Elements of Multicultural Assessment

[MUSIC PLAYING] Hello, and welcome to the Multicultural Psychologist podcast. I'm Linda Flanagan, the Geek Clinical Psychologist and Professor of Specializing in Assessment, Multiculturalism, Diversity, and Issues Impacting Education, Trauma, and Mental Health. I'm excited to introduce to the mental health community this podcast and online community that will explore cultural differences and the impact of culture on psychological treatment and assessment. In other words, how do we, as clinicians, think about, read, and assess people from different cultures? I used to term culture in the broadest sense of that term. So we're going to be exploring gender, race and ethnicity, economics, LGBTQ status, disability status, educating diverse psychologists, and assessment measures. The list is endless, and I'm looking forward to diving in. It is critical at this time to continue to explore issues of culture, even when some of these conversations might be sensitive. My goal is to make the TMP podcast and community places of safety and respect. I would like to thank our sponsor, the Society for Personality Assessment. Please like the Multicultural Psychologist podcast on social media or join our mailing list to receive notifications of podcast release dates and guests. I've been fortunate to assemble guests who are at the top of our field. So sit back and enjoy our industry leading experts. Prepare to be taken on their journey through education, research, experience, and practice to examine cutting edge issues at the intersection of culture and psychology. Our guest today is A Jordan Wright. And I presume you prefer to be called Jordan. Please, yes. Or Doctor Wright, you know, Jordan, please. I'm Jordan. I am not big on bio reading, but I definitely just want to address a couple of points in yours. And then we're going to move on because your bio is so long. You are the clinical associate professor and program director of the Combined Clinical Counseling Psychologies PhD program in the Department of Applied Psychology at NYU. You receive your clinical doctorate from Columbia University and a Master's of Psychology and Education from the Teachers College at Columbia. And you're a diplomat and a fellow at a whole bunch of different things. What's your-- can you tell me like what's your latest appointment been? Because I saw something mentioned online. What's your latest appointment that you want to tell us about? Yeah, I'm a joiner. I like joining things. Currently, I'm actually the president of the Society of Clinical Psychology, which is Division 12 at APA. And I've just taken over as president of the American Board of Assessment Psychology. OK, that's the one I saw, OK? And so what does that entail? The American Academy of Assessment Psychology? Yeah, so we are a board. We're actually reconstituting the entire process, but we're a board that works like the American Board of Professional Psychology for post-nominals. For we call it an ABAP, ABAP, AP. And when assessment psychologists show excellence in the field when they go through our process and do all of the hoops that we give them to jump through and prove that they are excelling in the field of psychological assessment, then they get an ABAP and they can put those four letters after their name. OK, OK. So I noticed that in addition to writing a handbook on a psychological assessment, your two main areas are obviously assessment, but also like you have a good body of work on culture, including LGBTQ, microaggressions, and sort of the topic of a lot of our discussion today, this essential series on culture and psychological assessment. So tell me about how you came to do this essentials project and what made you take it on? Yeah, so my sort of academic trajectory after I graduated from my PhD program, I went on faculty at Columbia University and I started doing really search mostly in LGBT psychology, discrimination, microaggressions, that sort of stuff, social justice in psychotherapy, and then started doing more work because I was teaching assessment, and I saw holes in the assessment literature and I saw things that needed to be written in the assessment literature. I wrote my first book way back, it feels like ages ago, in assessment, and I've written multiple books since then, mostly in assessment, and more recently, I have decided to combine the two in 2021, I believe, I sustained an injury, I was part of a hate crime, somebody called me the F word and shoved me down, I was wearing rainbow glasses, I broke some bones, broke those glasses, which I hate. This was in New York City in a gay neighborhood, in a queer neighborhood, and it really galvanized me, it galvanized my work back towards social justice and not just toward LGBT issues, but also anti-racist issues, as I was working with the American Psychological Association at that time, to put out anti-racist resolutions and anti-appressive resolutions, committing the American Psychological Association to doing better than we have done in the past when it comes to colluding with oppressive systems and structures in our world. And so, fast forward, more recently, I found that there was a hole in the literature out there around culture and assessment, not culture and testing. There are a few books out there that are really about culture and testing, so there'll be chapters on a specific test, and it'll tell you what it says about using that test with diverse clients or something like that. But when I looked at a few of those when I'm doing treatment patients, right? Yeah, and it's a good start, we need that. We need to know if these tests stand up with the clients we're working with, with the person sitting across from me, can I use this test in an ethical and valid way? But it's not, we can't end there. That's not the only role that culture and privilege and oppression play in the assessment process. So, I was interested in helming this book, which you contributed to it, I'm so grateful, but I really wanted, and I challenged all of our authors to really think about not just culture and testing, like our test sphere, but where does culture, where does oppression play a role in the entire process, in the relationship between me and my client? Where does my privilege affect the process of assessment? Where does it play a role? Because there's a lot of power in assessment. When it comes to forensic decisions, when it comes to diagnosis, when it comes to pre-employment, these assessments that we're doing carry so much weight and so much power that we can no longer ignore the fact that I, for example, a cisgender white male, wield a lot of privilege in that room. And if I'm working with a woman of color, she may interact with me in a different way than she would interact with you. The same words coming out of my mouth, the same scripted IQ questions may be heard differently out of my mouth than they are heard out of your mouth, because I have been, I look and feel like a lot of the oppressors out there. - Right, I just recently, in my work, and not just your book, but in a book on bipolar disorder really came to realize the diagnostic part of the assessment process is destiny. And I just, in many ways, and I gave that talk in the decolonization of psychology conference in Hampton University a couple of weeks ago, because once a diagnosis is embedded, and if it's a