The politicizing clinic: insights on 'the social' for mental health policy and practice

PURPOSE

In this paper, we explore how Brazilian socially sensitive therapy can respond to care-users' desire to change the social and political forces shaping their lives. We use this case to demonstrate the limits of the "social determinants of health" agenda which, when operationalized, tends to leave questions of lasting structural change aside.

METHODS

We report on mixed methods ethnographic and epidemiological results from the 1982 Pelotas (Brazil) birth cohort study, a prospective study of 5914 children. Ethnographic analysis explored the cyclical relationship between schooling, mental health care, conceptualizations of mental distress, social and political engagement, and experiences with diverse forms of discrimination. Epidemiological bivariate and multivariate analyses examined differences in socio-political participation and the reporting of discrimination at different time-points for participants who used therapy with those who did not. Effect modification analysis tested the hypothesis that the socially empowering effects of therapy were greater for marginalized and minoritized youth.

RESULTS

Most young people living in situations of precarity experienced therapy, particularly when based in schools, to be a blame-inducing process. A more fulfilling and impactful therapeutic experience took shape when young people were able to shift the focus away from symptom reduction and behavioral management toward narrative life analyses, social debate, and political agency. Use of socially sensitive therapy was statistically associated with increased political participation and reporting of discrimination after controlling for confounders. The empowering effects of therapy were greater for those with less formal education and family income, but not for young people who identified as black, brown, or non-white.

CONCLUSION

The findings underscore the importance of considering agency, sociality, and politics when theorizing "the social" in clinical practice, and health and social policy.

A systematic review of client’s perspectives on the cultural and racial awareness and responsiveness of mental health practitioners

Culturally and racially responsive practice continues to be a common challenge among Mental Health Practitioners (MHPs). To the authors’ knowledge, this systematic review was the first to collate and synthesize clients’ perspectives of MHPs’ cultural and racial awareness and responsiveness from around the world. Original studies that were published between 2010 and 2021 reporting on qualitative data about clients’ perspectives regarding MHPs’ cultural-racial awareness and responsiveness were included in the review. The studies’ key findings that addressed this review’s question were synthesized and analyzed using reflexive thematic analysis. This review found 48 papers that met inclusion criteria, which represented the views of 652 clients across 10 countries. Three major themes and eight subthemes were established that concerned characteristics of the MHP, the client, and the therapeutic alliance. The results of this review indicate individual and systemic factors that influence mental health access for people from culturally and racially marginalized groups. Ongoing training of MHPs, increased racial and cultural representation among MHPs, inclusive physical settings, and reduced discrimination by MHPs are among the key findings and directions based on the results of this review.

Before allyship: A model of integrating awareness of a privileged social identity

Introduction

Although the American Psychological Association encourages clinical psychologists to recognize and understand the experience of social privilege both within themselves and the individuals and communities they serve, there is a dearth of research in the field to guide this pursuit. According to the available literature, an essential barrier to social privilege integration is its implicit and covert nature that prevents consistent consciousness due to hegemonic forces.

Methods

This study explored the process, from initial social privilege awareness to the moment of the study, through individual interviews. A social-constructivist, grounded theory approach was utilized as it was aligned with the understudied phenomena oriented around social justice.

Results

The result is a developmental model of social privilege integration that explicates accumulated exposures to privilege, the resultant threat to and protection of personal identity, and the conducive factors that lead to reconciliation.

Discussion

Implications of this theoretical model include the importance of a developmental perspective to cultivate an understanding of individual prejudice attitudes and discriminatory behaviors, as well as a roadmap toward equitable change. This model may be used by clinical psychologists across multiple settings in response to the most recent APA multicultural guidelines.

Reliability and Validity of the Korean Version of the Social Justice Scale in Nursing Students

The purpose of this study was to translate and adapt a scale to evaluate social justice in nursing students and to examine the validity and reliability within a Korean context. With a survey design, a total of 267 nursing students were recruited, and data were collected using a self-administered study questionnaire to measure their levels of SJS. Using SPSS/WIN 28.0, construct validity, item convergent and discriminant validity, concurrent validity, and internal consistency reliability of the scale was evaluated. Exploratory factor analysis supported the construct validity with a four-factor solution; that explained 55.52% of the total variance. Criterion validity was demonstrated with the Social Issues Advocacy Scale (r = 0.78, p < 0.001). Cronbach's α coefficient for the scale was 0.96. The findings show satisfactory construct and criterion validity and reliability of the Korean version of the SJS for measuring social justice in nursing students.

