An episode of “Changing the Conversation” podcast
Hosts Joey Rodriguez and Lola Nedic discuss culturally responsive strategies and the future of culturally responsive care. This episode is sponsored by the New England Mental Health Technology Transfer Center Network (MHTTC).
March 11, 2024
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Lola Nedic, Co-host (00:05): Hello and welcome to Changing the Conversation. This episode is sponsored by the New England Mental Health Technology Transfer Center. I’m Lola Nedic. I am a clinical research coordinator at Beth Israel Deaconess Medical Center, and I am also the Harvard site coordinator of the New England Mental Health Technology Transfer Center.
Joey Rodriguez, Co-host (00:23): And I’m Joey Rodriguez. I’m a clinical research student at Beth Israel Deaconess Medical Center and McLean Hospital.
Lola (00:29): We are co-hosting this episode today. This is the fifth and final episode of our Culturally Responsive Care series. We’ve interviewed three clinicians, as well as one peer specialist with lived experience of psychosis, to talk about their experiences with culturally responsive care.
Joey (00:47): And in this episode, we will be recapturing key points from the Culturally Responsive Care series, as well as discussing lingering questions we had from the series. And I’m really excited to highlight our positionality in academic training, to be providers. We’re in a unique context of privilege where we also eventually, maybe, get one day to decide what’s prioritized. And our positionality also is in hospital care. We work in hospitals, so we have that insight of getting to know oppressive systems, to some extent. Who’s in power? You have colloquial, white, able-bodied males who are hiring specific people, but we’re in a position in our careers where we get to start to decide how we’d like to have those decisions be continued if we continue to proceed in this field. And as a byproduct of this, we are in a unique position to ask providers who are in the field and have their feet on the ground, what it’s like providing care and also what it’s like providing culturally responsive care.
Lola (01:54): So actually, all of our guests had brought up the idea of doing your homework and spending time outside of those sessions, learning more about your clients and being part of these communities that they’re a part of. But something that I was left wondering is, how are these providers making time for this in their lives? Because so many of them have a hundred clients, more clients actually, and are booked every single day from 9:00 to 5:00, and then have their own lives. I’m wondering how they’re able to make space for these things that are clearly necessary for their therapeutic work but don’t have time in the workday to do.
Joey (02:35): Yeah. Chia Hsuan advocated that doing your homework looks like participating in the community. Amanda Weber suggested that part of doing your homework is definitely working on yourself. And Vera suggested that doing your homework means being heavily involved with the people of that culture in every aspect. And Raul mentioned how important it is to tailor your language to the customs and traditions of the people that you’re providing care with. I highly recommend you listen to these episodes because I’m not giving them justice right now. They are amazing episodes.
Lola (03:10): Yeah, definitely. And one of the reasons I was so excited to do this series is because culturally responsive care, and cultural humility, and all that stuff, is such a hot topic right now, but it’s discussed as something that’s nebulous and it’s not well-defined. Providers and clients are not given many tools and strategies on how to actually become more culturally responsive. It’s just something we encourage in our providers, but don’t give them the tools to actually do well. So I was excited to hear from these providers about what steps they’re taking towards being more culturally responsive. And I think what surprised me a little bit was the emphasis that all of the people we interviewed, they all place so much emphasis on culturally responsive care being a lifelong process, not being something that you start at step one, and then it’s a complete ladder, and then you end. It’s something that you’re never going to completely finish, but it’s something you can work at and improve upon throughout your career and your life.
Joey (04:16): Yeah.
Lola (04:17): The way that we talk about culturally responsive care now is that it’s something that requires us learning a lot about our clients, and that is absolutely true. You absolutely have to learn about your clients’ backgrounds, and their beliefs, and value systems. But Amanda Weber said that it’s really important to think about the role that you play in these spaces and think about the biases you hold, your positionality in this space and in the world, and how that interacts with your client’s positionality and the way they move throughout the world.
Joey (04:49): Yeah.
Lola (04:49): I think that’s something that really sat with me when we did these interviews was, it is just as much thinking about your own role in the world as it is thinking about your client’s.
