Cultural competency in the treatment of obsessive-compulsive disorder: practitioner guidelines

Abstract

This article provides clinical guidelines for basic knowledge and skills essential for successful work with clients who have obsessive-compulsive disorder (OCD) across ethnic, racial and religious differences. We emphasise multiculturalist and anti-racist approaches and the role of culture in shaping the presentation of OCD in clients. Several competencies are discussed to help clinicians differentiate between behaviour that is consistent with group norms versus behaviour that is excessive and psychopathological in nature. Symptom presentation, mental health literacy and explanatory models may differ across cultural groups. The article also highlights the possibility of violating client beliefs and values during cognitive behavioural therapy (CBT), and subsequently offers strategies to mitigate such problems, such as consulting community members, clergy, religious scholars and other authoritative sources. Finally, there is a discussion of how clinicians can help clients from diverse populations overcome a variety of obstacles and challenges faced in the therapeutic context, including stigma and cultural mistrust. Key learning aims (1) To gain knowledge needed for working with clients with OCD across race, ethnicity and culture. (2) To understand how race, ethnicity and culture affect the assessment and treatment of OCD. (3) To increase awareness of critical skills needed to implement CBT effectively for OCD in ethnoracially diverse clients. (4) To acknowledge potential barriers experienced by minoritized clients and assist in creating accessible spaces for services.

A pilot study of experiencing racial microaggressions, obsessive-compulsive symptoms, and the role of psychological flexibility

“…A framework such as that of ACT that can be incorporated as therapists work to help clients facilitate cultural identity and social support to protect against racial trauma (Liu and Modir, 2020) and emotion regulation strategies can be facilitated to help clients flexibly cope with experiences of racism (Graham et al ., 2015). There are numerous recent clinical guidelines and models for supporting people of colour with OCD that could be incorporated, adapted, and studied further (DeLapp and Gallo, 2022; Steele, 2020; Williams et al ., 2020; William et al ., 2022b). Future research should examine how to adapt such protocols and treatments for various settings and types of providers given the importance of finding multi-pronged solutions for mental health (Kazdin, 2022) and brief single session interventions delivered within community specific settings could be an option as well with frameworks such as those described by Schleider et al .…”

Best practices for CBT treatment of taboo and unacceptable thoughts in OCD

“…The International OCD Foundation offers excellent training through its Behavioral Therapy Training Institute (BTTI; www.iocdf.org). In addition, cultural considerations must be taken seriously as what is considered taboo or unacceptable varies from culture to culture (Williams et al, 2020). Obsessional content may also be informed by specific religious practices and sociocultural value systems that are important to the community the client identifies with.…”

Cross-Cultural Communication in English-Language Family Therapy: Conceptual Challenges and Opportunities

“…Therapists can facilitate open and respectful communication by creating space for each family member to share their experiences without fear of judgment or marginalization. By validating the diverse range of experiences within the family unit, therapists can promote trust, understanding, and collaboration among family members (Williams et al, 2020).…”