Episode 20
Monique Toohey - Cultural Intelligence for Mental Health Professionals
In this episode Trisha interviews Monique Toohey a Psychologist who is also a certified CQ Facilitator. Monique shares her story of shifting in her awareness of culture and in her beliefs and experiences from being a part of the dominant culture to being a part of both the dominant and a minority culture. These experiences prepared Monique to approach mental health with clients from many different backgrounds with curiosity and deep caring about the people she is working with. The challenges for mental health professionals in a multicultural community are raised with both acknowledging the need for cultural intelligence in the profession. There is also an interesting discussion on the difference between cultural safety and cultural intelligence and the confusion that is sometimes created when people think of cultural safety.
Please connect with Monique on LinkedIn and sign up for her free webinar on Cultural Intelligence in Mental Health Care and / or go deeper with her 2 Day training course.
Transcript
I would like to acknowledge the Tharawal people, the Aboriginal people of Australia, whose country I live and work on. I would like to pay my respects to their elders, past, present, and emerging and thank them for sharing their cultural knowledge and awareness with us.
Trisha:Hi there everyone. I'm Trisha Carter, an organizational psychologist and explorer of cultural intelligence. I'm on a quest to discover what enables us to see things from different perspectives, especially different cultural perspectives. And why sometimes it's easier than others to experience those moments of awareness. The shifts in thinking. And for those of you who've listened to some of the earlier episodes, you'll be aware that Cultural Intelligence CQ the capability to be effective in situations of diversity is made up of four areas.
Trisha:There's motivational, there's knowledge, there's metacognitive, and there's behavioural. And there's a strong evidence base that tells us that CQ helps us operate effectively with people who are different to us. And in this podcast, we're focusing more on the metacognitive aspect, thinking about our thinking. And today we want to think about the cultural intelligence that mental health professionals need, the ability to work effectively with people from different backgrounds, cultures and identities as they seek help with their mental health and well-being, which is so important.
Trisha:I first met my guest today when we worked on a committee together as part of the Australian Psychologist Society, and we were focusing on psychology and culture, and we were working to increase the cultural capability of psychologists across Australia. And we even had the pleasure and privilege to present together at an Australian conference. and also a Monique is also a certified CQ facilitator as well.
Trisha:So, this is something that Monique has had on her heart for many years. So Monique welcome. And please tell us something about you and why you are on a quest to help people increase their cultural intelligence.
Monique:Thanks, Trisha. Thank you so much for having me on your awesome podcast. This is such a privilege for me and lovely to see you after such a long time. Of not, I've not really communicating with you, except in the online world. And again, I wish I was right next to you. I love the idea of the CQ quest or a cultural intelligence quest, and, that's a really interesting question, as in why I'm so motivated about this, but I think the answers lie in my personal background and parts of my own identity journey, and that's sort of continuing to change and evolve as I get older.
Monique:And really starting from when I was quite young, I think. And, and I think it actually comes from a very deep place of or a value point of social justice. So I think that the manifestation and development of cultural intelligence in people as a relationship skill, I see it as a really fundamental relationship, a skill that in previous generations perhaps we didn't need to rely on as much as what we do need to on now in a globalized context where we've got such interactions with people who are not like us and who may say and experience the world in a different, different way to us.
Monique:Actually, I know it pushes me as a social justice, issue, really. And and the curiosity about difference and I gre up in a really multicultural, space in, in a place called the City of Greater Dandenong in Melbourne and, and a lot of my cultural context that I grew up in was very multicultural. That's, that's sort of that's, that's a frame of reference that I'm coming from as I curiously explore who people are deep down and in a mental health context.
Monique:that same curiosity is actually really required when you're having people in, in a counselling context or in a broader mental health context to understand who people are deep down, not just their not just their feelings and their thoughts, but who people are and what makes people who they are.
Trisha:Yeah. You can't just see people as a diagnosis as that stands across, you know numerous different cultures. It's completely different in different situations. Yeah.
Monique:Yeah that's right.
::Trisha
So Monique. I know we're coming from a position of commonality and lots of real interest, but I'm going to take you to the questions that we ask all our guests. So what is a culture other than the culture that you grew up in, that you have learned to love and appreciate?
Monique:I love this question. It's it's actually quite provocative. Trisha. Good for you. okay. We'll have to go back to go forward. I grew up in the 1970s and 80s as a kid in primary school, in a very traditional two parent two kid two pet household, and Anglo-Australian household. I'm six generation Australian with a lot of UK and Irish ancestry on both sides.
Monique:I was baptized Catholic at the insistence of a very religious paternal grandmother her name was a Nana Too as in Nana Toohey but Nana Too she was referenced as Both of my parents actually aren't too religious. I mean, Dad’s experience at Catholic boarding schools as a child wasn't so awesome and all the way, but continues to identify nominally as Catholic.
