DIVERSITY: RACE AND CULTURE

 Heydell Vera-Murphy
DIVERSITY PRESENTATION

 1. Case’s introduction
 Demographics
 Assessment
 Treatment

 2. Considerations and guidance for working with race and culture

 3. Adaptations

 4. Reflections
DEMOGRAPHICS

 Female in her 40s – Ana

 Nationality: South-american - Bolivian
 Ethnicity:
 Native language: Spanish
 Living with 4 children and her husband in supported accommodation
 Unemployed
 Diversity characteristic: Race and Culture
ASSESSMENT INFORMATION
 PROBLEM DESCRIPTOR: Low mood

MDS Scores
 PHQ-9: 21 (Severe symptoms of low mood)
 GAD-7: 19 (Severe symptoms of anxiety)
 WASAS: 23 (Work: N/A – Home:8 – Social:5 – Private leisure:5 – Family: 5)
 PHOBIAS:8 (Social phobia:0 agoraaphobia:0 Specific phobia:8)

 RISK LEVEL: Score 1. Low (infrequent suicidal thoughts)

 MEDICATION: Citalopram - Dose: 20 milligrams - Time: 6 months

TREATMENT INFORMATION:
 PERSONAL STATEMENT:

 GOALS FOR TREATMENT :

• Stop feeling sad all the time
• To clean the house
• To do gardening
• To contact my family in Bolivia more frequently
• To meet new people
• To learn English

 SELECTED INTERVENTION: Behavioral Activation

RELEVANT POLICIES AND LEGISLATIONS

 THE EQUALITY ACT, 2010: The most current legislation relating equal opportunities
and diversity. Everyone has the right to access services regardless their race
or/and culture.

 NICE, 2018: Stigma attached to mental health difficulties affect ethnic minorities
to access mental health services in the early stages of illness; therefore people’s
diverse needs should be tailored and reviewed to ensure the facility to access
services.
GUIDANCE TO WORK WITH THIS CASE

 SH. Friedmant et al (2009): immigrants appear to have an increase of

suffering from mental health illnesses; however the process of acculturation
can benefit the adaptation to the new environment.

 Hays,P.A (2001): Addressing and researching the client’s culture.

 Papworth, (2013): People from different cultures may have different

features of depression.

 Thompsom R.A et al, (2019): An evaluation of the transition from BAME

community mental health worker to IAPT low intensity psychological wellbeing
practitioner
GUIDANCE TO WORK WITH THIS CASE

 Gurpinar-Morgan, Murray and Beck (2014): Similar ethnicity between

client and clinician.
o Benefits:
• Better understanding of the client’s culture and difficulties
• Adaptations to the client's treatment are easier to make
• Recognition of similar experiences
• Increased Empathy as more points in common
o Difficulties:
• Easier to make assumptions about the client’s life and experiences
• Misunderstandings (important to discuss the similarities and differences)
• Confidentiality issues
 ADAPTATIONS
 Ana asked for an Spanish therapist as her English was very poor and she did not
feel comfortable with an interpreter.

 Ana’s educational level was low, in addition her concentration was affected by
her low mood, therefore I had to have extended sessions as the process is
slower.

 Ana’s had the option of face to face or telephone appointments.

ADAPTATIONS

 Investigation of Bolivian culture was essential to understand Ana’s

situation and beliefs.

 Outcome measures were translated in Spanish to facilitate the process.

 CBT materials were design and translated in Spanish.

 The sessions were conducted in Spanish.

TO IMPROVE

 To send remainder of the sessions in Spanish as Ana had difficulties to

understand the letters and messages.

 Avoid assumptions, as I am also from Latino-America.

 The materials could be send with more time in advance to facilitate

Ana’s understanding

 Remain focus on the therapy instead of listening to Ana’s stories.

STRENGTHS

 Ana appreciated to have the sessions in Spanish from Latino-america.

 The therapeutic alliance was strengthened by the language (Spanish)

and similarities between Ana’s country (Bolivia) and my country’s
(Colombia) culture.

 The materials were designed with graphics and pictures more than
writing to facilitate Ana’s understanding.

 To offer longer sessions worked well for Ana’s process

MAIN POINTS

 Culture and race need to be addressed together as it strongly influence

the perception of people’s experiences

 Our society is diverse therefore research and better understanding of

people’s culture is crucial to offer a inclusive mental health services

 Adaptations are necessary to build a relationship with the client and to

ensure a positive therapeutic alliance.
 REFERENCES
 Equality Act. (2010). c.15. London Stationary Office. from the UK National
Archives website: http://www. legislation. gov. uk/ukpga/2010/15/contents.

 Hays, P.A (2002)Addressing cultural complexities in practice: A framework

for clinicians and counselors Journal of Marital and Family Therapy;
Hoboken Vol 28, Iss.1, 122-123.

 Hakim, N., Thompson, A.R. (2019). An evaluation of the transition from BAME
community mental health worker to IAPT low intensity psychological
wellbeing practitioner. Cambridge University Press, from
http://eprints.whiterose.ac.uk/141505/
 REFERENCES
 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, 714-725.

 Papworth,M.(2013). Adapting CBT for use with individuals form Minority

Groups. Low intensity Cognitive-Behaivioral Teraphy: A Practitioner’s
Guide. Oxford: SAGE.

 SH.Friedmant et al, (2009). Determinants of Minorities Mental Health and

Wellness. Effects of demographics Trends on Individuals and
communities. Springer, pag 15.

 NICE (2018) Promoting health and preventing premature mortality in

black, Asian and other minority ethnic groups, from
https://www.nice.org.uk/guidance/qs167/chapter/Quality-statement-5-
Support-for-people-with-mental-health-problems