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Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD

Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD Program Transcript

[MUSIC PLAYING]

CANDACE MCLAIN: Hey everybody, Dr. Candace McClain here. I am a core faculty at Walden University in the clinical mental health program. I'm here to talk to you just for a very brief couple of moments today about avoiding pathology and diagnosis assessment and treatment planning. Part of how this came about for me was a few years ago, I really had this epiphany that all of this avoiding, pathologizing, avoiding, biases, really starts with understanding our counselor identity.

And so I think it's important to look at, OK, what is my role and responsibility in my identity as a counselor first and foremost. And if we look at the roots of how counseling really got started, it was really based more on a developmental model, and a model of wellness and health, versus some of the other fields who were more medical model and built on diagnosing and looking for pathology. And so I think it's important to really differentiate and understand, as counselors, our identity and how it's different than other fields.

And really how that also dovetails in to the next topic is that our identity as counselors is crucial in understanding our own world view. Now, sometimes I'll ask students, what's your world view? Are you aware of your world view? And they look at me, like, what's that? Well, we have heard that word thrown around quite a bit, worldview. But I think it's really important that we continue to analyze, reflect, and have self awareness of what that means.

And so when we look at our own world view, we're really looking at our values, ideas, thoughts, and beliefs about ourselves, others, and the world that we live in. And that includes the biopsychosocial cultural spiritual model as well. And so you can't really help but when you're analyzing and reflecting on your worldview, having some kind of self- awareness of cultural humility as well in that process. And so it often involves a lot of self reflection, introspection, but also dialogue and conversations that are very authentic and very courageous with colleagues, peers, supervisors, faculty, and even family members.

And so I think that that's a really important piece I want to encourage everyone to look at. Ironically enough, according to the ACA Cross-Cultural Competencies and Objectives, there are three core categories that are expected of counselors in order to have these competencies related to culture and awareness. And the three sections all involve this awareness that we need to have about our attitudes and beliefs, and that's also dispositional, right. And then also the knowledge and the skills under each area.

And the three areas ironically, like I said, are awareness of our own worldview is the first one. The second one is awareness of our client's worldview. And the third one is

Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD

culturally appropriate interventions and strategies. If we are indeed doing those three areas; exploring, and having self-awareness, self-understanding, courageous, authentic conversations with other people about our attitudes and beliefs, and we're working on the knowledge and the skills, then we can prevent and avoid pathologizing in our clients.

Many years ago, I worked in residential treatment with all adolescent girls, and I was leading a transitional living workshop in which the focus was success upon transitioning from foster care or residential care onto your own as a client into the world. You know, being discharged.

And our topic for that week was actually looking at trade schools and college and how to find a career. And we got about halfway through our group, and I had one of my clients, who is Native American, Lakota, from South Dakota, and who had grown up on the reservation. She raised her hand and she asked, well what if we don't want to go to college or a trade school? What if that's not really defined as success in our family and to us?

And for the first time, I paused and just said, wow, you're right. That's a great question. And internally, went home-- um, actually went after work and processed with colleagues how I felt very convicted that by assuming that this was the definition of success for all of our clients that that was very not cultural competent at all. And it was imposing our world view onto our clients. And could potentially have been damaging if we hadn't rectified that.

In that space, I also recognized that some of the other counselors had an idea that was different. And that was, well, no, they need to do X, Y, and Z to be successful. And it's not normal or right, if you will, if all they want to do is be an artist, or make crafts, or weave rugs. And that was very, very eye opening for me, because to see the discrepancy of how something so simple as having a blind spot of our own as counselors, and being biased, and not being aware of our world view and our clients worldview could turn into something like pathologizing our clients. It's very scary, but also eye-opening for me.

So I think that that's just one brief example. But I think the best way to look at it is if you're doing, ethically, what you should be doing and following the codes, and seeking and going above and beyond those codes by looking deeper at your own personal and professional growth in dispositions, character, skills, and knowledge, then you're going to prevent, hopefully, many of those instances of pathologizing clients.

Whether it be religion, cultural pieces of ethnicity, sexual orientation, or whatever the differences are and the diversity is, it's our responsibility to be culturally competent and look at and have that awareness at all times. And then be challenging ourselves with collaboration and supervision. So, I hope that that's helpful. I look forward to hearing and learning about all of your world views, and see how you guys wrestle with these things while you're in training. It's very exciting. Take care.

Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD

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