Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-05T04:05:33.390Z Has data issue: false hasContentIssue false

How can psychotherapists improve their practice with service users from minoritised ethnicities? An application of the Declarative-Procedural-Reflective (DPR) model of clinical skill development

Published online by Cambridge University Press:  03 January 2022

Alasdair Churchard*
Affiliation:
Oxford Institute of Clinical Psychology Training and Research, Oxford, UK

Abstract

Many white psychotherapists may lack the skills required to work effectively with service users from minoritised ethnicities. This article proposes that the nature of this skills deficit can be understood through applying the Declarative-Procedural-Reflective (DPR) model of therapist skill development. The DPR model has been used in a range of psychotherapeutic contexts, and it provides a systematic account of how therapists from all modalities develop and can improve their skills. Adapting this model to white therapists’ skills in working with service users from minoritised ethnicities allows the identification of specific areas of skills deficit, and therefore clear recommendations as to how to address those deficits. The application of the DPR model to this context suggests that there are clear areas of skills deficit in terms of knowledge base, the practical skills of carrying out therapy, and the ability of therapists to reflect on their work with service users from minoritised ethnicities. I conclude by making a number of suggestions as to how those deficits could be addressed, both by individual therapists and at a systemic level.

Key learning aims

  1. (1) To explore why some white psychotherapists find it more difficult to work effectively with service users from minoritised ethnicities.

  2. (2) To conceptualise difficulties in working with service users from minoritised ethnicities as an issue of clinical skill, knowledge and attitude development, where therapists’ skills can be improved if specific deficits are appropriately addressed.

  3. (3) To use the structure of the DPR model to better understand how deficits in therapists’ skills, knowledge and reflective ability may have an impact on their work with service users from minoritised ethnicities. This allows the identification of specific areas of deficit, and therefore clear recommendations as to how to address those deficits.

  4. (4) This is primarily addressed at CBT therapists, but the points raised in this article apply to all schools of therapy.

Type
Empirically Grounded Clinical Guidance Paper
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Further reading

Beck, A. (2016). Transcultural Cognitive Behaviour Therapy for Anxiety and Depression: A Practical Guide. Routledge/Taylor & Francis Group.CrossRefGoogle Scholar
Bennett-Levy, J. (2006). Therapist skills: a cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34, 5778. https://doi.org/10.1017/S1352465805002420 CrossRefGoogle Scholar
Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. In Stedmon, J., & Dallos, R. (eds), Reflective Practice in Psychotherapy and Counselling (pp. 115135). McGraw-Hill.Google Scholar
Hardy, K. V. (2008). Race, reality, and relationships: implications for the re-visioning of family therapy. In McGoldrick, M., & Hardy, K. V. (eds), Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice (pp. 7684). Guilford Press.Google Scholar
Pieterse, A. L. (2018). Attending to racial trauma in clinical supervision: enhancing client and supervisee outcomes. The Clinical Supervisor, 37, 204220. https://doi.org/10.1080/07325223.2018.1443304 CrossRefGoogle Scholar

