TEAM-CBT For Diverse And Multicultural Populations

Learn how to apply CBT for diverse and multicultural populations

In this video, Sunny Choi focuses on using TEAM-CBT for diverse and multicultural populations. He emphasizes the need for culturally responsive therapy. In this therapy, you recognize the unique experiences and challenges faced by various groups.

Sunny highlights how the experiences of marginalized and oppressed clients can lead to their trauma. Understanding the concept of privilege across various identities is essential for effective therapy.

In intersectionality, a person's experiences or privileges result from several identities, such as race, gender, etc. These overlapping factors often create unique challenges or advantages for that individual.

Therapists must know their privileges to recognize their blind spots or biases. Often, implicit bias or unconscious attitudes and stereotypes can lead to microaggressions. Microaggressions are subtle acts of discrimination that are usually very impactful. Examples of implicit bias include making assumptions about a person's profession based on their race or gender.

Sunny highlights the value of asking clients about their experiences using DSM's 16 assessment questions. In the context of Asian CBT, he advises paying attention to physical symptoms. Since they will be more likely to be reported or shared. Additionally, by using the five secrets of effective communication, you can build empathy with your clients.

This session focuses on several cultural considerations in therapy for diverse populations. Watch the full webinar to educate yourself on diversity and to practice cultural humility.

IN THIS VIDEO:

Jill Levitt: We're going to start the webinar now. I'm just going to tell you all a couple of technology related things and then we'll begin the presentation so throughout the presentation today if you'd like to enter questions for our presenter you can enter them in the Q and A so at the bottom of your screen you should have a Q and A icon and if you click on it you can enter questions if there are little questions procedural questions I'll answer them throughout the presentation the remainder of the presentations I'll be holding and I'll relate those questions to their presenter during a designated Q and A time at the end of the presentation. Notice that you won't be able to chat with other participants the chat box is closed but we'll but we will be engaging with you through various polls and the presenter may also be asking you to answer some questions in the chat box that will go directly to Sunny and myself I'll also mention to you at the end of the presentation what you'll need to do in order to get continuing education credit. Do note that attendance is being taken and you do need to be present for the presentation in order to get CE credit so now I'm going to begin so the presentation today is entitled someone is giving someone is entering something asking if there's sound yet so what I'll do is ask can you as an audience participant, can you let me know if you can hear me talking, okay great that was just one person's problem now I'm relieved thank you all for helping me out okay you don't need to enter I gotcha okay so today you'll be hearing from Sunny Choi who will be presenting on TEAM-CBT for diverse and multicultural populations I'm just going to tell you a little bit about what is Feeling Good Institute because I'm Feeling Good Institute of the sponsors for this wonderful workshop today so we're leaders in the advancement of effective therapy our mission is to train and certify therapists in advance cognitive behavioral therapy or TEAM-CBT which you'll be hearing more about today we have video based therapy across the United States and Canada and treatment centers in New York city Silicon Valley and Israel and we focus on cognitive behavioral therapy as well as cognitive behavioral therapy research so that we know that what we're doing is actually effective. So as I said FGI’s mission is to provide quality TEAM-CBT by training and supporting therapists with cutting-edge cognitive behavioral therapy to continue in the mission of helping therapists to learn and improve their CBT skills FGI has undertaken a diversity initiative to identify blind spots within the TEAM-CBT approach that might intentionally unintentionally make this therapy less effective less accessible to diverse populations in order to increase our awareness of unconscious bias FGI now has a diversity committee that provides resources and trainings to clinicians to improve their cultural knowledge and humility. Sunny's webinar today is the first of many trainings that we will offer to support the mission of the diversity committee. Note that you'll also be receiving some information via email after the presentation with next steps that you can take if you'd like to continue to train in this area you can see the mission of the diversity committee on this slide and now let me introduce you to our wonderful presenter today Sunny Choi. Sunny is a clinical therapist focusing on providing services to underserved populations such as ethnic minority lgbtq and low-income clients using TEAM-CBT he's collaborated with other clinic members such as medical physicians and nutritionists to provide holistic integrated care to his patients an effective strategy that results in quick recovery. He also collaborates with other community members to educate and advocate for the delivery of effective and quality services for underserved populations. So now I'll turn it over to you Sunny.

