Diversity Corner

The Department of Psychiatry Chair’s Advisory Committee on Diversity Issues is proud to introduce new content for the Diversity Corner. This part of the website features rotating content with the goal of providing a glimpse into diversity-related events in our department as well as stimulating general discussion of diversity-related topics. If you know of an individual, event or topic that you feel would be appropriate for the Diversity Corner, please let us know!

This quarter’s content features considerations for how close examining of a person's identity markers (e.g., race, ethnicity, language, nationality, biological sex, gender identity, age, marital status) and how they might intersect is critical in a therapeutic settings:

Background

Intersectional theory examines the complexity of identity, emphasizing that individuals are more than the sum of their parts, or individual identity markers. Intersectionality developed out of the feminist movement and was first coined by Kimberlé Williams Crenshaw, a scholar of critical race theory who explored the intersections of being both black and a woman. Crenshaw posited that a clear understanding could not be achieved by considering her gender identity and cultural-ethnic identity independently, but by considering both together. Since its development, the theory expanded to include other identities and is the focus of diversity research.

Using an intersectional approach to inform clinical practice and develop diversity-informed case conceptualizations has become widely accepted in the field of psychology. Considering the intersection of a person’s identity markers (e.g., race, ethnicity, language, nationality, biological sex, gender identity, age, marital status, parenthood, religion, socioeconomic status, sexual orientation, education, national origin, disability/ability, etc.) offers the opportunity to gain deeper understanding of an individual’s experiences and their complex, often multi-dimensional, identities.

Just as no two patients who enter your office are the same, no two sets of intersecting identities are the same. Consider, for example, the experience of a young Chinese-American man coming in for treatment whose grandparents immigrated to the United States 50 years ago, to those of a young Chinese-American man who immigrated to the United States with his family during his childhood. Although these individuals may share the same gender and ethnic background, the intersections between these identities, their level of acculturation, language, and family roles may result in different experiences. From an intersectional perspective, multiple membership categories and the relationships between these memberships are considered.

Case Example

To further illustrate this concept, consider the following case example. Whether you are reviewing this on your own or utilizing the material to facilitate dialogue with a colleague, we ask that you consider each set of questions in the order they are provided:

Michelle, a 27 year-old, biracial (Black & Japanese) female, is seeking individual psychotherapy at this time for stress management.

  • What are factors that you consider for Michelle’s initial conceptualization given the identity markers provided thus far?

Michelle is an attractive, able-bodied, self-identified heterosexual woman in a committed relationship and has no children.

  • How do her physical attributes impact your conceptualization of her identities?
  • How important are her sexual orientation, relationship status or parental status to your conceptualization, and why?

Michelle is articulate, well-educated (she holds a Master’s degree in Public Administration), and is a published author who works as a freelance journalist.

  • Does a patient’s professional identity and achievements impact your conceptualization? If so, how?
  • Do these aspects of her identity matter more, less or similar than some of the other identifiable identity markers presented?

As a child of divorce, Michelle grew up frequently moving between the working class neighborhoods of her parents’ homes, who lived in different parts of the country.

  • Do her early familial experiences impact your conceptualization of her intersecting identities today? If so, how?
  • Which of Michelle’s identity markers stands out the most at this point?
  • What, if anything, do you want to know more about regarding Michelle’s intersecting identities?
  • Has this new piece of information impacted your conceptualization of Michelle, and if so, how?

Later in treatment Michelle discloses experiencing childhood sexual abuse from multiple perpetrators and reports that she began engaging in sex work as a teenager to support herself.

  • Take a moment to focus and reflect on all aspects of her identity at this point. What is your conceptualization of Michelle at this point? It can be easy to move towards targeting treatment and treatment goals around what Michelle has shared at this point in therapy, however, consider if, and how, these experiences relate to and impact her identity.

She tells you that she grew up “fish” and experiences “survivor’s guilt” but is apprehensive of explaining further.

  • What does it mean when a patient uses language you are unfamiliar with, and how would you respond in these situations?
  • How does her self-identification as a “survivor” change your conceptualization at this point?

Later in treatment Michelle discloses that at age 20 she had gender-affirmation surgery.

  • Consider that this disclosure happened 2-3 months into therapy with Michelle. How does this aspect of her identity intersect with other aspects you were already aware of?
  • Has your conceptualization changed, and if so, how?

Conclusion:

Today, appropriate clinical practice requires diversity-informed conceptualization, treatment planning and interventions. To assume that any one identity is salient over all others limits the ability of clinicians to help their patients achieve the positive change they are seeking through psychiatric care. Taking an intersectional approach provides clinicians the context and framework to understand a patient’s experiences and perspectives, including the impact of and relationships between their various identity markers. The aim of the above case example was to illustrate the importance of adopting an intersectional approach to conceptualization and allow for reflection on how to utilize this approach. Please take a moment to review the final discussion questions below on your experience of this exercise and your own intersecting identities.

Final Discussion Questions:

  • How has your conceptualization and understanding of Michelle’s intersecting identities changed over time?
  • Which of Michelle’s identities, if any, are most salient?
  • What are some of your own intersecting identities?

References

Cheshire, L. C. (2013). Reconsidering sexual identities: Intersectionality theory and the implications for educating counsellors. Canadian Journal of Counselling and Psychotherapy, 47, 4-13.

Hays, P. A. (2001). Addressing cultural complexities in practice: A framework for clinicians and counselors. Washington, D. C.: American Psychological Association.

Biographies:

Nicholas Grant, Ph.D. is currently the American Psychological Association (APA) William A. Bailey Health and Behavior Fellow through the American Association for the Advancement of Science (AAAS) Congressional Fellowship. He completed his Ph.D. in Clinical Psychology at the Pacific Graduate School of Psychology (PGSP) at Palo Alto University, where he worked as a research assistant with the Center for LGBT Evidence-based Applied Research (CLEAR). He completed a predoctoral internship in behavioral medicine at Tulane University's School of Medicine and a clinical fellowship at the San Diego VA /UCSD where he specialized in LGBT mental health.

Jennifer F. Hsia, Ph.D., is currently an Assistant Professor in the Clinical Psychology Ph.D. program at the California School of Professional Psychology – Alliant International University (CSPP) in Los Angeles, California. She received her Ph.D. in Clinical Psychology from the University of South Dakota (completing her predoctoral internship at VA Puget Sound – American Lake) and completed a postdoctoral fellowship at the San Diego VA/UCSD where she specialized in Primary Care Mental Health Integration and Tobacco Cessation. Dr. Hsia teaches in the Health emphasis area at CSPP with clinical interests in behavioral medicine. Her research interests include substance use in ethnic subpopulations, issues of acculturation, and microaggressions related to intersecting marginalized identities.