Monique:Mum's religious background is Protestant, but has never really identified as such. And she's over the years, her religious identity, I think, has changed from atheist, if you call that a religious identity, the lack thereof, or agnostic. but her adherence to religious holidays is, more related to Australian cultural scripts rather than any affiliation to religion. Now, despite growing up in a really multicultural background, as I mentioned before, I was actually very colour and culture blind.
Monique:I was it probably wasn't until my teens that I started to really be able to see culture more clearly. I had friends from a lot of culturally diverse backgrounds, but I started to say it through the prism of racism and also some intergroup conflict. You know, within the school of certain groups, you know, disagreeing with each other.
Monique:But I really had zero socio political context for any, as you know, I wanted the standing of where people come from and why. I had no family members overseas, so very, very Australian centric, and didn't travel overseas until my 20s. But I was clear on one thing. All right through my these particularly in my latter teenage years, which are which I'll come to discuss in a minute, but I very clearly thought, Trisha, we Aussies don't have culture and it's just other people that do.
Monique:Yep. I remember having that conversation with my mum. She's like, what do you mean? And I'm like, not, we don't have it like they were invisible. But I later learned to dissect that psychologically. I can tell you the privilege that comes in being a member of a majority group is invisibility.
Trisha:Yeah.
Monique:And invisibility in a modern Australian cultural context occurs when whiteness is all around you on TV, in the media, parliament, in schools, through some university courses and in many workplaces. in my families, you know, my family of origins, friendship circles were predominantly white. So it's not surprising that I had such a view. and invisibility, you know, dominates the landscape for some of us.
Monique:invisibility also occurs when I grow up in a space where I didn't have to leave my house and have to justify my background, so I never got asked where I was from. I never worried if I was the token anything in any room. Maybe I was the woman in a room, but, I never had to worry about discrimination.
Monique:I didn't have to work harder to try and prove myself and prove how excellent and worthy my existence is. Or to hold up on the shoulders the status and reputation of an entire group, or a non non-dominant group. and certainly never have I had to justify the loyalty, goodness and humanity of the group to which I identify with.
Monique:And God forbid, any member of that group behave in an un-Australian way, or even having to have your.
Trisha:A wonderful phrase.
Monique:Yeah, yeah. And your identity denied being called un-Australian. no matter how Australian one actually behaves. so I then started to, I guess wake up culturally as I got older, particularly when I went to university or studying psychology, but again, in a really predominantly white and Catholic environment, going to the Australian Catholic University. But at this time I also was dating, a man who was born in Australia, but his parents were from Bosnia.
Monique:And this is also about the time of sort of the, the, the war that was breaking out in Bosnia as well. And, but at the time I had he asked me on our first date, he asked me what religion I thought he was. And I'm going through all of them; Buddhist, Hindu, dun, dun, the you know, I've gone through all of them.
Monique:And he was Muslim and followed Islam. And I had a no reference point. I didn't even articulate it as if I had it., I'd heard of it. But, and so when he said, well, actually I’m the one that you didn't get and and I had no intellectual, emotional or stereotypic reference point for Muslims at this time, I'm like, okay, I and and he was pretty passionate about that.
Monique:And, I actually had very little reference point for being Catholic as much, almost as much as being Muslim. I hadn’t grown up in a really strict Catholic household or church care. So during that first year, when I was compelled to be studying Catholicism, I started to get a sense of how people were different, religiously and culturally.
Monique:And after about a year, Trisha, of sort of studying comparing faiths, I felt really comfortable and actually embraced Islam and became Muslim and within about a month I wore I wore the hijab. So the scarf that Muslim women wear, as you probably say everywhere and entered second year of psychology very visibly Muslim. This was a big shift.
Monique:The reactions of other people were immediate and very, Trisha, from being neutral like you doo you?To being, explicitly racist and and for the next 30 years, that's how old I am. I describe holding over a bicultural identity, which I'd never done before, both holding the majority status as a white Anglo Celtic woman, but also minority status as a visible Muslim woman.
Monique:And I have experienced both white privilege and religious discrimination in the same day. Yeah, I've been othered by white Australians and by Muslims. and I've also experienced being loved and respected, respected and embraced by both Australians and Muslims.
Trisha:Yes, yes.
Monique:So as you, as I've walked through the world for the last 30 years, my identity, you know, is very has very much come to the fore, but it's my love to it from a psychologist, you know, and from a psychological understanding. Tried to unpack probably my own lived experience and the experience of other people who are less privileged.
Monique:and within a mental health context, understand fundamentally the different role that identity and cultural scripts play, not only in making someone who they are, but influencing people's beliefs, their emotional expression, the resources that they rely on to recover from not being, well, and, and to make them fundamentally who they are and, and also culturally influence strengths, which I think we don't often reference.