Sunny Choi: Thank you Jill, thank you Feeling Good Institute for inviting me to this presentation in the spirit of TEAM-CBT. I want to do a self-disclosure exercise right away it was a little difficult preparing for this presentation and you can ask all my friends about that I got a lot of attention and a lot of triggers of pulling in my past and present experience relating to race and identities especially relate at this very divided time I've always also always self-conscious and anxious about public speaking. So maybe it's also an exposure exercise right now. Ever since I was a kid I was very self-conscious of the way I speak I moved from Hong Kong when I was 12 we're very broken english and I remember when I first got here there was one time when I was in class when I had a really runny nose and I was looking for tissue so I was really desperate talking to before you know it half the class was wondering what I was talking about and eventually they did figure out and then the next thing I heard is a lot of laughter and a lot of ridicule and I still remember them doing this landed eye gesture to me and I actually thought I don't have standardized I don't know what they're talking about that actually was one of the first few times I experienced discrimination because when I was in Hong Kong I was just like everyone else. So and those kind of bullying and harassment happened for many years afterwards and fast forward a few years later when I was in high school I remember I've always have a childhood dream of being a psychologist because I like talking to people but then I was told by many adults including my academic advisor that I should focus in science and engineering because my english is not that good. Yeah I still remember when my mom told me Sunny you shouldn't do anything that require talking yeah you're not good at it. So I end up choosing science and engineering I was an engineer for many years and in addition to my other identities such as being also being gay growing up I always thought that I was not good enough and I was ashamed that I was inadequate and I looked to others to tell me who to be and what to do and I always want to act like my white friends because I thought that if I do that I would be more worthy. Yeah I even took action training for many years it didn't really work though I don't think so this is part of my story and as I grow up become a clinician eventually I heard much sadder stories from other people who are multicultural and under represented. I'm here to talk about diversity but no one really can represent all different views of diversities I do believe that in order to better understand these populations it is important to have a vulnerable dialogue like this and then listen as openly as you can. I heard there's a lot of there's a lot of participants today maybe you also share the same view that the world has become somewhat a lot polarized and this is a time to talk about this subject again I'm not expert in this but I'll share with you my story and story of many of my brothers and sisters. The objective a threefold one is to help you understand the challenges of underrepresented and multicultural populations, two is to describe how these experiences are being marginalized and oppressed result in trauma, three you learn some hopefully learn some therapeutic techniques using TEAM-CBT of course joe already referenced that there are a lot of trainings available for you to learn about TEAM-CBT. Also so a little bit more about me as you know by now I'm actually end up being a therapist very happy about it I've learned TEAM-CBT for seven years once I met Dr. David Burns and as I referenced earlier psychotherapy is not my first career and after graduating from UCLA and Stanford I worked 20 years in engineering and management and at that time I actually did try to climb up to that status and got makes pretty good money but that's not what I love because I know that ultimately I want to fulfill my childhood dreams of being a therapist of helping people change their life through therapy because it works for me also. So during the last 10 years I've been working in different organizations a lot of awesome organizations that provide culturally and language appropriate services such as northeast medical services recently and also San Mateo County behavioral health and I serve a very diverse populations ranging from working poor and this is like for many of these working poor who work full time but they can either barely afford to to live at home or they live in cars so and then a lot of people of color who discriminate got discriminated in many layers and I'll talk about more of those later then. There are a lot of lgbtq people that are harassed every day because of who they are and whom they love and then there are a lot of women who are abused but afraid to speak up. Then there are a lot of hard-working immigrants immigrants like me who work really hard contribute a lot to the country but then we're told that they're stealing american jobs. A lot of jobs that a lot of regular americans don't even want these folks along with me suffer a lot of mental health issues from early trauma in the US and we did not seek out a lot of mental health services early because of a lot of stigma and also lack of culturally and language appropriate services and working with these population can be also challenging.

