PsyD Alumnus Reports from Northern IraqMarch 19, 2010
In the fall issue of Widener Magazine, Jennifer Dublisky profiled alumnus Nishant Patel ’09, a doctoral graduate of the Institute for Graduate Clinical Psychology who was then bound for a one-year assignment working as a mental health program coordinator in the Kurdish section of Northern Iraq. He recently wrote into Widenermagazine.com from Kurdistan to update us on his work.
The Cadence of “Culture” by Nishant Patel, PsyD
Over the course of my five-and-a-half month stay in Northern Iraq thus far, I have learned much. One lesson has been the utility, or lack of utility of several psychological theories and interventions in an international context. Thankfully, the Institute of Graduate Clinical Psychology at Widener, in particular a couple of professors, had provided me with an introduction to the vast and rather nuanced field of cross-cultural psychology. While I was able to grasp some of the concepts intellectually through coursework, it has only been here in Iraq where I have begun to develop a more thorough understanding of psychology abroad, specifically in a non-Western culture. I hope to illustrate some of my initial and on-going challenges, as well as my diminutive triumphs by sharing some experiences with trainings that I have conducted here in Northern Iraq (Kurdistan) with a U.S.-based human rights and development non-governmental operation (NGO).
Over the past few months, I have carried out a series of trainings for Iraqi social workers who work with institutionalized individuals, either directly in settings such as detention centers, reformatories and orphanages or those who work indirectly through research and policy reform. The trainings have been held roughly once a month, each lasting four days. The training modules have covered the topics of the social work process, legal advocacy, psychopathology and treatment, trauma and systems work and crisis intervention.
The modules are created by social work interns in the U.S. The problem was that previously when I first joined the training program, there had been a lack of communication between the trainers, including myself, and the interns. The modules designed were very academic; while imparting in the first module in a training session, I had two hours to explain the dense topics of cognitive-behavioral therapy, solution-focused therapy, crisis intervention and task-centered interventions. Since that experience, the other trainer and I have reworked the curriculums extensively to explain important concepts more simply (such as replacing “coping mechanisms” with “ways of solving problems”) and to eliminate certain content that we felt was not essential (i.e., four power-point slides differentiating Acute-Stress Disorder from Post-Traumatic Stress Disorder).
I have also taken part in two one-day trainings for community mental health workers (CMHWs) who have been providing treatment to torture survivors. This intervention has been a component of a research study that is being conducted by Johns Hopkins University. During the first training session, I was to answer questions from the CMHWs about a monitoring form that was being used to assess Depression/PTSD symptoms. It became apparent that the CMHWs did not understand many of the symptoms, some of which were strictly psychology jargon that would barely be comprehensible to native English speakers, let alone translated into Kurdish and applied to the Kurdish culture, where treatment of mental health issues through talk therapy is a relatively new, and foreign, idea. The conversation with CMHWs during that training session was much more extensive than I had thought, but the CMHWs, the Kurdish field manager, an American psychologist and I reached consensual agreement on how to define each symptom in a culturally-relevant way. The form has since been revised and approved by the primary investigator at Johns Hopkins University, and has now been redistributed to the CMHWs.
I was asked by one of the field managers to take part in the second training with CMHWs on the theme of culture. The topic was chosen to try to address concerns by a couple of the CMHWs who had complained their designated intervention was not culturally appropriate. I structured my talk starting broadly by describing identity and larger group affiliations and then tried to speak more specifically about mental health and culture. In retrospect, I may have increased their skepticism of American interventions being used in Northern Iraq by speaking honestly about how psychopathology is culturally constructed and mediated, and about the diversity of healing paradigms. Yet, I believe in having direct and open conversations about culture and the role of psychology when something such as the use of manualized treatment, an imported American creation, is rightfully called into question by individuals of different cultures. By way of luck, my attempt to understand the role of culture has led me to begin to become more proficient in how to bridge cultural gaps by meaningful collaboration–a vital lesson in any form of international work.