Reflections on culturally competent practice with Nellie Anderson
Narrator [00:00:02] Welcome to the Emerging Minds podcast.
Chris Dolman [00:00:08] Hello, my name is Chris Dolman, and today we’ll be hearing from Nellie Anderson, a practitioner who’s worked extensively with children and families from refugee communities who’ve experienced torture and trauma prior to their arrival in Australia. In today’s episode, we hear from Nellie about some of the perspectives and practices she draws on in her work to support children’s mental health and social and emotional wellbeing in ways that reflect both cultural competency and curiosity.
[00:00:37] Yeah, so thanks for your time today. Perhaps you could just say, what’s your role at STTARS?
Nellie Anderson [00:00:42] Sure, so I work for an organisation called STTARS, which is an acronym for Survivors of Torture and Trauma Assistance Rehabilitation Service. And basically, that’s a counselling service for refugees. I’m in the child and youth focussed team and my role as a counsellor/advocate, so predominantly providing mental health support, but we recognise that children and families from a refugee background sometimes experience like discrimination or hardships. So there’s also an aspect of advocacy and working for systems to support them more as well.
Chris Dolman [00:01:17] Right, could you say something a bit about, you know, when you’re beginning to meet with a child from a cultural background that’s different to your own. How do you go about that or how do you begin or how do those conversations get underway?
Nellie Anderson [00:01:29] So I guess in terms of practicality, I always assumed that if I’m going to be working with a child or young person, particularly someone still in primary school, the whole family is sort of going to be someone I’m supporting. So I make an effort to meet with the family and the parents or guardians first. Sometimes with the young person present, and sometimes not just depending on what the parents are most comfortable with. And I guess that just helps to get a narrative from the parent’s perspective and to build trust, because any change that’s going to happen sort of has to happen within the family system, not just in a one on one session with the young person, so I think it’s really important to build that rapport and trust with parents. And sometimes families might not know what counselling is or what mental health is, so it’s really important to sort of explore what their expectations are and what their hopes are.
Chris Dolman [00:02:27] What is it you’re wanting to initially understand when you’re meeting with families from a cultural background different to your own?
Nellie Anderson [00:02:32] Sure. I guess quite often the referral will have come from a school or an outside agency, and sometimes there might not be clear communication to the family exactly what counselling is about, so I sort of take a stance that when I meet with the family, they might not have a full informed consent about what counselling, or the service is. So I just go into every conversation like almost before the counselling starts, like almost explaining what it is, because I think having clear expectations from the parents and the young person can really help to build the rapport and to make sure that we’re sort of working in a respectful way, and in a helpful way.
Chris Dolman [00:03:18] Great. And what then initially becomes important for you in terms of meeting with them?
Nellie Anderson [00:03:23] So I think for me, the relationship is always the most important thing, I find. You can’t move forward or get very far if there’s not a relationship or trust, and I guess a lot of the families we work with, you know, they’ve been through situations where their trust has been broken, where there hasn’t been a lot of safety, so you’re probably not going to find a lot of information or perhaps ideas that are discussed might not be followed through if there’s not a trust or relationship there. So that’s definitely my first priority, and then I guess I try to understand from the parent’s perspective what they’re worried about. And sometimes that can be different to what the young person worried about or what the school is worried about, but it’s kind of holding or, you know, all these narratives together and trying to find a common point to find a way forward.
Chris Dolman [00:04:19] Does that contribute to trust in a way?
Nellie Anderson [00:04:22] Yeah, it’s that kind of idea of like a balanced alliance, or if you come in just talking about what the child’s worried about, then the parents are going to sort of find it unhelpful, and then on the other side, if you talk to the parents and, you know, maybe they say, “oh, my kid’s always awake at night playing video games, not doing homework”, and you come to the kid and say that to them in a kind of way that’s not trying to understand their point of view, then the kid’s going to think, “why would I talk to this person? What, how is this possibly helpful for me?”
Chris Dolman [00:04:58] And so, and in working with families from diverse cultural backgrounds then, are there other things that your kind of keeping close to you?
Nellie Anderson [00:05:07] Every family I work with is different from a cultural background than my own, which is white and Caucasian, and so I try to be aware of my own understandings of family, of mental health, of expectations of children. And it can be difficult at times, but I try to make sure that I’m not putting my own cultural norms or expectations on the family. And then it can be interesting because there’s the country of origin and other things that have informed how the family’s function prior to coming to Australia. And then there’s this kind of really interesting point of discussing with the family how you parented in a different context, how, what’s working here and what’s not working.
