Culturally Enhanced Practice
Clinicians working with individuals from different backgrounds, including but not limited to cultural, ethnic, socioeconomic, or sexual orientation, must be aware of the role of cultural competency in working with diverse populations. For instance, a presenting behavior may have different connotations and meaning in the individual’s culture than in the culture of the clinician. Cultural humility does not require clinicians to be experts in every culture, but rather implies that clinicians must be aware of how their own interpretation of symptoms and suicidal behaviors impact the assessment and therapy. Not fully understanding an individual’s views on suicide may result in an insufficient understanding of risk and protective factors; this may exacerbate suicidal thoughts and behaviors rather than lessening symptoms. For example, when a group of American Indian/Alaska Native (AI/AN) youth describe their culture’s concept of suicide, they report that suicide is considered an expression of the tribe’s current and past suffering, not an individual issue. Hence, for the AI/AN population, closeness to the tribe is a protective factor, and including members of the tribe in the intervention yields culturally enhanced treatment.¹
If an individual does not speak English, an interpreter or a language line will be needed. Using a family member, especially a child, to translate should be avoided. The clinician needs to be aware of basic skills in providing therapy through an interpreter, such as asking questions directly of the patient or client, instead of asking the interpreter “ask if she…” or “tell her that.” Therapy with an interpreter impacts the therapeutic encounter, as therapy no longer consists of a dyad but a triad. While being aware of the interpreter’s presence, the clinician should talk to the patient or client, read body language, and show empathy to the patient or client, not the interpreter.²
The Suicide Prevention Resource Center further recommends that mental health professionals and administrators:³
- Understand the cultural/ethnic context of people receiving their services.
- Ensure that the administrative and treatment team include representation of the cultures that they serve.
- Provide information and resources that respectfully address the values, beliefs, culture, ethnicity, and language of all the populations they serve.
- Allow for cultural/ethnic considerations to be communicated, such as preferences regarding personal space, geography, familiarity, as well as words/examples that should be used or avoided.
- Wexler LM, Gone JP. Culturally responsive suicide prevention in indigenous communities: unexamined assumptions and new possibilities. Am J Public Health. 2012;102:5 800-6.
- Hamerdinger S, Karlin B. Therapy using interpreters: Questions on the use of interpreters in therapeutic setting for monolingual therapists. Retrieved from www.mh.alabama.gov.
- Suicide Prevention Resource Center. Culturally competent approaches. Retrieved from Suicide Prevention Resource Center