Monique:We know one's attributes about who you know, what makes people who they are as more individualist, more personal characteristics. And I think culture plays a really big part in influencing, the development of characteristics, universally. And it's something that's barely acknowledged, but it's something very powerful to draw on in counselling and mental health settings. that's all the things that I love.
Monique:When you said, what did I, what I, I come to love, I think I've got a bit of a weird inanswer So I think I've come to love Muslim culture, that Muslim culture isn't just one thing, you know, there's such a huge you know, it's know this community. I think it's the outside, you know, it's just like, you know, it's like Australians don't want one thing and it's really hard to pin down what it means to be an Australian in the very same way.
Monique:It's very hard to pin down what it means to be Muslim. and very much depending on things like your history and, and, and practice and how you see the world, you know, things vary. So I think almost like what I love about Muslim cultures is something very similar to what I love about being Australian in it. You know, our asset is our diversity.
Trisha:Yeah. That's a wonderful way of thinking about it. I was thinking of different Muslim people I know and thinking how very different they are when you said it, because certainly. But it's the same. I mean, you wouldn't say that. You know, all representatives of the Christian faith are similar, and it's crazy that we even think that of Muslim people.
Trisha:Yeah, yeah.
Monique:We think we think it because we're all susceptible to things like bias and yes, and our brains being lazy, you know, so, you know, we fundamentally have the same, you know, bias. And so some of that in-group out-group dynamic now is at play, no matter where you are in the world. And no matter which part of which group you are in at the time.
Monique:So the same type of psychological dynamic is, is at play. And I actually love unpacking that. I love saying,, why do we just fall into, you know, some, some cognitive traps or biases, like what, What leads us to fall into those traps where we don't see what is right in front of us and unpacking and bringing that to light like the word group entitativity.
Monique:It's an awesome word. No one can barely say it.
Trisha:Yes, it's.
Monique:Entitativity, which is that group over there? They're all the same. You, you know, and and you know, as in, we're normal with that group even though we're complete individuals in our grouping. But the group over there, they're all the same. And in fact, I can almost communicate to each other like they've got a planning intention, you know, just, yeah, feel even more fearful.
Monique:And I just I'm really like, yeah. So where is that a thing? Yes, of course that's a thing because you all fall into it, you know. Yes.
Trisha:Would that life was very easy, for all of us. So I'm wondering within all this, if you can tell me about a time when you experienced a really perhaps significant shift. This sounds like there've been so many in that period. but, you know, when did you. And maybe it's that situation you just spoke about that you suddenly became aware of a new perspective, or is there a different one that you wanted to share?
Monique:Honestly, Trisha, I have many. but I'm actually going to share one from when I was 12 years old. I believe you. You have you have certain memories of your childhood for different reasons. This one was because in this moment I remember being humiliated. So as a 12 year old it was probably quite traumatic, a traumatic for me to remember.
Monique:And I'm going to caveat trauma. And it was, it was teenage trauma. So it was like.
Trisha:I'm with you.
Monique:Dramatic is probably the better word here. Not trauma. I was in year seven. It was after school. I was at my friend's house. It was 1998. The context. Context is very important.
Trisha:Yes.
Monique:And I was with a group of friends and we were listening to a lot of UK pop groups because they dominated the charts at the time that I was growing up. So Bros. Rick Astley. Eurythmics. Just for context. Right. Context.
Trisha:Yeah, I'm with you right now.
Monique:Our I clearly remember holding a position in a debate about the racial background of one of the members of one of these groups, and I clearly debated the position that because one of the members was a person of colour, that they couldn't possibly be British, they had to be from somewhere else because in the UK it was you, that you had to be white was my frame of reference. Now, as my friends laughed at my ignorance and told me how wrong I was, and that people could be born in a particular country and not be white.
Monique:Okay, much to my surprise, and I do cringe about it. I cringe about this conversation every time I think about it, Um, a very big shift occurred that one that's in that Britain. As much as I was exposed. It makes me think very much now, what was I exposed to that led me to the position that a particular country, you know, that is in or national could only be ascribed to white people.
Monique:So I think, okay, innocent 12 year old doesn't know any better. But what was going on in my social context, what was lacking in my social context at the time that led me, the 12 year old, to think and assert that position. Okay, so I think about it going, was it what I was exposed to, you know, in terms of.
Trisha:Was it media?
::Monique
Was it, you know.
Trisha:Did your parents watch Coronation Street?
Monique:I, I think they might have, you know, like I said, interesting lack of diversity, the lack of conversations about things going on in the world at at the time, obviously I had no I had no family overseas. My parents hadn't travelled overseas. They still haven't travelled overseas, they’re very much Australian based and and just no reference point at that time that challenged that assumption.
