Embracing Uncertainty as a Path to Competence: Cultural Safety, Empathy, and Alterity in Clinical Training

Kirmayer, Laurence J.

doi:10.1007/s11013-013-9314-2

Cited by 58 publications

(62 citation statements)

References 11 publications

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“…Such writing needs to reflect the 'trans' in 'transdisciplinary' -a synthesis of data, analysis, reflection and interpretation across and beyond disciplines (Bammer, 2012). If, as discussed earlier, the researcher's transdisciplinary approach extends to working with community or traditional knowledges (Horlick-Jones & Sime, 2004;Kirmayer, 2013), the writing may also need to speak to these sectors (Giacomini, 2004, p. 181 Make the data visible and argue for the unique or special way in which the data will be used.…”

Section: Towards a Concept Of Transdisciplinary Writingmentioning

confidence: 99%

Where’s the Data? Using Data Convincingly in Transdisciplinary Doctoral Research

Palmer

Fam

Smith

et al. 2018

IJDS

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Aim/PurposeThe aim of this paper is to identify some of the issues in writing a transdisciplinary doctoral thesis and to develop strategies for addressing them, particularly focusing on the presentation of data and data analysis. The paper, based on the authors' own experience, offers guidance to, and invites further comment from, transdisciplinary doctoral candidates, their supervisors and their examiners, as well as the broader field of interdisciplinary and multidisciplinary researchers. BackgroundThe paper uses the authors' experience of writing four very different transdisciplinary doctoral theses to examine the diverse responses received from examiners and what this means for the thesis writing process. The theses and examiners' reports span an array of disciplinary and transdisciplinary epistemologies, ontologies, and world views. Methodology A preliminary review of the examiners' reports revealed a common concern with the definition of 'data' and with 'data analysis'. The examiners' reports were then more formally coded and thematized. These themes were then used to reflect critically on the four theses, within a broad interpretive framework based on the idea of writing 'convincingly', and in light of current literature on the meaning of 'data' and the idea and aims of transdisciplinarity. ContributionThe paper offers specific strategies for doctoral candidates, their supervisors, and examiners in working with the burgeoning number of doctoral research projects that are now taking place in the transdisciplinary space. Using Data Convincingly in Transdisciplinary Research10 Findings Doctoral candidates engaged in transdisciplinary research need to define what they mean by data and make data visible in their research, be creative in their conceptions of data and in how they communicate this to examiners, specify the quality criteria against which they wish their work to be assessed and hold discussions with their supervisors about examiner appointments and briefing, and communicate to examiners the special value of transdisciplinary research and the journey on which it takes the researcher. Our conclusion connects these findings to the development of an emerging concept of transdisciplinary research writing. Recommendations for PractitionersSee below under 'Recommendations for Researchers' (For the purpose of this paper, practitioners are the researchers). Recommendations for ResearchersThe paper makes the following recommendations for transdisciplinary doctoral researchers:• Make the data visible and argue for the unique or special way in which the data will be used • Make clear the quality criteria against which you expect the work to be judged • Be creative and explore the possibilities enabled by a broad interpretation of 'data' • Transdisciplinary research is transformative. Communicate this to your examiner. Impact on SocietyAs more complex and 'wicked' problems in the world are increasingly addressed through transdisciplinary research, it is important that doctoral research in this area be ...

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Section: Towards a Concept Of Transdisciplinary Writingmentioning

confidence: 99%

Where’s the Data? Using Data Convincingly in Transdisciplinary Doctoral Research

Palmer

Fam

Smith

et al. 2018

IJDS

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“…Cultural humility promotes deep cultural reflection because it provides an opportunity to explore fundamental uncertainties, even questioning the paradigm of psychotherapy itself [34]. With humility, psychotherapy itself is understood as one option within a range of possible healing practices.…”

Section: Humilitymentioning

confidence: 99%

Teaching Not-Knowing: Strategies for Cultural Competence in Psychotherapy Supervision

