social level
  • Acknowledgement that while racism and discrimination can directly influence wellbeing, this also happens indirectly through experiences of othering, isolation, identity problems etc
  • To consider these experiences in formulations (see Beck, 2016)
  • Recognition that as health professionals the systems we are part of are likely to perpetuate these experiences
  • Explore how racism and discrimination is experienced by clients in different/specific services, i.e., racialised people more likely to be detained and less likely to be offered talking therapies or how in physical health settings they are less likely to be offered pain medication and more likely to die in childbirth etc.

 

5. Resources and papers from diverse authors/clinicians

The term “ethnic minority” is widely and regularly used to describe “non-White, non-Western” communities.  This is problematic as the implication is therefore that all people from racialised background can be summed up in one smaller, inferior and “other” group. This is replicated in psychology, where European/Western and White ideologies are synonymous with “normal”. This is also perpetuated in research whereby European/Western and White psychology content is regarded as superior (more sophisticated and scientific etc). This doesn’t only reinforce biases within psychology, but also fails to make good use of the ideas, theories and models developed by the vastly diverse communities that are part of the global majority. To account for this, you can consider the following:

  • Are all the resources and papers you are sharing developed and/or written by only European and American authors/clinicians? If so, how does this effect the lens from which the teaching is being delivered?
  • Are we critically evaluating the resources we include in the context of difference and biases?
  • How do you decide the quality and usefulness of resources?
  • How can you actively seek and include resources from the global majority?
  • What are the merits of including resources developed and/or written by the global majority within the given context?

 

Below is an example of how to review teaching slides with an anti-racist focus (there is no audio in this video). A more accessible PowerPoint version is available in the processes section below.

 

Visit our other EDI sections using the left-hand menu.

Processes involved in reviewing a set of teaching slides with an anti-racist focus

An example of how to review teaching slides with an anti-racist focus (Powerpoint file)

Explanation/further information regarding our processes - Ruth Akindele, Maya Loonat & Ciara Masterson

We agreed to use the teaching session CBT: working with anxiety – Exposure.  Firstly, Ruth reviewed the slides, then we discussed across a couple of meetings.  These are the notes from that work, which were used to consider and amend the slides.

We agreed that fear itself and the exposure/habituation theoretical models are probably applicable cross culturally – these are based on animal learning studies and physiology rather than psychology.  Literature we found exploring the efficacy of exposure-based treatments suggests good outcomes cross-culturally.  CBT models, which bring in thoughts about fear and the behaviours we use to manage it are probably applicable cross-culturally at a process level (i.e. that all these things are connected) but the content of thoughts and behaviours is likely to be different, therefore we thought we may need different questions to elicit thoughts and feelings from people from minoritized communities.

The next steps were to identify any literature to support these ideas.  Maya led this work.  The questions focused on in our search for literature are in bold below, with the material we found.

  • Is fear thought about and dealt with differently in other cultures?

Socio-cultural influences are likely to shape the experience and expression of fear and anxiety with symptomatic expressions, interpretations and social responses varying widely between cultures (Kirmayer, 2001).

Clinical presentations of anxiety may reflect cultural-specific symptoms and syndromes. For example, some somatic symptoms may be seen as bizarre when encountered outside their usual cultural contexts, such as sensations of ‘heat’ or ‘peppery feelings’ in the head which are common in regions of African. This can lead clinicians to mistakenly diagnose these individuals as delusional or psychotic (Ifabumuyi, 1981, as cited in Kirmayer, 2001)

Another example is that different cultures fear different things. Witchcraft, sorcery and supernatural phenomena which are still important among people such as Yoruba in Nigeria. Within Yoruba communities, people with no psychological problems will routinely believe that others (who appear harmless) may be plotting against them, and they cannot talk about specific concerns due to fear of the sorcerer’s retaliation (Saul, 2001).

Many similarities are assumed within one culture, such as Western, but there are differences found, for example the British appear to be significantly more inclined than other Europeans to base their fear on imagined events (Scherer et al., 1986).