For one there are lots of patients like I have unlimited patients waiting for to see me and they're not a lot of resources in these organizations not even a lot of clinicians who understand the culture or languages. As a result we have to see patients really quickly sometimes 30 minutes sometimes 40 minutes like I sometimes see 12 patients a day really got the practice TEAM that's the good part work with a lot of diverse population population diverse behavioral health issues like addiction mood issues relationship issues domestic violence also a lot of physical pain issues too and it's not easy working with this group because they have a lot of resistance sometimes or lack of understanding or stigma with behavioral health so you have to understand those resistance and it's a little bit difficult difficult to treat in the beginning and as a result a lot of clinician including me got burned out from working in this environment. I see them as my brothers and sisters so I have a love and compassion for these people but I know that that's not enough. Fortunately I found he I found Dr. David Burns early on seven years ago and I was very excited right away with my engineering background I actually thought that TEAM is very science scientific and evidence-based and methodical and easy to follow and most importantly it fits the need of the multicultural and underrepresented population because they tend to have less time and less resources and so with TEAM I could really helping them heal in a few sessions so that they can go on to do their things and I can go on to see more patients and from my experience and I talked to David quite a few times already that TEAM-CBT does work very well with this population so before we start. I want to take a poll just to understand your treatment approach to ask how often do you consider different forms of discrimination such as a microaggression systematic oppression in your treatment and then I'm going to give you 30 seconds to give a quick answer yeah great so sunny I can see people are starting to answer the poll I'm gonna give you guys another 30 seconds.

Jill Levitt: I'm seeing the polling come in so if you're sitting at your computer just go ahead and click always sometimes or never. I'll give you 10 more seconds here. Okay I'm going to click end poll and share the results now Sunny you can see the results right.

Sunny Choi: Yes I do yeah so always it's 31 that's awesome that's awesome and but at least people sometimes ask that's also important I guess you depending on different situations so that's good. So from my experience in general is at least good to ask and consider these types of experience with most of your clients because you don't know where they come from and I'll explain to you in the next few slides why is it important to at least ask in order to maximize the or the awesome power of TEAM-CBT it is important to understand the unique and marginalized experiences these popular populations face because the many of us really face lifelong challenges that have many layers of discrimination and biases and it not just impact them psychologically but also physically and financially and racism and prejudice that they experience comes from implicit bias and normal lies attitude that I'll talk about later on but in order for all of us including you to listen and to understand what they're going through it will require a lot enormous amount of vulnerability to be exposed emotionally to these marginalized experiences. I think that's why I had a hard time coming up with these slides myself so in the next few slides I'm going to talk about different types of biases and discriminations and then how they shape the populations. In order for us to understand the biases and discrimination the first concept that is important to understand is concept of privilege or lack thereof privilege is basically unearned advantages and benefits that individuals have in membership on membership in a dominant group now you can have privilege in some areas and you may not have may be lagged off in other areas so and it's important for clinicians to know themselves whether how privileged they are. So for the next few minutes let's review what are the different areas of privileges and then you examine yourself where are you in each of them. So in the area of race if you are a person of color you generally have less privilege than most white people it is pretty common when you walk into the stores if you're people of color as doc if you especially if you have darker skin like no matter you're black brown or Asian if you're darker screen people like tend to follow you or or not treat you as welcoming. Me for example when I was a director in a tech company I was a I always bring my white engineers but every time to see my customers and every time like a lot of times they assume that my white engineer is my manager or director in the area of class if you're a poor working class you're generally more disadvantaged than the middle online class. In fact statistically they are less five times less likely more likely to have poor health. One reason is the lack of affordable healthy food access because I remember when I grew up living in East Oakland before I become hip they did all most most of the stuff they have is like these mcdonald's they're not the healthiest for you no it tastes good but it wasn't very healthy for for us. In the area of gender identity women tend to have less advantage as demand and probably many of you have heard that women in general made 81 cents of for every dollar that a man makes and that's already an improvement over the years and in the areas of sexuality the lgbtq community tend to have less advantage than the heterosexual folks in fact and this is I know this because I work with lgbt teenager. The statistic is that of the teenager population 24 of them from the lgbtq identities and even though they are like about five to six percent of that teenage population. In the area of ability people with disabilities have less advantage of than people without disability they actually have to consciously figure out whether they can go to certain restaurants or access to buildings or parks and people who don't have those disability probably don't even think about it and that's the key you don't think about when you have privilege that's why sometimes people say I don't have privilege well you don't think about when you have it. You know then in the area of religion a lot of non-christians tend to have less advantage than christians again it's just in general and one example is that a lot of in US and in many western culture the religion religious day as being celebrated as holiday versus other ones don't really talk about that much. In the area of age people who are over 40 tend to have less advantage than the younger people and this is true especially where I live in the Silicon Valley I know of many unemployed 40 plus euro tech workers who just couldn't find a job even though there are abundance of jobs out there finally on the rank and status probably many of us in this car if you have a college degree you tend to have more advantage than the non-college degree folks and average over the lifetime earn about 56 percent more than the non-college degree folks. So think about what top privilege you are this is not to make you feel guilty if you're privileged I have a lot of privilege too in many areas or shameful for not having privilege in those area because we really for the most case we don't have a lot of control over what we're dealt with and it's also important not to stereotype and treat these no just because you're a woman you assume that there are certain ways but treat them as individuals but it is important to be aware of your own privilege in those areas or lack thereof. Because knowing your privilege will enable you to be aware of your blind spot when you talk to these patients who don't have it and hopefully and we'll talk about it more later you will examine more and you will study more about that area if that's important to you now knowing your lack of privilege in those areas is also important. For example it will help you when you're being triggered either when you have like a lot of my female counterpart, would have these male dominant male figure in as their clients and it will really trigger them so they will understand why or in some cases when you are talking to someone who are very similar as you and who are also have lack of privilege in those areas you may get triggered during the sessions and you may feel a certain way but ultimately knowing your privilege or lack thereof will help you connect more with your patients and to have more empathy with them. It's also important to note that in some cases in my experience there folks do have a lot less privilege than others so not everything is created equal and sometimes people who are lack of privilege are hard to spot one is because they lack representation another is because it's not always physical so for example I for when I was in tech making lots of money and high position I looked like I was privileged but then I'm also gay and with a husband for many years now love him and couldn't really married him because of my lack of privilege in the in that area and finally if you know these privilege. These privilege or lack of really form the way we think and our personal belief so actually at least for me it's very helpful to understand what they are as I said it is very important not to define the first feature we notice about that person's identity and represent everything about them and not take account of intersectionality. Intersectionality is when different social identities intersect for example you could be I'm gay and also Asian so different those different identity intersex and it is important to understand the intersection the discrimination through the lens of intersectionality.

