Limitations of Trainings in Cross-Cultural Competence - The Practitioner Perspective.

INTRODUCTION: Objective: Trainings in cross-cultural competence1 are of increasing importance for psychotherapists in order to provide adequate mental health care for patients with a migration background. Yet, little is known about practitioners´ perspectives on working with migrants. Method: Problem-centered interviews with 30 practitioners offering psychotherapy within the German mental health care system have been analyzed using Grounded Theory Methodology to get an insight into practitioners´ experiences with cross-cultural work. Results: Practitioners have to deal with strong feelings of insecurity in their cross-cultural work. Feelings of insecurity were influenced by practitioners' underlying cultural concepts, how specific they perceived the cross-cultural contact to be and how they saw themselves in their professional role as psychotherapists. Interestingly, the analysis shows that trainings in cross-cultural competence which mainly convey "culture specific" knowledge on a rather theoretical level might even increase practitioners' feelings of insecurity. Conclusions: Conventional teaching formats in cross-cultural competence might not provide psychotherapists with sufficient space to reflect on their insecurities, their "cultural concepts", and their expectations of themselves in their professional role. Therefore, other settings are required. Dealing with practitioners' perceived lack of knowledge in the context of culture could be an effective starting point to deal with cross-cultural insecurities.

[Structural discrimination and racism in hospital care: the role of the economic conditions in intercultural openness]. / Strukturelle Diskriminierung und Rassismus in der Krankenhausversorgung: die Rolle ökonomischer Rahmenbedingungen in der interkulturellen Öffnung.

BACKGROUND: Racism and structural discrimination in German healthcare have been little studied to date, although intercultural openness has been demanded for many years. At the same time, the processes of economization are progressing, especially in hospital care. This study examines current challenges of intercultural openness, including the influence of the economic framework. METHODS: One hundred twelve guided interviews were conducted with hospital employees in Berlin from various professional groups and departments. They were asked about challenges, how they were coping, and ideas for solutions. RESULTS: The consequences of economization are particularly visible in the care of patients with a history of flight or migration. A lack of resources combined with a lack of funding for language mediation leads to overburdening of healthcare workers and the tendency toward culturalization, in which the "culture" of the patients is used to explain their actions, and open racism. The breeding ground for this is the multiple insecurities experienced by staff due to the additional needs of these patients. Culturalization is described as an attempt to cope with their emotional distress in the face of lack of time and staff shortages. First and foremost, the wish for more time and additional staff was voiced. This being granted, further measures to reduce racism and structural discrimination were defined. DISCUSSION: In order to counteract racism and culturalization, measures that focus on the economic framework conditions and institutional change processes are central.

'Genetic loading' or 'evil mind': current conceptions of depression in Myanmar from the perspective of healthcare professionals.

In Myanmar, a country that has just recently opened up to the international community, Buddhist and traditional healing methods are still widely applied to various diseases and conditions. The aim of this study was to ascertain how professionals from the biomedical healthcare system in Myanmar experience interactions with patients with depression, based on the professionals' conceptualisation of this disorder. Six problem-centred interviews were conducted and analysed with grounded theory methodology. The interviewed professionals conceptualised three ways of understanding depression, including different treatment strategies: a biomedical, a contextual and a Buddhist concept of depression. Concerning the patients' perspective, the professionals mentioned somatic, religious and supernatural explanatory models, as well as corresponding help-seeking behaviour. Our results suggest that by taking a biomedical approach, professionals risk neglecting both the needs and resources of Myanmar patients with depressive symptoms.

[Lifelong Learning and Tolerance of Uncertainty - About the Professional Self-Conception of Practitioners in Transcultural Mental Health Care]. / Lebenslanges Lernen und Unsicherheitstoleranz in der transkulturellen Behandlung.

OBJECTIVE: Investigating the relationship between the challenges perceived by practitioners in the transcultural field of mental health and their professional self-conception. METHODS: Problem-centered interviews with 30 practitioners working in mental health care professions. RESULTS: A professional self-conception which is based upon lifelong learning processes seems to facilitate the dealing with perceived challenges in the transcultural work. CONCLUSION: Promotion of transcultural competence requires learning environments that allow for reflexion and long-term mentoring (e. g. supervision).