Running a support group for many years for early career psycholologists, I know that as a profession, we are diverse, although not nearly diverse enough!
I know psychologists with backgrounds that include:
- Mental illness
- Chronic illness
- Disability
- Neurodivergence
- Racial and cultural diversity
- Gender and sexuality diversity
- Diversity of spiritual and religious belief
- Socioeconomic diversity and poverty
- Appearance and body diversity
- Rurality
And more!
A frequent worry I have encountered from colleagues who have lived experience or come from marginalized groups is feeling like a square peg in a round role, worrying about the professional risks of self-disclosure, sometimes having experienced distresssing experiences of the Psychology Board being notified when there is no impairment or risk to the public, or wondering if psychology is for them because they’re not from what they feel is the ‘right background.’ This happens even in groups one might not think about – for example, men are a tiny and decreasing minority amongst psychologists, at a time when men and boys are often struggling.
I find this terribly sad and frustrating, because understanding and responding to diversity is a core competency for Psychologists in Australia. What’s more, the mental health sector has an increasing focus on the value of lived experience. In my work for a large NGO, it is not uncommon to start conversations with frontline workers by sharing who are are as humans, including our lived experience – because this stuff matters.
As psychologists, it is critical to respect and listen to diverse voices, including in psychology. We must understand that lived experience is important and valuable and that people are the experts in their own lives. I don’t think we can truly respect diversity unless we respect and listen to diverse voices within our own profession.
This isn’t just an issue that I might get on my high horse about as an individual. It’s also an issue of professional competency and ethical behaviour.
Working with people from diverse groups is one of the eight core competencies set by the Psychology Board. It is also one of the competencies set out in The International Declaration on Core Competencies in Professional Psychology, to which Australia is a signatory. In this declaration, working with diversity and demonstrating cultural competence requires:
- Knowledge and understanding of the historical, political, social and cultural context of clients, colleagues and relevant others
- Demonstration of cultural humility
- Recognition of the impact of one’s own values, beliefs and experiences on one’s professional behaviour, clients and relevant others
- Working and communicating effectively with all forms of diversity in clients, colleagues and relevant others
- Being inclusive of all forms of diversity in working with clients, colleagues and relevant others
In psychology, the demonstration of cultural humility is important because it helps us to learn and to better support members of marginalized groups. It requires that we listen to voices of lived experience, even (especially) when those voices might say things that are challenging or difficult for us to understand. It requires deep introspection, and sometimes changes of language and behaviour that might fly in the face of our professional training or practice that we have seen senior colleagues engage in! However, this doesn’t mean that it is appropriate to reject lived experience perspectives either within our profession or from those we may support.
The most appropriate response is to listen and reflect, understanding that whilst we have training and are scientist-practitioners, we have an ethical obligation to engage in cultural humility. We don’t always know what we don’t know. The history of psychology is rife with human rights violations, from the way we conduct research, to how we’ve gained consent, to the therapies we have used. It has often taken the voices of members of marginalized groups to challenge the status quo within the profession. We must listen to those voices. This is why the DSM stopped classing homosexuality a disorder, why we try not to give children phobias, why we don’t engage in conversion therapy. We learned those things are harmful by listening to voices of lived experience. And we still have a long way to go as a profession.
It’s very easy to engage in practice that is harmful, thinking we are doing good. We might think a particular approach is correct because it’s ‘evidence-based’ and ignore those telling us it’s unhelpful or even harmful. We might use language that is stigmatizing and offensive, not because we intend to stigmatize or offend, but because it’s the language we’ve always heard, the language we’ve seen modeled in more senior members of the profession, or it’s language we’ve grown up using. It takes cultural humility to be able to deeply listen when people who are affected by us tell us that we are doing wrong. That can be upsetting because often we’ve been trying to be professional and to do the right thing. Cultural humility requires sitting with this discomfort, even when someone has given you information in a way that feels confronting. It can be hard to do.
One straightforward way of managing interactions that was originally developed for working with people with complex needs, but encourages reflection in a way that I think is helpful when we might feel challenged is the 4P model used in Cognitive Analytic Therapy. The 4P’s stand for:
- Pause
- Pulls/Pushes
- Patterns
- Professional response
When hearing information that is difficult to take in or confronting the idea is to pause rather than immediately jumping to a response. Take a step back, especially when you notice in yourself a desire to become defensive or to punish or reject.
Reflect on the ‘pulls’ that you are feeling from the other person, and the ‘pulls’ they might be experiencing. For example, there might be an urge to be dismissive of a concern raised, or to avoid, abuse or punish.
Reflect on whether there might be patterns in what is happening in the moment. For example, could someone have experienced the same treatment in their own life and found it harmful? Might they be highlighting a problematic pattern they’ve noticed in the profession? Is a style of communication being used common within a particular group? What is the historical and cultural context of the communication? If someone is from a marginalized group and is confronted with harmful (even if well-intended) behaviour, their communication may appear to be very blunt, or be seen as impolite.
Finally, consider a professional response that is sensitive and appropriate. This means reflecting on the assumptions you may have made that come from your own biases. It might mean acknowledging that you feel hurt and confronted and choosing an effective and professional response rather than lashing out in return. It could mean withdrawing, or sitting with painful emotions rather than responding. Consider whether there may be factors such as the double empathy problem and cultural differences that can interfere with understanding.
Here are some further readings:
International Project on Core Competencies in Professional Psychology
The weirdest people in the world?
Ceara Rickard, Psychologist 