Monique:Now obviously as a cultural intelligence facilitator, I go, oh, that that's that's cringeworthy now by comparison.
Trisha:But you were 12 yeah.
Monique:Not criticism. Just looking back to understand that it isn't that far ago. Not long ago. For people who are in my particular cohort, I'm born in 1975. to think that we grew up with certain assumptions, that was like being totally blown out of the water that some people hold those assumptions or hold similar assumptions. That fundamentally don't reflect the world that we live in.
Monique:So whether it's lack of exposure, lack of experience, lack of connection in that we our assumptions go unchallenged until we don't don't. And being able to put yourself in different circles. So those assumptions are challenged. yeah. But by comparison, Trisha, I look at my daughter, so I know there's a fundamental generational shift with the advent of things like social media and the internet making it very possible for all, all of our kids to meet and talk to anyone from overseas within.
Monique:A click or a swipe. And by by comparison to my very worldly and emotionally culturally intelligent 12 year old daughter who I have right now.
Trisha:Yeah.
Monique:The other day she was in the back of my car with her friend. I was driving them to school, and my daughter asked me to turn the radio off, and I and and it was of a group that I thought she liked. And I said. And she said, well, because we're boycotting listening to this K-pop K-pop group because of how badly they management are treating them well.
Trisha:Wow.
Monique:Yeah! And I'm like, okay, respect and I turn the radio off. so this this understanding, you know, like I said, who her interests are are not UK pop group bands. Yeah. Korean girl and boy pop group bands, you know, and Japanese anime and Japanese. You know, groups and and the whole world has been opened up to her. As, as has fostered her love of different cultural groups and exploration and her own emerging identity, which is so fascinating to watch.
Monique:So as I recount my little story of a very monocultural story to go, it is reflective of the time that I grew up in.
Trisha:Absolutely.
Monique:Her story, reflective of the time she is growing up in. But this is really important for leaders who are in a particular age group, perhaps to understand why we do still hold certain biases and assumptions about the world that we live in, and groups of people within the world and the younger generations are absolutely not holding those same assumptions.
Trisha:And thank goodness for that. I can, I can see the differences, in my children, who are probably the generation above your child and and they seem vast to me. So the next one down is even more. I was suddenly reflecting today because something came across my feed, about, climbing Mount Everest. And so if you'd asked me, as a 12 year old who was the first person who climbed Mount Everest, I would have told you, Sir Edmund Hillary and I would not have mentioned Tenzing Norgay.
Trisha:But it was a partnership. It was a pair of people who first climbed to Mount Everest, and the two of them, you know, but for so long, history was described to us through the eyes of the white person who was more important than a person of colour, who was with them.
Monique:This is so coincidental that you raised this, because today I administered an adult intelligence test, the WAIS. And on that test is the question, Who is Edmund Hillary? Yes it is. And to get a correct answer, you need to say that he was the first person, that the.
Trisha:First person you can say he was.
Monique:Well, you could say he was a person that climbed. But the accurate answer is the first person according to the WAIS.
Trisha:Wow.
Monique:Which is incredibly biased and which actually physically inaccurate excludes any anyone from and from from the country of origin who climbed Everest first and I almost because I know that answer, I almost caveat it now, truthfully, no one knows who he is except that he's on a $100 bill, you know. Oh, and even then.
Trisha:Well, a most I think most New Zealanders would know him, but Australians might not be expected to. But yes, he's a bit of a hero in New Zealand. But, he was. Yeah. Anyway, a bit of a side story. So yeah, we won't go down that track, but yeah, it's that. I can't believe that's in the WAIS
Trisha:Wow okay. So then as a psychologist, thinking about the shifts that in your role as a psychologist, you have gone through to be, to be the mental health professional you are today. You know, I can just I mean, your story so far sort of answers that question because you you're telling us everything that you have learned that enables us to enables you to be a culturally intelligent mental health professional, which so many people may not be.
Trisha:Yeah.
Monique:I think one of those fundamental shifts was also when I became Muslim, I realized very quickly how the limited access that many Muslims had to mental health care. I was only one of three psychologists within the Melbourne Muslim community at the time. So I think this was around the early 2000s and and just and only and there was no I think there was only one person working in private practice and, and were located within other organizations.
Monique:So zero choice for a community to seek out psychological services, with someone who they might believe would understand them based on things like religious or cultural belief systems and lived experience and, and just of the really, really, low levels of mental health literacy, very high levels of stigma. around mental health care. And I have to say that over 25 to 30 years, it has been a significant shift.
Monique:I think that there's lots of, young people who have gone into the profession, psychology and have come through as psychologists. And I think that what I give that that's a big shift to the mental health care system, because if you want to go fundamentally, one of the main purposes of seeking out a psychologist or a counsellor is to feel understood.
