27 Jun 2017

Cultural Competence is Key

Cultural Competence is Key

When working with refugees or asylum-seekers, something as seemingly straightforward as greeting new patients with a handshake can compromise trust, says psychologist Rehman Abdulrehman, PhD, co-author of an online guide called "Working with Refugees from Syria and Surrounding Middle Eastern Countries," published by the Public Mental Health Initiative he directs.

"Some Muslims believe that any kind of cross-gender contact is disrespectful," says Abdulrehman, an assistant professor of clinical health psychology at the University of Manitoba and a member of APA's Committee on International Relations in Psychology. Let Muslim patients make the first move, he suggests. If they don't offer their hands, you could put your hand over your heart and nod instead.

Noting that most psychologists don't get training in working with refugees, asylum-seekers and asylees, Abdulrehman and others offer several tips for working with those who have fled their homelands:

Learn about patients' contexts. You'll need to learn about your patients' culture, religion and other factors, says Abdulrehman. Without that insight, it can be easy to mistake normal activities for pathologies, such as mistaking Muslims' pre-prayer washing ritual for obsessive-compulsive disorder. Build competence by reaching out to members of the particular community, he suggests. In addition, be sure to understand the sociopolitical context of the country people have fled as well as the country where they've resettled, says Rita Chi-Ying Chung, PhD, a professor of counseling and development at George Mason University who has worked with nongovernmental organizations to serve refugees. Also, find out about laws affecting refugees, the asylum process, family reunification policies and how to connect patients to medical, legal and social services, she says.

Emphasize trust building. Seeking help from a psychologist is not something many refugees and asylum-seekers are comfortable with. "The notion of coming to a stranger you've never met and spilling out your most embarrassing, shameful secrets is very foreign," says Adeyinka Akinsulure-Smith, PhD, a senior supervising psychologist at the Bellevue/New York University Program for Survivors of Torture. Chung agrees. When she goes into a refugee community, she doesn't want to be seen as an expert. Many refugees come from countries where psychologists could be seen as part of the government and intake questions seen as disturbingly intrusive. "They might perceive it as, ‘Oh, my gosh, I might suddenly disappear the next day,'" says Chung. Instead, she asks community leaders how she can help, then engages in active listening while working with people on everyday tasks. "I might be working with women in the kitchen, with difficult topics coming up," she says.

Focus on symptoms. Some refugees and asylum-seekers, especially Muslims, come from countries where talking about feelings isn't as accepted as it is here, says Abdulrehman. That's why he uses cognitive-behavioral therapy with his Muslim clients. In addition to focusing on symptoms, cognitive-behavioral therapy also has a practical, solutions-oriented approach that helps restore clients' sense of control over their lives, he says.

Build strong relationships with professional interpreters. Bringing another person into the therapy session introduces potential new complications, says Akinsulure-Smith. The patient may worry about confidentiality; an interpreter from the same country may have their own issues when hearing about the patient's experiences. Spend some time with the interpreter before the session, be clear that you expect word-for-word translation and debrief afterward, she suggests.

By Rebecca Clay

This article was originally published in the January 2017 Monitor on Psychology

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