Cultural Competence in Eating Disorder Treatment: Beyond the Symptom

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: 312-804-0810 E-mail: drschreier@drschreier.com Websites: http://drschreier.comhttp://chicagowalkandtalk.com http://thecolorsoftherainbow.com

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

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.

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

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…

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

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

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…

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)

Introducing Addressing:Hays (2001) Model of Addressing Diversity • Goes beyond “how to treat group X” model • Attends to the many complexities of each person’s identity (clients; therapists; researcher) • Creates a paradigm for understanding the matrix of diversity and difference

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 we’ll 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 Pleck’s work on white male identity development • Helms’ and Carter’s work on white racial identity development

Multicultural Assessment Model Axis VI (Adopted from Hays, 2008, p. 18) • Cultural Influences Age & generational influences Developmental disabilities Disabilities Acquired later in life Religion & spiritual orientation Ethnic and racial identity Socioeconomic status (SES) • Target Groups Child, Adolescent, Elders People with developmental/ acquired disabilities Peoplewith 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)

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

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…

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)

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

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 individual’s development across the lifespan?”

Age and Generational Influences • Answering these questions requires a knowledge of hx: • Specific culture • Larger picture (country, world)

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…

Developmental Disability • Whether it’s developmental or acquired note the importance of: • Cultural, social, & hx contexts in which the person lives • Politics of disability during the person’s lifetime • Impact of disability in functioning and on which domain • Visible or invisible?

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?”

R = Religion and spirituality • What is the place of religion and spirituality in this person’s life? What is their religious identity? • For some people, religious beliefs also create a culture? i.e., Jehovah’s 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)?

Religion and Identity • Is religion or spiritual practice important in this person’s identity? • I.e. in the Pacific Northwest (where I moved from) many people are unaffiliated with organized religion • This doesn’t mean that spirituality is unimportant however • How was the person’s life/life experience/upbringing shaped by specific beliefs of their faith of origin…

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

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.”

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).

Race • “The myth of human races constitutes one of man’s most damnable masses of misinformation, and…has led to wars, strife, murder and waste of natural resources” (Calloway & Harris, 1977).

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

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

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

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

S= Sexual Orientation • Everyone has one • Orientation = the direction of one’s desire. It’s not a lifestyle. • Men’s orientations tend to be more fixed and stable • Women’s orientation tend to be less fixed, more fluid

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

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

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 someone’s family came here • In relationship to what attitude towards their particular immigrant group

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?

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

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

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 person’s identity differently than persons construct themselves…

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 person’s reference group; e.g. being “ I am because we are” is a different construction of identity than “I am me.”

An example of the complexity of identity construction • Your own addressing model: • A • D • D • R • E • S • S • I • N • G

For Example…. Age Sexuality Gender Social Class Religion Disability Race Psychologist

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

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.

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: 312-804-0810 E-mail: drschreier@drschreier.com Websites: http://drschreier.comhttp://chicagowalkandtalk.com http://thecolorsoftherainbow.com

Peace and Harmony resides within you!

Cultural Competence in Eating Disorder Treatment: Beyond the Symptom