For example I sometimes work with these very wealthy and high-ranking folks at these high-tech companies who looked very privileged but because of they belong to a certain marginalized group or people of color or gay it really shaped the way they think and they think of themselves and also their current treatments from their peers who are more disadvantaged have more advantage than them in other areas. Like for example I am a I grew up as lgbt group in a Asian and christian family and it was very difficult not able to get support from these two groups that at that time at least that can accept me completely and I really had no other access to support at that time. In fact I have I had a client a teenager Asian transgender female every time she looks at the mirror she would be shocked and very sad she really want to come out but because of her age she's very scared to listen to her urge to come out and using David Burns positive reframing I told them hey those fears are protective. In fact based on my experience and observation you may be right that you may not want to come up now and get kicked out of home and be homeless which happens to allow transgender teenagers. So I work with her on the safety plan and introduce her with a lot of transgender resources. More importantly do a lot of five secret effective communication empathize with them because she's the I'm the first person she came out to and amazingly her mood got a lot better, even her mom noticed although I we couldn't tell her why when she asked all I can tell her is well I don't know these are teenagers so I I think it's important to accept them the way they are so that's where I left it to but it's still very sad because I know the reality too. I also work with some female victim of domestic violence who are women of color and when I first worked with them I said yeah just report to the police but of course I then I realized as I understand more about their intersectionality and their identities I just realized that the people of color have a history of being oppressed racially oppressed by police and they don't trust to report to the police and also in some culture, their cultural belief is not to leave their spouse so it's also important to understand the culture so that you don't suggest giving them any suggestions from your own worldview, adapt to their needs, don't push them for anything that they don't want they are not ready for work with them on a safety plan and provide culturally and language appropriate services to this community. Now based on these one tip for these people with identities who are more tend to get more marginalized or the intersection, one big pit for for this population is implicit bias. Implicit bias is defined as attitudes or stereotypes that affect our understanding actions and decisions in an unconscious manner some example of implicit bias is that black people are violent men are smarter in science I was a social work intern and my female medical intern always meet these high up doctor for internship and they always assume that the female are the social worker and I am the medical student.