References

Akechi, H., Senju, A., Uibo, H., Kikuchi, Y., Hasegawa, T., & Hietanen, J. K. (2013). Attention to eye contact in the West and East: autonomic responses and evaluative tatings. PLOS One, 8, e59312. https://doi.org/10.1371/journal.pone.0059312 CrossRefGoogle Scholar
Alcock, K. (2019). Thrown against a sharp white background: access, inclusion and anti-racism in clinical psychology [Conference presentation]. Group of Trainers in Clinical Psychology Annual Conference, Liverpool, UK, 4–6 November 2019. https://www.youtube.com/watch?v=GsDFPCNr4Lc Google Scholar
Apfelbaum, E. P., Norton, M. I., & Sommers, S. R. (2012). Racial color blindness: emergence, practice, and implications. Current Directions in Psychological Science, 21, 205209. https://doi.org/10.1177/0963721411434980 CrossRefGoogle Scholar
Atkinson, H., Bardgett, S., Budd, A., Finn, M., Kissane, C., Qureshi, S., Saha, J., Siblon, J., & Sivasundaram, S. (2018). Race, Ethnicity & Equality in UK History: A Report and Resource for Change. Royal Historical Society. https://files.royalhistsoc.org/wp-content/uploads/2018/10/17205337/RHS_race_report_EMBARGO_0001_18Oct.pdf Google Scholar
Azhar, M. Z., & Varma, S. L. (1995). Religious psychotherapy in depressive patients. Psychotherapy and Psychosomatics, 63, 165168. https://doi.org/10.1159/000288954 CrossRefGoogle ScholarPubMed
Baker, C. (2018). Mental health statistics for England: prevalence, services and funding. Briefing paper 6988. House of Commons Library.Google Scholar
Beck, A. (2016). Transcultural Cognitive Behaviour Therapy for Anxiety and Depression: A Practical Guide. Routledge/Taylor & Francis Group.CrossRefGoogle Scholar
Beck, A. (2019). Understanding Black and Minority Ethnic service user’s experience of racism as part of the assessment, formulation and treatment of mental health problems in cognitive behaviour therapy. The Cognitive Behaviour Therapist, 12. https://doi.org/10.1017/S1754470X18000223 CrossRefGoogle Scholar
Beck, A., Naz, S., Brooks, M., & Jankowska, M. (2019). Black, Asian and Minority Ethnic service user positive practice guide 2019. British Association for Behavioural and Cognitive Psychotherapies. https://legacy.babcp.com/files/IAPT-BAME-PPG-2019.pdf Google Scholar
Bennett-Levy, J. (2006). Therapist skills: a cognitive model of their acquisition and refinement. Behavioural and Cognitive Psychotherapy, 34, 5778. https://doi.org/10.1017/S1352465805002420 CrossRefGoogle Scholar
Bennett-Levy, J. (2019). Why therapists should walk the talk: the theoretical and empirical case for personal practice in therapist training and professional development. Journal of Behavior Therapy and Experimental Psychiatry, 62, 133145. https://doi.org/10.1016/j.jbtep.2018.08.004 CrossRefGoogle ScholarPubMed
Bennett-Levy, J., & Haarhoff, B. (2019). Why therapists need to take a good look at themselves. In Dimidjian, S. (ed), Evidence-Based Practice in Action: Bridging Clinical Science and Intervention (pp. 380394). The Guilford Press.Google Scholar
Bennett-Levy, J., Thwaites, R., Chaddock, A., & Davis, M. (2009). Reflective practice in cognitive behavioural therapy: the engine of lifelong learning. In Stedmon, J., & Dallos, R. (eds), Reflective Practice in Psychotherapy and Counselling (pp. 115135). McGraw-Hill.Google Scholar
Bennett-Levy, J., Thwaites, R., Haarhoff, B., & Perry, H. (2015). Experiencing CBT from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. The Guilford Press.Google Scholar
Bignall, T., Jeraj, S., Helsby, E., & Butt, J. (2019). Racial disparities in mental health: literature and evidence review. Race Equality Foundation. https://raceequalityfoundation.org.uk/wp-content/uploads/2020/03/mental-health-report-v5-2.pdf Google Scholar
Burnham, J. (2012). Developments in Social GRRRAAACCEEESSS: Visible-invisible and voiced-unvoiced. In Krause, I. B. (ed), Culture and Reflexivity in Systemic Psychotherapy: Mutual Perspectives (pp. 139160). Routledge.Google Scholar
Churchard, A. J., Malik, Z., & Shetty Chowdhury, S. (2021). A novel Self-Practice/Self-Reflection programme for CBT therapists from minoritised ethnicities [Conference presentation]. EACBT 2021 Congress, Belfast, Northern Ireland, UK, 8–11 September 2021.Google Scholar