Chris Dolman [00:05:58] How has that come about for you, that understanding?
Nellie Anderson [00:06:01] Yeah, so I guess I’m from a social work background, so I like to have believed I’ve always tried to respect a person’s own local knowledge or, you know, their self-determination. But I think that’s a lifelong journey. So I just think the nature of the work is by being reflective and acknowledging your mistakes, you’re open to learning more. So I think back now to how I worked with someone four years ago, two years ago, six months ago, and I sometimes I’m like, “oh, I really put my own values in front of what the young person’s values are.” And if I’m still with the young person, I will acknowledge that to them. So I just think, for example, you know, I’m a woman who’s kind of had a very individualistic upbringing and I’ve been able to pursue the things that are important to me. And I was working with another young girl who was really enjoying her education, but she’s also got a big family with brothers and sisters, which have complex needs. And she was finding it really difficult to manage both, and I think initially I was sort of encouraging her to pursue, you know, education is so important. And then it was in another conversation where we kind of reflected together that she has two things that are really important to her, which is her education, but also the collective wellbeing of her family and what that means to her. And through having that conversation together, we were able to sort of talk about how hard it is for her to to balance that and need to balance that for her own wellbeing. So I always try to do it, but I guess I think all practitioners make mistakes, and so being reflective and open to acknowledging your mistakes is probably where a lot of useful learning comes from.
Chris Dolman [00:07:52] Have you sort of discovered other ways where your own cultural norms or values inadvertently seep into your work, that you have to kind of take care?
Nellie Anderson [00:08:00] Yeah, I think they seep in all day, everyday. You know, it can be just as small as the way I phrase something might not make sense. It could be phrased in a different way, and I’m lucky to work with some really skilled interpreters and we can do a face to face interpreting and quite often they’ll say, “the way you’ve said this doesn’t make sense, but if I frame it in a different way, it’s going to make a lot more sense.” So I think one of the ways I try to work in understanding my own culture is to just be open-minded to any feedback or information or advice that is offered from anybody, if they’re from the same cultural background as the client or just a different person. Because I think, you know, the more you learn, the less you realise, you know. So, you know, it can just be those very small things like the way you phrase a sentence to really big things like, you know, themes or values that maybe are so indiscrete that you don’t even think about, but if you reflect a bit harder, can become a bit more obvious. I think one of the best things about my organisation is that we’re from multidisciplinary backgrounds and also it is an extremely multicultural organisation, different ages, different trainings. And it’s just so wonderful because I feel there’s so much knowledge within my organisation so that I’m constantly learning. And it’s not just one-way learning, it’s respectful and difficult conversations that help kind of scaffold learning for everybody. So it’s yeah, that’s one of the very helpful things in my work.
Chris Dolman [00:09:45] Do you have any insights on that in terms of what can contribute to an organisation creating a context for those reflection and difficult conversations?
Nellie Anderson [00:09:56] I definitely think it’s the peer to peer relationships, like you can’t have difficult conversations if there’s not trust. So being able to build those relationships in an organisation are really important. And I’ve worked in other organisations, but because STTARS is so multicultural, it really means that people who are from diverse backgrounds can speak a bit from their perspective and it’s really respected. So I guess not all organisations can be as multicultural, but maybe it’s about not being scared to hear a different perspective, even if it can be a bit confronting, and it doesn’t mean you always have to agree with it. But just learning to hear about different perspectives can just open your mind a little bit or have you looking at something a bit differently.
Chris Dolman [00:10:52] You said that what was one of one of the things that’s been important to you and your practise of working with people from a background different to your own is around respecting local knowledge. I’m wondering if you can say a bit more about when you say ‘local knowledge’, what it is you’re referring to and what you mean in terms of respecting that?