Yeah so I told them no I don't have the memory to to be a doctor yeah so so these are implicit biases and and you know many of us have it you know privileged or not privileged but what's more important is that it can develop into microaggression against the marginalized group. So microaggression is statement action or incident regarded as instance of indirect subtle or unintentional discrimination against those marginalized group and yeah some of my patients my clients always complain that they hear all kinds of these comments from people like oh you're so pretty as a black person or the one that I always hear for myself also a lot of asians immigrants oh where are you from and they don't mean I'm from Auckland or from bay area you know they are trying to on this you know like from China or something or yeah and then yeah I went and also when I was living in North Carolina for a year people always ask me yeah do you know so and so who's asian in chinese in UCLA when I was and I was like do you know how many asian people they have in at UCLA and then women always complain especially if I work with these people from google or Facebook that like they would ask like oh I didn't think you're a science major as if right and then they also complain that they are treating being treated as a token.

Another one that I always hear that I get annoying so if you do meet me don't don't say that to me yeah you don't act gay Sunny yeah yeah that's really annoying. I know that for some of you or some people they may say oh yeah these are just innocent and mild comments but they are very impactful for me and for many of my clients because the subtext is this people of color cannot hold high ranking position, the subtext is this we are not real american, the subtext is this woman cannot be scientist or mathematician and ultimately what I am hearing and what many of us are hearing is that we are not good enough and then some people say oh you're overreacting we didn't really mean it don't be so politically correct actually that's the very common reply lately .I don't know about you but imagine microaggression is like a mosquito bite and you got bitten one time yeah that's maybe okay but imagine you get bitten day in and day out year after year that gets pretty irritating and also anger and a lot of my patients are very angry as I asked him about these situations these comments and like what I said earlier what's more important is especially if you applied CBT and it is during this time when people are telling you these things in your brain in your thoughts you're being brainwashed, that you're not good enough that other people rejects you and guess what it is true in some level. Now many of my clients including me normalize these experiences and often don't bring it up during assessments for different reasons some of them are I hear about this since I was young other may feel guilty because like they are rich they have high positions or they shouldn't feel so ungrateful that's one of my comments I heard from one of my clients. So as a clinician it may be important for you to explain what microaggression is ask if they experience these because for my relation from my relationship with them from my experiences they will tell you like I've spent after I asked these specifically if they have experienced these experiences some of them just spent the whole session talking about it and how unwelcome they feel or another one that they would say yeah yeah yeah I don't mean like you're okay but I'm talking about the other minorities yeah that's also very offending. Now what's more blatant aggression and discriminations that some of these populations face is systematic oppression that because of a certain group that has privilege and then another group that don't and the privilege combined with institutional power actually create a system that really discriminates some groups we call them forget group and benefits the others which we call the dominant group and we're not talking about many years ago when the nazi somehow committed genocide to the jewish populations or the slave owner oppressing the black populations many years ago.