misdiagnosis, it's hard to untrench it from the systems of oppression, of just the inertia, and of people reconsidering information from colleagues. - Absolutely, we sort of don't talk about a permanent record when we're grownups, but diagnosis follows you. That diagnosis, that diagnostic label follows you, either in your medical chart or your own self identity, the way that you identify and feel about yourself, is very often wrapped up in a diagnosis, and that's not always a bad thing, right? We can revel in and we can find joy and pride in some of our neurodivergences, I have ADHD, and you were asking me how I juggle things. It's my ADHD, I have to be doing 35 things at once, and that actually is part of who I am. It's part of my identity, and I find pride in that diagnostic label. Diagnosis also unlock a lot of resources, right? We are gatekeepers, if somebody needs more time on an exam, they have to sometimes come with that diagnosis without assessment. So, it's not all bad, but there are some diagnoses when I think of oppositional defiant disorder. I know you and I have talked about this before, as a modern-- - A red disorder. - As a modern day, Dropetomania, and for the listers out there, I'll nerd out for a second, but Dropetomania was a diagnosis given to enslaved people when they ran away. It was seen as mental illness to want to run away from your captors, right? When you were an enslaved person, and ODD, the oppositional defiant disorder, is disproportionately diagnosed in children of color, and especially black children. Black boys especially. And so there are a lot of us who believe that maybe this is just a modern day Dropetomania, maybe we're uncomfortable with black boys asserting themselves, and acting out, and maybe. not being so comfortable in white spaces. And so they act out and we blame them. We diagnose them. So some of these diagnoses will follow them in a way that is actually, like you said, so entrenched in oppressive systems and structures. - So when I started to go out there and speak on race and psychology, one of the things that I found that at heart, I am an assessment person, even though I do other things, but when we looked at the body of research on treatment, there was like a lot more examples of race and ethnicity in terms of treatment, but not so much on assessment. And so when I write these chapters on assessment, I have to do like a ton of research just to get those 23 pages. And I wanted to sort of get your thoughts about the fact that you and I are out there and you are leader in this industry of speaking on assessment when it's pretty much underrepresented or not represented as much in the literature. - Yeah, it is a shortcoming in our little area of the field of psychology. The psychological testing literature, and I will use that very deliberately because most of our literature is about tests. It's not about assessment, the whole process. It's about tests. And most of our literature for the past over 100 years now has been aimed at proving that we're a science. It has been aimed at proving we can find this diagnosis. We are the detectives, the diagnosis lives in you, the individual, you, the client, you, the patient, you have this illness, and we can figure it out. We can find it out. We're forensic scientists in that way, as assessors, and that's the way our literature has moved. When in reality, our diagnostic system has changed constantly. It is socially constructed. What we have determined is I'm going to put air quotes around abnormal. I like to think of it as human exceptionality, things that are outside of the norm, things that we consider problematic change, right? Homosexuality was a mental disorder until 1973. Gender identity disorder was even more recent. There are things that shift. There are things that change. And so we are not doing as good a job in our little corner of the field at doing research that informs the fact that we're not just looking for the truth of the illness, of the disease that is in the individual. We are co-constructing that. We are deciding what questions we ask. We are deciding how we frame our assessment, is our assessment just to figure out a diagnosis or as our assessment to figure out how to help you thrive in this world, how to narrate your personal identity and your story and your lived experience in a way that illuminates a way for you to do better in this world. That's a very different framework for assessment, but it's not one that is informed our literature. So our literature you're right is behind when it comes to understanding how culture plays a role, the research, the literature is behind other areas of psychology, other areas in social work, other areas in counseling. They're doing a better job than we are and we need to push this forward. We need champions like you. We need people out there screaming and saying we need to be doing this research to show just how impactful oppression, systems of oppression are on mental health and what that means for us then identifying, diagnoses in the assessment literature. - So that sort of leads me to this question. I saw online about you while growing my homework that you were emphasizing the collaborative nature of assessment and you were also emphasizing that assessment is different from treatment and that it is a short period and window of time that we get to sort of be to snapshots of our clients. But it's sort of a forced relationship because you're trying to get information and you're providing a diagnosis and all it is internal information about someone and you just met them, right? Or you met them over two sessions or you met them over three sessions. So wondering if you think this collaboration and strange kind of process are even more difficult when the person across from you is from a marginalized population or a person from a culture or diverse cultures? - Yeah, I would say frankly, it's difficult no matter what. I will say if I get somebody who looks like me and is a queer Jew from Texas, born and raised in Texas, I think it's just as difficult. I will have assumptions that I make about them just like I have biases and assumptions about others because we all do and they were deeply ingrained in me. So I have done a lot of work calling for, like you said, a more collaborative process because when it comes to therapy, we can repair, right? We have time. If I make a mistake, I have time to fix that to work with you to repair any ruptures in our alliance. When it comes to assessment, if I get it wrong, I have very little recourse to repair it. There's not much I can do. If I have met you for our few sessions, I write up my report, I give you a diagnosis. If it's not accurate or if it's misrepresenting your lived experience or something like that, there's not much I can do in the way of repair. So the way that I think about it is, and I have completely stolen a lot of this from Steve Finn and his work in therapeutic assessment, but I am an expert in certain things, right? I'm an expert in some tests. I'm an expert in psychological theory. I'm an expert in a lot, but I am not an expert in my clients lived experience. And so I need my client to be that expert and collaborate with me. And I need to start honoring that more than I think we've done as a field. I think as a field of psychological assessment and psychological testing, we tend to give a bunch of, you