Schreier et al. (2010) found people from Japan reported lower fear intensity than did Europeans and Americans.  Further, Americans are found to be more expressive and emotional compared to Europeans and Japanese, with their fear and anxiety experience reported as lasting longer and with more bodily symptoms, particularly lump in the throat and frequent stomach troubles. Americans were also more likely to express their fears and anxieties by crying, sobbing, screaming, yelling and by withdrawing from people or things (Schreier et al., 2010).

Dong et al. (1994) noted that Chinese self-reported levels of anxiety were lower than those in Western countries.  Chinese students scored significantly lower than British students in their need to avoid fearful situations (Higgins, 2004) and for the British women admitting fear was culturally approved.

  • Have we any evidence of the sort of impact culture will have on thoughts and behaviours in response to fear?

When comparing individualistic and collectivist cultures, collectivist had higher social anxiety and more positive attitudes towards socially avoidant behaviours (Heinrichs et al., 2006). Collectivist cultures are believed to give greater priority to the maintenance of group harmony, with those from East Asian countries and those who have migrated from East Asian to the West report higher levels of social anxiety than those from individualistic cultures (Kitayama et al., 1997; Kleinknecht et al., 1997).

There may also be culture-specific expressions of fear and anxiety, such as Taijin Kyofusho (TKS) which is a culturally-specific expression of social anxiety disorder (SAD) – it is believed to be particularly prevalent in Japanese and Korean cultures. The major differences between typical SAD in Western cultures is that a person with TKS is concerned about doing something or presenting an appearance that will offend or embarrass the other person, in contrast, SAD is defined as the fear of embarrassing oneself (Choy et al., 2008).

  • Are there any useful questions we can ask to elicit people’s thoughts and fears?  Is there anything we need to consider specifically in this clinical work with ethnically minoritized people or in relation to religious communities?

Perhaps we could tailor interventions to specific cultural subgroups, which has been associated with good treatment effects (e.g. Chang et al., 2020).  We need to probe and ask questions around cultural variables and how they might relate to the patient’s problem. This can assist the therapist/psychologist in accommodating to the client’s cultural context rather than expecting a Western and standard method to fit the patient (Tanaka-Matsumi et al., 1996).

We need to consider cultural syndromes when working clinically with ethnically minoritized people. Cultural syndromes are used to describe behavioural, affective, and cognitive manifestations which can be unique to specific cultures, such as Taijin Kyofusho or khyâl (wind) attacks.  These resemble panic attacks that are attributed to dysregulation in the flow of putative wind-like substances in the body. They are characterised by a mix of specific panic attack symptoms (dizziness) and culture-specific symptoms (tinnitus and neck soreness; Koydemir & Essau, 2018).  Another example is a Japanese fear of displeasing others due to their own gaze, which may be labelled as a ‘delusion’ due to the difference in Western norms. However, in Japan, fear of “eye-to-eye confrontation” is quite common (Kashara, 1972).

We must also take the patient’s view into account regarding culture and recognise that they may have different ways of connecting symptomatology that does fit with Western or biological definitions. Non-Western patients are prone to somatize their distress, so therapists/psychologists may need to probe and ask questions around this (Kirmayer, 2001).

Patient’s self-reported problems are usually influenced by the cultural context of their learning history. For example, Chinese patients predominantly reported somatic complaints and did not verbally express other psychological symptoms. However, when explicitly inquired about symptoms, they acknowledged psychological symptoms (Tanaka-Matsumi et al., 1996).

 

References

Beck, A. (2016). Transcultural cognitive behaviour therapy for anxiety and depression: A practical guide. Routledge.