The Use of Social Justice Concepts in Rehabilitation Counselor Education: Results of an Exploratory Study

Divisive social rhetoric and prevalent racism make the need for infusing social justice throughout counselor education even more urgent than the decades—long calls for it. There is a dearth of empirical inquiry into the ways social justice concepts are enacted across rehabilitation counseling curricula. The current study used an exploratory survey to collect information about the techniques used by rehabilitation counselor educators ( n = 71) to infuse social justice across all of their courses, including their pedagogical choices, rates of frequency for updating coursework, and professional development choices. Findings reveal that educators have favorable attitudes about social justice, are more likely to use academic journals and related disciplines in course development, and to use self-reflection and intuition-based opportunities for social justice professional development. Implications of the findings also include relevancy for supervisors and practitioners, who have the responsibility to and lead social justice education once trainees have entered the field as professionals.

Deconstructing institutional racism and the social construction of whiteness: A strategy for professional competence training in culture and migration mental health

The position presented in this article draws on the professional insights of the authors, reflecting on issues of global political importance in culture and migration mental health. As institutional theory perspectives continue to develop, solutions to complex social problems such as racism require embodied knowledge if the lines of authority and basic occupational routines are to be meaningfully renegotiated. Embodied knowledge is socially situated and self-reflexive and reflects cumulative and marginalized experiences that contribute to a better understanding of institutional racism and the social construction of whiteness. The authors foreground the development of critical consciousness and emotional literacy in order to be more professionally competent in institutional contexts of mental health training, education and practice. To this end, elements of due process, transparency, inclusiveness, community engagement and accountability are at the center of a political and intellectual movement towards epistemological justice to promote antiracism and social justice in culture and migration mental health. The authors define decolonial intersectionality as a clear philosophical vision outlining how best to respond to those at risk of experiencing racism and the associated mental health burdens.

A Preliminary Investigation of Social Justice Perceptions Among U.S. Speech-Language Pathologists: Clinical Implications

Purpose The purpose of this survey research is to provide preliminary data regarding speech-language pathologists' (SLPs') perceptions of the role that social justice (SJ) plays in their work. As our professional organizations call us to advocate and communicate with regulatory agencies and legislative bodies to promote quality care for all individuals, this topic has become particularly important at this time. At present, there is a lack of data in peer-reviewed publications within the discipline of communication disorders on SJ and even less regarding the perceptions of SLPs on SJ. Method The survey was sent to American Speech-Language-Hearing Association (ASHA)-certified SLPs, identified by the ASHA ProFind database, across six U.S. geographic regions, including both urban and rural communities. Four themes were explored through the survey: (a) importance of SJ, (b) awareness of SJ, (c) current practices related to SJ, and (d) barriers to SJ implementation. Results The majority of respondents view SJ as important to the profession (91.2%) and value the work of creating equality among groups (96.0%). Many SLPs are actively involved in implementing SJ principles in their own practice by accepting Medicaid (40.7%), engaging in political outreach (55.0%), and providing transdisciplinary educational outreach (77.9%). Identified barriers to incorporating SJ include time (62.7%), resources (65.6%), and finances (70.0%). Conclusions Working for SJ is important to a majority of the respondents, and various efforts are implemented to create equal opportunities for service to clients. Barriers continue to exist that limit the degree to which SLPs can work toward SJ. A list of actions to be considered in order to promote SJ in the field is provided. Supplemental Material https://doi.org/10.23641/asha.16584044.

Building a Climate for Advocacy Training in Professional Psychology

Counseling psychologists have been at the forefront of social justice and advocacy efforts in the discipline of psychology. Despite these foci, few graduate training programs in psychology offer formal courses or training in advocacy, social justice, and public policy. To develop and fill a pipeline of professionals involved in social justice and advocacy efforts, graduate training programs in psychology must expose and prepare students to these areas. The purpose of the current paper is to describe how faculty within the professional psychology program at the University of Denver incorporate advocacy, public policy, and social justice education and training into their program. We describe how the program climate and curriculum were created to meet these training needs.

