Structural Competency as a Framework for Training in Counseling Psychology

Ali, Alisha; Sichel, Corianna E.

doi:10.1177/0011000014550320

Cited by 51 publications

(65 citation statements)

References 28 publications

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“…The approach outlined in this paper suggests that addressing how inequality impairs trust in relationships and generates ambivalent images of self and other is a critical component of culturally competent psychotherapy, with implications beyond the clinical setting. This directs us toward developing a kind of “structural competency,” recognizing how culture and systemic structures form a dialectic that produces inequality—it is not only culture but economic and sociopolitical structures that impact the therapeutic relationship (Ali & Sichel, ; Metzl & Hansen, ). An “extraclinical language” of structure can help us integrate historical, cultural, and economic forces as part of our clinical formulations.…”

Section: Clinical Practices and Summarymentioning

confidence: 99%

Reconsidering culture, attachment, and inequality in the treatment of a Puerto Rican migrant: Toward structural competence in psychotherapy

Gaztambide

2019

J Clin Psychol

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Cultural competence refers to our ability to understand, engage, and treat patients from diverse backgrounds or belief systems different from our own. Although addressing culture and cultural difference as part of diversity is important, it is also critical to consider how systemic and economic forces influence the patient's presenting problem and clinical interactions. Summarizing research on cultural competence, attachment, and inequality, this paper reconsiders diversity considerations by discussing how structural inequities disrupt one's ability to trust others interpersonally and across cultural difference. Psychotherapy from this point of view is a relationship that attempts to address the effects of inequality at an individual level by repairing trust and using that trust to work toward change. To illustrate this perspective, the author presents a case of a Puerto Rican migrant whose developmental and family history was impacted by colonial, racial, cultural, and socioeconomic inequality. K E Y W O R D S cultural competency, cultural humility, inequality, Latinx, psychodynamic psychotherapy, Puerto Rico "Superiority? Inferiority? Why not the quite simple attempt to touch the other, to feel the other, to explain the other to myself? Was my freedom not given to me then in order to build the world of the You?" (Fanon, 1952/2008, p. 181) Frank (Pseudonym): Hi, Doctor… Gaztambide? [He pronounced it: "Gas-tum-bide"] DG: Hi, Frank? Yes, this is Daniel Gaztambide [I pronounced in Spanish: "Da-nielle Gaz-tam-bee-day"], returning your call. Frank: [In Spanish) But doctor… you're Puerto Rican? DG: [In Spanish) Yes, from San Juan. Frank: Ah, [Pause] de area metro./Oh, [Pause] from the metro area. Frank/DG: [Silence].Frank: [In Spanish] En ese caso, Francisco a la orden!/In that case, Francisco, at your service! Upon hearing my name pronounced over the phone with a distinct island-born Puerto Rican accent, there was a shift in "Frank's" tone. The weight of a strange, foreign name gave way to familiarity, inquiring with curiosity and warmth as to whether I was Puerto Rican. When I added I was from San Juan, the capital and center of the Area Metropolitana or "Metropolitan Area," this triggered another shift in Frank. A distance opened up, an "Ah" pregnant with suspicion and contempt. I noted this rapid oscillation in affect as silence punctuated the space between the said and the unsaid. Then, as if something slid out and then back into place, "Frank" became "Francisco," the distance between us morphing into a familiar and almost deferential tone-"at your service!"Once engaged in treatment, I would come to find out that Francisco was born and raised in a small town in what we called la isla-"the island" as shorthand for the Puerto Rican countryside. This would turn out to be an ambivalent appellation, signaling that the capital and broader metropolitan area were somehow separate and distinct from the rest of the island, which existed "out there" beyond the city limits. The metropolitan area served as the economic and po...

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Section: Clinical Practices and Summarymentioning

confidence: 99%

Reconsidering culture, attachment, and inequality in the treatment of a Puerto Rican migrant: Toward structural competence in psychotherapy

Gaztambide

2019

J Clin Psychol

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“…However, the university-based dental hygienists favored Option 2. This option incorporates a greater emphasis on structural competence, [48][49][50] which directs attention to the structural and psychosocial complexities of working with vulnerable populations.…”

Section: Educational Frameworkmentioning

confidence: 99%

Educational Models for the Re‐Establishment of Dental Therapy Education in Canada

