Cultural Processes in Psychotherapy
Over three decades of multicultural competence research has aimed to identify factors related to disparate outcomes for racial and ethnic minority clients and to increase the quality of and access to mental health services for underrepresented populations. Within this broad area, my specific focus is in the processes through which therapists and clients who come from differing backgrounds (e.g., race, religion, sexual orientation) manage conversations about culture and whether these interactions are associated with treatment outcomes or processes.
- Multicultural Orientation: Our lab works to understand how therapists attend to cultural interactions and processes in therapy. This research has also led to a focus on the concept of “multicultural orientation,” which we define as a ‘way of being’ with the client,” whereas “. . . multicultural competencies can be viewed as a ‘way of doing’ or perhaps how well a therapist engages in and implements her or his multicultural awareness and knowledge while conducting therapy” (pp. 274–275; Owen, Tao, Leach, et al., 2011). Our initial paper in this area proposed a multicultural orientation framework comprised of three interrelated dimensions: (a) cultural humility, defined as a counselor’s tendency to be other-oriented and respectful of diverse perspectives; (b) cultural opportunity, or the degree to which a counselor picks up on and addresses cultural themes in therapy when they arise; and (c) cultural comfort, or the counselor’s level of ease in engaging in discussions of culture and identity. We have been particularly interested in how these dimensions influence client outcomes and session processes. Our most recent work focuses on white client-therapist dyads to examine how multicultural orientation emerges when racial sameness may distract therapists from attending to salient cultural topics.
- Microaggressions: Our lab investigates specific types of cultural exchanges, including the impact of racial and ethnic microaggressions, or subtle everyday exchanges that convey condescending messages to individuals based on their racial or ethnic minority status, on the process and outcome of psychotherapy. A primary aim of this research is to understand how the interpersonal relationship between clients and therapists influence cultural interactions during counseling sessions. Currently, we have been particularly interested in how individuals detect and make attributions about these types of cultural interactions. To this end, we are utilizing innovative video based studies to test both content-based responses to varying multiculturally focused vignettes as well as reaction times.
Cultural Identity Development
A major strand of my research pertains to the examination of the academic trajectory for racial-ethnic minorities in elementary school through college and for girls and women who pursue science, technology, engineering and math (STEM) education. Each of the following projects described below are designed to identify as well as confront psychological and contextual barriers to students’ educational experiences and improve their academic opportunities. Ultimately, my work is influenced by a belief that educational disparities stem from systemic inequity, which affect the way individuals understand who they can become and, in turn, what is expected of them. Thus, it is paramount that psychologists, counselors, and educators understand how these processes occur and commit to developing “social vaccinations” for children to help them develop immunity from infectious agents (e.g., racism, sexism) of social inequities.
We Are Rose Park. There is a growing body of research showing links between educational disparities among Students of Color and racial-ethnic identity development. Broadly defined, racial-ethnic identity development pertains to the processes through which individuals understand, affiliate with, and integrate her or his racial or ethnic group(s) as well as their perceived sense of acceptance by other racial and ethnic groups. Past studies with racial minority school-aged children have demonstrated relationships between students’ views of their race and/or ethnicity and several school-related outcomes, including perceived barriers toward education, perceptions of belongingness within the school, degree of trust toward teachers, and academic performance. For the past two years, I have collaborated with Rose Park Elementary School in a project titled, “We Are Rose Park” to examine these relationships and to identify potential school-based interventions, which influence students’ positive identity development and experiences in school. In May 2016, our project culminated in an art showcase, exhibiting numerous pieces of student art, which reflect culture and identity Click on link to view examples: http://education.utah.edu/engagement/rose-park.php
If You Really Knew Me. Through my work in Rose Park, I observed art education as a powerful modality through which psychological constructs, like identity, can be examined. Funding through the Beverley Sorenson Art Education Program supports our team’s collaboration with an art educator at Escalante Elementary School in which Students of Color are the numeric majority. My partner will be designing an eight-week program, If You Really Knew Me, involving students and their parents in an art project focusing on family heritage, culture, and identity. As the researcher, my aim is to examine how parents and children discuss these topics as they create a family piece of art representing their families as well as how the process of culturally relevant art making in a school setting influences their sense of belonging and agency within the school. We have developed topics for parents and their children to discuss prior, during, and following their art making to assess these areas. Further,we will utilize an intersectional framework to illuminate the voices of parents, children, teachers, and relevant stakeholders and demonstrate how identity shows up in the classroom and influences relationships, attitudes and behavior tied to educational experiences.
Bridges to College. To address a more proximal point in the higher education pipeline for traditionally marginalized students, our lab is also involved in research to identify specific factors predicting first generation and racial-ethnic minority students’ academic trajectory after high school. To this end, I am collaborating with the Utah College Advising Corps (UCAC), a college bridge program at the University of Utah created to increase the enrollment of racial-ethnic minority and first-generation college students. Along with UCAC staff, we are interested to learn more about the factors leading to higher enrollment (e.g., meetings with advisors, declaring a major during their first year of college). We are currently analyzing data from the 2010 UCAC cohort, which will provide us with clearer understanding of patterns of enrollment, attendance, and graduation for this population. Direct implications will include suggestions for other U.S. college bridge programs and high schools with a large number of first-generation college students on how to increase interest, enrollment and persistence in higher education.
Racial Health Disparities in Maternal Health
Although so many societal messages paint pregnancy and birth as the most joyous of life events, for many women, “joyous” does not capture the full picture. The behind the scenes conversations between soon-to-be parents are often wrought with questions like, “Will this pregnancy go smoothly?” “Will my future baby be healthy?” “Will I suffer from perinatal or post-partum depression?” For many U.S. racial-ethnic minority women, these questions also include “Will my baby stay alive after birth?” or “Will I survive childbirth?” According to reports by the Centers for Disease Control and Prevention, the rates of pregnancy-related deaths is three times higher for African American, Native American and Alaska Native women than white women (CDC, 2017). African American babies are nearly 2x as likely to be born at a low birthweight (< 5.5 pounds) compared to non-Hispanic White babies. There are number of intraindividual factors that play a role in ensuring the health of a pregnant woman and her newborn, however, according to American College of Obstetricians and Gynecologists, systemic racial bias is a significant source of these maternal health disparities. In a national study with 2,700 women, 33% of Indigenous women, 25% of Latinx women, and 23% of Black women reported one or more types of mistreatment (e.g., verbal abuse, requests ignored, discrimination) by their doctors, nurses or midwives (Reproductive Health, 2017). Physicians may consider these types of negative interpersonal interactions as less critical than mastering specific medical interventions, however, medical educators have long recognized that the patient-provider relationship cannot be overlooked.
Project ARIISE (Addressing Racial Inequities through Interprofessional Simulation and Experiential Learning) is a community-university collaboration, involving the LIFT Simulation Lab (Dr. Susanna Cohen)and the Department of Educational Psychology (Dr. Karen Tao, which aims to improve patient care and clinical empathy by training clinicians and future clinicians to recognize their own implicit and explicit bias and repair relationships through respectful communication and dialogue. Project ARIISE places the patient experience at the center of student learning.