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.

Causal attribution for mental illness in Cuba: A thematic analysis.

Explanatory models (EMs) for illness are highly relevant for patients, and they are also important for clinical diagnoses and treatment. EMs serve to capture patients' personal illness narratives and can help reveal how culture influences these narratives. While much research has aimed to understand EMs in the Western hemisphere, less research has been done on other cultures. Therefore, we investigated local causal attributions for mental illness in Cuba because of its particular history and political system. Although Cuban culture shares many values with Latin American cultures because of Spanish colonization, it is unique because of its socialist political and economic context, which might influence causal attributions. Thus, we developed a qualitative interview outline based on the Clinical Ethnographic Interview and administered interviews to 14 psychiatric patients in Havana. We conducted a thematic analysis to identify repeated patterns of meaning. Six patterns of causal attribution for mental illness were identified: (1) Personal shortcomings, (2) Family influences, (3) Excessive demands, (4) Cultural, economic, and political environment in Cuba, (5) Physical causes, and (6) Symptom-related explanations. In our sample, we found general and Cuba-specific patterns of causal attributions, whereby the Cuba-specific themes mainly locate the causes of mental illness outside the individual. These findings might be related to Cubans' socio-centric personal orientation, the cultural value of familismo and common daily experiences within socialist Cuban society. We discuss how the findings may be related to social stigma and help-seeking behavior.

'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).

[Conceptions of "transcultural competence" and their relevance for the psychiatric-psychotherapeutic care. Results of an interdisciplinary literature review]. / Konzeptionen von "transkultureller Kompetenz" und ihre Relevanz für die psychiatrisch-psychotherapeutische Versorgung. Ergebnisse eines disziplinübergreifenden Literaturreviews.

The concept of transcultural competence is increasingly discussed in Germany as a requirement for providing adequate psychiatric-psychotherapeutic care for persons with a migration background. To this day, understanding of this concept is heterogeneous. This overview aims at systemizing existing definitions of transcultural competence in psychology, medicine and related fields to improve understanding of the term in practice. 130 German and English language scientific papers were analyzed and were evaluated qualitatively with grounded theory method. The analysis produced 3 approaches: a technological approach, a component approach and a positioning-and-attitude approach. The suggested categorization of the understandings of the term transcultural competence allows for a detailed overview of the current definitions of this term and thus provides criteria for a better evaluation of implemented transcultural competence in fields of psychiatric-psychotherapeutic care.