Chang, D. F., Ng, N., Chen, T., Huanti-racist curriculum review slidesng, T., Miao, I. Y., Cao, Y., & Zhang, Y. (2020). Let nature take its course: Cultural adaptation and pilot test of Taoist cognitive therapy for Chinese American immigrants with generalized anxiety disorder. Frontiers in Psychology, 11, 547852

Choy, Y., Schneier, F. R., Heimberg, R. G., Oh, K. S., & Liebowitz, M. R. (2008). Features of the offensive subtype of Taijin‐Kyofu‐Sho in US and Korean patients with DSM‐IV social anxiety disorder. Depression and Anxiety, 25(3), 230-240.

Dong, Q., Yang, B., & Ollendick, T. H. (1994). Fears in Chinese children and adolescents and their relations to anxiety and depression. Journal of Child Psychology and Psychiatry, and Allied disciplines, 35(2), 351–363.

Fernando, S. (2014). Mental health worldwide: Culture, globalization and development. Springer.

Fernando, S. (2017). Institutional racism in psychiatry and clinical psychology (Vol. 17517893, No. 0). London: Palgrave Macmillan.

Heinrichs N, Rapee RM, Alden LA, et al. (2006).  Cultural differences in perceived social norms and social anxiety. Behav Res Ther 44, 1187–1197.

Higgins, L. T. (2004). Cultural effects on the expression of some fears by Chinese and British female students. The Journal of Genetic Psychology, 165(1), 37-50.

Kasahara, Y., Fujinawa, A., Sekiguchi, H., & Matsumoto, M. (1972). Fear of eye-to-eye confrontation and fear of emitting bad odors. Tokyo: Igaku Shoin, 74-80.

Kirmayer, L. J. (2001). Cultural variations in the clinical presentation of depression and anxiety: implications for diagnosis and treatment. Journal of Clinical Psychiatry, 62, 22-30.

Kitayama, S., Markus, H. R., Matsumoto, H., & Norasakkunkit, V. (1997). Individual and collective processes in the construction of the self: Self-enhancement in the United States and self-criticism in Japan. Journal of Personality and Social Psychology, 72(6), 1245–1267.

Kleinknecht, R. A., Dinnel, D. L., Kleinknecht, E. E., Hiruma, N., & Harada, N. (1997). Cultural factors in social anxiety: a comparison of social phobia symptoms and Taijin kyofusho. Journal of Anxiety Disorders, 11(2), 157–177.

Koydemir, S., & Essau, C. A. (2018). Anxiety and anxiety disorders in young people: A cross-cultural perspective. In Understanding uniqueness and diversity in child and adolescent mental health (pp. 115-134). Academic Press.

McInnis, E. E. (2017). Black psychology: A paradigm for a less oppressive clinical psychology. In Clinical Psychology Forum (Vol. 299, pp. 3-8).

Pillay, S. R. (2017). Cracking the fortress: Can we really decolonize psychology?. South African Journal of Psychology, 47(2), 135-140.

Reisman, J. M. (1991). A history of clinical psychology. Taylor & Francis.

Saul, H. (2001). Phobias: Fighting the fear. Arcade Publishing.

Scherer, K. R., Wallbott, H. G., & Summerfield, A. B. (Eds.). (1986). Experiencing emotion: A cross-cultural study. Cambridge University Press.

Schreier, S. S., Heinrichs, N., Alden, L., Rapee, R. M., Hofmann, S. G., Chen, J., ... & Bögels, S. (2010). Social anxiety and social norms in individualistic and collectivistic countries. Depression and Anxiety, 27(12), 1128-1134.

Schwebel, M. (1974). The inevitability of ideology in psychological theory. International Journal of Mental Health, 3(4), 4–26. http://www.jstor.org/stable/41344017

Tanaka-Matsumi, J., Seiden, D. Y., & Lam, K. N. (1996). The Culturally Informed Functional Assessment (CIFA) Interview: A strategy for cross-cultural behavioral practice. Cognitive and Behavioral Practice, 3(2), 215-233.

Warrilow, T., Trant, C., & Masterson, C. (2023). Progress in ‘decolonising’ training: The journey so far. Clinical Psychology Forum, 1(371), 58–65. https://doi.org/10.53841/bpscpf.2023.1.371.58