At least a 90-minute session should be allocated for a culturally and linguistically diverse (CALD) client but be prepared for multiple sessions to gather the required material. As much information as possible about the client’s cultural background should be sought before the interview, but do not assume that the client will align with this information. Think in advance about obtaining and recording consent from the client. The consent form may have to be prepared in the client’s language if English proficiency is limited.
If an interpreter is required, meet the interpreter before the session and brief him or her about the nature and purpose of the interview. In some cases the interpreter may need special knowledge, particularly if the client is suspected to be experiencing psychotic symptoms. The interpreter needs to get used to the client and should become part of the managing team. The interpreter will also need to be debriefed after the session.
Take an open and curious approach to the interview and engage with the client to understand his/her cultural background. Avoid handshaking with clients of the opposite gender as it may be frowned upon in the client’s culture. For many non-Western cultures a gender match between the client and the psychologist is appropriate. Use micro counselling skills carefully by adjusting space, level of eye contact and non-verbal language.
Rapport with the client may be enhanced through neutral conversation, an elaborated introduction and self-disclosure. Provide information about your professional role and the boundaries of this. Issues of confidentiality should be discussed,
as well as how any collected information will be used.
Seek information about the client’s demographics, keeping in mind that research on CALD clients highlights certain demographic factors – such as being female, younger or older, uneducated or highly educated, unemployed, lacking English language proficiency, or having refugee or asylum seeker visa status – as indicators of higher risk of psychosocial stress. It is important to explore other family members’ education and employment status to identify psychosocial stressors.
Enquire about the client’s country of origin, as there is a higher risk of acculturative stress when there is a greater difference between the country of origin and the host country. The client’s belief about his/her own ethnicity is important as it reveals the degree of affiliation with the original ethnic group or the host society. The client’s acculturation may vary from those who are marginalised and separated to those who are assimilated or integrated into the mainstream. The questions and content of the interview will have to be adjusted depending on the acculturation of the client.
It is useful to know about the practical and emotional support that is available to the client. Is there someone to help with care of children, filling in forms and accessing available services? Similarly is there someone the client can share problems with as well as enjoy good times? As many non-Western cultures are collectivist in nature and emphasise mutual support, it is helpful to know if the client resides near the ethnic community or is geographically isolated.
Explore the client’s reasons for migration and extent of awareness of the host country. Research indicates that those who are reluctant or forced to migrate, or have limited information about their adopted country, can be more vulnerable. There are more settlement-related stressors at the early stage of migration, so length of time in the host country is important to ascertain.
Collect the client’s own understanding about reasons for seeking help, ideas about mental health, and previous and anticipated treatment. Explore any cultural explanations of the client’s problems, interpretations of stressors and cultural approaches to managing difficulties. It is also important to check for culture-bound syndromes which may mimic mental disorders but are explained within the person’s culture.
While gathering information about the client’s biopsychosocial history, explore everyday routine, roles and living skills. Information about the client’s family and household should be sought, as those living alone and maintaining long distance relationships with spouses or family members may be at risk. There may be concerns about family members in the country of origin or legal and visa issues associated with family members joining the client. On the other hand, those who have family members in Australia may be experiencing role or intergenerational conflicts.
In the case of refugees and asylum seekers, it is important to explore the pre-migration and transit experiences as these can be traumatic and aversive.
Recapitulate the gathered information. Socialise the client with the cultural explanation of his or her problems (using the terms used by the client, such as “nerves”, “possessing spirits”, “misfortune”). Identify the client’s strengths and weaknesses, as it is vital to enhance the self-esteem of the client and acknowledge the cultural strengths. Give tentative information about any future assessments or interventions. Allow some time to cross-check and confirm information. Invite the client to ask questions and express an opinion about the session. Conclude the meeting by thanking the client and showing appreciation for his or her cooperation.
The APS Psychology and Cultures Interest Group advocates for the needs of CALD clients and aspires to enhance the cultural competencies of all psychologists. It has over 100 members from across Australia and offers regular CPD activities in addition to three newsletters per year. For more information on the Interest Group, go to www.groups.psychology.org.au/cultures/