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Iraqi Refugees and Cultural Humility: a Mental Health Professional

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Iraqi Refugees and Cultural Humility: a Mental Health Professional Running head: IRAQI REFUGEES AND CULTURAL HUMILITY Iraqi Refugees and Cultural Humility: A Mental Health Professional Training Program by Megan Brunmier Marsh A.B., Bowdoin College, 2008 M.S., Antioch University New England, 2013 DISSERTATION Submitted in partial fulfillment for the degree of Doctor of Psychology in the Department of Clinical Psychology at Antioch University New England, 2016 Keene, New Hampshire IRAQI REFUGEES AND CULTURAL HUMILITY i Dedication To all the scientists and clinicians who view themselves as global citizens and have devoted their lives to the global humanitarian cause, To all of my educators, especially Mr. Matthew Weimer, who have always encouraged me to define my horizons globally, To my mom and dad who have, at every turn, sacrificed their own comfort to ensure that I would encounter the most impassioned educators, And to my grandparents, because of everything. IRAQI REFUGEES AND CULTURAL HUMILITY ii Acknowledgements This project has been both imaginable and manageable because of the support of many individuals who I would like to acknowledge here. Foremost, thanks should be given to Dr. David Whitestone, who connected an enthusiastic clinical trainee with a profound clinical need and who continues to strive toward the best possible services for new Iraqi Americans. Tariq Alziadi, Carissa Dwiwardani, Janice Jaffe, Barbara Piotti, and Jason Rivera showed such enthusiasm for this project that however I continue to contribute to refugee services in the future will be in large part on momentum they created with their encouragement. The voices of Gargi Roysircar and Susan Hawes have both spoken through me and into this writing. They have challenged me intellectually and supported me personally in transformative ways. I am so grateful to my dissertation committee who not only permitted but encouraged me to run with a newfound intellectual and emotional passion. After asking Dean Hammer to serve on my committee, he responded first by asking the topic; I will never forget how brightly his face lit up when I told him. He made my efforts feel relevant. In an unqualified show of support for me, Lorraine Mangione agreed to be on my committee before ever knowing the topic and has since been one of the loudest and most convincing voices of support for my identity as a writer. Roger Peterson is a mentor whose spirit I see, appreciate, and feel is kindred. He is a gift to my life. Finally, I could not have completed even a piece of this project without the love and support of Sarah Seames and Sam Penson, Kate and James Myall, Adam Lord, Sarah Kopencey, and Thomas Hulslander, all who have laughed and cried with me and, in so doing, have become family. IRAQI REFUGEES AND CULTURAL HUMILITY Table of Contents Dedication ....................................................................................................................................i Acknowledgements ......................................................................................................................ii Abstract ........................................................................................................................................1 Chapter 1: Review of the Literature .............................................................................................2 Iraqi Refugees .........................................................................................................................5 Refugees and Mental Health ...................................................................................................10 Mental Health in Country of Origin...................................................................................10 Mental Health during Migration ........................................................................................11 Mental Health in Resettlement ...........................................................................................12 Refugees and Mental Health Service Utilization ...............................................................12 Cross-Cultural Mental Health Services .............................................................................13 Rural Mental Health Vignette ............................................................................................15 Specific Objectives of Project ............................................................................................17 Chapter 2: Conceptual Framework ..............................................................................................18 Practice-Based Evidence .........................................................................................................18 Cultural Competence ..............................................................................................................19 Clinician Self-Awareness ...................................................................................................19 Clinician Awareness of Client ...........................................................................................20 Clinician Application of Culturally Appropriate Interventions .........................................21 Ecological Systems Theory.....................................................................................................22 Ecological Systems ............................................................................................................22 Refugees in the Ecological Field .......................................................................................23 IRAQI REFUGEES AND CULTURAL HUMILITY Conceptualizations of Pathology .......................................................................................23 Epistemology and Competence..........................................................................................25 Cultural Humility ....................................................................................................................27 Humility and Safety ...........................................................................................................27 Experiential Education .......................................................................................................30 Social Justice ...........................................................................................................................37 Program Development Model .................................................................................................41 Training Program ....................................................................................................................41 Chapter 3: Method .......................................................................................................................44 Part I: Planning and Implementation ......................................................................................44 Step 1: Establish the Need for Programming .....................................................................44 Step 2: Establish a Research Basis for Program Design ....................................................46 Step 3: Address Cultural Identity Issues in Program Design .............................................46 Step 4: Design the Clinical Program ..................................................................................47 Step 5: Develop the Infrastructure .....................................................................................48 Steps 6-8: Evaluate and Leverage Resources ....................................................................49 Step 9: Develop the Proposal .............................................................................................49 Part II: Program Implementation and Sustainability ..............................................................50 Step 10: Implement the Program .......................................................................................51 Step 11: Evaluate the Program ...........................................................................................51 Step 12: Build and Preserve Community Resources .........................................................52 Step 13: Develop an Advocacy Plan ..................................................................................52 Step 14: Develop an Information-Sharing Plan .................................................................52 IRAQI REFUGEES AND CULTURAL HUMILITY Step 15: Attain Program Accreditation ..............................................................................53 Chapter 4: Results ........................................................................................................................54 Part I: Planning and Implementation ......................................................................................54 Step 1: Justifying the Training Program ............................................................................54 Step 2: Research Basis for the Design of the Training Program .......................................64 Step 3: Cultural Issues in the Design of the Training Program .........................................75 Step 4: Design of the Training Program ............................................................................77 Step 5: Infrastructure of the Training Program ..................................................................82 Steps 6-8: Resources of the Training Program ..................................................................94 Step 9: Expert Reviews of the Training Program ..............................................................95
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