know, we might do a clinical interview and then give a bunch of tests and then make our decision. I think we need to respect our clients and their lived experience and the way that they are viewing themselves and the world around them more than we have historically. And that true collaboration where you bring your expertise of your lived experience and I bring my expertise in testing and we can work together to come up with some conclusions of how you can live a better life, how you can find a better fit for yourself or how you need to tailor your treatment, right? How we can collaborate to inform what types of therapy are going to be most effective for you or even medication, we collaborate around that. I think that helps us get a long way there because I am never going to understand your lived experience. Whether you are from a historically marginalized or traditionally minoritized population or not, I am still not going to fully understand your lived experience in the way that you do. - And the point being, one of the points you made earlier is within your even. There's an assumption and a fantasy that the person across from us thinks that because we're similar, we've gone through similar experiences. The point that I really wanted to come back at you with is I think that might be a remnant of us thinking that psychologists are just blank slate that people come in and they bounce something off of, right? And in addition to that, that we sort of minimize the power of differential. All right, inside just wanted to see what you thought about those two things about the sort of blank slate, not us meeting in a therapy room and all of our backgrounds and traumas meeting, but that we're just as blank impartial slate. - Yeah, I mean, if the listeners could look at us right now, they would know that we are not like slates, right? I wear my queerness on my face. It's hard for me to hide. You wear your woman of color-ness on your, like we are not blank slates. That is a remnant of Freud. Like, Freud is alive and strong when we are pretending to be neutral, when we are pretending to be objective, when we are pretending that you, like every interaction that I have with a client is 100% about the client and their issues. None of that is true. None of that is rooted in reality. If somebody comes to me for therapy, for assessment, if they Googled me, which is presumably how they would find me, they would know that I am a queer man. They know there, and many of them come because of that. Now, they may feel more comfortable with that, and that's great. If they feel more comfortable with me than frankly, and this is a little mercenary to say, but the data I get from them is gonna be better, right? If they feel more comfortable with me in a clinical interview, they are more likely to let down their guard, to let down some of those defenses and filters. They may feel less shame in admitting some of the things that I'm asking, and I'm asking clients to be very vulnerable, right? In a clinical interview with somebody I've never met before, or I've met once before to do consent or something, I am asking a lot of them. I am asking them to be very vulnerable with me. And so if they're not comfortable with me, because of all the baggage I'm bringing in, and my identities, and what I look like, and how I come across, I'm gonna get worse data from them, and maybe they are better off going to somebody that does have a similar background if that makes them more comfortable. If it doesn't, there's no knowing how that's going to impact the relationship, and then, the data that we get from that. But we are not blank slates. We are not blank slates. That's just not a thing. So, you know, the history of bias and racism and oppression and homophobia and all the isms and I'm not minimizing them by saying them. We talk a lot about them now. We talk about the history of psychology of teaching history and systems now. So it's I'm down that path. But I wanted to know when you were doing this essential series and when you were reviewing chapters, did you learn anything? Oh, I learned so much. So this book I I love. I love this book. The first half of the book is really about broader issues. So how do we think about social justice in assessment? How do we think about collecting cultural data in the assessment process? How do we think about test bias? We do still need to think about test bias. What do we think about types of tests when we're looking at IQ? What does culture mean in IQ? The second half of the book is about working with specific populations. So that's assessing black and African American clients. It's assessing Latin A clients, assessing Asian and Pacific Islander American clients, assessing neurodivergent clients. We have a great really interesting chapter on non minoritized clients. Why do we have to think about culture when it's a white man, a cisgender heterosexual white man. Why do we even have to think about culture then? We do. We start to think we have a great chapter on that. You know I looked at these chapters and I took them to heart. I really tried to work with the chapter authors and make them the best chapters they could be. But they drove so much of the content and I learned a ton about especially working with particular clients from divergent backgrounds, from particular cultures. I am not an expert in every single culture I couldn't be. So I didn't want to write those chapters, which is why I recruited experts in different cultural backgrounds, different race ethnicities, different genders and gender identities, sexual orientation. I invited experts in these different communities and cultures to write the chapters and think through these issues. And I learned a ton just by reviewing and editing the chapters and more of my comments on every single chapter were like, you peaked my interest with this paragraph. I wonder if you've thought even more about this like it's just sparking my mind of all the different things we maybe haven't even thought about yet about the different ways oppression plays a role in the assessment process. Remember in particular, that we talked a little bit about this idea of modern-day draptomania. And it made me go back and think and rework and not just in that chapter, but in a lot of other things that I'm working on in the presentations to think about what are diagnoses and pathologies placed on various cultures as a result of this systematic oppression. And it is really a quite interesting question. It really is. I wrote an article in 2021, I think, and I found a research study that I just think is a lovely little research study. They basically wrote up a little scenario about an adolescent girl and they gave it to teachers and acid teachers to talk about the scenario. And the scenario was randomly given to two different groups of teachers. And in one, they were the exact same scenarios, except one, the girl was identified as a white girl and one, she was identified as a Latina girl. And across the board, teachers who are amazing. Teachers are heroes and this is not a dig at teachers. It is an illumination of our inherent internalized biases. Across the board, the teachers rated the white girl as assertive and the Latina girl as aggressive. What that means is systemically, like we as a culture have decided what behaviors we accept from white girls and what behaviors we do not