Integrating French second-language experiences into clinical psychology training to enhance retention of English-speaking trainees

Context: Minority communities need access to linguistically/culturally sensitive mental health services. In this respect, Québec Anglophones face a retention challenge: Many English-speaking clinical psychology trainee students leave Québec upon graduation, thereby reducing the available pool of English-speaking mental health practitioners. Reasons include linguistic challenges in establishing a sustainable clinical practice in Québec, such as inability to meet French-language requirements of the Ordre des psychologues du Québec and/or inability to build a practice that includes Francophone clients. Concordia's Psychology Department is instituting a novel approach to addressing this challenge by integrating French-language experiences for English-speaking trainees into its program. This provides the project setting; we will closely study Concordia's experience and conduct a systematic review of literature on relevant best practices.

Main objective: Deliver a report on best practices for French second-language training and assessment for trainees in clinical psychology with a focus on potential implications for trainee retention.

Procedures: Procedures include (1) Examining the literature worldwide on best practices for language-training of mental health clinicians; (2) Interviewing 30 Concordia clinical psychology trainees; (3) Interviewing participating clinical supervisors; (4) Consulting community-based practicing clinicians about experiences using their secondlanguage-French with Francophone clients.

Data analyses: Systematic Reviews of the literature; Qualitative Analyses of interview data.

Potential contributions:

• enhancing retention of English-speaking clinical psychology trainees in Québec, thereby increasing support for the Anglophones community; laying foundations for future mixed-methods assessments of such second-language training support;

• providing support for similar English-language experiences for Francophone trainees, thereby further increasing the availability of practitioners for Anglophones.

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communications to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems. Cultural misunderstandings can exacerbate these problems. Past research funded by Dialogue McGill has identified ways in which psychotherapists can effectively intervene to overcome linguistic and cultural barriers. The current research proposes to directly evaluate these interventions.

Main Objectives: We will: (1) carry out a systematic review of psychotherapy effectiveness in cross-linguistic and cross-cultural settings; use (2) use qualitative inquiry to study linguistic/cultural misunderstandings between clients and their therapists; and (3) use quantitative techniques to study the impact of interventions designed to mitigate these misunderstandings.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all of whom speak English as a second language and prefer English as their first official language. Half will be in a situation of language match with their therapist, and half will have a mismatch, in terms of preferred official language.

Data Analysis:  Qualitative inquiry will give us a close reading on best practices when working with linguistic and cultural diversity. Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. Some models will include participants from previous Dialogue McGill-funded projects, enhancing statistical power.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec, as well as improving training of mental health professionals. Results will be relevant to other settings characterized by linguistic and cultural complexity.

Linguistically- and Culturally-Sensitive Psychotherapy: Training and Retaining Migrant & Minority Therapists

Mental health care in multicultural communities is enhanced when local therapists represent the population and when these therapists are trained in linguistically- and culturally-sensitive psychotherapy. Unfortunately, many trainees do not feel well-prepared for diversity and migrants/minorities face barriers to building a career in Québec.

We will: (1) use qualitative inquiry to study perceived training deficits and career barriers in psychologists trained at anglophone institutions; (2) use quantitative techniques to establish a consensus model of the changes needed to retain multicultural expertise in Québec. 

Participants will be 40 clinical psychology trainees and 40 licensed clinical psychologists. This project will use a cultural consensus design, a mixed methods approach with four sequential steps: (1) qualitative interviews (in this case, analysis of previously collected interviews); (2) free listing responses to open-ended questions; (3) sorting the most common responses while thinking aloud; and (4) survey design based on the consensual sorts.

The qualitative interview and think-aloud transcripts will be studied using qualitative inquiry, specifically thematic analysis. The free listing, sorting, and survey components will be studied using quantitative analysis; frequency analysis, multidimensional scaling, and cultural-consensus analysis, respectively.

We anticipate this project will improve training of mental health professionals and will yield steps to boost retention of migrant/minority psychologists in Québec. We will develop recommendations for the two anglophone training programs, and for the professional order. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Dere, J., Jurick, T., Zhou, B., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps towards a cultural-clinical psychology. In M. Gelfand, C.-Y. Chiu, & Y.-Y. Hong (Eds), Advances in culture and psychology, volume 8 (pp. 195-245). OUP.

• Voloshyn, A., Dussault, È., Segalowitz, N., Ryder, A. G. (2022, September). A qualitative study of clinical psychologists’ reflections on their work with linguistically- and culturally-diverse clients [Paper session]. Presentation at the 6th World Congress of the World Association of Cultural Psychiatry, Rotterdam, Netherlands.

