Defining and assessing key behavioral indicators of the Shifting Cultural Lenses model of cultural competence.

Models of cultural competence highlight the importance of the sociocultural world that is inhabited by patients, and the question of how best to integrate sociocultural factors into clinical assessment and intervention. However, one significant limitation of such approaches is that they leave unclear what type of in-session therapist behaviors actually reflect cultural competence. We draw on the Shifting Cultural Lenses model to operationalize culturally competent in-session behaviors. We argue that a key component of cultural competence is the collaborative relationship between therapists and patients, in which therapists shift between their own cultural lenses and those of their clients, as they co-construct shared narratives together. Accordingly, we propose that culturally competent therapist behaviors include accessing the client's views, explicitly presenting their own views as mental health care professionals, and working towards a shared understanding. We further specify the latter set of behaviors as including the practitioner's integration of the patient's view, their encouragement of the patient to consider their professional view, and the negotiation of a shared view. We developed a coding system to identify these therapist behaviors and examined the reliability of raters across 11 couple and 4 individual therapy sessions. We assessed whether the behavioral codes varied in expected ways over the first 3 sessions of 2 therapists' couple therapy as well. Operationalizing the behavioral indicators of the Shifting Cultural Lenses model opens the door to the integration of both process- and content-oriented approaches to cultural competence.

Beyond the reproduction of official accounts: parental accounts concerning health and the daily life of a California family.

Considering the purported bias of interviews to elicit "official accounts"--conveying conventional teachings from health promotion--and limited insights individuals may have into their own health behaviors, the challenges of relating health as talk (directed at researchers) to health as enacted are examined. Focusing on one family from a study of dual-earner middle-class Los Angeles families, I propose and apply four analytic lenses to a conjoint analysis of ethnographic interviews and videorecordings of family life to examine the parental claim that their family is a "healthy family." Findings indicate that parental accounts enable deeper insights into health as entrenched in everyday life, here revealing the centrality of a relational view of health as "family well-being" (vs. individual health) extending into the social world. Discussion considers debates over the extent to which "discursive consciousness" in interview settings illuminates health-relevant practices in everyday life contexts.

"A massive long way": interconnecting histories, a "special child," ADHD, and everyday family life.

Focusing on one family from a study of dual-earner middle-class families carried out in Los Angeles, California, this article draws on interview and video-recorded data of everyday interactions to explore illness and healing as embedded in the microcultural context of the Morris family. For this family, an important aspect of what is at stake for them in their daily lives is best understood by focusing on 9-year-old Mark, who has been diagnosed with attention-deficit/hyperactivity disorder (ADHD). In this article, we grapple with the complexity of conveying some sense of how Mark's condition is experienced and relationally enacted in everyday contexts. Through illuminating connections between lives as lived and lives as told, we explore the narrative structuring of healing in relation to Mark's local moral world with the family at its center. We examine how his parents understand the moral consequences of the child's past for his present and future, and work to encourage others to give due weight to his troubled beginnings before this child joined the Morris family. At the same time, we see how the Morris parents act to structure Mark's moral experience and orient to a desired future in which Mark's "success" includes an appreciation of how he is accountable to others for his actions. Through our analyses, we also seek to contribute to discussions on what is at stake in everyday life contexts for children with ADHD and their families, through illuminating aspects of the cultural, moral and relational terrain that U.S. families navigate in contending with a child's diagnosis of ADHD. Further, given that ADHD is often construed as a "disorder of volition," we seek to advance anthropological theorizing about the will in situations where volitional control over behavior is seen to be disordered.

Cultural competence and psychotherapy: Applying anthropologically informed conceptions of culture.

The authors apply two contemporary notions of culture to advance the conceptual basis of cultural competence in psychotherapy: Kleinman's (1995) definition of culture as what is at stake in local, social worlds, and Mattingly and Lawlor's (2001) concept of shared narratives between practitioners and patients. The authors examine these cultural constructs within a clinical case of an immigrant family caring for a young boy with an autism-spectrum disorder. Their analysis suggests that the socially based model of culture and the concept of shared narratives have the potential to broaden and enrich the definition of cultural competence beyond its current emphasis on the presumed cultural differences of specific racial and ethnic minority groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Narrating troubling experiences.

This article presents a process-oriented perspective that relates to the broad question of how self-related experience comes to be endowed with meaning. The approach highlights the implications of 'living by' particular culturally based understandings in specific contexts and centers on how jointly cultural, social, and cognitive processes offer potentialities for orienting the experiential self without determining self-related experiences. This process-oriented perspective revolves around the interplay between the range of historically contingent cultural resources available for endowing experience with meaning and the socially and structurally grounded processes through which individuals learn about, orient towards and traffic in interpretive plausibilities--a socially situated experientially based process. This perspective is informed by, and provides an entree for exploring, variability within a cultural setting. The narrative accounts examined are from individuals who grew up speaking either Ojibwa or Cree (both Algonkian languages) in First Nations communities in Manitoba, Canada.