accept from Latina girls. This is what I opened up to me. And not just that the implications there too, right? In terms of the discipline in terms of the relationship, the mentoring that's formed a lot of how white people progress is that there are high expectations of them. And which I think is one of the most fascinating, underexplored areas of psychology is that expectations really have a huge part on whether children from various ethnic groups succeed, right? And go to college. Absolutely. I think this systemic oppression, which I'm going to call it systemic oppression, but it is entrenched and it is generational. Even our younger teachers who are learning this stuff in their graduate training and they are aware of it and they are woke and they are all these things. It doesn't mean we don't still have these internalized biases and prejudices that we have to fight against because they don't just come from our own personal conscious values. They come from what we see on TV. They come from advertising. They come from a larger culture. They come from a teaching profession that doesn't have many Latina teachers that doesn't have as many black teachers as, you know, it's overwhelmingly white. So you're absolutely right that it's not just identifying problems and diagnosing kids of color or queer kids or trans kids. It's not just that, but it is then the effects of that throughout the entire trajectory of their development because those early experiences get internalized by the kids themselves. It makes it harder for them at school, not just because of their academic self-advocacy, but all of those teachers need more. You have to be better as a kid of color. Like you just have to do better and it's stacked against these kids and that is just going to perpetuate the same disparities that we have seen for generations. The thing that I worry about when I'm thinking and writing about trauma, which is where we're turning to is the impact that that has. When you tell a child what we call legacy advice, you have to be twice as good, right? Like what does that even mean? And you literally can't always be twice as good, but I worry about the traumatic impact of saying that a parent saying that to their child. And that sort of turns me to trauma. So one of the things that I think is the most under-explorant thing in our assessment process is trauma. We don't think about it very much. As Sudo is sometimes just sort of sticks up like an iceberg, a tip of the iceberg. And we kind of know that there's something there, but we don't explore it. And it's not an academic test. It's not a cognitive test. It's not an executive functioning test, but we often don't look at it. But we look at its proxies. You know, we look at emotional dysregulation and we call it something, right? We don't label that as underlying trauma. So my thought is, is like we sort of ignore it. And then we have various forms like minority stress trauma, which stemming the LGBTQ community racially based trauma. And how do we talk about it, test for it, given that it's not truly encompassed really in our DSM or even conventional training on trauma theories? Yeah, no, it is a great point. That's a great question. We have a trauma problem in our field, in the mental health field. We've got a trauma problem because we have defined trauma in a very narrow way or the DSM has. We haven't. The DSM and we go along with it has defined it in such a narrow way. And when we think of trauma, we think of PTSD, very formal post-traumatic stress disorder. But trauma can exist, does exist in many other forms. If you look at the literature, there's a great literature around adverse childhood experiences. And there's a great literature on negative life events. This is not a literature I knew much about. Most of it comes out of South Africa and Australia, not as much from the US, not as much from the UK. But it's looking at all those negative life events like bullying. Bullying does not meet criteria for trauma in the DSM. It is not an adverse childhood experience, ACEs, which are like early childhood neglect and abuse. But it absolutely plays a role in how we develop our defenses, how we develop our armor in this world or our personality or whatever it is we're walking through the world with how we interact with the world. All of these negative life events, which I'm going to call trauma, we like we have traumas and we don't acknowledge them. Because we have been so focused on PTSD trauma, our measures are commonly used measures, that's what they test for. And so if that's not elevated, we just say, oh, there's no trauma here. But in actuality, we are missing so much trauma that's happening. We are missing the race-based traumatic stress, the queer-based traumatic stress. We are missing the invalidations, the constant invalidations that queer kids go through. throughout their lives that everybody, when you're talking about those B twice is good. That's an invalidation as well. That is an adverse experience being told you have to be better. And being told you better work twice as hard as your white peers and that kind of stuff. That is traumatic. Like that is a harsh thing to hear about the world, about your family, about your values. It's tough. So our typical measures are not good enough. A colleague and I, a colleague who is brilliant. Keisha Constantine and I, several years ago, developed a measure called the right Constantine structured cultural interview. And I don't usually like plugging like my stuff, but this is free. It's free for use. If you Google it, WCSCI, the WICSKI, WCSCI, it's free for use. Just download it, use it, but it is one of the explicit purposes and goals of this measure is to look at your history, not just of your values because that's part of it because it's a cultural interview. We want to know your cultural values, those values that were imbued in you by your family, your neighborhood, your community, all these things, your beliefs. But we also want all of those experiences of oppression, all of those experiences of invalidation that you have suffered throughout your development so that we can use it to help conceptualize your story better. This goes back to that collaboration. This is a collaborative interview. I'm asking you questions about your view on your lived experience. How do you create that narrative of what you've been through rather than just saying you have emotion dysregulation? Go fix it. Let's think about why you may not trust your emotions. Let's think about why you may not be so good at handling those negative feelings that bubble up in you. A lot of that can be traced back to all of those invalidations, all of those oppressions, all of those discriminatory experiences, all those negative life events that you have suffered throughout your development. So, you know, we have these standards for educational and psychological assessments for ensuring fairness and testing. What do you think their impacts are in terms of our field generally and what impact do you think that they have on a practical aspect of assessment? Yeah. So, the standards are, you know, it's a document created by the American Educational Research Association, the American Psychological Association and the National Council on something measurement and education or something like that, NCME. And it is put out. It is actually under revision right now. There is