Minority stress: the excess stress to which people from stigmatized groups are exposed as a result of their minority position. May account for group differences in mental health outcomes.

- Unique – not experienced by all people
- Chronic – stable, underlying social construct, enduring
- Socially based – stems from institutions and structures beyond the individual

“Objective” events and conditions. It is clear what happened.

E.g. Election, Prejudice/Discrimination, Harassment/violence

Stress-­ameliorating factors

- Intrapersonal (within yourself, e.g. spirituality/religion, strong minority identity)

- Interpersonal (outside of yourself, e.g. social support)

Aspects of identity

- Prominence/Salience = How important is identity to sense of self.

- Valence = how positive/negative you feel about the identity

- Integration = How integrated are your different identities with one another?

Subjective processes. Rely on individual perception/appraisal of a situation.

E.g. Expectation of Rejection, Concealment, Internalized Negativity

Effects strength of a relationship. Third variable that either decreases or increases strength of a relationship.

A implies B depends on the moderator.

Type of Moderating factor.

Intrapersonal (within yourself, e.g. spirituality/religion, strong minority identity)

Interpersonal (outside of yourself, e.g. social support)

Type of Moderating factor.

Prominence/Salience = How important is identity to sense of self. Valence = how positive/negative you feel about the identity Integration = How integrated are your different identities with one another?

A implies B because mediator

Women moving into the workforce in 60’s and 70’s is misleading because women of color, immigrant women, poor women have always been in the workforce.

Reproductive rights to abortion and contraception fought for as “choice” yet forced sterilization of Black women, indigenous women, women with disabilities, and other “unfit mothers” was ignored.

Understanding individuals experience multiple marginalized social identities. Axes of oppression are not just interrelated but bound together. Multiple social statuses of race, ethnicity, class and gender are experienced simultaneously. It’s one thing. Not separate.

E.g. identifying as a woman of color.

Kimberlé Crenshaw coined the term.

Problem: Single-axis framework in anti-discrimination law. Excluded idea of intersectionality, being discriminated against because of both gender and race.

Black women claimed discrimination yet dismissed since legal concepts of discrimination saw it in terms of “gender” only or “race” only – rendering the category Black women as invisible.

Separate identities (e.g. black, female) then add them together.

Early solution. Double jeopardy. Layers of multiple oppression. Disadvantage is accumulated.

Additive = Separate identities added together

Additive is simpler, but inaccurate. Can do quantitative research and generalize.

Intersectional = Overlapping identities that can’t be separated.

Intersectional is qualitative data. Qualitative data can’t be generalized easily.

More frequent and severe harassment:

Women of Color > Men of Color, White women, and White men

Qualitative. Interviews with Black gay and bisexual men. Ask about identity and experienced discrimination.

Ask: Let’s suppose someone dropped in from another planet and asked you to tell them about your life as a Black gay or bisexual man. What would you say?

Answer: Some say they are Black first and gay or bisexual second. Others say that they are gay or bisexual first, and then Black or male second. Then, there are others who say they don’t feel as if they can rank these identities.

Which theme(s) you won’t be able to see from an additive approach?

- Racism within White LGB community

- Heterosexism within Black communities

A religious organization claiming to include most or all of the members of a society and is recognized as the national or official religion.

A large, organized religion not officially linked with the state or government.

e.g. The United States has the most denominations in the world. It is a result of the immigrant heritage

A sect can be defined as a relatively small religious group that has broken away from some other religious organization to renew what it considers the original vision of the faith

Small, secretive religious groups that represent either a new religion or a major innovation of an existing faith

Religion:

- Latin religare: “to bind together”

- Organizes the collective spiritual experiences of group of people into system of beliefs, practices, and rituals

- Tradition, oral and written

Spirituality:

- Latin spiritualitas: “breath”

- Broader concept than religion--dynamic, personal, experiential process

- Quest for meaning and purpose, transcendence, connectedness, values

- Personal quest for answers to ultimate questions about life, meaning

- Gives one a sense of peace/joy

Tensions and opportunities exist between psychology and religion. Research demonstrates the multifaceted views taken by psychologists as they address areas of living that have personal implications.

There is also tension between religion and health care. With most health providers being irreligious in their clinical approach, lack of knowledge, or there might be competing religious views.

Religiosity has found in previous meta-analyses to have positive, negative, and no relationships with mental health outcomes.

Religiosity seems to be associated with

- Lower reports of psychological distress (depression, anxiety, guilt, negative mood, etc.)

- Higher reports of happiness & satisfaction with life

- Higher reports of self-actualization or purpose in life

Small effect size (r = 0.10)

- Strongest relationship found with personal devotion (r = 0.15) vs.

ideological religion (r = 0.08) and institutional religion (r = 0.06).

- Strongest relationship found with with self-actualization (r = 0.24)

vs. satisfaction with life (r = 0.12) and psychological distress (r =

0.02).