Nellie Anderson [00:11:11] So I think local knowledge, there’s kind of two layers to that. One is perhaps the local knowledge of the community. So someone’s from a country, what’s the norm of parenting there and what skills and values are used, and then on top of that, a lot of our families have experienced displacement or hardship. And so the family has adapted to deal with that trauma or hardship. So then there’s the local knowledge in how did that family function, or cope during that hard time. And I think those adaptions can show up in maybe day to day life in Australia and in the resettlement phase and perhaps be pathologised as dysfunctional or, like not a family that’s functioning well. But when you look at it in the context of ‘this is what the family did to survive an immense trauma’, it’s a lot more respectful, and so then if a family’s made some adaptions to manage through the stress, it’s about looking at, with that stress has now passed, how does this family change again to fit the context that they’re living in.
Chris Dolman [00:12:23] By taking that view, or that position, how does it shape your practise? How does it make something? How does it create something in your work with families?
Nellie Anderson [00:12:31] I hope it creates respect and also a space to explore safely. So like, for example, there’s one family I’m working with and the father has had a horrific trauma or torture story and has actually said he’s been drinking since the age of ten and still drinks now. And so we’ve explored what drinking has meant in his, in his situation. So it has meant escaping from bad memories, it’s also meant collectively as a community, that’s a way that people have come together when they’ve been feeling lonely. And so because we’ve explored it in that context, it doesn’t mean that we’ve excused the behaviour. So we have very honest conversations about, like how does this behaviour fit with looking after your children and how do you keep them safe? But by framing it around it being a coping strategy, there’s less blaming. And I think because there’s less blaming, there’s more room for him to be truthful. And by holding that space, he can kind of explore his own choices. And at the moment, that’s, he’s kind of limited his drinking to certain times when the children are supervised or when he’s not needed to be at school or, you know, caring for the kids. So it’s not a happy ending, but it kind of has moved somewhere because we’ve been able to have that conversation.
Chris Dolman [00:13:58] Does it make a difference to the kind of conversations you might have with him about its impact on his children and his parenting in that kind of thing in some way?
Nellie Anderson [00:14:07] Yeah, because I think if we came from a sort of a position of blaming or a position of saying, “this is what’s good for you and your family”, then there’s no space for him to share his story or his understanding of the problem. So you’ve got to help people move through at their pace and their understanding.
Chris Dolman [00:14:27] I’m also wondering about what that means in terms of what he can therefore come to speak about or understand in terms of his children’s experience as well, because you’ve created that. You’ve given him that space already in some way.
Nellie Anderson [00:14:41] Yeah, it’s tricky. I think he’s trying very hard. But because he, I guess the other thing and we say this lot in parents is they’ve had so much trauma and stress of their own, they’re so overwhelmed that empathising or trying to understand even their children can be difficult. And it’s not because they don’t love them or because they don’t care. It’s because their buckets are so full that, unless someone can listen and understand to them and share that weight, how can they do that for their children?
Chris Dolman [00:15:15] Sure. Yeah. Yeah, I’m thinking a bit about just that idea. You know, like if if we expect parents to understand their children’s experience without us taking the time to understand theirs, you know, is that a further injustice or unfairness in a way?
Nellie Anderson [00:15:29] I think it absolutely is, and I think so many of the families we work with have experienced immense cruelty and, you know, the worst of humanity. And if someone who, you know, has come, who’s living in a privileged life here can’t even just spend some time understanding the context of how the families working in, how can we begin to work together to support for a better outcome?
Chris Dolman [00:15:55] Does that link to other things that are important to you and your work or your organisation’s work?
Nellie Anderson [00:16:00] Yeah, I think one of the other wonderful things about STTARS is that we look like advocacy and human rights, so it’s not just about the one on one counselling relationships, it’s looking about, looking at a systemic level or community level, like what do community perspectives do to people from multicultural backgrounds? What can we do to change it or what can we do this to support?
Chris Dolman [00:16:27] Can you say a bit more about what you become interested in, in terms of a community perspective around a problem?
Nellie Anderson [00:16:33] Yeah, I guess like maybe in a counselling room one on one or in a room with the family, a problem can be understood, but there’s no, like that, there’s a limit to that. If as soon as they leave the room, that problem continues to be a problem. So just for example, I’m working with a young boy at the moment and he’s got quite a difficult trauma story and he’s really having trouble to manage the behaviours that are expected of him at school. And so I think in the counselling room, he feels like he’s understood and talks about the expectations of where he came from is very different and that he doesn’t have full control of his emotions because of these experiences. So I think he feels understood in the room and to some degree with his family. But then when he leaves the room, when we started working with the school, it just went straight back to the narrative around him being, “he’s a naughty boy and he’s, you know, being manipulative and attention-seeking.” And slowly, we’ve tried to change that school’s perspective and particular teachers to help understand that this behaviour is a reaction to trauma, not because he’s a bad person or attention-seeking. And that change is actually much more important because at the school, one-third of his time oppose to in the counselling room with me once a week. So I guess our work, particularly the child and youth team, is it’s with families and it’s also at schools because that’s such an important support system.