a task force that is revising right now. I hope that they will do a good job. I am not part of that, but I hope that they will do something great. Two things that come to mind first and foremost. This is about testing. This is not about assessment. So, this is really about tests. It is about ensuring validity, reliability of tests, fairness of tests has gotten in there, which is great. And I think that that is a start. And I hope that they re-emphasize this issue of fairness, this issue of ensuring that the tests that we use are actually measuring the same constructs across different groups of people. If I am measuring something like hypervigilance, right? If I am measuring, which traditionally really high hypervigilance may be paranoia, like this sort of, I am very aware of what's going on, but that may mean something very different for a cisgender white male versus a woman of color, right? So, hypervigilance for a cisgender white male when they may not have a lot to be worried about just walking down the street. Because somebody who culturally actually should be looking out for themselves and it is justified, that same scale may be measuring something slightly different for those groups. And that would be not sort of a fair scale when used with a person of color in that hypothetical example. So, I think that it is doing good on the testing side. The other side of it, and where I think we fall a little short, kind of goes back to why I've decided to take on the essentials book, is when people look at the standards, they think, "Okay, this is our North Star. This is what we're aiming for. This is what we need to do. And if we are following this, we are doing good work." And I think that may be true for the testing part of an assessment. But then they forget about all the other stuff. They forget about all the other biases that they may hold, and they may hold confirmation bias, and they may collect all the right data, but then just cherry pick the data that fits the narrative that they already believe about this client, and throw away data that doesn't confirm what they already think about that client. That's not in the standards, because the standards are about testing, it is about test development, it's about using tests. It's not about the assessment process as a whole, and I think that may do a little bit of disservice when people conflate those two things, and think that as long as they're following the standards, they're doing ethical and valid work. I don't actually think believe that that's true. I think it is necessary, but not sufficient. You have to do everything in the standards, but you actually have to do more than that to have a really good ethical, valid assessment of an individual. We talk a lot about, or I've seen it written, that people now say, "Well, a lot of the test bias, test question bias has been eliminated." I was wondering, "What are your thoughts on this?" to DevTill, into your last response, is not that we eat from placing so much emphasis on individual test items as opposed to the overall process. Yeah, I think anyone who claims that we've gotten rid of bias and tests just don't believe any other thing out of their mouth. If they're like, "Oh, it's a completely culture-free measure of IQ." There's no such thing as a culture-free measure of anything, even in the process, even if I'm sitting down one-on-one with a kid or an adult and saying, "Show me what you can do." There's culture in that. That's a very American value. Show me what you can do. Whereas if you go elsewhere, part of your general intelligence may actually be how well you collaborate with people or how well you cooperate with people, and that may be part of intelligence. There's nothing culture-free, no items are culture-free. I don't think we've gotten rid of it. We have to know that. I often say, "We have to be better than the tests." The assessment psychologist has to be better than the tests. We have to know going in that there's some bias in our tests, and we have to know in what direction. If I am testing a kid of color with a general IQ test, that is pretty good, and they've done a lot of work, and they are way better than they used to be, definitely, when it comes to cultural bias, I can be pretty sure that it is likely to be an underestimate of their actual ability. I know that going in. I know that there's some bias built in, and I know that it is in that direction. I am going to underestimate how smart this kid is. In a survey, I may overestimate some psychopathology in individuals of color or queer individuals, as individuals, is probably going to overestimate the problems in that population. But I need to know that going in, and then marry it to that collaborative process. I need to then think about, "Okay, what is this person telling me about who they are, about how they view the world, about how they're walking through the world, and their own narrative and their own history and their own experiences? How can that help me make sense of this test score?" Rather than saying, "Here's a test score, here's what it means." Right. Particularly in the area of personality assessments and things like paranoia, when we talk about them a lot of times, it's to the effect of, let's look at that data in conjunction with what the person is dealing with, what they're confronting on a day-to-day basis, and the mistrust of systems, deliberately. So I want to go on, since you thought it up, I want to go to IQ, it's one of my particular areas, that I talk a lot about, and a lot of the IQ and cognitive measure testing is about the risk, but the gap in racial performance is often studied, but in the gap, that's what they're there, they have narrowed, but still persist. But a lot of the data talks about, well, you know, and obviously IQ differences among race has been used as a sort of a cornerstone of scientific racism. I don't want to minimize that, but what intrigues me more if this particular juncture is going back to this debate that wise and other people, and the people that wrote the chapter in your book, talk about what are we measuring, right, when we measure IQ, are we measuring advantage, are we measuring social economics, and what do we do when we think we are measuring education availability, education enrichment, when we think that we're measuring something other than the faint Q, what do we do? Oh, that's the $10 million question right there. What do we do with this? So let me start with the fact that IQ obviously is a controversial-ish construct. IQ is called. about. So what we have determined in our culture constitutes IQ. We've got models, we've got theories. It's, you know, most IQ tests are built around the Catelle Horn Carroll model of intelligence, which is, you know, you have a general intelligence factor and then there are subfactors that go into it and whatnot. What we do know is that within a culture IQ is very predictive. So I don't want to throw it out. I don't want to throw out IQ. It is very predictive of a lot of outcomes, a lot of important outcomes. So measuring IQ early on predicts later happiness, life satisfaction, educational attainment, occupational attainment, all these sorts of things. So it has value, but big, but capital, but it is culture bound. How we define what we're looking at is fully culture bound. We also need to stop thinking about IQ as immutable and permanent. Like