Need for culturally sensitive clinical psychologists in Singapore

The ability to be sensitive to the culture of a client is important in the practice of clinical psychology in Singapore. With a multi-racial (74% Chinese, 13% Malay, 9% Indians & 3% Others) and multi-religious population (including 33% Buddhists, 19% Christians, 14% Muslims), this is important as the ability of a psychologist to relate a client’s mental health issue or problem according to their cultural context is associated with positive client outcomes. For example, Kumpfer (2002) and colleagues found that psychologists providing family interventions who adapt their therapy with the culture of the clients in mind improve engagement and retention of their clients.

However, no prior research has been conducted to explore the effectiveness of post-graduate programmes for training clinical psychologists in Singapore in preparing future psychologists to be culturally competent. Currently, there are four clinical psychology training programmes in Singapore provided by two universities. Using a qualitative approach, the research psychologists in the paper currently discussed examined this issue by interviewing five students ifrom the clinical psychology training programmes, five clinical psychologists who have graduated locally, and five academics from the two schools (Geerlings, et al., 2017).

Four main themes were revealed from the study:

Culture of clinical psychology

All the participants agreed that clinical psychology practice relates to universal human concerns, such as the need to be connected. However, the clinical psychologists and psychologists-in-training from the programmes in Singapore found that certain western approaches and ideas were less suitable for the local clients. For example, these psychologists highlighted that clients from Singapore were not comfortable talking about their feelings during Cognitive Behavioural Therapy (CBT).

Cultural context of training and practice

The medium of instruction for the training of clinical psychologists in Singapore is English. However, a variety of languages are used in Singapore, and clinical psychologists may find it a challenge to conduct psychotherapy in Malay Language, Mandarin, Tamil, or other dialects. In addition, there is also a need for resources, such as psychological assessment tools and mental health screening questionnaires, to be available in the local languages.

The psychologists studied also pointed out that there is a strong dependency on foreign knowledge on the practice of clinical psychology in Singapore. Most of the psychological models and theories were adapted from western models, and may not be suitable for practice in Singapore. One psychologist stated that, “It is really hard to find articles relating to how to treat a Chinese or Malay”. Although the supervisors in the programmes are experience and skilled clinical psychologists, their lack of familiarity to the local culture may lead psychologists-in-training to rely on their own resourcefulness to adapt their practice to the local clients in Singapore.

Ensuring culturally sensitive psychology practice

To be culturally sensitive, the psychologists reported to engage in three strategies:

i) Reflective psychology practice

The clinical psychologists interviewed reported that they engage in reflection to be aware of their client’s cultures. For example, certain mental health issues may hold cultural bearings, such as the desire to ‘maintain face’ in Chinese and Malay families. Instead of imposing clinical psychology solutions to their clients, the psychologists may present them with an alternative culturally sensitive perspective.

ii) Adaptive psychology practice

Clinical psychologists who are sensitive to their client’s cultural needs may also adapt to provide more effective psychological therapy and psychological assessment. The psychologists may use Singlish, and translate the theories or psychological assessment questionnaires. These adaptations are often shared through informal learning networks, and are made as the psychologists gain more familiarity with the cultural context in Singapore.

iii) Holding dialectic models

On top of the clinical psychology models that clinical psychologists hold, the psychologists studied may also hold an alternative model that is compatible to the beliefs in Singapore. For example, psychologists with Chinese-Singapore clients who report seeing ghost of their ancestors may refrain from diagnosing these clients as having hallucinations. Instead, these psychologists would maintain that these experiences are in line with the cultural beliefs of their clients.

Pathways to developing cultural competencies in psychologists

To develop cultural competencies, the psychologists interact with others from a different cultural background in Singapore. With a deeper knowledge of other cultures and religions, the psychologists gain more confidence in their ability to engage with clients from diverse cultures.

Obtaining supervision from an experienced psychologist with knowledge of the Singapore culture was also highlighted as a route towards culturally sensitive practice. This is especially common in psychologists who have just graduated from a clinical psychology programme in Singapore, and has just started working.

Conclusion

The research paper indicated that the programmes training clinical psychologists in Singapore provide valuable skills and knowledge in improving mental health care in Singapore. On top of didactic training, the programmes also provide important skills for clinical psychologists in treating clients with mental health issues, such as depression and anxiety, and in administering psychological assessments.

However, challenges exist with most of the psychological knowledge learnt deriving from western models and theories, and faculty members dominantly consisting of clinical psychologists from western countries. Clinical psychologists in Singapore have to adapt to improve client outcomes in a religiously, linguistically and culturally diverse clientele. Clinical psychologists trained in Singapore has learnt to modify their therapeutic approach through clinical supervision and increasing cultural sensitivity through personal experience instead of relying solely on their training experiences and resources.

It is also hoped that with the growing number of clinical psychologists in Singapore and the maturation of the field, resources for the local population and locally normed psychological assessment tools will be developed. It will also be useful to have psychological assessment tools that can be administered in Mandarin, Malay and Tamil, with clinical psychologists who are conversant providing psychological therapy in these languages.

The article discussed may also indicate the importance for clients who strongly identify to their culture (e.g. as a Malay-Singaporean or Chinese Singaporean) to assess the sensitivity of a clinical psychologist in choosing one to go to for psychotherapy or psychological assessment. As a clinical psychologist myself, I find that clients feel safer and more understood when their psychologist are able to understand how their culture views the problems that they are going through.

References

Geerlings, L. R., Thompson, C. L., & Tan, G. (2017). Culturally Competent Practice: Experiences of Students, Academics, and Alumni of Clinical Psychology Degrees in Singapore. Journal of Tropical Psychology, 7.

Kumpfer, K. L., Alvarado, R., Smith, P., & Bellamy, N. (2002). Cultural sensitivity and adaptation in family-based prevention interventions. Prevention science, 3(3), 241-246.