Monique:Most people want to say, I would like to be understood, and what do they mean by that? They would like to be respected, that would want to be not judged. they want things to be obviously kept confidential. So then. And I can say that. Yeah, well, of course they're going to be kept confidential. But that's actually something that people still want because they fear that it won't be because there's a distrust about a service that you don't know nothing about.
Monique:So someone asserts that they want confidentiality to still, because there's some fear and anxiety about what who are you? And will you hold me safely in your care as I tell you things about myself and or things that are going on, you know, within myself in terms of health or familial context, that might be causing distress there. There's just so many things.
Monique:And I think one of the things that I've really when I look back at my career and as something that's coming through the evidence now in terms of who psychologists or mental health practitioners need to be for their clients, is an advocate before they’re a therapist. So advocating for access, advocating for, you know, communities to have access to knowledge about mental health.
Monique:yeah. Yeah. And just availability of services, which is an ongoing issue. and then so coming through and saying your role is not just sitting there in a diagnostic position, probably one of mental health practitioners might think that's the most important thing that we do. And in therapy, working with certain groups, that is the least important thing that you do.
Monique:The most important thing that you do is establish a safe relationship with your client, because that will get you the best treatment outcomes. Right. And when we break down, what does it mean to establish a safe relationship or a trusting therapeutic relationship with our client? Goes more than just being a nice person with a few degrees. Yeah. All well-intentioned.
Monique:So there is there is something around. There's some stats, Trisha, around that 50% of clients from minority backgrounds do not come back into care after the first session.
Trisha:Oh, wow. 50%?
Monique:50% And a lot of clients, I do work and have worked predominantly with the Muslim communities to advocate type of services within school context, but also within community and now private clinic context. and, and one of the most common things that I hear is around experiences of, not being understood, or having some, you know, some negative experiences and then wanting to come in to care with someone who I believe understands them, that they don't have to justify or explain who they are first before they put the problem on the table.
Monique:But I want someone to say the problem on the table in reference to who they are, not just the problem on the table as viewed through the eyes of a therapist who isn't like them.
Trisha:Yeah.
Monique:Yeah, yeah. Well, not having to justify the client this morning and he, he knows I’m Muslim. I've been counselling for a very long time, but every now and again he still feels and he goes, Monique, we say Alhamdulillah when we're thankful. Alhamdulillah is an Arabic word meaning like praise be to God. Thanks be to God.
Monique:Like thank God, you know. So he's saying, and I said, you sound very optimistic today, Hey goes – Yes Alhamdulillah. We say it and a like I know you say it, I say it too. But I so it struck me that is he said that I'm like if you were a non-Muslim counsellor, he might well feel that he has to explain what that word means.
Monique:He might not say that word at all.
Trisha:He might have just. Yeah. Not not taken that position.
Monique:Yeah. So the client, I always say to therapists as I because I offer mental health, you know, training in particular to help people to be a bit more culturally responsive, albeit culturally intelligent, to say, who do you, the therapist, need to be? So your client brings their whole self into the room. Who do you need to be?
Monique:And I think the answer is confident and confident to ask things around culture and religion and belief systems and non-dominant norms or family structures, and to feel and to hold that safely and close to beyond, without judgment, because someone could sit there and receive information that is outside their lived experience and just nod their head and think to themselves, where do I go with this?
Monique:Should I go over there, or I don't want to offend if I say something wrong and then not engage with the content, that's been handed to you.
Trisha:So that is confidence. I think there's an element of curiosity there as well, isn't there? So that element of, you know, first of all, being willing to explore it and to consider that it might even be different. So remember back to your younger self who was, as you described it, culturally blind. and people say that thinking it's a good thing.
Trisha:And I know you were saying it thinking it was a negative thing. And so, you know, I remember back to that presentation that we did to that psych conference, and we were talking about how some people show up in completely different ways with their mental health that they might want to speak first about a stomach-ache. And, you know, so a lot of psychologists will go well why aren’t you at the GP, for crying out loud, you know, so, if we if people you were saying what, how do you need to be I think you need to be curious.
Trisha:I think, yes, you do need to be confident. And it's interesting. There's , as I've asked people about the shifts they've made, there's often been a significant other as a part of the shift, and often there's been an element of that significant other that has created trust. You know, it might be a loved one, it might be somebody that trusted.
Trisha:It might be somebody that they considered the possibility, the different way of thinking because of who that person was. And so I think you're absolutely right that getting people to think about how do you need to show up to create this safe space for your clients - It's really important. Yeah.
Monique:Fundamentally, one of the things that's very lacking across the mental health service sector is is ways to get information about culture. even there's a lot of things that are lacking on people's intake form. So even from that first engagement with the client sometimes, intake forms are not asking what a client's cultural background is, what languages are spoken, what their faith background is.