Cromarty, P., Gallagher, D., & Watson, J. (2020). Remote delivery of CBT training, clinical supervision and services: in times of crisis or business as usual. The Cognitive Behaviour Therapist, 13. https://doi.org/10.1017/S1754470X20000343 CrossRefGoogle ScholarPubMed
Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health, 18, 117. https://doi.org/10.1186/s12939-019-1082-3 CrossRefGoogle ScholarPubMed
Davis, D. E., DeBlaere, C., Owen, J., Hook, J. N., Rivera, D. P., Choe, E., … & Placeres, V. (2018). The multicultural orientation framework: a narrative review. Psychotherapy, 55, 89100. http://dx.doi.org/10.1037/pst0000160 CrossRefGoogle ScholarPubMed
Dogra, N., Vostanis, P., Abuateya, H., & Jewson, N. (2007). Children’s mental health services and ethnic diversity: Gujarati families’ perspectives of service provision for mental health problems. Transcultural Psychiatry, 44, 275291. https://doi.org/10.1177/1363461507077727 CrossRefGoogle ScholarPubMed
Dolcos, F., & Denkova, E. (2014). Current emotion research in cognitive neuroscience: linking enhancing and impairing effects of emotion on cognition. Emotion Review, 6, 362375. https://doi.org/10.1177/1754073914536449 CrossRefGoogle Scholar
Dovidio, J. F. (2001). On the nature of contemporary prejudice: the third wave. Journal of Social Issues, 57, 829849. https://doi.org/10.1111/0022-4537.00244 CrossRefGoogle Scholar
Elfenbein, H. A., & Ambady, N. (2003). Universals and cultural differences in recognizing emotions. Current Directions in Psychological Science, 12, 159164. https://doi.org/10.1111/1467-8721.01252 CrossRefGoogle Scholar
Equality and Human Rights Commission (2016). Healing a divided Britain: the need for a comprehensive race equality strategy. https://www.equalityhumanrights.com/sites/default/files/healing_a_divided_britain_-_the_need_for_a_comprehensive_race_equality_strategy_final.pdf Google Scholar
Falicov, C. J. (1995). Training to think culturally: a multidimensional comparative framework. Family Process, 34, 373388. https://doi.org/https://doi.org/10.1111/j.1545-5300.1995.00373.x CrossRefGoogle ScholarPubMed
Farrell, J. M., & Shaw, I. A. (2018). Experiencing Schema Therapy from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. Guilford Publications.Google Scholar
Fernando, S. (2010). Mental Health, Race and Culture (3rd edn). Palgrave Macmillan.CrossRefGoogle Scholar
Freeston, M. H., Thwaites, R., & Bennett-Levy, J. (2019). ‘Courses for Horses’: designing, adapting and implementing self practice/self-reflection programmes. The Cognitive Behaviour Therapist, 12. https://doi.org/10.1017/S1754470X19000138 CrossRefGoogle Scholar
Fuertes, J. N., Mueller, L. N., Chauhan, R. V., Walker, J. A., & Ladany, N. (2002). An investigation of European American therapists’ approach to counseling African American clients. The Counseling Psychologist, 30, 763788. https://doi.org/10.1177/0011000002305007 CrossRefGoogle Scholar
Gawronski, B., & Bodenhausen, G. V. (2017). Beyond persons and situations: an interactionist approach to understanding implicit bias. Psychological Inquiry, 28, 268272. https://doi.org/10.1080/1047840X.2017.1373546 CrossRefGoogle Scholar
Gobel, M. S., Chen, A., & Richardson, D. C. (2017). How different cultures look at faces depends on the interpersonal context. Canadian Journal of Experimental Psychology/Revue canadienne de psychologie expérimentale, 71, 258364. https://doi.org/doi.org/10.1037/cep0000119 CrossRefGoogle Scholar
Graham, J. R., Sorenson, S., & Hayes-Skelton, S. A. (2013). Enhancing the cultural sensitivity of cognitive behavioral interventions for anxiety in diverse populations. The Behaviour Therapist, 36, 101108.Google ScholarPubMed
Gurpinar-Morgan, A., Murray, C., & Beck, A. (2014). Ethnicity and the therapeutic relationship: views of young people accessing cognitive behavioural therapy. Mental Health, Religion & Culture, 17. https://doi.org/10.1080/13674676.2014.903388 CrossRefGoogle Scholar
Halley, J. O. M., Eshleman, A., & Vijaya, R. M. (2011). Seeing White: An Introduction to White Privilege and Race. Rowman & Littlefield Publishers.Google Scholar
Hardy, K. V. (2008). Race, reality, and relationships: implications for the re-visioning of family therapy. In McGoldrick, M., & Hardy, K. V. (eds), Re-Visioning Family Therapy: Race, Culture, and Gender in Clinical Practice (pp. 7684). Guilford Press.Google Scholar