Chris Dolman [00:18:10] Nellie, when you’re meeting with a child and family from a culture, you know, perhaps you know very little about, say, like what guides you in that?
Nellie Anderson [00:18:19] Yes. So there’s some cultural groups that we probably work with quite commonly and then there’ll be times when you get a referral and you go, “oh, I’ve never met with someone from that cultural group before.” And in a way that’s really refreshing because it means that you go in with like a genuine curiosity that perhaps wouldn’t be there if you’re used to working with the same cultural group. So I guess if there’s anybody who I know has expertise as a counsellor or from their own background in working with that community, I might have a chat to them about particularly maybe the overall experiences and historical significance of like how they might have come to Australia and maybe just some, you know, is counselling a common thing there?
[00:19:06] If I have time, I might do a bit of research, but that’s not always the case. But then I guess, you know, the people that are the experts are the ones that are sitting in front of you. So I might just come in really curious and just ask them, “what does counselling mean to you? What does mental health mean to you? What’s it like living in a different country?” So I think it can be really challenging and confronting, working with new communities, but it doesn’t necessarily have to be, because if you kind of used the resource in front of you, which is the person you’re working with, that’s all the knowledge you really need.
Chris Dolman [00:19:39] Thank you. You use the words ‘genuine curiosity’. Could you say a bit more about the type of curiosity that stand you in good stead in those situations?
Nellie Anderson [00:19:47] Yeah, I think when you work with people from different backgrounds or just anyone that’s from a different experience than your own, you can be curious and you can kind of be curious from a personal point of view. But that might not be the curiosity that is going to help in the counselling context. So when I say ‘genuine curiosity’, I mean curiosity in a way to inform the work that you’re going to be doing in the counselling room opposed to just I’m curious about your culture and getting side-tracked on something that might not be more. It might be more for me than for the person in answering it.
Chris Dolman [00:20:25] There’s some hazard sometimes or dilemmas that come along with meeting with a person from a cultural background that you’re more familiar with.
Nellie Anderson [00:20:31] Yeah, I think there can be, in one hand it’s helpful because you kind of know some ideas about what some of the experiences they might possibly have had or ways to communicate that help. So I think you’ve got to hold that information, but be willing to let it go at any time. Because just as if you interviewed a hundred thirty-year-olds who were born in Australia, we would all have different examples of what counselling and mental health is. So when you’ve worked with people from similar cultural backgrounds, it’s really important not to stereotype and assume that they’re all going to have the same understanding or the same values or the same hopes. So when you work with a completely new culture, it’s easier to sort of not fall into that trap.
Nellie Anderson [00:21:23] And what helps you not fall into that trap when you’re meeting with people from a culture you’re familiar with?
Nellie Anderson [00:21:28] I think it’s being really mindful and aware that the questioning you have is for the person sitting in front of you, oppose to something that you’ve based it on before. And also just that kind of, you know, that flexibility or fluidity. So you might go in and I guess that’s the same for all counselling. You go into a session with a plan, but if the person who’s sitting in front of you isn’t really interested in what that is, you’ve got to go with them and go with what seems to be important to them. So, yeah, I think it’s about having an idea, but being fluid and able to sort of let that sit to the side if it’s not fitting with the session or the person you’re working with.
Chris Dolman [00:22:08] Are there other things that you’d like to suggest from your own experience and you’re in context in addition to what you’ve said already?
