Cultural Aspects of Clinical Psychology Training Programs Claire Thompson Associate Professor, Clinical Psychology Central Queensland University Australia
Acknowledgements Lennie Geerlings Netherlands Anrilia Ningdyah Indonesia/ Australia Catherine Dong Singapore Kim Granland Singapore/Australia Tan Hui Hui Singapore Alexandra Blazely - Australia 3
Outline Origins of psychology Globalisation and psychology training Cultural aspects of clinical psychology training Challenges facing psychology Community programs: teaching, research, practice
Clinical Psychology: A Western Import? Historic clinical psychology movement: from the north to south from west to east Much academic knowledge flowed in these directions Often related to colonisation
Psychology: a Euro-American Import? (Geerlings, 2015)
Psychology: A Western Import? Origins: in Australia - academic programs in Indonesia - clinics in Singapore - mental asylums in Malaysia - foreign educated scholars Programs gradually taken over by local specialists Often remained dependent upon foreign knowledge Diversity of content & competence
Common Features of Clinical Psychology Training: Combines knowledge, skills, ethics training Uses multiple teaching and learning methods: didactic teaching practical teaching supervised practice research training Integrates research and practice Emphasises professional ethics
Four Models of Clinical Training Scientist-Practitioner model Practitioner model Clinical-Scientist model Competency-Based model 10
Scientist-Practitioner Model The Boulder Conference of 1949 Integration of science and practice in training programs Scientific component includes research training Practice taught through internship method Professional psychology role combines research and practice Criticised for lack of human/social focus 11
Practitioner Model Vail Conference, Colorado 1973 Focus on client and community needs Students motivations, interpersonal skills, attitudes important Training emphasises practical experiences, needs of society, program evaluation for quality improvement Criticised for lack of emphasis on research 12
Clinical-Scientist Model Focus on training in research and application of scientific knowledge Provide practical training opportunities for training and research Apply scientific method to solving human problems Disseminate clinical knowledge to scientists, practitioners, policy makers 13
Competency-Based Model Set of competencies to be achieved in professional training Shift away from content-based models Objective outcomes, clearly defined and measured Specific sets of competencies developed by professional associations 14
The International Project on Competence in Psychology First met in USA, 1995 Workgroup of 9 countries, reference group of 77 countries Explored regulatory and definitional systems Identified core global competencies for psychologists International Declaration of Core Competences in Professional Psychology, 2016 endorsed by International Association of Applied Psychology (IAAP) and International Union of Psychological Science (IUPsyS)
IPCP Definition: Cultural Competence Competent professional behaviour based on awareness, knowledge, understanding, of cultural influences on psychological work necessary to perform professional psychological services, recognising diverse worldviews and practices of self and clients from different cultural backgrounds understanding of self & other as bearers of culture: influenced by historical, social, economic, and political determinants understanding of how these influence psychological theories, models, and practices. 17
Globalisation and Education
Psychology Education (2014) Indonesia: 19 Professional clinical training programs Often not clearly named as clinical psychology degrees Malaysia: 16 Universities offering psychology programs 11 Postgraduate programs, only 2 clinical training
Psychology Education Singapore 2014: 5 Universities + many private colleges & polytechnics offering psychology programs Undergraduate psychology often in partnership arrangements with international universities 4 Professional clinical training programs from 2 universities Many psychologists train in Australia, U.K. or USA Singapore 2018: 1 additional university undergraduate program 3 Professional clinical training programs remain Many new/different partnership arrangements
Psychology Education Globally Differing content and standards depending on origin: SEA, Aust, UK, USA not equivalent E.g. Hons in a total of 2, 3 or 4 years Masters vary from 6 months to 2+ years Confusion for students Confusion for public The business of education influences content Emphasis on $$$ Clinical training often not viable business
Cultural Aspects of Clinical Training: Experiences of Students & Academics Three studies: Netherlands, Australia, Singapore Qualitative methodology Individual interviews ~ 30 mins each Clinical psychology students & academics Invited participants to discuss experiences: Studying: How much consideration for cultural issues is included in your training program? Teaching: How does your program prepare students for multicultural practice? Practice: Can you tell me about a multicultural clinical practice situation you encountered? Interpretative Phenomenological Analysis (IPA) (Geerlings, Thompson et al., 2017) 29
Europe: The Netherlands A binary population: 80% native Caucasian Dutch Autochtonen 20% migratory background Allochtonen EuroPsy certificate: (3 + 2 years) based on professional core competences of European Federation of Psychology Associations (EFPA). Post-Masters 2-years training required for Clinical Psychology (Geerlings, Thompson, Kraaij & Keijsers; Europes J. Psych. 2017)
Australia Complex registration requirements including language and visa requirements Dissatisfaction common, despite progress of profession; clearer standards, e.g. Clinical Psychologist can lead to disunity Cultural issues related to indigenous and migrant groups
Singapore Multi-Ethnic Society Psychology not (yet) regulated Government regulation in process Along with Allied Health professions Consultation with Singapore Psych Society Voluntary registration with Singapore Register of Psychologists (SPS) Wide variety of qualifications & experience Only 2 clinical programs available
Netherlands - Results N = 14 Students, Academics, Alumni Perceived clinical psychology practice as being based on western ideas Research-based knowledge may be insufficient for understanding individual clients Training was difficult at times difficult for participants who do not identify as culturally western I felt like I was walking on eggs because my training and outlook didn't match the outlook or the way people [here] were oriented towards their world 34
Netherlands - Results Academics felt time pressure restricts students attention to cultural aspects of training Restricted freedom in adapting programs due to requirements of clinical psychology education Academics felt personal responsibility for addressing cultural diversity in the classroom, as it was not a structured part of the curriculum Practitioners learnt by experience - sensitivity in care, taking things slowly, taking time to establish a personal relationship, build trust and explain much more of what is implicit in their approach. 35
Australia - Results N = 12 Students & Academics; 2 universities Varied experiences of culture Students developed strategies for culturally competent practice, but the experience of cultural competence development was difficult Western bias in training; research & theory Need more structured cultural competence development in professional training programs. (Geerlings, Thompson, Bouma & Hawkins; Aust. Psych, 2017)
Singapore - Results N = 15; Students, Academics, Alumni; 2 universities Universally applicable aspects of clinical psychology identified e.g. counselling skills; biological bases Some therapies considered western-oriented involve openly discussing emotions and feelings not directly focused on problem-solving don t include spiritual aspects Lack of locally developed resources literature focusing on practice in Singapore standardised tests with norms for the local population (Geerlings, Thompson & Tan, J. Trop.Psych, 2017).