Hayes, J. A., Owen, J., & Bieschke, K. J. (2015). Therapist differences in symptom change with racial/ethnic minority clients. Psychotherapy, 52, 308314. https://doi.org/10.1037/a0037957 CrossRefGoogle ScholarPubMed
Hirsch, A. (2018). Brit(ish): On Race, Identity and Belonging. Vintage.Google Scholar
Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L. Jr, & Utsey, S. O. (2013). Cultural humility: measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60. https://doi.org/10.1037/a0032595 CrossRefGoogle ScholarPubMed
Imel, Z. E., Baldwin, S., Atkins, D. C., Owen, J., Baardseth, T., & Wampold, B. E. (2011). Racial/ethnic disparities in therapist effectiveness: a conceptualization and initial study of cultural competence. Journal of Counseling Psychology, 58, 290298. https://doi.org/10.1037/a0023284 CrossRefGoogle ScholarPubMed
Journal of Family Therapy (n.d.). Standing Against Racism and Inequality. https://onlinelibrary.wiley.com/page/journal/14676427/homepage/jftracismandinequalitystatement Google Scholar
Kelley, N., Khan, O., & Sharrock, S. (2017). Racial prejudice in Britain today. NatCen Social Research. https://natcen.ac.uk/media/1488132/racial-prejudice-report_v4.pdf Google Scholar
Kline, R. (2014). The ‘snowy white peaks’ of the NHS: a survey of discrimination in governance and leadership and the potential impact on patient care in London and England. Middlesex University, London, UK. https://mdx.figshare.com/ndownloader/files/23772857 Google Scholar
Knight, K., Sperlinger, D., & Maltby, M. (2010). Exploring the personal and professional impact of reflective practice groups: a survey of 18 cohorts from a UK clinical psychology training course. Clinical Psychology and Psychotherapy, 17, 427437. https://doi.org/10.1002/cpp.660 CrossRefGoogle ScholarPubMed
Knox, S., Burkard, A. W., Johnson, A. J., Suzuki, L. A., & Ponterotto, J. G. (2003). African American and European American therapists’ experiences of addressing race in cross-racial psychotherapy dyads. Journal of Counseling Psychology, 50, 466481. https://doi.org/10.1037/0022-0167.50.4.466 CrossRefGoogle Scholar
Kolts, R. L., Bell, T., Bennett-Levy, J., & Irons, C. (2018). Experiencing Compassion-Focused Therapy from the Inside Out: A Self-Practice/Self-Reflection Workbook for Therapists. Guilford Publications.Google Scholar
Kuyken, W., Padesky, C. A., & Dudley, R. (2009). Collaborative Case Conceptualization: Working Effectively with Clients in Cognitive-Behavioral Therapy. Guilford Press.Google Scholar
Laidlaw, K. (2015). CBT for Older People: An Introduction. SAGE Publications Ltd.CrossRefGoogle Scholar
Lee, S. (2020). ‘We will not give up on London slavery memorial’, BBC, 10 June 2020. https://www.bbc.co.uk/news/uk-england-london-52995586 Google Scholar
Lombardo, C., Milne, D., & Proctor, R. (2009). Getting to the heart of clinical supervision: a theoretical review of the role of emotions in professional development. Behavioural and Cognitive Psychotherapy, 37, 207219. https://doi.org/10.1017/S135246580900513X CrossRefGoogle Scholar
Ludgate, J. (2016). Self-management in CBT training and supervision In Sudak, D. M., Codd, R. T., Ludgate, J. W., Sokol, L., Fox, M. G., Reiser, R. P., & Milne, D. L. (eds), Teaching and Supervising Cognitive Behavioral Therapy (pp. 243264). Wiley.CrossRefGoogle Scholar
McCallum, C. M., & Wilson, A. (2017). Multicultural Competence in the Supervisory Relationship: An Inclusive Model. NYS Child Welfare/Child Protective Services Training Institute, 13.Google Scholar
Mercer, L., Evans, L. J., Turton, R., & Beck, A. (2019). Psychological therapy in secondary mental health care: access and outcomes by ethnic group. Journal of Racial and Ethnic Health Disparities, 6, 419426.CrossRefGoogle ScholarPubMed
Murphy, M. C., Kroeper, K. M., & Ozier, E. M. (2018). Prejudiced places: how contexts shape inequality and how policy can change them. Policy Insights from the Behavioral and Brain Sciences, 5, 6674. https://doi.org/10.1177/2372732217748671 CrossRefGoogle Scholar
Naeem, F. (2019). Cultural adaptations of CBT: a summary and discussion of the special issue on cultural adaptation of CBT. The Cognitive Behaviour Therapist, 12. https://doi.org/doi:10.1017/S1754470X19000278 CrossRefGoogle Scholar