that number is not a permanent number. IQ testing looks at a snapshot of someone's cognitive abilities at that point in time. Everybody who's an assessment psychologist knows if I give an IQ test three years later, it's not going to be exactly the same score. So did that person's brain like grow or shrink or something like that? No, of course not. IQ is a snapshot of someone's cognitive abilities at that moment in time. And what constitutes what goes into someone's cognitive abilities absolutely includes educational access and opportunity. It absolutely includes cultural and educational capital, right? We know that for example, kids who come from households where they have a stay at home parent, they can afford to stay at home parent who reads to them a lot at night. And this sort of thing fair better on IQ tests than those who come from higher poverty neighborhoods where both parents have to work and there's less amount of time for them to read to them at night and be as present academically or educationally early on. That is about access. That is a socio-economic issue. That being said, and I write a lot about this, psychologists need to stop what I call hiding behind the thermometer. I see this argument a lot that IQ tests are just a thermometer. They're just measuring. It's not my fault if kids of color or adults of color are underperforming. Like that's just what the thermometer is telling us. If it is eliciting the more systemic and structural inequities and inequalities in our society, so be it. I don't think that that argument is great because we are the psychologists who get to decide what we're measuring. We absolutely get to choose what it is we're measuring and what it means. We get to draw the conclusions from it. So if I'm going to give a report to somebody and it's going to have a big impact on that client's life, on that kid's life, I better be very clear that I in good conscience have written about IQ in a way that tells anyone who might read that report. This is not permanent. This is a reflection of how they're doing right now and contributing to how they're doing right now are all of these contextual factors and I better put that in the report. And how do you do that? That's one of the you know, that's one of the things that I get asked a lot is how do you do that, right? And I just like to get your ideas about what are some of the things that you include to sort of contextualize as the IQ scores. Yeah. So when I do like a cognitive section in a report, you know, we're all trained to write a paragraph on verbal ability and a paragraph on visual spatial ability or whatever. And the way I was trained to write it and the way that I trained a lot of people for a lot of years to write the verbal ability was to write like an overall like their verbal ability is average for their age. And then their fund of vocabulary is this and their ability to think abstractly in language is this because that's how it came out on this test. Now I will not write that section without contextual information. So I will add a sentence to sentences to the end of that paragraph saying this reflects them working really hard. If they are, for example, narrative origin, if they're autistic, this reflects all of the effort they're putting in to communicating through language in neurotypical ways or if it is below average, this reflects or contributing to this is a history of spotty attendance at school. Or you know, I will contextualize it. I will also try and contextualize it forward and say this shows that they're very likely to excel in school and especially in these types of tasks at school. I will write a little bit more. It's more work for sure. But what it does is exactly what you said, it relies less heavily on that one test, how they were doing that one day in our office, staring at me, right? Who knows if that's a purely accurate reflection of their real ability? We know that there's test error. We know that some of that error is random. We know some of it is systematic and some of it is oppression based on racist and some of it, you know, there's a lot of stuff in there. So I will not write that section without some context in it. I want to turn our discussion to talk about the LGBTQ populations because of the concern about the high levels of oppression, anxiety, serious mental illness, suicidality, and also my thought that that is too an area that's not heavily explored in terms of minority stress models are not fully incorporated in our assessment processes. But I was wondering like what your thoughts were about the numbers which are and the people obviously behind the numbers that are really struggling right now. They're struggling with instances like you indicated before a violence increasing and all the sort of ways that marginalized and kicked on and oppressed culture are sort of operating. And I just wanted to sort of get your thoughts about this in general and then with regard to assessment particularly. Yeah, so I work a lot in the peer community. I'm going to talk mostly now about the trans and gender diverse community because they are under attack right now. This is some of the most blatant sanctioned discrimination happening to any oppressed group. It is visible. They are being weaponized politically. They are being stamped out left right and center by too many people. It is uncomfortable. It breaks my heart. How this community and on top of that access to gender affirming care, gender affirming medical care and health care is getting harder and harder to access. Places are closing down because of our current climate. Those places that do gender affirming care often put up barriers. So for example, the WPATH standards that most recent WPATH standards say that to access gender affirming care, we should not require psychological testing. That being said, most places that offer gender affirming care still require some sort of psychological testing. That is a barrier for many people who can't afford a private assessment or don't know how to get one or find one. We are gatekeepers right and we're colluding with that because we're gatekeepers. I do know a lot of pro bono assessments and write letters and I don't think we should be gatekeepers. I'm not giving IQ tests. I'm not doing comprehensive assessments. I'm just saying, yeah, let them have it. Let's trust them. Let's believe them because they are being oppressed and marginalized. Nobody is going to fake it to be treated more poorly in our society. Let's believe them when they say they need this care. We also know that gender affirming healthcare is one of the most effective treatments out there for anything. For when it comes to treatment of gender dysphoria, the outcomes for gender affirming medical care are way better than any of our therapies are for depression or bipolar or anything. They're way more effective. So there isn't enough research happening on assessment with trans and gender diverse communities. We did through the Society of Clinical Psychology last year and the assessment section. We did a webinar series on issues and assessment of the trans and gender expansive communities. I'm currently working with some of those folks and some others on a paper on best practices. We're working on that now in assessment with this community. The trick with this community is not a trick. The issues with this community is that there's