Social Justice in Counseling Psychology: Then, Now, and Looking Forward

In this article, a diverse group of early, mid, and advanced career scholars call for counseling psychology to continue to evolve in our integration of social justice action in our field. In doing so, we first consider our history as proponents and enactors of social justice, highlighting the ways in which counseling psychologists have served as social justice leaders in psychology. We then discuss our field’s contemporary challenges to, and opportunities for, social justice progress as we work toward equity and justice. Finally, we offer recommendations for counseling psychologists individually and as a field to move forward in our social justice action. Given our longstanding social justice values and our unique training as counseling psychologists, if we aim with intentionality to use our skills toward systems change, counseling psychologists are poised to have a strong and proactive role as social change agents within psychology and society at large.

Toward a Psychological Framework of Radical Healing in Communities of Color

Advancing beyond individual-level approaches to coping with racial trauma, we introduce a new psychological framework of radical healing for People of Color and Indigenous individuals (POCI) in the United States. We begin by providing a context of race and racism in the United States and its consequences for the overall well-being of POCI. We build on existing frameworks rooted in social justice education and activism and describe a form of healing and transformation that integrates elements of liberation psychology, Black psychology, ethnopolitical psychology, and intersectionality theory. We briefly review these conceptual foundations as a prelude to introducing a psychological framework of radical healing and its components grounded in five anchors including: (a) collectivism, (b) critical consciousness, (c) radical hope, (d) strength and resistance, and (e) cultural authenticity and self-knowledge. We conclude with a discussion of the applications of radical healing to clinical practice, research, training, and social justice advocacy.

Becoming an Advocate: Processes and Outcomes of a Relationship-Centered Advocacy Training Model

Counseling programs across the country are increasingly incorporating social justice advocacy training into their curricula. However, much remains to be learned about the developmental processes by which students develop advocacy skills and apply those skills after they graduate. To address these questions and drive further innovation in the field of advocacy training, we conducted an evaluation of the Community Advocacy Project, a yearlong microlevel advocacy training model that teaches mental health counseling master’s students to use relationship-centered advocacy with individuals in marginalized communities. We interviewed 19 counselors within 2.5 years of their graduation from the project about their experiences of the program and their current advocacy work. Using qualitative description, we developed a model describing processes of Internal Grappling, Building the Advocacy Relationship, and Integrating the Advocate Identity that highlights the importance of a yearlong one-on-one advocacy relationship, intensive reflection and supervision, and community collaboration.

Breaking Institutional Habits: A Critical Paradigm for Social Change Agents in Psychology

There is a growing concern in counseling psychology that the field is not matching its commitment to social justice with adequate preparation of social change agents. Compiling and building off of a uniquely interdisciplinary framework, this article offers an alternative way forward for psychologists and trainees. Recommendations include a reorientation to institutions in which psychologists are immediately embedded and a legitimization of direct-action methods.

Implementing Social Change: A Qualitative Analysis of Counseling Psychologists’ Engagement in Advocacy

In recent years, many counseling psychology training programs in the United States have adopted social justice principles into training. Although previous studies have provided thought-provoking discussions on social justice advocacy, they mostly reflected the voices of psychologists in academia; therefore, the advocacy work of practitioners has been neglected. In order to explore the advocacy experiences of counseling psychologists in practice, we utilized qualitative content analysis to analyze semistructured interviews with 11 practitioners who were trained in social justice-oriented counseling psychology doctoral programs. The findings were clustered under three domains: (a) participants’ development of a social justice orientation, (b) different ways of implementing advocacy in practice, and (c) positioning advocacy in psychology. The interviews depicted resources and challenges with regard to integrating advocacy into practice indicating that counseling psychologists continue to struggle with systemic barriers that limit their advocacy actions. We discuss implications for research, practice, and training in counseling psychology.

Black Lives Matter: A Call to Action for Counseling Psychology Leaders

Police brutality and widespread systemic racism represent historical and current sources of trauma in Black communities. Both the Black Lives Matter movement and counseling psychology propose to confront these realities at multiple levels. Black Lives Matter seeks to increase awareness about systemic racism and promote resilience among Black people. Counseling psychology states values of multiculturalism, social justice, and advocacy. Executive leadership in counseling psychology may seek to promote racial justice, yet struggle with how to participate in Black Lives Matter movements and address racial discrimination within larger systems spontaneously and consistently. However, counseling psychology trainees and professionals are actively involved in the Black Lives Matter movement, leading the way forward. Through the framework of spontaneity in social movements, this manuscript highlights what counseling psychologists are currently contributing to Black Lives Matter and makes recommendations that build on the opportunity counseling psychologists have for further involvement in the movement.