Neville, H. A., Gallardo, M. E., & Sue, D. W. (2016). The Myth of Racial Color Blindness: Manifestations, Dynamics, and Impact (1st edn). American Psychological Association.CrossRefGoogle Scholar
Owen, J., Imel, Z., Adelson, J., & Rodolfa, E. (2012). ‘No-show’: therapist racial/ethnic disparities in client unilateral termination. Journal of Counseling Psychology, 59, 314320. https://doi.org/10.1037/a0027091 CrossRefGoogle Scholar
Patel, N. (2004). Difference and power in supervision. In Fleming, I. & Stern, L. (eds), Supervision and Clinical Psychology: Theory, Practice and Perspectives (pp. 96117). Brunner-Routledge.Google Scholar
Patel, N., & Keval, H. (2018). Fifty ways to leave …… your racism. Journal of Critical Psychology Counselling and Psychotherapy, 18, 6179.Google Scholar
Payne, B. K., & Hannay, J. W. (2021). Implicit bias reflects systemic racism. Trends in Cognitive Sciences, 25, 927936. https://doi.org/10.1016/j.tics.2021.08.001 CrossRefGoogle ScholarPubMed
Pieterse, A. L. (2018). Attending to racial trauma in clinical supervision: enhancing client and supervisee outcomes. The Clinical Supervisor, 37, 204220. https://doi.org/10.1080/07325223.2018.1443304 CrossRefGoogle Scholar
Powell-Hopson, D., & Hopson, D. S. (1988). Implications of doll color preferences among black preschool children and white preschool children. Journal of Black Psychology, 14, 5763. https://doi.org/10.1177/00957984880142004 CrossRefGoogle Scholar
Rathod, S., Kingdon, D. G., Pinninti, N., Turkington, D., & Phiri, P. (2015). Cultural Adaptation of CBT for Serious Mental Illness: A Guide for Training and Practice. John Wiley & Sons Inc.CrossRefGoogle Scholar
Rathod, S., Phiri, P., & Naeem, F. (2019). An evidence-based framework to culturally adapt cognitive behaviour therapy. The Cognitive Behaviour Therapist, 12. https://doi.org/10.1017/S1754470X18000247 CrossRefGoogle Scholar
Richeson, J. A., & Sommers, S. R. (2016). Toward a social psychology of race and race relations for the twenty-first century. Annual Review of Psychology, 67, 439463. https://doi.org/10.1146/annurev-psych-010213-115115 CrossRefGoogle Scholar
Rosen, D. C., Kanter, J. W., Villatte, M., Skinta, M. D., & Loudon, M. P. (2019). Becoming an antiracist white clinician. In Williams, M. T., Rosen, D. C., & Kanter, J. W. (eds), Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care across Settings (pp. 147168). New Harbinger Publications.Google Scholar
Scherr, S. R., Herbert, J. D., & Forman, E. M. (2015). The role of therapist experiential avoidance in predicting therapist preference for exposure treatment for OCD. Journal of Contextual Behavioral Science, 4, 2129.CrossRefGoogle Scholar
Schön, D. A. (1983). The Reflective Practitioner: How Professionals Think in Action. Basic Books.Google Scholar
Sue, D. W. (2015). Race Talk and the Conspiracy of Silence: Understanding and Facilitating Difficult Dialogues on Race. John Wiley & Sons.Google Scholar
Sue, D. W., & Spanierman, L. (2020). Microaggressions in Everyday Life (2nd edn). Wiley.Google Scholar
Sue, D. W., & Sue, D. (1999). Counseling the Culturally Different: Theory and Practice (3rd edn). John Wiley & Sons.Google Scholar
Sue, D. W., Sue, D., Neville, H. A., & Smith, L. (2019). Counseling the Culturally Diverse: Theory and Practice (8th edn). John Wiley & Sons.Google Scholar
Thwaites, R., Bennett-Levy, J., Davis, M., & Chaddock, A. (2014). Using self-practice and self-reflection (SP/SR) to enhance CBT competence and metacompetence. In Whittington, A., & Grey, N. (eds), How to Become a More Effective CBT Therapist: Mastering Metacompetence in Clinical Practice. Wiley-Blackwell,.Google Scholar
Utsey, S. O., Gernat, C. A., & Hammar, L. (2005). Examining white counselor trainees’ reactions to racial issues in counseling and supervision dyads. The Counseling Psychologist, 33, 449478. https://doi.org/10.1177/0011000004269058 CrossRefGoogle Scholar
Watkins, C. E. Jr, & Hook, J. N. (2016). On a culturally humble psychoanalytic supervision perspective: creating the cultural third. Psychoanalytic Psychology, 33, 487517. https://doi.org/10.1037/pap0000044 CrossRefGoogle Scholar
Williams, M. T., Printz, D., Ching, T., & Wetterneck, C. T. (2018). Assessing PTSD in ethnic and racial minorities: trauma and racial trauma. Directions in Psychiatry, 38, 179196.Google Scholar
Submit a response

Comments

No Comments have been published for this article.