1 Integrating Indigenous Spirituality with Western Psychotherapy: A Practical Approach Dr. Nadia Rojas Jones EdD LMFT Septermber, 2014
2 Culture Stella Rodriquez Patterns of learned and shared behaviors and beliefs characteristic of a particular social, ethnic, or age group. Includes ways of thinking, communicating, interacting, and views on roles, relationships, customs, and values. Includes beliefs and attitudes about race, ethnicity, gender, age, sexual orientation, religion, disability status, socioeconomic status, geographic location, and other characteristics
3 Health Disparities Despite demographic trends, disparities in outcomes for minority groups are evident in virtually all measures of health. Differences remain after adjustment for socioeconomic and healthcare access factors. Year 2000 Mortality per 100,000 White Black/AA Difference Heart disease Cancer Infections per 100,000 HIV
4 Increasing Cultural Diversity African, Asian, Native, and Latino Americans needing outpatient mental healthcare are less likely to receive it than Whites. African Americans, Latinos, Asian Americans, and Native Americans are more likely than Whites to leave mental health treatment prematurely. African Americans and Latinos are less likely than Whites to receive guideline-adherent treatment when suffering from anxiety disorders and depression. African Americans are overrepresented among persons suffering from serious mental illness who fail to receive minimally adequate treatment.
5 Cross-Cultural Education of the Healthcare Workforce Cross-cultural education is a key intervention strategy in reducing health disparities Research studies have demonstrated its effectiveness on patient satisfaction, medication adherence, and health outcomes. Three Primary Approaches Address attitudes: cultural sensitivity, awareness, approach Increase knowledge: multicultural/categorical approach Develop skills: cross-cultural approach
6 Indigenous Beliefs Indigenous = native Customs, rituals, practices and beliefs that are specific to a culture or population. Unique vision of how the universe came into being, is structured, shapes peoples behaviors in life, how does it shapes peoples behaviors in life, and it gets transmitted through narratives.
7 Some Latino Healing Traditions Incas Maya Aztecas Indian African
8 Latino Traditional Medicine Use herbs Includes a spiritual aspect Relies on many specialists Uses stories to have an impact on issues.even to scare
9 European Medicine Blood, humor, bile, and phlegm in the body. Disease could be a punishment from God.
10 African Medicine Started in El Congo Connection between the living and the dead Also used root medicine and herbs Healers were the elders Influence of Ancestors
11 Curanderismo and Chamanismo Illness is divided into three inter-related categories Somatic Psychological Spiritual
12 Diagnose of Disease and Treatment modalities Disturbance of imbalances of hot and cold Disturbance of organs Spiritual origin of illness Emotional origin of illness Spiritual/religious ceremonies Indigenous medicine Folk psychological approaches Herbs
13 Use of enchantment/magic Shamanic rituals (includes ayahuasca traditional ceremonies in Peru and Brazil) Chants, prayers, herbs on the streets or on ceremonies (case example Gangster family) Medicine woman or man, village healer Voodoo Priest or Priestess Santero, Padrino, Yoruba Bruja, brujo: witch Card, candles, leaves, spiritual readers
14 Names and Modalities Used by Healers in our Community Espiritista Espiritualista Partero Brujo Yerbatero Sobador Curandero Cartero/leedor Huesero La senora especial Emolientero
16 Culturally Identified Issues in our Community Ataque de nervios El susto Mal de ojo Empacho Mal puesto Story of dissertation Pregnancy issues Mal aire Mollera caida Matriz caida Bilis y envidia Case pregnancy and prayer family
17 How do they heal? What do they Use? Velas Hierbas Estatuas Rosarios Agua bendita Altares Piedras Dichos Copal Limpias Banos Oraciones Barridas La familia Sobadas Velas Arbol de la vida Amuletos Cadenas de proteccion Arroz Cancion Baile Poesia Fabulas Leyendas Case anxiety
20 Modern Approaches: Contemplative Theory
21 5 A s Model A Flexible, Patient Centered Approach Integrated approach to assessment and intervention Well-established & evidence-based Familiar to PC clinicians & PC teams Highly adaptable to the preferences of patients Self-Management Model with 5 A s (Glasgow, et al, 2002; Whitlock, et al, 2002)
22 Cross-Culturally Competent Integrated Behavioral Healthcare using the 5A s 5) Arrange Specify plans for follow-up (visits, phone calls, reminders) 1) Assess Risk factors, behaviors, symptoms, attitudes, preferences Personal Action Plan 2) Advise Specify options for treatment, how symptoms can be decreased, & how functioning & quality of life can be improved 4) Assist Provide information, teach skills, and help problem-solve barriers to reach goals 1. List goals in behavioral terms. 2. List strategies to change health behaviors. 3. Specify follow-up plan. 4. Share the plan with the healthcare team. 3) Agree Collaboratively select goals based on patient interest and motivation to change
23 Assess Seek to understand the patient s faith and customs Are there any religious beliefs or spiritual values, traditions, or customs that are important for me to know about so that I can understand your current situation? Hay alguna creencia religiosa, valores espirituales, tradiciones, o costumbres que son importantes que yo sepa para poder entender mejor su situacion actual? A mi me gusta: yo me pregunto si ustedes tienen ciertas creencias o si han utilizado otros servicios antes para este problema o problemas similares. Muchos de mis clientes consultan con sobadores, brujas, o van a que les lean al vela o las cartas. Ustedes usan algo de eso?