2016

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Effective psychotherapy requires a culturally competent clinician. Cultural competence is broadly understood as the ability to work skillfully across cultures, engaging the perspectives and identities of both clinician and patient [1]. The concept has been moving from the margins to mainstream of psychiatric pedagogy [2,3]. While cultural competence is increasingly seen as a core component of training, it remains challenging to operationalize. Arguably, all psychotherapy is cross-cultural, as even a clinician and a patient from similar sociodemographic backgrounds may have widely differing constructs of mental health, relationships, and indeed of the psychotherapeutic process itself. Clinicians must skillfully navigate these complex cultural issues to achieve the alliance, attunement and collaboration necessary for a positive treatment response [4]. The complexity deepens as trainees, patients, and supervisors bring many different cultural systems into play when engaged with one another in therapeutic and educational experiences. A culturally competent supervisor must provide teaching strategies to help the trainee navigate these intersecting cultural forces.Two approaches to cultural competence dominate the literature, each of which fall short in helping supervisors develop these teaching strategies. In the first approach, rigorous and structured instruments, such as the DSM-V Cultural Formulation Interview or the previous Outline for Cultural Formulation, offer concrete tools but have incurred critiques for being rigid or formulaic when culture is inherently fluid and evolving [5]. In the second approach, theoretical writings on cultural competence present thoughtful critiques of mainstream paradigms and assumptions but offer few strategies for embodying these insights in specific educational techniques. Supervisors are thus left with the predicament of needing to teach their trainees to navigate issues of culture without a clear sense of just how to do so [6,7]. The great challenge of teaching cultural competence is to reconcile the gap between pre-written algorithmic approaches and the clinical positions of openness, curiosity and uncertainty that are the hallmarks of a culturally competent practice. This paper offers a set of supervision strategies that bridge the gap between prescriptive clinical instruments and more theoretical discourses on culture. We have distilled these strategies from a focused review of the education, culture, and psychotherapy literatures to devise a theoretical approach and skill set that educators can implement into practice. We have named our model for teaching cultural competence the "not-knowing stance". Readers familiar with MentalizationBased Therapy will recognize Bateman's description of "notknowing" as one part of a therapist's position [8,9]. This paper draws from this and other literatures to expand the term "not-knowing," defining and operationalizing a core stance required in cross-cultural clinical and teaching spaces. We delineate three primary teaching components of...

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“…In theory culturally competent health care services should benefit patients with diverse cultural assumptions, expectations, and life routines as well as address health disparities (Brach & Fraser, 2000;Smedley, Stith, & Nelson, 2005). Further, there is evidence that locally developed cultural competence training programs are successful in those particular local contexts (Kirmayer, 2013). Cultural competence on the part of practitioners should improve their ability to build rapport (Beach, Saha, & Cooper, 2006) and positive rapport is associated with better patient adherence to medication (Zolnierek & Dimatteo, 2009).…”

mentioning

confidence: 99%

“…When people's everyday concerns, routines, resources, and abilities are not taken into account in developing explicit or tacit expectations (of treatment compliance, of behavioral changes, of improved functioning), outcomes may not be optimal. Tacit scripts and expectations drive everyday routines for families and for clinics alike (Kirmayer, 2013), as well as the wellbeing of people struggling with life's challenges such as poverty, disabilities, mental illness, infectious diseases, or chronic diseases. During a 3-year mixed methods research project with rheumatology and neurology physicians and their patients, these kinds of implicit cultural issues emerged as important to patient experience both inside and outside of the clinic.…”

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confidence: 99%

Practice to research: Integrating evidence-based practices with culture and context

Weisner

Hay

2014

Transcult Psychiatry

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There are ways to integrate culturally competent services (CCS) and evidence-based practices (EBP) which can improve the experiences of patients and their families and communities when faced with health problems, as well as the effectiveness and positive experiences of practitioners. CCS and EBP evidence should be jointly deployed for helping patients and clinicians. Partnership research models are useful for achieving the integration of CCS and EBP, since they involve close observation of and participation by clinicians and practitioners in the research process, and often use integrated qualitative and quantitative mixed methods. We illustrate this with 3 examples of work that can help integrate CCS and EBP: ongoing collection of information from patients, clinicians and staff, or "evidence farming"; close study and continuous improvement of activities and accommodations; and use of evidence of tacit, implicit cultural scripts and norms, such as being "productive," as well as explicit scripts. From a research practice point of view, collaborative partnerships will likely produce research with culture and context bracketed in, and will contribute stronger research models, methods, and units of analysis.

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Embracing Uncertainty as a Path to Competence: Cultural Safety, Empathy, and Alterity in Clinical Training

Cited by 58 publications

References 11 publications

Where’s the Data? Using Data Convincingly in Transdisciplinary Doctoral Research

Where’s the Data? Using Data Convincingly in Transdisciplinary Doctoral Research

Teaching Not-Knowing: Strategies for Cultural Competence in Psychotherapy Supervision

Practice to research: Integrating evidence-based practices with culture and context

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