Sunell¹,

Wright²,

Udahl

et al. 2019

Journal of Dental Education

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With the closure of the Canadian dental therapy program in Saskatchewan in 2011 and the increasing need for oral health providers, there have been growing discussions at the national and provincial levels regarding the re‐establishment of a provider with dental therapy abilities. The aims of this study were to define models for dental therapy education in Canada and explore how dental therapy abilities could best be integrated into Canadian post‐secondary education. In 2017, purposeful sampling was used to invite key informants to participate in a semi‐structured interview. Participants were individuals from government, education, and regulation and those working with underserved populations in Canada and internationally. A 75% response rate (n=53) was achieved. Thematic analysis was employed for coding of data and generation of themes. Respondents highlighted the need to include minimally invasive restorative services in the current scope of dental hygiene practice across all Canadian jurisdictions and to build dental therapy abilities with or upon accredited dental hygiene curricula. The models supported by respondents were a fourth‐year option built on three‐year diploma education, a one‐year postgraduate diploma based on a baccalaureate degree and a current dental hygiene registration, and a three‐year dental therapy diploma incorporating core courses in accredited dental hygiene diploma education. While the respondents' views were divergent, the educational model that received the most support involved a two‐ to three‐term addition to current three‐year dental hygiene diploma education. In contrast to international trends, the respondents valued learner flexibility to exit with a diploma dental hygiene credential, thus making the dental therapy scope optional. These educational models provide a starting point for further analysis and exploration.

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“…At worst, we were positioned to promote what Teo (2008) describes as epistemological violence because it includes girls in the collection of data but excludes them from the analysis and interpretation of data (Bal & Trainor, 2016). Meanwhile, this process simultaneously runs the risk of reifying the narrative of pathology and constructing legal-system-involved girls as an inferior other (Ali & Sichel, 2014; Spivak, 1988). Why had this not been as evident to us before?…”

Section: Ethical Paradoxesmentioning

confidence: 99%

“…After our consultation with Professor Fine, and our reflection on the critical events where we saw the devaluation of girls and the promotion and internalization of a single story of pathology, it was clear that we had some thinking to do, and that thinking involved the clear articulation of our values as researchers. This entailed reflection on how we engaged in inquiry (Campbell, 2016) and how we could humanize the process by which we generated knowledge (Ali & Sichel, 2014).…”

Section: Getting “Unstuck”mentioning

confidence: 99%

“…How could we disrupt existing structural dynamics that treated girls’ input as unimportant? How would we address the tensions of conducting research in which girls’ roles were primarily as research participants, while simultaneously delivering an intervention with a transformative change-oriented agenda (Ali & Sichel, 2014; Schneider, 2013)? Framed in this way, we re-construed the outcomes of interest in dominant paradigms (e.g., girls’ arrest) as the consequences of formal (e.g., institutional) and informal (e.g., gendered) hierarchies (Ali & Sichel, 2014).…”

Section: Introductionmentioning

confidence: 99%

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Negotiating Ethical Paradoxes in Conducting a Randomized Controlled Trial: Aligning Intervention Science with Participatory Values

Javdani

Singh

Sichel

2017

American J of Comm Psychol

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In this article, we describe ethical tensions we have faced in the context of our work as intervention scientists, where we aim to promote social justice and change systems that impact girls involved in the juvenile legal system. These ethical tensions are, at their core, about resisting collusion with systems of control while simultaneously collaborating with them. Over the course of designing and implementing a randomized controlled trial (RCT) of an ecological advocacy intervention for girls, called ROSES, ethical paradoxes crystalized and prompted us to engage in critical reflection and action toward the aim of moving away from conducting research on legal-system-involved girls and moving toward a more democratic, participatory process of inquiry with girls. Our experience revealed two intertwined paradoxes that ultimately served generative purposes. First, in collaborating with legal system stakeholders, we observed a single story of girls' pathology narrated for girls, without girls, and ultimately internalized by girls. Second, in reflecting critically on the ethical implications of our study design, it became clear that the design was grounded in a medical model of inquiry although the intervention we sought to evaluate was based, in part, on resistance to the medical model. We describe emergent ethical tensions and the solutions we sought, which center on creating counternarratives and counterspaces that leverage, extend, and disrupt our existing RCT. We detail these solutions, focusing on how we restructured our research team to enhance structural competence, shifted the subject of inquiry to include the systems in which youth are embedded, and created new opportunities for former research participants to become co-researchers through formal roles on an advisory board.

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Structural Competency as a Framework for Training in Counseling Psychology

Cited by 51 publications

References 28 publications

Reconsidering culture, attachment, and inequality in the treatment of a Puerto Rican migrant: Toward structural competence in psychotherapy

Reconsidering culture, attachment, and inequality in the treatment of a Puerto Rican migrant: Toward structural competence in psychotherapy

Educational Models for the Re‐Establishment of Dental Therapy Education in Canada

Negotiating Ethical Paradoxes in Conducting a Randomized Controlled Trial: Aligning Intervention Science with Participatory Values

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