Joey (04:59): I agree, and I think we had a specific lens on cares pertaining to early psychosis, but I think this concept pertains to any mental health provider listening to this right now. Chia Hsuan said, a lot of the tools that were devised to assess and detect, whether it be risk for psychosis or a mental health condition, they were devised from a certain type of Eurocentric point of view. And I think it’s actually injustice to say that that’s a bad thing. I think it’s more important to acknowledge the fact that that is one way of interpreting someone’s internal experiences, right? And I could see that there are circumstances where that is very, very helpful. I could also see circumstances where that is very, very limiting. But I think the fact that we over generalize one interpretive mechanism to capture a broad human experience, that is a bit of a wrinkle that I’m really grateful that we were able to have podcast guests speak more on.
Lola (06:04): And something that struck me is that a lot of the clinicians we spoke with emphasize that it’s important to also be vulnerable with your clients and to let them know when there are times that you’re not really sure what to say or how to approach this. If you’re feeling a little burnt out or tired that day, you can say that.
Joey (06:24): Letting them in the room.
Lola (06:26): Yeah, let them into your space because they’re letting you into their space, right?
Joey (06:30): Mm-hmm, and I think what’s really cool is that, I think the idea of letting someone in the room is also applicable to clinical training. I think you asked specifically, “What’s something that you benefited from, from your trainees as a supervisor?”
Lola (06:49): Right, mm-hmm.
Joey (06:49): And this was something that Chia Hsuan said, she said, “It’s really, really embarrassing, but I showed them my early clinical tapes in training,” and she said, “That was, one, a way to let them in the room and, two, to I think be more consistent in the things that you value.” If we’re actually going to build relationships with other people, then it should be representative of the relationships that we have inside the therapeutic atmosphere and also outside the therapeutic atmosphere.
Lola (07:19): Right. In that interview as well, we talked about letting go of the idea that you are an expert because in these academic spaces, expertise is something that’s so valued, but once you enter that room in a therapeutic space, you are no longer the expert. And you have to let go of that, and almost take the backseat, and let your client be the expert of their own experiences, and let them really take the reins. And so I think in cases like that, I think therapists can get uncomfortable, and they feel this dissonance between their client’s experiences and their experiences, and they feel a discomfort. And I think that’s, what she was saying in the interview was, her interns could literally tell she was uncomfortable in the room.
Joey (08:08): I think it can be interpreted as letting go of being an expert. I think it could also be interpreted as making space for what you don’t know. So it’s not the case that you don’t know everything that you learned in grad school, but it is the case that that might not be enough for you to be a perfect provider, which I think is reassuring to anyone, any mental healthcare provider, who’s listening to this because this is another initiative of the podcast. It’s like, hey, a lot of culturally responsive care stuff hasn’t been taught in grad school. It’s more so like, hey, there’s a lot that goes into having a relationship with someone and establishing a therapeutic relationship that isn’t necessarily touched on in theory or in a textbook, or isn’t built into the theory. So it’s not in the textbook to begin with.
Lola (08:57): That’s an important point that you’ve made is that a therapist can’t necessarily be a perfect person. And, well, actually Marsha Linehan once said, “A great therapist has to be really good at apologizing.”
Joey (09:10): Yeah, that’s a great quote.
Lola (09:10): And I think, it’s a great quote, but I think it’s hard for me to reconcile that because I’m working so hard to become a good person, and I want to go to grad school, and I want to be the best clinician that there ever was, and I want to hit the ground running and be perfect, but in fact, I’m going to mess up a lot of times. And these people that we interviewed have messed up a lot of times also, and you just have to get good at acknowledging when you make mistakes, apologizing for them and just moving forward because it is, like we said, a lifelong process. And unfortunately, no matter how much we prepare, we’re going to mess up a bunch.
Joey (09:49): Yeah, and I think that ties into the next key point, which is, what does doing your homework look like, right?
Lola (09:53): Mm-hmm.
Joey (09:54): One, I think you already mentioned it, Lola, it’s acknowledging the fact that you are a fallible human being, and then it’s like, okay, now we can actually start to improve because we-
Lola (10:04): Unfortunately, yes.
Joey (10:05): Yeah, right? Chia Hsuan said, “Spending not only time with the person that you are providing care with, but getting more familiar relationally with the community that they involve themselves with.” She made a really good point here.