Multicultural Counselling Competency MCC developed in USA (Sue et al., 1982) Model for cultural sensitivity among psychologists Tripartite model: awareness, knowledge and skills for cross-cultural practice Largely untested outside of USA One previous study of MCC in the Netherlands - MCC training positively appreciated by psychologists (Kramer & Sbiti, 2007). 39
MCC Sample Netherlands: n = 106 22 (21%) non-majority culture/ethnicity 17 (16%) had cross-cultural work experience Australia: n = 40 8 (20%) non-majority culture/ethnicity 3 (7.5%) had cross-cultural work experience Singapore: n = 33 17 (52%) non-majority culture/ethnicity 14 (42%) had cross-cultural work experience 40
Multicultural Awareness Knowledge and Skills Survey What is culture? What is Clinical Psychology? MAKSS: 60 questions or statements 4-point Likert-scale three subscales: Awareness Knowledge Skills Scores for each subscale: 0 to 4 41
Culture: The Netherlands 42
Culture: Australia 43
Culture: Singapore 44
Clinical Psychology: The Netherlands 45
Clinical Psychology: Australia 46
Clinical Psychology: Singapore 47
Results: Netherlands Students Academics Alumni M SD M SD M SD Awareness 2.53.22 2.58.16 2.62.20 Knowledge 2.44.26 2.36.31 2.57.28 Skills 2.58.34 2.40.30 2.70.36 Cross-cultural experience had significant effect on MCC Effect on Knowledge and Skills Not on Awareness No effect of being cultural minority 48
Results: Australia Students Academics Alumni M. SD M. SD M. SD Awareness 2.61.19 2.74.30 2.60.27 Knowledge 2.50.28 2.67.38 2.56.31 Skills 2.57.34 2.85.41 3.00.31 No effect of identification as cultural minority or of cross-cultural experience 49
Results: Singapore Students Academics Alumni M SD M SD M SD Awareness 2.53.19 2.70.14 2.49.17 Knowledge 2.45.26 2.76.47 2.38.41 Skills 2.49.19 2.96.23 2.49.26 No effect of identification as cultural minority or of cross-cultural experience Academics reported higher Awareness and Skills than students and alumni 50
Training Challenges Students are willing to adapt to working cross culturally - but may not clearly know how to do this Building experience, knowledge, confidence Some experience cultural differences as a barrier to clinical practice Academics tended to emphasise cultural selfawareness - culture as inherent characteristics of their clients and themselves Students express more fear of doing cultural damage
Professional Challenges Diversity of experience, qualifications, governance Agreement on competencies needed while valuing cultural diversity Providing services in culturally appropriate ways Providing training experiences that include cultural diversity as well as clinical and research training
Community Programs Address challenge of delivering psychology to the community, through group-based programs Combines clinical practice training with research Provide supervised practice for clinical trainees Include cross-cultural practice & research evaluation Big Tent Trauma training for early childhood workers (Melbourne, Australia) Train Your Brain - Programs for older adults with MCI (Singapore)
The Big Tent Project The Cairnmillar Institute, Melbourne A series of six 2-hour workshops conducted with child support workers kindergarten teachers, pre-school support workers, maternal child health nurses Typically in multi-cultural settings Trauma focussed training & supervision Understanding trauma in children, including cultural factors Skills in engaging families Self-care for workers Reduces stress and secondary traumatisation (p <.05) (Thompson, Blazely, Chochovski, 2018) 56
Train Your Brain - Psychoeducation for MCI with English Speaking older Singaporeans Developed at NUH Singapore, based on international research Cultural modifications to content and process Investigated feasibility in a small pilot sample Improvement in MoCA cognition: (p =.003) Very positive feedback All completers could name something they learned 70% had changed lifestyle factors 100% would recommend the program to others (Granland, Thompson, Dong, 2017) 57
TYB Chinese Language Version Translated TYB into Chinese for Singaporean Chinese-speaking older adults Pilot trial using established translated versions of assessments Showed improvement in overall cognition Improvement in memory, specifically the delayed verbal episodic memory (Tan, Thompson, Dong, 2018) 58
Conclusions Cultural training should be structured into programs, including practical experiences Students should be encouraged to openly discuss cross-cultural experiences Standardisation of descriptions of courses and qualifications would be helpful Consistency of qualifications & registrations is desirable but must also respect cultural differences Cultural humility needs active inclusion of others cultural worldviews, reflection on thoughts, feelings, behaviour about client s cultural worldviews, and commitment to life-long cultural learning and respect. 59
Community Psychoeducation 60
Clinical Research Collaborations 61
Clinical Research Collaborations 62
Teaching 63
Teaching 64
Students 65
Colleagues 66
Terimah Kasih 谢谢 Thank You c.l.thompson@cqu.edu.au 67