a big, then diagram. There's a host of issues that have to do with transness that have to do with gender diversity and that have to do with being oppressed very publicly. And we need to assess the impact of that oppression. We need to assess the impact of the invalidation of their identity. We need to assess all of that. The other circle in the Venn diagram is that they are humans who have the same sort of psychopathology as everybody else. Right? So they have other issues that may have nothing to do with their transness or their gender identity. They may have nothing to do with the oppression. Now they interact. That's why I call it a Venn diagram. They are intersecting and it's sometimes hard to tease apart, but we need to be thinking in that model in our assessments. We need to be looking at these two things concurrently and thinking about how do they intersect? How do they interact? Are there some issues that are actually purely psychological? And then we can take their treatment toward those things that are purely psychological? Are there other things that it really have to do with oppression? And then what do we do about that? Because I can't fix our country right now. I can't fix the oppressions that are happening politically. I can't fix the turning tide of majority sentiment. I can't fix that myself for them. So my options then are to recommend some sort of therapy to help them adapt to them better, which doesn't feel great. My other options are to start advocating and start doing work and helping them advocate and find some queer joy, queer euphoria, find all the great things to be proud of in their identities and help them advocate for themselves. Like we can really tailor it toward queer affirming models of finding joy, finding comfort, finding community, finding places in their life where they actually feel more safe. There was a great article that came out a couple of years ago by Lisa Diamond and colleagues that looked at the minority stress theory. My minority stress theory basically says we have all of these invalidations and negative experiences based on minority stress, and that overwhelms us and it over taxes us and it makes us anxious and that we have used that a lot and it makes a lot of sense. This article said let's flip that backward. Let's actually say minoritized individuals are at their baseline nervous in our world. And what we're looking for is security. We are constantly on the lookout for those places, those communities, those systems where we actually feel safe, where we can feel ourselves. It's not that we're on the lookout for oppression where we're on the lookout or hyper-vigilant to danger, we're actually on the lookout for safety. We're actually constantly on the lookout for the places where I can feel authentic and I can be vulnerable. And that may be a way of turning our recommendations in an assessment around to say you need to change some things in your life so that you can feel more authentic, more of the time, you can feel queer joy and queer pride. Well, you know, it's an interesting dichotomy because we want to talk about what is, which is the system of oppression and minority stressors that people have to go through on a daily day basis. But during this time, we also want to help groups and cultures think about their resilience, think about finding joy and I don't want to compare groups, but that's sort of a thread that I've been hearing running throughout a lot of minoritized communities in the last few months is finding areas of joy, finding areas of inner community inside of their own communities, safety, finding sources of support that are real sources of support and advocacy. But your point is we'll take in a lot of cultures and communities are not just a calculus of oppression, right? They have opinions and even psycho pathologies and other things that are apart and separate from the oppressive systems and I'm glad you emphasized that because particularly now I think that's very important and as clinicians to explore who's your source of support? What are your areas of taking care of yourself right now when you're being bombarded with images that are not so positive? So I question, I'm kind of like pulling back a little bit and I've been thinking about these APA ethical guidelines that are in the process and I'm trying to like marry them to what's going on right now and we still sort of elevated the interest of the client, the equitable treatment of the client, advocating for them to have just results. And so I'm wondering how you sort of think about these guidelines when we hear a device of talk even among our psychological community, how do you sort of incorporate what we say is being expected of us as clinicians? Yeah, I think we are at a crossroads as a field, as a discipline. I think that in the way that a lot of people are talking about a constitutional crisis, I kind of feel like we have a professional crisis at our hands and we as a field, the American Psychological Association or other big organizations, have a decision to make right now. Are we going to kind of roll over and we are in the midst of redesigning or redefining our ethical codes right now? Are we going to say as long as it's legal or as long as it's within state law or soften our stance on justice and soften our stance on equity? Or are we going to double down and say, actually, this is quarter who we are. We are a field that is dedicated to mitigating and decreasing human suffering and human struggles. That is what we are meant to do. And for me, in order to truly live up to that mission, to truly decrease human struggles and human suffering, we must double down on social justice. We must start thinking about populations. We can't just think about the individual sitting in front of us. We have to think about the greater good and greater society. And so it remains to be seen what will happen with these ethical codes. I know they are out for public comment right now as of the taping of this. And I know there are a lot of groups that are not super happy with the draft at the moment because they just aren't strong enough. They are not committed enough to social justice and true equity to drive our field and to create a core identity of what we see ourselves able to be because we're in a weird position that that may be in contrast with some laws in some states. We're trying to bring back up our earlier discussion on trauma which in terms of liberation therapies and liberation analysis sort of has the social justice elements to it, right? And it would be a different profession if we eliminate those. So that's what I wanted to say, that's what I want to say about that. And I'll add, it would be a worse profession. It would be a profession. I would be less proud to be a part of my passion is in training. So I'm a program director and a doctoral program. I train students. I do talks. I guess lecture a lot. And I like this is my passion is in training. And I am a big believer that we need to set up the next generation in our field of psychology to be better than we were to be more social justice oriented than we are currently. My generation is doing better than the generation before I think, but we need to keep that momentum and help them be way better than we are right now. We have ways to go. I want to just am I last couple of questions have to do with the training and assessment. This field is not very diverse. 