Different aspects of religiosity

- Personal devotion: personal, internalized devotion (e.g., intrinsic religious orientation, emotional attachment to god)

- Ideological religion: beliefs aspects (e.g., religious fundamentalism, belief salience)

- Institutional religion: social and behavioral aspects (e.g., church attendance, extrinsic religious orientation)

- LGB-identified people in the U.S. tend to be less religious than the overall population.

- Large percent are either protestant or non-religious.

- 40% indicated sexual orientation acted as catalyst to question religious identity. (They find more liberal religious doctrines/communities, became more spiritual,

or rejected religion.)

-18% emphasized being spiritual but not religious, believing God was a loving, accepting being, and rejecting the views of organized religion.

- Most go to church only a few times a year or not at all.

- Most that do go to church go to a congregation that is mostly heterosexual.

Perceptions that one’s religious organization as affirmative of LGB people were:

- Directly linked with greater religiosity/spirituality and lower internalized heterosexism.

- Indirectly linked with better mental health (via religiosity/ spirituality and internalized heterosexism).

- Large percent are either protestant or non-religious.

- 40% indicated sexual orientation acted as catalyst to question religious identity. (They find more liberal religious doctrines/communities, became more spiritual, or rejected religion.)

-18% emphasized being spiritual but not religious, believing God was a loving, accepting being, and rejecting the views of organized religion.

-10% associated their religion with oppression against LGBT people, but also women and other minority groups.

-6% experienced “trauma, blatant cruel rejection, sexual abuse by priests, being disowned by family, sent to conversion therapy, or otherwise banned from their church or childhood homes.

Paradoxical associations between multiple measures of religiosity (e.g., intrinsic religiosity, religious fundamentalism, and general religiosity) and prejudice. Religion is both the "maker" and "unmaker" of prejudice.

- Religiosity ~ both prejudice and tolerance towards African Americans (Hall et al., 2010; Whitley, 2009).

- Religiosity ~ prejudice against gay men and lesbian women (Whitley, 2009)

Two components of religiosity associated with measures of prejudice

- Belief in a higher power

- The rigidity/flexibility of religious beliefs

- Flexibility ~ Positive attitudes towards racial & value violating groups

- Belief in God ~ Negative attitudes towards value violating groups

Secular = Therapeutic knowledge and practice is based on science.

Sacred = Therapeutic knowledge and practice is based on religious understandings of the human condition.

Rational = Therapeutic knowledge/practice come from creative and clever human reasoning

Mystical = Therapeutic knowledge/practice come from the activities of other-than-human persons

Technical = Therapy requires transportable skills, procedures, remedies and techniques for assessment.

Relational = Therapy requires relationship with more powerful others who share gifts of healing.

Amalgamation of Western theory and Traditional aboriginal theory and practice.

- Spiritual principles

- Cultural metaphors

- Psychological theories

- Counseling techniques

The healing endeavor is understood to be a spiritual undertaking. Indigenous understandings of spirituality and ritual practice figure prominently.

The model of adaptation should take into consideration the unique characteristics of the population being served.

Changes to treatment content or process that include

• Additions, enhancements, or deletions

• Alterations to the treatment components

• Changes in the intensity of the treatment

• Cultural or other contextual modifications

If you don't, you end up having the problem of fitting data to the model, instead of the other way around.

Crazy like us: Globalization of the American Psyche (Watters, 2010)

”It is the psychiatric equivalent of handing out blankets to sick natives without considering the pathogens that hide deep in the fabric. (p. 253)”

Achieving a balance between culturally competent practice and selection of interventions that are scientifically rigorous is especially challenging when delivering interventions to ethno-cultural groups (ECG).

Culturally adapted interventions had 4.68 times greater odds than other conditions to produce remission from psychopathology in 16 studies reported.

• Ecological Validity Model
• Cultural Adaptation Process Model

- Consequences (parental skill)  -> less aggression (child benefit)

- Ignore, Distract, Redirect -> less annoying behaviors

- Clear limits, Household rules, Consistent follow-through -> more responsibility, predictability, obedience

- Praise encouragement and rewards celebrations -> more social skills, thinking skills, motivation

- Involvement, Empathy, Attention, Play, Talking, Listening, Problem solving -> more problem solving, cooperation, self esteem, attatchment

Limit: Balancing fidelity and fit:

• Do adaptations change the theoretical propositional model or the implied theory of change?

• Did the adaptation change the proposed core components and procedures to such an extent that what was adapted becomes a different treatment?

• Is change still a function of the therapeutic techniques that respond to a particular theoretical model? Or are there other mediating factors that might be due to the adaptation?

• Originally conceptualized for Latino populations

• Consists of eight elements for adaptation: Language, Persons, Metaphors, Content, Concepts, Goals, Methods, Context

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• Expanded on the Ecological Validity Model

• Three general phases and ten specific target areas

• Phase 1: Change Agent (researcher) and a Community Opinion Leader collaborate to find a balance between community needs and scientific integrity.

