Class 3: Anti-Oppressive Practice in
Clinical Settings
AUGUST 27, 2012
RECLAIMING FUTURES ANTI-OPPRESSIVE
PRACTICE TRAINING 2012
Objectives for Today
 To understand how privilege and oppression appear
in clinical settings.
 To learn tools to constructively challenge dominant
power structures and arrangements in clinical
settings.
 To promote liberation, strengths and empowerment
in clinical settings.
From Last Session….
 Briefly discuss examples of organizations that work
to improve the power of clients.
Core Competencies
 Describe threats to anti-oppressive practice in
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clinical settings.
Apply tool to identify quality of anti-oppressive
practice components in current setting.
Describe common “tresspasses” that occur in clinical
settings.
Describe and apply a “liberation” lens in clinical
settings.
Apply methods to advance evolution of clinical
practices from an AOP perspective.
Overview of Today
 Explore evolution of cultural competence to anti-
oppressive frames and AOP-related threats in
clinical settings.
 Discuss AOP-specific counseling/intervention
models and skills including liberation frameworks.
 Use tool to reflect on strengths/needs regarding AOP
elements in local clinical settings.
Reflecting on Pre-Work for Today
 Do your clinical services have information available
about ethnic/racial or gender-related success rates?
 If yes, how do you assess the rate you found? If not,
why does this not occur?
 What did you learn as you explored this question?
Brief History of Cultural Competence in Clinical Work
 Increasing acknowledgement of diversity in the last
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30 years
Minor shifts in “appreciating difference”
Growing awareness of disparities
Increasing grounding in clinical ethics that attention
to “cultural competence” important
Tendency to place focus on practitioner
responsibility for shift – rather than balance action
with larger organization and community changes
Definition of Cultural Competence
 A set of congruent behaviors, attitudes, and policies that
come together in a system, agency, or among professionals
and enables that system, agency, or those professionals to
work effectively in a cross-cultural situation. Operationally
defined, cultural competency is the integration and
transformation of knowledge about individuals and groups
into specific standards, policies, practices and attitudes
used in appropriate cultural settings to increase the quality
of health care therapy improving or producing better health
outcomes (Cross, Bazron, Dennis and Issacs, 1989).
Contrast with an AOP Foci…
 A clear theoretical and value base that promotes
egalitarianism and power-sharing;
 An understanding of one’s social location and how it
informs relationships and practice behaviors;
 A challenge to existing social relationships in which
powerful groups maintain power and influence over
less powerful groups; and
 Specific practice behaviors and relationships that
minimize power imbalances and promote equity and
empowerment for users of service. - Larson, 2008
Acknowledging Whiteness in the Dominant
Discourse of Treatment
 Majority of human development and human behavior
theory not grounded in diversity
 Need for acknowledging that this has created a hegemonic
discourse which permeates all human (and related) services
– rendering other perspectives less valuable, dysfunctional
or invisible.
 Rich literature exists to describe: diverse ideas about
identity development and strengths across the human
community, impact of racism on human functioning
(including trauma response and intergenerational loss &
phenomenon of racial micro-aggression), and diverse
perspectives on social and health-related behavior but all is
seldom integrated into our traditional practice with youth.
Common Threats to AOP Practice in Clinical Settings
 Labeling
 Micro-Aggression
 Unacknowledged realities of the trauma of racism to
aggravate and/or exacerbate other issues facing
clients
 Unexamined/underutilized cultural
strengths/resilience
 Lack of reflexivity in practitioner stance (lack of selfawareness, fear of issue, unexamined privilege)
Labeling Theory
 Understanding of deviance as social rather than
psychological phenomenon.
 Deviance is not an inherent property of any specific
behaviors or persons. Rather it is a model of social
definition.
 Deviance is thus created through a process of
interaction in which moral meanings are assigned to
specific behaviors or attributes. Persons who engage
in these behaviors or possess these attributes are
then selectively chosen and labeled as deviant.
Labeling Theory (Continued)
 Social audience is a critical variable in labeling theory.
 Social audience, not the individual actor, that determines
if a specific behavior is deviant.
 The process of creating and applying moral meanings
(good, bad, normal, deviant) is a moral enterprise
conducted by moral entrepreneurs – people who create
and enforce rules, selectively label behaviors and persons
as deviant.
 Highly valued realms of culture (psychiatry, law,
religion) are responsible for the creation, definition and
control of deviant types and stereotypes.
Labeling Theory (Continued)
 Labeling theorists are concerned with the processes and
consequences of labeling
 When negative and pathologizing labels are effectively
applied, the label impacts all social relations as the
labeled person is moved from a normal position in
society to a deviant role.
 The role carries with it a special status and role
expectations the leveled person is expected to fulfill the
role requirements of a “patient” or a “prisoner.”
 Often these role expectations become a self-fulfilling
prophecy for both the individual and the social audience.
Labeling Theory (Continued)
 Further, labeling theorists point out that these roles
are stigmatized and are usually not reversable.
 Thus, once labeled, a stigmatized person is rarely , if
ever, allowed to resume a normal role or position in
society.