4% African American Hispanic slightly less Asian. So 15, 14 less than 15% and the numbers in assessment are even lower. And so I wanted to get your thoughts about how do we train and educate a more diverse array of clinicians. Yeah, it's super important. I go to these conferences and I see a sea of people that look like me, right? I see a sea of white people, not very many queer people, but I see a lot of white people. I don't see a lot of people of color at these conferences, specifically around assessment, neuropsych assessment or personality assessment. I see very few. It becomes tricky now that we're not allowed to face any admissions decisions on any socio-demographic characteristics. We're not allowed to ask socio-demographics. So it becomes harder to think about how do we diversify the field. I think that this is a pipeline issue. I think that we need to start earlier. We need to start in high school, telling high schoolers, going to communities and going to high schoolers and telling them how sexy psychology is, right? How awesome it is to be a psychologist, how fantastic it is. We then need to make a piece psychology sexier. We need to make the undergrad psychology major sexier. And then we need like, we can't make the decisions based on socio-demographic characteristics. We can't just say, let in more black students. That's not legal right now. We're not allowed to do that. But we can encourage more to apply. We can go to these communities and say, we need you. We need you in this community because your community needs you. We need people from different communities. We need the helpers to look more like the people we're helping, to have similar experiences and lives and lived cultural values. And we need to diversify our field as a whole. When it comes to assessment, we need to, again, do a better job, I think, historically, when it comes to training and assessment, we do a good job of training our graduate students in testing. I think we actually do a very bad job. Overall, of training them in assessment and clinical decision making and all the fun stuff, all the things that we need a psychologist brain to do, not a psychometrist brain, a psychometrist like we can train anyone to give an IQ test, or to hand over an MMPI or a PAI like surveys are not tough to give. They're not even that tough to interpret, but putting it all together and telling a story about a person and why they're struggling, why they're suffering, and how they can better thrive in this world. That's the fun stuff. And I think if we made it more enticing, and if we built Ian more of this culture stuff, it's again, going back to the essentials book, if we built this essentials book and the material in it into the training and didn't make it like an adjunct, like, oh, and by the way, we'll do a day on culture. No, we need to do it in every single class period when we're training. It might entice more of our graduate students of color, our queer graduate students to specialize in assessment, knowing how important it is to get these things right. What are your research areas of assessment? Do you think that we need to explore further? What sort of is sort of in your crawl about what we need to be doing in the future? Yeah, I think we need to be doing a better job of researching how to contextualize test scores. So knowing that one test score, and I'm part of the problem, I write the handbook of psychological assessment. If you go to the handbook of psychological assessment and you turn to any page, it'll tell you, you know, an elevation on this score means this, right? And that's kind of true. And I'm revising this now and I try and write it in a way that's like, it may mean this, but think about it in this way. And I try and give a little nuance. But too many textbooks will say an elevation on this score means depression. A low score on this scale means that they have low verbal ability. That may or may not be true. We need to do better research and understanding what a low score means within the context of that person's history, context, lived experience, experience of oppression, access to resources, access to education and educational opportunities. We need to do a better job of researching that. That's the thing that bothers me the most when I get reports given to me to evaluate how good they are or people who apply to work with me and send me a sample report. Like, that is not necessarily what that score means. Stop pretending like you've put someone on a scale and said there are 150 pounds. That is what it is. Their IQ is a 100. They are average. Stop pretending that our test scores mean exactly the same as the underlying construct they're named after. Right. Right. What are your current projects that you can tell us about? Where are you going to be next? Yeah. Sleeping. I am currently working on the next edition of the Handbook of Psychological Assessment. That's my next big writing project. But I am also the Wixkey. We are culturally adapting the Wixkey at the moment, which I know sounds easy, but it's really hard. The Wixkey is that structured cultural interview. It's got a lot of questions that relate to different areas of culture and oppression. Right now, we're doing a big project to adapt it for Mandarin speaking individuals in America. So to culturally adapt it, you have to think about what questions matter to that population. So we have to do lit reviews around what questions might matter. And then we have to get experts to weigh in. And I've got amazing graduate students who are leading this charge and working with me on it. And then once you get all of that, then you translate it into Mandarin. We're doing the same. We're just at the tip of the beginning of doing the same thing with Spanish. Spanish is actually quite a bit more difficult in some ways than Mandarin. Because the Mandarin speaking clients are all coming from China. They're all coming from one place and not that China is homogeneous in its culture, but the experience of Chinese immigrants tends to be a little bit more homogeneous than the experience of Spanish speaking immigrants. Because they may be coming from South America, they may be coming from Spain. They may be coming from Central America. They're coming from and their experiences are much more disparate and diverse. So figuring out what matters to a Spanish speaking population is really tough to do. So we're at the beginning stages of culturally adapting and then translating that into Spanish as well for primarily Spanish speaking clients. So what people reach out to you if they want to gain contact with you? What's your handles and how do people get in contact with you? Yeah, I'm terrible at social media, but I am on LinkedIn. You can find me, you can literally just Google me, age, or write it at LinkedIn. Or you can email me if you want to nerd out about this stuff. Feel free to email me. My email address is [email protected]. This has been another enlightening and rich conversation addressing the delicate balance of the role of culture and psychology. For more episodes of the multicultural psychologists, watch us for future monthly episodes. Don't forget to follow us on social media. You can join our mailing list at www.bmulticulturalpsychologists.com. Goodbye for now from Linda Flanagan and the Multicultural Psychologist podcast. [BLANK_AUDIO]