Linguistically- and Culturally-Sensitive Psychotherapy: Improving Communication to Improve Outcomes

Context: Linguistic mismatch can lead to communication problems that interfere with psychological treatments for mental health problems—not least, because these are linguistic interventions. Cultural misunderstandings can exacerbate these problems. Yet there ways in which psychotherapists can engage in positive ways with linguistic and cultural diversity. Studying how this is best done is particularly relevant to the Quebec situation.

Main Objectives: We will: (1) use quantitative techniques to study the impact of linguistically- and culturally-sensitive therapy on outcomes; and (2) use qualitative inquiry to study the conversations that unfold between clients and their therapists.

Research Procedures: Participants will be 12 anxiety and/or depression patients from a migrant and/or minority background, all bilingual but half who prefer English as their first official language, half who prefer French. Within each subgroup, half will be in a situation of language match with their therapist, half mismatch, in terms of their preferred language.

Data Analysis: Quantitative modeling will allow us to study the impact of change over time through daily self-report assessments. We will be able to see how specific therapeutic interventions benefit specific patients. Qualitative inquiry will give us a close reading on what works—and what does not work—when working with linguistic and cultural diversity.

Potential Contributions: We anticipate this project will improve mental health care for English-speaking patients in Quebec suffering from mental health problems, as well as improving training of mental health professionals. Our results will be relevant to other cultural settings characterized by linguistic and cultural complexity.

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Outputs:

• Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

• Ryder, A. G., Doucerain, M. M., Zhou, B., Dere, J., Jurcik, T., & Zhou, X. (2021). On dynamic contexts and unstable categories: Steps toward a cultural-clinical psychology. In M. J. Gelfand, C.-y. Chiu, & Y.-y. Hong (Eds.), Handbook of advances in culture and psychology (pp. 195–243). Oxford University Press. https://doi.org/10.1093/oso/9780190079741.003.0005

• De Oliveira Jr., O., Hammami, S., Quadrio, J., & Ryder, A. G. (2022, May). Creating a front-line transcultural mental health clinic for Montreal-Nord youth. Poster presented at the 2022 Summer Institute for School Psychology, Montréal, QC.

• Ryder, A. G., Quadrio, J., Stora, L., Taing, J., Yampolsky, M., Tao, D., & Segalowitz, N. (2022, May). La culture, la langue et la santé mentale: La « Acculturation Toolbox » pour les chercheurs et les cliniciens. Paper presented at the 44th Annual Congress of the SQRP, Saint-Sauveur, QC.

• Voloshyn, A., Segalowitz, N., Zhao, Y., Ryder, A. G. (2021, July). Linguistic minorities and access to mental healthcare: The case of second language health communication anxiety. Paper presented at the 25th conference of the IACCP, Olomouc, Czechia.

CKOL: Documentation on Health and Social Services in English-Speaking Quebec

The Community Knowledge Open Library (CKOL), created by the Quebec English-Speaking Communities Research Network (QUESCREN), Concordia University, is a growing online repository of documents from groups and stakeholders serving and working with English-speaking communities in Quebec. The objective of the current project for which we are seeking funding is to add material related to health and social services in English-speaking Quebec to the existing CKOL database.

This material will be gathered from existing project partners, and we will establish new partnerships with members of the Community Health and Social Services Network (CHSSN), from whom we will also start obtaining CKOL material. Integrating new documents into this user-friendly one-stop database will increase access to knowledge through an enriched CKOL database. This will make it easier for stakeholders to meet the health care and social service needs of English speakers in Quebec.

Linguistically- and Culturally-Sensitive Psychotherapy: Evaluating an Approach to Assessment and Treatment

The Centre for Clinical Research in Health (CCRH) successfully established a university- funded state-of-the-art research clinic at Concordia University (of which the principal investigator is co-founding member). The clinic is launching an evidence-based, culturally-sensitive psychotherapy program for migrants with anxiety and/or depression. This larger project provides investigators with a valuable opportunity to evaluate the effectiveness of language-sensitive mental health interventions in a real-life clinical setting.

It is therefore proposed to: (1) Integrate research tools (developed with previous Dialogue McGill funding) into the assessment battery completed by all clients completing the treatment protocol used with migrant clients at CCRH. (2) Use qualitative techniques to study video-recordings and transcripts of actual clinical sessions to study the consequences of language discordance on effective communication and treatment. (3) Use quantitative analysis techniques to test whether potential problems identified by the assessment battery are linked to problematic features of actual clinical interactions. Hypotheses are: H1: Indices related to better functioning in a given language will predict fewer in-session communication difficulties when the treatment is conducted in that language. H2: Fewer in-session communication difficulties will predict more rapid symptom improvement.

