Scenario:

Sarah is a 25-year-old transgender refugee woman who follows the Muslim faith. She was diagnosed with Post-Traumatic Stress Disorder (PTSD). Sarah experienced trauma symptoms and was stressed due to post-migration issues such as housing. She encountered oppression due to her identity; Sarah’s family rejected her. She was misgendered by settlement workers and denied services by her shelter counsellor. She has experienced poverty and was not given enough food at the shelter. Several landlords rejected her application for housing due to her gender identity.

How did I apply an anti-oppression approach when working with her? Read on to find out. However, before I answer this, let me define what anti-oppression practice entails.

Anti-oppression practice is a perspective on practice and advocacy that assists practitioners in reflecting on power and oppression (Hines, 2012). An anti-oppressive practice framework studies identity as a central aspect of oppression and assesses differences used to set apart individuals or groups. It “centers the experiences of equity-deserving groups to build structures and systems that work for everyone”. (CICMH, 2022).

How I used an anti-oppression approach at different levels when working with Sarah

The LGBTQ+ refugee population faces oppression on multiple levels, becoming excluded and marginalized by the dominant society. Anti-oppression addresses oppression at multiple levels (Hines, 2012).

Intrapersonal level - client skill building

Safety and stability are crucial when working with trauma survivors, as they cannot recover from their trauma without sufficient stability (Fisher, 1999). Here are the techniques I used with Sarah to stabilize and promote empowerment:

• I provided psychoeducation to teach her how to recognize her triggers and her symptoms and how to manage them; this included grounding skills and coping strategies to keep her safe.
• I encouraged her to focus on daily activities, such as walking.
• I helped Sarah enroll in an expressive art program so she could express her stressors, trauma, and migration experience and reduce social isolation.
• Sarah disclosed suicidal thoughts; on a scale of 1-10, I asked her how intense the suicidal thoughts were. She scored seven; however, she had no plan. I conducted a suicide risk assessment, and I assisted her in creating a safety plan. I also offered her crisis lines that were linguistically appropriate and interpreted in her language of choice.

Interpersonal level – my social location as the provider and Sarah

• I reflected on my cultural and religious beliefs and how they might affect my relationship with Sarah since we speak the same language; also, my name indicates that I follow the Muslim faith. I combined cultural competence and cultural humility to engage in self-awareness, self-reflection, and self-critique to address the power imbalance.
• I used a culturally responsive care approach, including Cultural Formulation interview techniques.
• I informed Sarah about my previous experience working with LGBTQ+ refugees and provided appropriate self-disclosure about my settlement journey in Canada. At the beginning of the assessment, Sarah asked to be addressed as “they”; however, she felt comfortable when she learned I have experience working with the LGBTQ+ community and asked to be addressed as a female.
• I informed Sarah that there was no need to disclose the details of her trauma; I also told her she could take breaks if she felt overwhelmed during our sessions. My goal was to create a safe place for Sarah to establish a good rapport; from my experience working with refugees, they are often hesitant to seek counselling with professionals from the same cultural background.

Organizational changes

• I advocated for Sarah with the management of the settlement agency whose staff misgendered Sarah, causing her distress. As a result, all settlement workers at the agency received training to provide inclusive services. The organization implemented clear policies regarding misgendering individuals and inequality.
• This experience showed me the power of advocacy, education, and partnership to create positive change for this and other vulnerable groups.

Benefits

Using an anti-oppression and culturally sensitive approach helps providers assess the client's needs and identify those needs based on the client's words. It prevents assumptions based on immigrants' and refugees' cultural backgrounds and respects their unique experiences. It empowers the client, promotes social justice, and increases their knowledge about their rights. It also improves communication, trust, and rapport with the service provider.

The client feels validated and recognized for their unique experience. Sarah said, "I felt I was seen for the first time, understood, and respected.”

References & Resources

APA-DSM5_Cultural Formulation-Interview

Centre for Innovation in Campus Mental Health [CICMH]. (2022). What is anti-oppressive practice? Retrieved from: https://campusmentalhealth.ca/toolkits/anti-oppressive-practice/what-is-anti-oppressive-practice/

Fisher-Borne, M., Montana Cain, J., & Martin, S. (2015). From Mastery to Accountability: Cultural Humility as an Alternative to Cultural Competence, Social Work Education, 34:2, 165–181, https://doi.org/10.1080/02615479.2014.977244

Hines, J. M. (2012). Using an Anti-Oppressive Framework in Social Work Practice with Lesbians. Journal of Gay & Lesbian Social Services, 24(1), 23–39

Paralikar, V. P., Deshmukh, A., & Weiss, M. G. (2020). Qualitative Analysis of Cultural Formulation Interview: Findings and Implications for Revising the Outline for Cultural Formulation. Transcultural Psychiatry, 57(4), 525–541. https://doi.org/10.1177/1363461518822407