Mental health care at the margins: A critical ethnography of psychological practice in an inner city community mental health setting.

摘要

Within the past several decades, the field of psychology has attempted to improve psychological services for a greater diversity of people. However, despite these attempts, research continues to document a "gap" when it comes to mental health care services for marginalized populations. Various studies have addressed the issue of this "gap" in mental health care; however, most adhere to positivist assumptions regarding sociocultural aspects of experience, understanding culture and identity as immutable qualities existing within individuals, rather than as an interpersonal phenomenon that is negotiated between and among people and institutions. As a result of these assumptions, many past studies do not take into account this dynamic aspect of culture and the way in which it plays out within psychotherapeutic environments. In an effort to shed some light on the nuances and challenges of socioculturally sensitive practice, the current study utilized an ethnographic method in order to explore the practice of clinicians who were attempting to offer psychological care to a marginalized population. Results demonstrated that both psychologists and clients are caught up in a "web" of systems and identifications which impact the provision of psychological services. These findings support the notion that psychologists may benefit from expanding the traditional scientific lens when it comes to exploring issues of culture in psychotherapy, particularly when it comes to addressing the gap in services to marginalized groups.