We're talking about now it's still very common on the racism of to have race when you when we see racism that some authority or even police misuse their power to abuse or kill people of color. It's also very common to see sexism when women are being harassed all the time with minimal repercussion we see it a little bit better now the last few years but it's still happening because I'm still hearing it. For a lot of people with middle eastern descent they are also facing a lot of discriminations I personally had a clan who is from teenager middle eastern descent who was very suicidal and find very little meaning to live because he was treated like nothing being bullied in school and then when he goes home when he try to relax and watch televisions all he sees is all these portrayals of them as villain or terrorists on the immigrant side there is also a lot of discriminations an oppression. I had a patient who is an asylum seeker he was literally put in a cage for four months with other people in there waiting for his documented family to work with the lawyer and the system to to get him out. He did eventually got out unfortunately after the initial euphoria he suffered a very severe depression and panic attack from the trauma he experienced which I believe is not necessary which the anger was necessary is healthy. I'm still shocked to hear whenever I hear these stories for my brothers and sisters but it's happening right now what's important when you work with these population is again I'm not seeing this happen to everyone and we do need to treat people as individual but knowing that systems of oppressions and microaggression happen to these folks it's important to ask and see how they affect them. Understand there's a power difference between you there may be a total difference between you and them so that you can use the five secrets of effective communication so that they can feel heard and validate the experiences. Use the five secrets to trace their strength from adversity because these populations are one of the most strongest, grateful, kind person I met I'm very resilient. In fact during the covet time when I work with different population the underserved and marginalized population actually dealt with it very well, yeah they're better than the average groups it's also important to positive reframe the experiences as healthy emotions anger anxiety sadness in from the experience a healthy emotions so that they can help them realize of the injustice and the dangers in the reality. So just a quick some quick take away from the last few slides I now mention it many times just be aware that these discrimination does exist for these groups and again you don't need to assume they have it just be aware that this does happen and understand the concept of different identities and intersectionality and as most importantly from my own experiences assess and enquire specific experience and maybe even do some psycho education because they don't even sometimes they don't even realize or it's happening to them and then the rest is just using what you have learned from TEAM-CBT from Dr. Burns so that you can hear those runes from the drama. Yeah one extra issue topic I want to mention is for some of this group is psychosomatic issues which is really the physical pain and other symptoms aggravated by the emotional stress and that happens with a lot of my asian patients referred by a lot of primary care doctors they would come with like headache, high blood pressure, heart palpitation, gastrointestinal issues, airport bowel syndromes and then the my doctor colleagues would not know what's the source but then as I but as I work with them as using TEAM-CBT as they got ill from the depression from the anger issues from their anxiety those symptoms went away. My theory is that it's more acceptable for the asian culture to recognize physical symptoms and it's not acceptable to express certain emotions like when I grow up I cannot get sad or cry because my mom would say that's bad luck especially if you're in casino never cry yeah so know that next time you you you interact with your asian friend. Yeah and anger is not a good thing because it shows disrespectful for for your parents so I was learn to be Sunny just smile yeah but somehow stress is okay because it shows that I was hard working so you may have experienced those two with your clients in fact I had one client I mentioned it at before in other intensive that have really severe hive situations and a lot of doctor thinks that it's some kind of incurable auto immune response and she was also depressed and when anxious so I used TEAM-CBT model to help her recover and again those hives went away when she got better emotionally in fact at the end I work with her on relapse prevention and that's when I work with her to understand that whenever you have a first indication of hives understand you may have some unexpressed anger that you may need to use the five secrets of effective communication to express. I told them that's your spidey sense yeah and then for the asian population you may actually need to do a little bit more psycho education about emotions and then ask about their thoughts of course but also ask about the physical sensations it's very important. So the next thing to keep you yeah I want to ask you a poll question, the poll question is this from your practice do you have a question in your intake about trauma due to oppression or other forms of discrimination.

Jill Levitt: So I just shared the poll with everyone and we see the I'm seeing the numbers rolling in so I'll give you 30 seconds or so to jump on your computer wake up and answer the poll, we still have some answers coming in and actually Sunny I'll ask you there's a question that you might even want to answer now because it's related to what you're talking about about the intake which is just what are some respectful ways to ask about microaggressions toward people of color or part of lgbtq groups so even if you wanted to share some of your language people might appreciate that.

Sunny Choi: Yeah I will actually answer that on my next slide.

Jill Levitt: Oh okay amazing I can read your mind let me end the poll and share the results with you now and then you can talk about the results.

