Therapists guide for working with BAME clients
The IAPT (Improving Access to Psychological Therapies) programme has been aiming to improve access to therapy in the UK for years now and has had some success. However, a review in 2018 revealed that those from minority backgrounds are still less likely to use IAPT services, complete the treatment, reliably improve, and receive a full recovery from the treatment. This disparity is most pronounced in Asian men.
To try to combat this, BABCP have put together some advice for what therapists can do. [1]
The first point is that therapists should ask the ethnic background of the client with confidence and record this for administrative and service evaluation purposes. Many are unwilling to do this so as not to offend, but doing this respectfully while effectively communicating the reasons has been shown to enhance therapy and get the conversations about background, faith and family organisation tarted. It can also be helpful to ask clients to complete a “genogram” (family tree) which will help the therapist learn a lot about the clients situation organically.
The second point is to culturally adapt therapy for the needs of someone from a specific group, modifying the language and techniques of an existing therapy for the needs of the particular community. The key is educating oneself about the religious beliefs and metaphors used by the community to better relate and communicate to them.
When you intend to work with people who are asylum seekers it’s good to seek additional training about the effects of complex trauma as there are high rates of PTSD, psychosis, depression and anxiety disorders among this group. ‘This group of people may have additional needs beyond therapy that the therapist may need to refer the client to with their consent. In addition, receiving supervision from a supervisor experienced in working with complex trauma is also important as well as the therapist taking care of their own mental health when they are frequently exposed to trauma work.
It is possible hat the service user will disclose disturbing experiences that can be overwhelming particularly for empathetic therapists and those who experience vicarious trauma; for example violence, exploitation, and female genital mutilation. If this is the first time they have disclosed this information it is important when appropriate to obtain consent to make sure their physical health needs are met, the police can ensure their safety, and that legal teams make them aware of additional information in that area. It may be desirable for the therapist to be supervised while working with an asylum seeker, and it is as critical as ever that the therapist take care to ensure their own mental health is holding up if they are being exposed to more extreme trauma recounting than usual.
It may be neccesary to work with interpreters. It’s important to make it clear to both the client and the interpreter what the interpreters role is and how confidentiality works, emphasising that this will be respected by the interpreter also. The client should be allowed to request a different interpreter if they feel they are not being represented properly, but it is helpful to find one that works early on in the process so that the same one can be used throughout therapy. Another caveat to this is that family members are not allowed to be interpreters, to ensure accuracy and to ensure the client can say what they want to (without being pressured) = in confidence.
The full guide linked below has more in-depth information but these are the main points. Not just therapists but those in management roles would do good to read them to find out how they can help.