• Phase 2: Evaluation measures are selected and adapted in a parallel process to the adaptation of the intervention.

• Phase 3: Integrating the observations and data gathered in phase two into a new packaged intervention.

• Each phase consists of an on-going process of evaluation, revision, and reinvention.

• E.g. Parent training

A refugee is an asylum seeker who has been accepted by the United Nations High Commissioner for Refugees (UNHCR), or a friendly country as a refugee.

"Refugee" is a legal status. Not everyone can self-identify as a refugee by this standard.

"Forced” immigration: A refugee can not go home because they fear persecution. Forced to run from their home country because their government will not protect them, and may be responsible for persecution. Note: People forced to move because of natural disasters are not considered refugees generally.

Persons who are not U.S. citizens or nationals that enter the U.S. with the intent to remain for an indefinite period of time or, once in the U.S., are granted permission to do so (lawful permanent residency).

Persons who are in the U.S. and make their claim for refugee protection from here, rather than from overseas.

Asylees have the same status criteria as refugees – persons seeking protection in the U.S. on the grounds of fear of persecution for reasons of race, religion, nationality, membership of a particular group, or political opinion.

Not called “illegal refugee.”

2015: Forced displacement hits a record high. There are more than 21.3 million refugees in the world.

Top refugees around the world are from Somalia, Burma, and Ethiopia. These are also the top refugees in Minnesota.

▪ Rates of PTSD range from 10-40%.

▪ Rates of major depression range from 5-15%.

▪ Children and adolescents often have higher levels

PTSD: 50-90%

Major depression: 6-40%.

▪ Risk factors for the development of mental health problems include the number of traumas, delayed asylum application process, detention, and the loss of culture and support systems.

1. Safety

2. Reconstruction

3. Reconnect

The interface between counselor and client that takes the personal dynamics of the counselor and client into consideration alongside the dynamics found in the cultures of the counselor and the client.

Multicultural counseling is relative new (last 10-20 years).

Three Domains of Cross-Cultural Competence (A.S.K.)

▪ Awareness: Counselor awareness of personal values & biases

▪ Skills: Development of cultural intervention strategies & techniques

▪ Dynamic Sizing: If client doesn’t want to talk about culture. See how important those issues are in order to move forward with treatment plan.

▪ Scientific Mindedness: Use scientific method. Hypothesis, and then try to refute hypothesis. Assume that it culture not important and look for evidence to the contrary.

▪ Knowledge: Understanding the worldview of the “culturally different” (But can’t understand all human experiences. If you don't know, best to balance out researching on your own and asking the client.)

Mood disorder that causes a persistent feeling of sadness and loss of interest.

Have to meet a certain number out of total possible symptoms. Depression might look different for different cultural groups.

DSM-5: PTSD

Diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific stipulations and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The sixth criterion concerns duration of symptoms; the seventh assesses functioning; and, the eighth criterion clarifies symptoms as not attributable to a substance or co-occurring medical condition.

• 12-month prevalance (over any given 12 months): 27% of adults experience some mental illness (making the U.S. the country with the highest prevalence)
• Lifetime prevalance (over a lifetime): 47.4% chance for average American to have any kind of mental health disorder

Steps that might include factors that lead to disparities:

- Help-seeking

- Access

- Diagnoses

- Treatment

Studies tend to ignore the overrepresentation of African Americans in high need populations.

• Specific to one or more societies

• Influenced by prevailing cultural norms

• Example: Hikikomori

• After the U.S., Ukraine, Colombia, New Zealand, Lebanon, and France have the next highest rates of mental health disorders of any kind, all falling between 18.9 percent and 21.4 percent in a 12-­month period.

• Japan, the People’s Republic of China, Nigeria, and Israel have the lowest rates (between 6.0 percent and 7.4 percent), especially for depression.

• For substance abuse, the U.S. is the third, after South Africa and Ukraine.

• Occurs cross-­culturally, but symptom expression may vary

• E.g. Schizophrenia: 

Catatonic sub-­type (won’t move, won’t react) is rare in U.S. but is more common in non-­ Western countries. Paranoid sub-type more common in UK than India.

“… psychotic disorders characterized by gross distortions of reality; withdrawal from social interaction; and disorganization of perception, thought, and emotion”

= social withdrawal, pulling inward.

A culture-bound syndrome (primarily in Japan) Especially males

Extreme isolation and withdrawal from society.

Start as teenager. Teenager stays in their room.

Could last for 10-20 years.

Defining abnormal vs normal. Societal expectations and “norms”.

Biases in mental health practitioners.

e.g. White people were more likely to get diagnosis given bipolar disorder. African American people were more likely to get diagnosis of schizophrenia for same symptoms.

Schizophrenia = enduring, hard to maintain relationships.

Bipolar disorder = possibly more manageable in comparison.

How willing people are to go out and seek services for mental health treatment.

- Stigma, need social support

- "Model minority" for Asian Americans

- Poverty (mental health care is expensive)

- Access disparities