Sunny Choi: Yeah I was one of the know before too and I did not realize because I did ask about trauma I did ask about trauma do you experience trying I think that's a very common question also oh I don't have trauma I wasn't raped I was in physical abuse so I it's actually important to ask whether you've been experiencing this type of oppression because when you when I did ask for some of the folks that I talked to they open up and pull off their heart and tell me what's going on in fact that intake become like a empathy session so it's important to ask specifically about that. Yeah now again I'm not saying that it'll happen to everyone but just ask that one question it would be very important. So people ask what kind of questions we may want to ask during intake well actually the DSM have a handbook called cultural formulation interview that have a list of 16 assessment questions that would be very good to start asking about questions so that you can see the experience from a cultural lens, it's evidence based it's DSM 16 assessment question couple questions that I thought it was kind of interesting to ask and again you can review it in the DSM you can even I think you can even google it they'll they have those 16 questions one is are there any aspects of your background or identity that make a difference to your problem that's question number nine. I thought that was a good icebreaker to kind of ask about those questions that you want to ask about trauma. Another one is has anything prevented you from getting the help you need and then there was a list right family commitment stigma or discrimination, a lack of services that understand your language or background. Another question that I thought it was very important to ask would be question number 16 which I referenced earlier some which is about the power dynamic. Sometimes clinicians and patients misunderstand each other because they come from different background or different expectation have you been concerned about this and is there anything we can do to provide you with the care you need and then you can even list perceived racism language barrier and all the other barriers that they may face and some of them and then I thought that when you ask this then you may even this is a good segue to the more intense questions about oppressions or microaggression. Although I must say sometimes I'm just blunt and I would just ask them directly and they actually told me pretty quickly and I think they're waiting for someone to ask them yeah for some of these people. So I want to show you a case study of how I apply what we talked about earlier plus some TEAM-CBT model to work with one of my patients. Again this is you know I don't we don't have a lot of time so I'm not I'm not going to go very detailed into the TEAM model but just how you apply these extra things in the TEAM model so I had a latina patient the phq-9 is like pious with suicidal ideation and on the brief mood survey is the highest on depressed and anxious have a lot of panic attacks cutting a lot of pain issues to a point where she cannot even walk, a lot of social anxiety talking to people like on the privileged side she was really lacked off low socioeconomic background, a woman being physically abused by her parents, bully at school for being overweight and lgbtq community lesbian she's a lesbian like what I say I love her though. It's like she's very wonderful grateful person very kind kind not nice very kind person also very insightful about her own situation and just couldn't get out of it so during the testing stage one thing to remember when you do the developer and remove survey one of the testing is the anger right well she puts zero on the anger and I say well how can you not be angry when you experience all these things so I really work with her to process her experience of being bullied being discriminated being abused and of course eventually she did you know put the more appropriate number which is like as high as the other ones on the anger because it's actually a good thing she's angry and of course during the empathy stage I spend a lot of time understanding grieving with her that her experience, her feelings are not distorted that she recognized her strength, she's very resilient and kind and grateful and one thing that helped for me at least is I do some self-disclosure about me being gay and I was undocumented and it seems to kind of lower that power differences and then she was able to tell me more in fact she told me that she was gay or she is gay after I self-disclose. On the agenda sending stage is important to I think it's an assessment of resistance, now that's what David called it now educate her on emotions that and positively frame those anger that anger is a good thing how can you not be angry because anger actually helped you detect your injustice that was happening to you and we just need to dial it down because instead of you using your anxiety to repress your anger because your anxiety because you're afraid that there will be even worse abuse so now you have like really high anger and high anxiety so I work with her to lower her anger so she doesn't feel anxious about it and about expressing the anger and then help her express those anger in a positive way using five secrets and also expressing her sexuality using five secrets. Now of course because of her sense of anxiety which is true protective we also decided that it's only safe to do it outside of her family so during the method set sessions we do a lot of help her with a lot of self-disclosure exposure work which is like the process which you know she decided she want to overcome a process resistance and then do a lot of externalization of voices because there's a lot of self-doubt, not good enough type of thoughts that I have to help her talk back to and actually record it and have her reprogram in her mind but the result is actually it's very good. She eventually get better with no depression, the physical symptom again went away. Thank god no more suicidal ideation the good thing is she came back to visit me one time some relapse but very minor and then told me that she has a partner for a year now at that time and is going to graduate school in psychology because she wants to help other people like her to to heal and I said okay well that's awesome and that's why I'm doing this by the way that's why I'm changed my career because to see people like that here. So a quick summary of TEAM-CBT because we talk about a lot of these concepts and again I'm not going to details and Jill will maybe give you some more information later on where you can get more TEAM-CBT training just a quick summary on the test and assessment stage you need to make sure you address the shame of going to seeing a therapist so that they can tell you more about what's going on especially from my experience the asian population because they don't know much about mental health issues or even their own emotions. Address the power differences address the power differences so that they will be more equal as you and tell you as a peer what's going on I know I keep saying that and I can get a little annoying but ask them specific traumatic experience don't just say do you have any trauma. Again ask about their emotions thoughts behavior but also sensation physical sensation is very important to ask during the empathy stage validate the grief, acknowledge the anger but importantly recognize the resilient these people are not don't see them as victim they're actually very strong stronger than me in many cases they just have some areas that we can help them get through using TEAM-CBT and a lot of empathy and after this empathy stage you may actually want to go back to your assessment and testing to re-ask some of these questions because they may actually tell you more because they did to me.