Monique:It could just but what usually is country of birth and that's it. The country of birth is so limiting a question because people identify different culturally. So my husband, for example, is Australian born. But if you asked him what he identifies as ethnically, he would say Turkish. His parents are not born in Turkey, they're born in Greece, but they're born as part of a Turkish minority group in Western Thrace, called Western Thrace.
Monique:And. So, you know, even to say it, my daughter says, so are we Greek? And I said, no, but my but my grandparents are born in Greece. Yes they are, but I don't know if identify as Greek that identify as Turkish. Why do they identify as Turkish? Yes, I speak both Greek and Turkish, but they identify as part of a Turkish minority group in Greece.
Monique:So that's how complex ethnicity and culture are. And to go back because if, for example, someone wrote I was born in Greece, but they have all these other identifiers and then that's a misnomer for where you need to go in therapy or how you'd start hypothesizing so and so there's no. And it's to see that that's what the intake form is.
Monique:It isn't just around the collection of data that's as ambiguous or unimportant as, you know, someone's age. Like all of these are cultural influence. Age is important. Culture is important. Gender, sexual identity is important. Like a whole lot of things make someone who they are.
Trisha:And one of the things we say, you know, when we're teaching cultural intelligence is that you don't have to know every single thing about every single culture. And, you know, I'm I wouldn't want mental health professionals to think that they had to or they needed to just limit themselves to dealing with the people who are specifically like them.
Trisha:but at the same time, I think if they have that confidence and curiosity, then they should be able to approach people and create an environment of safety. there are so many other questions I want to ask, and I realize we're coming close to the to the timing aspect. I wonder if we could think about safety for a minute and think about a phrase that's often used as cultural safety and just think, what does that mean to you?
Trisha:and how does it you know, influence what you're doing?
Monique:Yeah. Great question. I think what cultural safety ultimately looks like is my clients come back after the first session.
Trisha:Exactly. Yes.
Monique:That's what it looks like, as in clients coming back for a second or third or a sixth or a, you know, a times more than that session that they, visibly look like they're improving, you know, the treatment outcomes, that they are coming back, but also that they are, sharing information about who they are. so you might be able to get someone presents with anxiety, for example, which is like the common cold of a presentation for healthcare.
Monique:You could identify that and, and say, okay, well, I've told them how to do some abdominal breathing, and we've looked at a lifestyle and well-being plan for them. And, and, and we've done some psychoeducation about what anxiety is. And I've delivered cognitive behavioural therapy as a way, you know, they might have started doing some mood monitoring or recording thoughts.
Monique:And I've taught them about reframing their thoughts. and, and maybe I've told them to go and exercise. Yeah. or and to, you know, regulate their, their sleep patterns. So it's a pretty stock standard strategies given there. Okay. Have I asked them around. what are they culturally influenced strengths that will help them to manage this anxiety?
Monique:Have I asked them, are there any spiritual strategies that you draw on that you feel calm and relaxed? Have I explored the role of their family, and how the family context might be either either exacerbating.
Trisha:Adding to it, yes.
Monique:And leading them to feel anxious or soothing? and a part of their strongest social support resource, particularly from in if a client's from a collectivist community, which I need to ask. so there's a whole lot of questions, that I think if you don't, if you don't feel comfortable talking about culture because growing up in a family like I had, where you don't talk about religion or culture?
Monique:That is problematic if you, if and that is part of your own cultural baggage, your own identity development, cultural identity development has everything to do with how culture will show up in your counselling room. And I think the other thing that occurs there is this one of two things. When we don't have enough cultural knowledge, we do 1 or 2 things.
Monique:We either minimize it. And that's when we go into, that colourblind type of I don't see culture, I don't see colour. I just see the person, I say the person and their personality traits and the diagnosis I'm about to give them.
Trisha:You did it so well.
Monique:Or, we exaggerate. And we said, oh, so is your culture. Is your culture causing that problem? Is it you being Muslim? Is it your hijab that's causing that problem? Is it the fact that you're oppressed, causing why? And we exaggerate and draw on stereotypes, right. And we and we conflate someone's identity with the cause of the problem, which is, of course, a therapeutic mistake to do that. Do not ever.
Monique:But we do because we think that we use we're misusing conflated cultural knowledge. But we do need to find ways. And there are ways. A cultural formulation interview. It just very basic information on an intake form that you can explore gently. The introduction to say that you're actually really curious about who someone is. Can you tell me a little bit about yourself as an introduction question and see where the conversation goes from from there?
Monique:That question in itself. Tell me a little bit about yourself. It is a lovely, open ended question that is very different to where are you from? It is, it is it allows a client to vary, you know, to reveal what they're comfortable revealing and and to say how curious and, interested you are to know who the whole person is and that actually you have an interest in the cultural background.