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Outputs:

1. Unknown. (2020, May). Cultural scripts for normalcy and deviancy: A mixed-methods approach to understanding mental illness in new contexts [Presentation]. Interacting Minds Center, Aarhus, Denmark

2. Unknown. (2019, November). Linguistically- and Culturally-Sensitive Psychotherapy: A Proposal [Presentation]. Centre for Clinical Research in Health, Montreal, Quebec.

Communication Networks of Linguistic Minorities: Who Talks to Whom About Health?

There is a considerable literature documenting the help-seeking pathways of patients. The early stages usually involve considerable negotiation within a person’s existing social network before outside help is sought. The team has previously developed a social network measure designed to assess linguistic characteristics of social networks (Ryder & Segalowitz, funded by Dialogue McGill) as well as a measure of second language health communication anxiety (Segalowitz & Ryder, funded by Dialogue McGill). The overarching goal of this project is to finalize the adaptation of these measures to Multilanguage settings, establish their psychometric properties, and explore the interrelations of these instruments in Francophone and Anglophone community samples. To this end the project has proposes the following objectives: (1) Adapt the acculturation battery for use in multilingual settings. (2) Translate the adapted acculturation battery into French (the other measures have already been translated). (3) Implement an online system to deliver the entire set of measures in either language. (4) Evaluate the overall set of measures in Francophone and Anglophone community samples.

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Outputs:

1. Zhao, Y., Segalowitz, N., Voloshyn, A., Chamoux, E., & Ryder, A. G. (2021). Language Barriers to Healthcare for Linguistic Minorities: The Case of Second Language-specific Health Communication Anxiety. Health communication, 36(3), 334–346. https://doi.org/10.1080/10410236.2019.1692488

2. Ryder, A. G., Doucerain, M. M., Dere, J., Jurick, T., Zhou, B., & Zhou, X. (in press). From acculturation and psychopathology to cultural-clinical psychology. For M. Gelfand, C.-Y. Chiu, & Y.-Y. Hong (Eds), Advances in culture and psychology (vol. 8). Oxford, U.K.: Oxford University Press.

3. Chang, J., Pak, S., Doucerain, M. M., & Ryder, A. G. (2019, January). Validation of the AIM as a well-being and acculturation measurement tool [Poster presentation]. Sixth Annual Conference of the Centre for Clinical Research in Health, Montreal, QC, Canada

4. Tao, D., Doucerain, M. M., Segalowitz N., & Ryder, A. G. (2018, October). Social network and mental health help-seeking attitudes: The case of Chinese migrants in Montreal [Poster presentation]. 5th International Convention of the World Association of Cultural Psychiatry, New York, NY, USA

5. Tao, D., Doucerain, M. M., Segalowtiz N., & Ryder, A.G. (2018, July). What’s the relationship between one’s social network and mental health help-seeking attitudes? The case of Chinese migrants in Montreal. Paper presented at the 24th International Congress of International Association of Cross-Cultural Psychology, Guelph, ON, Canada

Still birth among Arabic speakers: Comparison with Francophones and Anglophones in Quebec

Language status is slowly emerging as a source of inequality in perinatal health for minorities in Quebec. Minority groups in Quebec are primarily defined by language, where Arabic, the most important immigrant language, accounts for 18% of foreign languages. In Quebec, language reflects ethnicity and social status, and is associated with cultural norms and access to health care. Previous research demonstrated that compared with Francophones, the Anglophone minority has a higher risk of numerous adverse birth outcomes, including stillbirth, preterm birth, fetal growth restriction, and infant mortality. Inequality in perinatal health for other minority groups, including Arabic speakers, has however not been studied. In the context of increasing immigration, the research will study inequality in stillbirth between Arabic speakers and Francophones and Anglophones in Quebec. The researcher hypothesize that Arabic speakers have a higher risk of stillbirth compared with Francophones, due to limited health care access, communication barriers, cultural or socioeconomic differences, or behavioral factors.

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Outputs:

1. Auger, N., Racape, J., Raynault, M. F., Bilodeau-Bertrand, M., Lee, G. E., & Janevic, T. (2020). Stillbirth among Arab women in Canada, 1981-2015. Public health reports, 135(2), 245–252. https://doi.org/10.1177/0033354919900894