On the assessment of resistance yeah use a lot of psychoeducation on emotions and I do that not just to the these populations but even to my younger ones I love spiderman I say well just pretend these emotions are your spidey sense your anxiety detect danger, your anger detect injustice, your sadness tell you where you are is not where you want to be and then positively frame those negative emotions like that and work with them to see well do you really need that much anger and anxiety right now you're older now you don't you may not need to right and assuming that they want the dollar down that's when you work with them on the method to pretty much restructure a lot of learned pattern either cognitive or behavior pattern from past trauma. And then in some cases it's not even restructuring it's for them to to acknowledge their spidey sense so that if they are afraid or unhappy with their abusive relationship maybe figure out a way to plan on leaving it, if they are angry that they are getting less money than their male counterpart work with them to use five secret about effective communication to ask for a race which by the way it works for a lot of my patients so so I think they're actually but I told them that I'm not a career coach and I don't guarantee a higher rate in those cases. So other considerations at least with the yeah a lot of these patients in this population have never seen a therapist so which is a good thing because they don't have the expectation that it will take years to heal and they're quite responsive for the TEAM-CBT model that is very focused and brief so just run with it you actually realize how fast they got healed despite all the trauma that they face yeah because they're again they have a lot of strength. When you use the interpreter be careful because some of these concepts that Dr. Burns taught us like paradoxical agenda setting or possible reframing may not be maybe may not be very easy for people to understand right away and making sure that the interpreter know what you're trying to say is important and this is from experience because I don't speak mandarin but I do understand mandarin and when they some of these interpreters say something about what's good about anger the way they say I said I didn't say that don't say that yeah so I have to like correct that person so when you use the interpreter make sure you you do it slowly and basically do psycho education to them too as you do that to your clients. And a lot of these populations especially the asian ones that work with really respect clinicians. The good thing is that they are great with homework and I often impress how much homework they did how much work they did outside of our short sessions but also the one thing you have to be careful of they may have some difficulty criticizing you or tell you something if they don't agree with but they won't do so make sure you're open with them that it's important for them to give me feedback in fact it's a good practice of five secrets when you do that and of course Dr. Burns session evaluation also talk about that too so I actually even told them well when you rate it make sure you know you tell me what's going on and and not what you want me to hear. So you hear a lot of information about the multicultural and marginalized populations you may be wonder what can I do. Well for one I think it's important to educate yourself, just like I've been educating myself about different populations. For that the FGI Diversity Team actually come up with some recommendation and one of the one that we want to share with you is the anti-racism training from the diversity and resiliency institute of El Paso if you go on the website google it you will see it it's free if you don't want any ceu train credit and I think it's only like very cheap like 60 if you want some credit and I think it's a day long yeah I went through that and it was quite a lot of different information and very quite useful. Be culturally humble what I mean is we do not know it or I don't know at all about diversity but know that you don't know it all but yes it's important be aware that it is happening recognize that these discrimination bias is happening and then do the research and cultural norms go to education I mentioned earlier and then be curious about the individuals experience and ask them these questions. I think it's important to be compassionate not just compassionate to folks who imagine but marginalized but I myself when I put this content together, a lot of feelings come up besides a lot of trauma but even for me I felt a lot of guilt, a lot of shame for my own biases, my own ignorance relating to diversity but at least I have a framework to process these issues due to my own marginalized experience but for others they may not have that framework to understand what it is like to be marginalized and with them. I believe it's important to be compassionate, to be patient, to be opened and honest with them, work with them even though they have different stages of understanding. Finally be an advocate I don't know about you but I sometimes when I'm self aware of my own privilege I feel guilty and bad and but what I also realize is with this privilege I do have a lot of clout and influences to help give the voice to these people just like what I'm doing now so that they have more rights and freedom. Join some groups to help these populations my sister was very active in asian women's shelter and there are many different organizations for different marginalized populations, you can google it but consider also giving reduce fee for this population because what I know is this the current resources for this population is not a lot so if you are willing to reduce your fee use your fee because they can't afford it not all of them a lot of them can afford it the one that cannot afford it would be good to for them to get a taste of the power of TEAM-CBT. Because I believe that we can all chip in to help maybe one day the 12 year old me who were like very devastated because all he was asking was a tissue can be more confident, feel more worthy and feel more belong belonging to this country thank you. thank you so much Sunny.

Q&A Session