Monique:What is it? Tell me what it is. I need a reference point. Rather than using the client as your encyclopedia for their cultural background. But if you have no reference point for it, you do not use their session to educate you. You go off and do some research as a reference point. So it helps our hypothesizing, our interpreting of certain things.
Monique:And when when a psychologist or therapist is put in a position to interpret what we're hearing, we our powerful position influences us to make decisions about where treatment needs to go based what we're hearing. We're hearing and seeing a person in their context because we've done enough to draw out who they are. We will hopefully head them in the direction of a better treatment outcome.
Monique:If we don't, they probably won't come back. Because we've missed it. It isn't just about the anxiety or the somatic symptoms that are presenting. It is about something that's happening in their social context, or it is something that's happening in the broader global political context. And influencing their identity like Islamophobia or racism or any other phobias.
Trisha:So one of the things that, you know, people talking about social safety is I often think people might get confused when we speak about cultural intelligence. So how do you see cultural safety relating to cultural intelligence?
Monique:I say cultural intelligence as a conduit to achieve cultural safety. I position, cultural safety is the outcome. Similar to what I mentioned before, we want our clients to come back to us so that they can continue treatment because very rare things are solvdd in one session or one meeting. So we want so we want cultural safety.
Monique:Sorry. We want to activate the skills related to the cultural intelligence model. So if we break that down just quickly we want to start to increase our own motivation and curiosity, but also a confidence to be delving into the cultural worlds of our clients. We thought we want to have enough cultural information. Well, first of all, we need to ask the right questions to draw that out from our clients.
Monique:Yeah. And and to use our own background research on different cultures or faiths or understanding, you know, different nuances or cultural values, as a really big factor to help to understand our clients better and to use that information to plan for what we want to occur in treatment. Okay. And then from a cultural strategy point of view, we want to continuously, through that engagement process, review not only our own biases, but we want to review and adapt our our style.
Monique:It could be a communication style or it could be, some of the activities that we're getting clients to do, you know, within session or for homework activities and to review them through the prism of culture, not just through the through the prism of, therapeutic effectiveness, or to see clients as resistant when really where the one doing something that in our clients into into a not safe space and then to activate.
Monique:So to actually the action certain things when we're in therapy with them. And that could be things like the way that we're communicating. One of the most obvious examples of this is when we, particularly if we are from an, you know, an Anglo Celtic background or you just know yourself that you're quite a direct speaker. So we're like, hi, how are you, Trisha?
Monique:Tell me, tell me, what are you here for today?
Trisha:Yes.
Monique:What can I do for you?
Trisha:Okay. I'm cringing.
Monique:Right, right. So. And I haven't done anything to soften that by saying, Trisha, how are you today? How is your morning? You know, how's how's things going? Tell me a little bit about yourself. And really soften and start to, in a very circular way, warm up our clients to the fact that they're in this really foreign room.
Monique:Talking to a stranger about their inner most world and just. And you can see this way clients, you know, particularly in a certain clients when there's, they're learning to trust, you know, only tell you that most important thing two minutes before they need to leave.
Trisha:Right? Yeah, yeah, yeah.
Monique:Because they've gone back and forth, back and forth and you, the clinician are thinking, where are they going? I don't even know what the problem is here. If because the client is presumably going around the bush and you, you're thinking this vagueness is like what's happening here? Have I missed something or you're trying as a clinician, you're trying to grab on to something and trying to fill up some imaginary diagnostic criteria in your head to the client's giving you very little except.
Trisha:In a in a workplace situation. At this point, I'm going when are you going to get to the point? What is the issue that you yeah. So yes, I'm with you.
Monique:That's right. Or you've been so direct that they won't come back because it's too confronting for them as opposed to go in softer and ask questions around the issue and allow the client to dictate the pace. So there's lots of things that we want clients ultimately to come back, but there's also a thing in with in terms of, I guess, cultural safety, where as a learner of that, that our own cultural safety can't always be guaranteeing that we need to be sitting on the rim of our culturally, of our cultural comforts, on which is the cultural courage zone, if you like, and to be awake to what might be going on in the room, even
Monique:if it's making you feel a slight amount of discomfort, clients can, depending on other things like trauma, background and lived experience. Can weather parts of your own storm. We can come back, and I think one of the things that I tell people, clinicians and other practitioners who are trying to lift their own cultural intelligence, perfection is not required.
Monique:Sometimes repair is. So sometimes we do cross. We do cross, you know, our cultural empathy with our clients or our personal, you know, that type. If we say something that maybe was clumsy, and we can do a U-turn on that at any time, as long as that you can acknowledge and try and listen out for.