Nellie Anderson [00:22:14] Yeah, I think the two that come to mind is one is, maybe community assumptions that are so obvious, you never even think to question them. So, for example, when I started working with kids, I just had the assumption that all refugee children would be so happy to be in Australia because it must be safer and more resources than the country they’ve come from. And that is not always the case. Like, a lot of children I’ve worked with from Syria share wonderful stories about the type of schooling and family relationships and support they had prior to the war. And then also lots of children maybe have been born into situations that are difficult, but it’s the norm for them, and they have family there and they’re used to it. So a lot of kids I meet are sort of enjoying life in Australia, but they have this real sense of grief for their home country. And I think a lot of people might make the assumption like, “oh, why are they sad, they should be happy they are here, they should be grateful that they’re here.” And I think that there’s that assumption that all refugees should be grateful that they’re in Australia, and that’s just not the reality. So I think there are these kind of assumptions that are made about different cultures, different religions or refugees in general that are sometimes completely wrong. So just kind of holding that in mind or thinking about, have you got that information from the person or is that something that you’ve heard from somewhere else and sort of weighing them up. I guess it would be perhaps just going in open-minded without any assumptions, but sometimes that, well that’s never completely possible. So it’s maybe if something’s not quite making sense in a session, checking, am I making an assumption about this person? And that’s what’s not fitting.
Chris Dolman [00:24:15] How do you go about beginning to engage children in your work, those children that are from cultural backgrounds, different to yours?
Nellie Anderson [00:24:25] So once again, sort of trust, relationship is the most important thing. So for me, particularly for kids who are not used to the idea of counselling, I’ll spend two or three sessions just building a relationship. That can still be what I’d consider an assessment, so you know, learning about their friends. But I don’t rush too much if you know, I get the sense that they’re quite nervous or probably because of the experiences, trusting someone could be quite difficult. I also think maybe the idea of someone coming to listen to the voice of the child and sort of privilege that voice can sometimes be different from other cultures where, you know, there’s a real respect for elders and you should just sort of follow, even though I don’t want a stereotype that, but I think the idea that someone’s going to come one and one and meet just with you and listen to what you’re saying can kind of be a bit surprising, a bit exciting, but a bit confusing and not like “what’s this about?” So I always just spend time building that relationship and that can take one or two sessions. It can take some time, but I think being patient and building that relationship sort of sets up the work for later on.
[00:25:39] And I think one of the things I do at the moment is quite often try and do like a genogram or if that’s a bit language-y, just draw like, to say, “can you draw me a picture of your family?” So I can kind of find out like who’s in the family according to them and who is next to who, and, “how do you feel about this person?” So I think using kind of drawing and books can just be a good way of, it might feel like play to them, but you’re also finding out a bit about them. And yeah, I think we’re lucky to have lots of books about emotions. So just talking like, “is that how anger fits for you? Do you ever feel angry?” So like, just using kind of everyday toys to have conversations. But I think by having those tools in the room, it’s less confronting than if you just sat with the kid who you’ve never met before and say, “tell me about your feelings.” And my-go to last backup plan is always UNO, like UNO is yet to fail me. So if particularly with like, maybe young males if they’re like, “I don’t want to do counselling and I’m being forced to by mum or dad or school.” I’ll say, “can you just sit with me for twenty minutes and we’ll play a couple of games of UNO?” Then we start chatting and quite often they’ll be like, “okay, I’ll come back again.” So I think just having lots of tools in your, your bag to build the relationship is really important.
Chris Dolman [00:27:07] What’s, what continues to draw you to this work, Nellie, after these years, do you think?
Nellie Anderson [00:27:13] I just love the work so much. It’s hard work not knowing about all the diversity that’s in front of you, but it’s also the best part. You learn something new everyday in knowledge, but you also learn about the human spirit, and I think just the young people that I work with truly, truly have an amazing amount of resilience. And I just like, it’s really sad work, but it’s also really inspiring to sort of see that everyday.
Chris Dolman [00:27:44] Does that shape your practice in some way, knowing that?
Nellie Anderson [00:27:47] It does, it means that if I’m having a day where I’m tired or a bit burnt out, I just remember like, I have a few kids that sit in my mind and I go, “if they kept hope through all that hardship, I can write-out like a stressful day at work”.
Chris Dolman [00:28:02] Great. Nellie, thank you so much for joining us today and sharing your insights and perspectives and knowledge and expertise around these areas.
Nellie Anderson [00:28:14] Thank you. It’s been great.
Narrator [00:28:17] Visit our website at www.emergingminds.com.au to access a range of resources to assist your practice. Brought to you by the National Workforce Centre for Child Mental Health, led by Emerging Minds. The National Workforce Centre for Child Mental Health is funded by the Australian Government Department of Health under the National Support for Child and Youth Mental Health Program.