Note: The more powerful the person or system
applying the label, and the less powerful the person
receiving the label, the more dangerous and
destructive this process may be.
Micr0-Aggressions
 Racial microaggressions are brief and commonplace
daily verbal, behavioral or environmental indignities,
whether intentional or unintentional, that
communicate hostile, derogatory, or negative racial
slights and insults towards people of color.
 Perpetrators often unaware that they engage in such
communications.
 Seem to appear in three forms: microassaults,
microinsults, and microinvalidation (see summary)
Wing Sue, Capodilupo, Torino, Bucceri, Holder, Nadal, & Esquilin, 2007
Trauma, Coping and Racism
 Clients in treatment frequently have substantial,
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multiple and sustained losses
However there is a deeper level of loss to consider
from an AOP perspective
Individual and community response to unyielding
trauma of racism
Intergenerational transmission of trauma response
Coping and stress management – resilience in the
face of racism
Why Strength-Based Approaches are Vital
 Strength-based approaches involve deconstructing
negative and confining labels and social
expectations that deny or obscure people’s strengths.
 Helper’s every action helps shape the client's
understanding of self and the world, for better or
worse, showing the great care must be taken in the
helping relationship.
 Highlights the importance of supporting a client’s
development of self-esteem (recognition of one’s
own strengths and worth) through behavior from the
helper that is consistently respectful and affirming.
Liberation Psychology
 Rooted in Paulo Friere’s pedagogy of the oppressed
– concientization or critical consciousness to define
process of personal and social transformation.
 Believed that traditional models of education are
instruments of oppression, reinforcing and
maintaining social inequities.
 Developed critical consciousness to teach individuals
how to read their surrounding circumstances and to
write their own reality. (Comas-Diaz, 2007)
Liberation Continued
 Liberation paradigm states that to articulate the personal and
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communitarian liberation language, individuals and groups need to
assume control to their lives, overcome their false conscience and
achieve a critical consciousness of themselves.
Psychology of liberation seeks to work with people in context
through strategies that enhance awareness of oppression and of the
ideologies and structural inequality that have kept them subjugated
and oppressed.
Collaborates with the oppressed in developing critical analysis and
engaging in a transforming practice.
Resonates with African American psychology based on Black
liberation psychology (also Afrocentrism).
Emerged from Latin American liberation theology.
AOP Counseling Foundations
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Most interventions have been formed without centering distress as
connected to identity and oppression
Critique of conventional approaches as individualized, localized
(instead of socialized), blaming and implicating dysfunction
instead of social causes
Rarely do we practice at the root cause level
Roles are infused with inequality, non-reciprocity and elitism
Spot this as it happens and commit to name it, own it, and undo it
This causes us to reflect on canons of professionalism in new and
creative ways
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Solidarity instead of distance, rigid boundaries & limited roles
AOP Counseling Practices
(mostly from Mullaly, 2007; Baines, 2007)
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Empowerment practices
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Real building of power among clients & community
Consciousness raising
Pragmatic concerns
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Crisis supports
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Advocacy
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Help with immediate needs
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Referrals
Normalizing
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Seeing their problems as not unique, but rather similar to others facing same problems
Collectivization
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A primary value that recognizes people as social beings who depend on each other for primary &
social needs
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Is the antithesis of individualism – normalizes needs & collective solutions to problems
Redefining & Reframing
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A consciousness raising activity to define private troubles as political issues, exposing the
relationship between personal experience & structural domination
AOP “Therapeutic” Lens
• Key tasks
▫ Affirm and “own” experiences of oppression
▫ Reject self-concept that flows from internalized oppression
▫ Understand the reach of micro-aggressions and one’s
response to it
▫ Look for, and affirm the uniqueness of each individual and the
injustices of their experience
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Core role is to counteract damages, build strengths, build
connections to others in same community, and build agency to
create change, self-help and community power
Personal is political – refuse to understand distress solely at
the individual level
Reflexivity in Practitioner Stance
 Importance of developing practitioner education and
ongoing support to see oppressive dimensions present in
clinical settings (including willingness to see, understand
and take action on their own privilege).
 Importance of building climate of openness and
“courageous conversations” to identify specific examples of
heretofore unexamined potential for oppression and to
explore/experiment with clinical practices that challenge
and change this.
 Strengthen connection to clinical focus on disparities
reduction rather than merely execution of evidence-based
practices.
Audit of Clinical Practice from an AOP Perspective
- In this session, discuss what you learned regarding
the AOP “index” for anti-oppressive practice in your
clinical settings.
- Discuss barriers and facilitators of progress –
especially identification of key allies and levers for
change
- Discuss potential projects that could be derived from
what was learned in this exercise for final project
Homework and Follow Up
 Read articles relating to AOP relevance and issues in
clinical practice.
For Next Class
 Seek out any organizational diversity or cultural
competence plans and bring examples to our next
class.
 If you can, please share them by sending to Cora who
can assist us in sharing them.
 Next class meeting on September 5, 2012