Monique:So I'll have clients and I might make an assumption and the client will go, no, no, no, that's that's not accurate. And I go, excellent. I'm so glad that you told me that. I'm so glad. And I reassure them, that they can be the person to tell me that Monique get on the other side of the line. And I'm I'm really happy for it.
Monique:And I look out for so that I can u-turn my interpretation or assumption or expectation for the client in some way.
Trisha:Yeah, I love that.
Monique:Because repair repair is part of all good relationships. Sometimes we do have to cross the boundary, but we can maintain a relationship. If you acknowledge that you've crossed something and step back. And make a repair. What? And so I ask more. More. I shift my question to the client, or I ask them for their feedback more often or I ask for clarification. Have I got it right?
Monique:If I heard this properly, if I heard this, it's this what I've heard because, you know, it's still bouncing up against my lived experience encyclopedia. And we can’t all filter information. So we are going to get it wrong. But you focus on the fact that you can repair, and that is a culturally intelligent thing to do.
Trisha:I think that willingness to repair is what helps create the safe environment for people. I find the people that I'm working with in workplaces, when we talk about cultural safety, can confuse safety with comfort, which, as you said before, if you are stepping into the willingness to admit mistakes, willingness to learn and grow, to step out into something when you're not sure of the outcomes, that's anything but feels anything but safe.
Trisha:It feels a stretch. And so, yeah, I think, the, the idea of cultural safety is something we should be creating, especially in clinical settings, especially in medical settings and yes, in a workplace, but not quite to the extent that people need to feel comfortable because there will be discomfort when we're dealing with people who believe things different to us, who operate differently.
Trisha:You know, whether it's around the communication style you describe or around focus on relationships versus task, you know, there's going to be discomfort, there's going to be some friction, there's going to be some frustration. And so I think that whole, expectation of always feeling good is not going to happen. So the safety thing, we need to clarify expectations.
Trisha:And it's a great discussion to have with people. and, and to recognize that you can be valued and appreciated even if you're feeling slightly uncomfortable.
Monique:Well, actually, I think it is part of a CQ. You know, a strategy because in in fact, when we feel difference that can be, felt by the body in different ways. So for some of us, yes, it can be felt as this is awesome. I'm awake. I'm so curious about this difference. And for other people it can feel uncomfortable.
Monique:But it's the best feeling because if one takes that moment to reflect on why they're feeling uncomfortable, it's your body articulating a cultural difference here that you don't understand and don't have a name for. like, go find it like that is that is a lovely part of, you know, being, I guess using that as a reflection piece to say in that session, there was this moment where I had this client and they were, for example, acting in a really dominant way, and that rubbed me up the wrong way.
Monique:I'm not sure how I feel about that, how, you know, how the assertion of that, you know, their power in that moment was rubbing me up the wrong way. Well, what's going on here? And it could in fact be a difference in power distance as a cultural difference. And so if you have no language for it, what your body does and many of us, when we don't have language for something, we just name the differences bad, felt bad, therefore it was bad.
Monique:Or is.
Trisha:Yeah, you.
Monique:and using only our or our cultural reference point to interpret a situation, you know, at times can be, limiting to say the least. Very limiting. You can And dangerous. And you know, I thought that too. so or using it as an absolute opportunity to go. I wonder what that moment was about. For me in the capture session and how it was related to some cross-cultural or intercultural difference going on between myself, therapist and my client.
Trisha:Perfect example of a shift and lots of cues to find the shift. Thank you so much Monique. This has been so rich it's gone a little bit over our normal length, but I think people will find it well worthwhile. Now, what I want to know is how can people connect with you? What have you got coming up that people can learn with you?
Trisha:so, so tell me a little bit of what best what is best for people to connect with you. First of all.
Monique:Thanks for short. people can connect with me on LinkedIn. Just look for my name and some of the upcoming things that I have is I've got a free webinar which will go online as well. So will be recorded if people so that is next Thursday. And on cultural intelligence in mental health care, it's an introductory hour, to really give an overview as to how cultural intelligence the model fits into mental health care and some of the difficulties in, in, in a system that doesn't have it just yet.
Monique:And, and then running a two day, program in June on cultural intelligence in mental health care and it's a level one. So we have two courses and it's over two days. So it's a really comprehensive course, really fleshing out some of the topics that we've discussed here today.
Trisha:All that is brilliant. I'm going to put links to those in the show notes. And if I can't find them, I'll, I'll get back to you and to your LinkedIn profile so that people can follow you because you are active on LinkedIn. And as we said at the beginning, that is where we have kept in touch, even though we haven't seen each other in person.
Trisha:Thank you, everyone for being with us for this, deep and stretching episode. I think there's lots of things that people have gained from this and please don't forget to check in with us next week. So make sure that you push the follow button on your app for your podcast, and so that you will hear the next episode of The Shift.