24 What would your parents and family usually do when dealing with this issues? Who do they consult with? Que es lo que hacian sus papas y familiares usualmente cuando lidian con estos casos? Con quien consultan? Anxiety little girl case example
25 Advise & Agree Seek to understand what has worked previously for this patient, so that potential solutions come from the patient and work in the context of their life and culture Describe the options for the intervention on the basis of assessment data using language that can be readily understood by the patient (check for understanding) If possible, use a language interpreter if it would enhance communication (ideally bi/multicultural)
26 Arrange Check for the client s understanding of the intervention plan using the teach back method We ve covered a lot today, and I just want to make sure that we re both clear about the plan. Can you tell me, in your own words, what our plan is? Hemos hablado mucho hoy, quiero asegurarme de que ambos estamos bien claros con el plan de accion. Me puede decir, en sus propias palabras, cual es el plan?
27 Assist Assist the patient in addressing any barriers to the intervention plan Is there anything that might make it difficult to carry out the plan? Hay algo que le hara dificil que ponga este plan a prueba? Are there any friends or family members who may not like the changes you plan to make? Hay familiares o amigos a quienes no les gusten los cambios que desea hacer? How will the changes you re planning be perceived by people in your neighborhood, church, or social group? Como seran percibidos estos cambios por la gente en su vecindario, iglesia, o comunidad?
28 The New Curanderismo Blending of the old and new methods of healing Culturally resonant therapy Including traditional healing into our therapeutic sessions: DMH forms! Use them Think about Jungian theory the shadow, all the archetypes Think about Gestalt theory the parts to become whole
29 REMEMBER Keep and open mind Think about the collective unconscious Be respectful and curious Do not be afraid, be honest! They can feel you
30 References 1. U.S. Population Projections: , Pew Research Center U.S. Census Briefs. Overview of Race and Hispanic Origin: U.S. Census Bureau. 3. Satcher, D., Pamies, R.J., & Woelfl, N.L. (2006). Multicultural Medicine and Health Disparities. New York: McGraw Hill. 4. Snowden, L. R. (February, 2003). Bias in Mental Health Assessment and Intervention: Theory and Evidence. Am J Public Health. 93(2): Smedley, B.D., Stith, A.Y, & Nelson, A.R. (Eds.). (2003). Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: National Academies Press. 6. Feldman, M.D., & Christiansen, J.F. (2008). Behavioral Medicine: A Guide for Clinical Practice. (3 rd Ed.). New York: McGraw Hill. 7. Hunter, C.L., Goodie, J.L., Oordt, M.S., & Dobmeyer, A.C. (2009). Integrated Behavioral Health in Primary Care: Step by Step Guidance for Assessment and Intervention. Washington, DC: American Psychological Association. 8. Pew Research Center. U.S. Population Projections: Robertson, P., & Zeh, D. Cross-Cultural Issues in Integrated Care. In Curtis, R., & Christian, E. (Eds.). (2012). Integrated Care: Applying Theory to Practice. New York: Routledge.
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