No abstract

Epistemic and social injustice occurs when therapists implicitly and explicitly impose personal, professional, and institutional power onto clients, and dismiss client experience which is embedded in cultural identity and social location. Despite research evidence highlighting the positive impact of broaching in cross-cultural psychotherapy, questioning the rationale and barriers to broaching is paramount. Drawing from scholarship on epistemic in/justice, we argue that the very existence of marginalization of a client in the life and in the therapy exemplifies epistemic injustice. Epistemic injustice bears two types-testimonial and hermeneutic injustice. When clients' experience of marginalization is decentered or discredited, testimonial injustice occurs. By not providing clients with opportunities to share this experience in therapy, there is little shared understanding cultivated in the cross-cultural dyad, contributing to hermeneutic injustice. Thus, epistemic in/justice requires broaching not as an option but as an integral part of therapy. Synthesizing scholarship in cultural competence, humility, intersectionality, and antioppressive practice, we define broaching as the therapist's tasks for intentional understanding of the cultural aspects and systemic oppression in the client's life-in-context. A therapist who is broaching is aware of cross-cultural similarities and differences and the workings of power in the therapy dyad and makes deliberate efforts to demonstrate this understanding to the client which includes explicit discussion in sessions. We propose pathways, dimensions, foci, and timing of ongoing broaching and bridging cross-cultural encounters in therapy. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic and social justice in therapy encounters. Public Policy Relevance StatementIn working with individuals who come from different cultural experiences, it is critical for therapists to acknowledge the presence of cultural similarities and differences and power disparities in therapy dyads. In order to understand how systemic oppression influences the client's experience, we must explicitly broach and bridge similarities, differences, and power differentials in therapy conversations as the pathway toward building a therapeutic alliance with the client. This process is embodying epistemic and social justice while respecting the client as a fully cultural human being. By integrating philosophical, theoretical, and empirical evidence of broaching and bridging in therapy, this article proposes a comprehensive Broaching and Bridging Model to guide therapists to initiate socially and epistemically just conversations with clients in health and social services. Centering epistemic justice in cross-cultural psychotherapy opens opportunities to not only foster justice in clinical encounters but also to allow a genuine space for surfacing and confronting intersectional systemic oppressions embedded in mental health care systems and policies.

Psychotherapy research has shown evidence of positive impacts of broaching cultural differences on the therapy process and outcomes. This increasing body of research also highlights a need to clarify clinical skills of broaching and subsequent bridging to guide therapists in crosscultural psychotherapy. In articulating microskills to promote broaching and bridging, we critically reflect on cautions against slipping into a technocratic approach that is a mechanical prescriptive skill-based guideline. Using critical theory on epistemic injustice, we examine how to integrate cultural aspects into therapy conversations that are aligned with epistemic and social justice. Drawing from sociolinguistic and critical scholars on language and power, we interrogate epistemic domains of knowledge and power during broaching and bridging in everyday clinical talks. We focus on theorizing and illustrating "how-to-do" broaching and bridging to guide therapists in everyday cross-cultural encounters with selected microskills such as a therapist's self-disclosure, cultural immediacy, and reflective listening. Using case illustrations with detailed transcripts for each skill, we interrogate how a client's epistemic status can be managed in the moment-to-moment conversation between a client and therapist in the continuum from dismissing to deepening the client's experience. A series of detailed case illustrations are intended to guide therapists' self-reflection and/or train therapists toward meaningful cross-cultural work. Lastly, we discuss the implications of broaching and bridging while situating this work as promoting epistemic justice in cross-cultural therapy encounters. Public Policy Relevance StatementIn working with individuals who come from different cultural experiences from their therapists, it is critical for therapists to acknowledge the presence of cultural similarities and differences and the workings of power within the therapy dyads. This means understanding how systemic oppression influences a client's experience; explicitly broaching and bridging any differences and potential misunderstanding; and including the impacts of systemic oppression as part of the therapeutic conversations, which may contribute to building the therapeutic alliance with the client. This broaching and bridging process, however, is more complicated than it appears because of the tacit nature of culture and power that is in motion during cross-cultural encounters. Paying attention to territories of knowledge and power (i.e., epistemic domains) in everyday therapeutic interactions, this article details microskills in broaching and bridging such as a therapist's self-disclosure, cultural immediacy, and reflective listening to guide therapists in health and social services toward achieving epistemic and social justice. aaa This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly

Objectives There have been concerns about the adverse effects of the COVID-19 pandemic on Canadian youth (aged 16–24) as they have the highest rates of mental health concerns. The objectives of the present study were to explore the experiences of youth with mental health and/or addiction concerns and their families during the pandemic, and to examine how adequate and equitable mental health services have been for youth and families from the perspectives of youth, parents, and service providers. Methods Using a descriptive qualitative research design and a university–community partnership, we conducted individual interviews with youth, parents, and service providers. The study involved a total of 25 participants (n=15 service users, n=10 service providers). Among the service users, 11 participants were parents and four were youth. We used thematic analysis to analyze interview data. Results The thematic analysis identified three themes in the data: (1) youth mental health concerns have increased, whereas supports have decreased, (2) families end up being the treatment team with increased burden, little support, and lack of recognition, and (3) inadequate and inequitable mental health services for youth and families are amplified during the pandemic. Conclusion At a time when mental health needs were higher, the mental health care system offered less support to youth and their families. For a more equitable response to the pandemic, we need an accessible and integrated mental health care system that shows a commitment to addressing social determinants and reducing health disparities and inequities in access to mental health services.

Background Canadian youth (aged 16–24) have the highest rates of mental health and addiction concerns across all age groups and the most unmet health care needs. There are many structural barriers that contribute to the unmet mental health care needs of youth including lack of available and appropriate services, high costs, long wait times, fragmented and siloed services, lack of smooth transition between child and adult services, stigma, racism, and discrimination, as well as lack of culturally appropriate treatments. Levesque et al. (2013) developed a framework to better understand health care access and this framework conceptualizes accessibility across five dimensions: (1) approachability, (2) availability, (3) affordability, (4) appropriateness, and (5) acceptability. The purpose of this study was to explore access to addiction and mental health services for youth in Ontario, Canada from the perspectives of youth, parents, and service providers. Methods This qualitative study was a university-community partnership exploring the experiences of youth with mental health concerns and their families from the perspectives of youth, caregivers, and service providers. We conducted semi-structured interviews and used thematic analysis to analyze data. Results The study involved 25 participants (n = 11 parents, n = 4 youth, n = 10 service providers). We identified six themes related to structural barriers impacting access to youth mental health and services: (1) “The biggest barrier in accessing mental health support is where to look,” (2) “There’s always going to be a waitlist,” (3) “I have to have money to be healthy,” (4) “They weren’t really listening to my issues,” (5) “Having more of a welcoming and inclusive system,” and (6) “Health laws aren’t doing what they need to do.” Conclusion Our study identified five structural barriers that map onto the Levesque et al. healthcare access conceptual framework and a sixth structural barrier that is not adequately captured by this model which focuses on policies, procedures, and laws. The findings have implications for policies and service provisions, and underline the urgent need for a mental health strategy that will increase access to care, improve mental health in youth, decrease burden on parents, and reduce inequities in mental health policies and services.