Lola (10:21): I think it’s interesting because we, along with the clinicians that we interviewed and also every other clinician we’ve ever spoken to, have acknowledged the critical role of homework, and yet no clinicians are being given the tools, and support, and paid hours honestly, to do that necessary work. They have to go outside of their work hours to do this and I think a lot of people just don’t have the time.
Joey (10:50): Yeah. In one sense, I think it makes sense to have someone who’s truly passionate about providing culturally responsive care go about it and pursue this passion on their own accord without funding, because I could understand how there is a weird flavor in someone attending church, for example, because they’re on payroll and they’re trying to be culturally responsive. I could see how that could be a little problematic. However, I do have this idea where you have to be so motivated to provide culturally responsive care in a way that really meets the expectations of the conversations that we’ve had so far, and also our own expectations. And a lot of that has to really come from you genuinely caring about healing others and supporting other people.
Lola (11:33): No, absolutely, and that’s the issue, right, is that it’s not something that’s well integrated into our practice. It’s not baked into undergraduate curriculums. I’m told it’s not baked into graduate curriculums either. It’s not something that’s being emphasized at trainings that clinicians are going to. It simply is not a big enough part of the system of educating these providers, and so it does become something that you have to be exceedingly passionate about to spend time outside of work doing.
Joey (12:06): Yeah. What does it mean to bake culturally responsive care curriculum into academia?
Lola (12:12): That’s a really good question, Joey, and I think that that’s where a lot of people get stuck with this, right, because there’s a limited amount of tools that people use to practice. There’s the Cultural Formulation Interview, which I think a lot of people use, but acknowledge it can be flawed sometimes. There’s frameworks like the Power Threat Meaning Framework, stuff like that. I think those are all really great starting points. I want to see more tools. I want to see more culturally adapted systems of care. I want to see, there’s culturally adapted CBT and there’s CBT for psychosis, and there’s no culturally adapted CBT for psychosis.
Joey (12:50): Yeah, right. A good teacher, any teacher, right, may instill curiosity into their students and into what’s being taught. And I think that there can be more intentionality around instilling a sense of curiosity to, hey, I wonder if different people react to the same thing, right?
Lola (13:14): Mm-hmm.
Joey (13:14): Or, hey, I wonder if someone from Madagascar and their culture, and someone from Nigeria, reacts to blank in a same way that someone from Canada might, and someone from a rural city in Mexico might. I do think that it’s a responsibility of academia to focus where they’re instilling curiosity into.
Lola (13:38): Yeah, I definitely agree. I think that the thing that is nice about culture, right, is that it’s so nebulous and so fluid, but in systems of academia, it is not helpful for something to be that abstract. And we need to be developing systems to better teach our students about culture and the effect that it has on clinical care, particularly in early psychosis.
Joey (14:03): Yeah, and you do make a point, there’s only so much teaching about culture that you can provide in a classroom setting, right?
Lola (14:09): Right.
Joey (14:11): Yeah.
Lola (14:12): I want to have tools that are culturally adapted, and I also want to be given the resources to culturally adapt those tools myself.
Joey (14:21): Yeah. I think more people with diverse backgrounds should be in positions of leadership, and also we should have people who have lived experience of mental health conditions in positions, or at least having a seat at the table, where they could influence the trajectory of how we construe culturally responsive care and what it means to facilitate it.
Lola (14:41): I think we need to move past the idea of people having just a seat at the table, right? I think we need to be putting people with lived experience at the head of the table. I think that’s when we’re really going to make progress.
Joey (14:55): Yeah, and I hope endeavors like this Culturally Responsive Care podcast helps get the conversation started around this, around changing these initiatives and start getting the gears moving.
Lola (15:06): Joey, thank you so much for being with me today, and having this conversation, and doing this project with me.
Joey (15:12): Thanks everyone.
Lola (15:13): And to our listeners, join us next time on Changing the Conversation.
Erika Simon, Producer (15:17): Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube, for more resources to grow your impact. Thank you for joining us. This episode is sponsored by New England Mental Health Technology Transfer Center, New England MHTTC, and was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Our hosts for this series are Joey Rodriguez and Lola Nedic. Join us next time on Changing the Conversation.
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