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Psychologists cross cultures

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Child psychology is a vexed issue at the best of times, but in a foreign country with a vastly different culture and set of familial traditions, the added complications for practitioners are tremendous.

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The inordinate difficulty of the task at hand hasn’t deterred Angela Simcox and Bridie Gallagher, two UK-trained clinical psychologists who are operating Indigo Psychological Services, Cambodia’s first private practice to specialise in child mental health and development.

“It depends on what the issues are and what the parents are already bringing to the table; the understanding they have of the kind of work a psychologist does,” Simcox says.

“There’s not really many psychologists here, so sometimes parents come to us with a medical model in their head and think their children are going to be cured in one session. Other times they know that’s not the case. We don’t try and impose anything on anyone and we’re very clear about what we’re doing the whole way through.”

Dr Simcox co-founded Indigo back in 2010 after a period of working with children and adolescents through local NGOs.

Six months ago she was joined by Dr Gallagher, who had recently finished her clinical training in Leeds.

In the time since, Simcox and Gallagher have seen their caseload steadily increase, largely through word of mouth.

While catering for the children of expat families, the majority of the pair’s caseload comes from local Cambodians, posing a set of challenges rarely addressed by western clinical training.

Unsurprisingly, foremost among those challenges is the language barrier between the western practitioners and their Khmer-speaking clients.

“It’s usually the parents who might need some translation,” says Simcox.

“I don’t think it’s advisable to do the whole thing through translation, that’s why we’re trying to get more Cambodian psychologists. Sometimes direct translation isn’t even the issue – I mean, some of the words and concepts we’re talking about don’t exist in Khmer.

“We have to think very carefully about the cases that we work with, because our profession is based on communication and understanding people’s behaviour and language. And if we’re talking about a Cambodian family who have no English, from the provinces for example, then it’s very hard to help them because we live in very different worlds. It’s also very difficult for us to understand and make a professional judgement about what is the correct path or developmentally appropriate behaviour even is in that context.“

One of the problems generated by the confusion of psychology with other medical disciplines is the idea that behavioural problems are, at root, generated from within the child, rather than being an interaction between their biological make up and  their surroundings.

Gallagher’s role within the practice is to work with a child’s family and school environment in order to identify the adjunct causes of a child’s behaviour, the necessity of which is not always apparent to the families in her care.

“That’s one idea that’s hard to communicate and sometimes doesn’t make sense to people, both here and abroad” says Gallagher.

“But then there’s another level to that and it’s about child development, this idea that what happens to a child while they’re growing has an impact on their behaviour, their emotion, their whole presentation. It doesn’t really match with what many people believe about how children grow up, and we try to find a way to bridge that.”

“Part of our work is doing some research to find out more about what Cambodian parents think about what’s important for their children and how their children develop. I am making a gross generalisation here, because a lot of Cambodian people are psychologically minded and completely understanding of the impacts of traumas or loss.”

“Family is a very different thing here,” adds Simcox, “compared to the families we worked with through our training in the west, where you’re talking about mum and dad and the kids. That’s easier; you’re talking about fewer people. The problem we face is that maybe parents or one of them are quite keen to be engaged but they come back later saying: ‘well, the grandparents think …’ There’s so many people around the child, that sometimes it becomes hard to work with them all.”

Gallagher adds that this is not always a setback; often, a large extended family provides a level of support for a child.

In other countries, in the event of a potentially harmful or violent family situation, child psychologists have the ability to call on a welfare bureaucracy to remove a child from a dangerous situation.

Without the availability of these second line services in Cambodia, protecting children from the risk of harm requires a measured and tactful approach from professionals, which is often at odds with their clinical training.

“Child protection is a fine line. We’re very clear, as psychologists, as to what is and isn’t acceptable. Here, we don’t know where that line is culturally, and what we should respect and what we have to keep within our own personal boundaries. So it’s a problem working with families where you think that it may be harmful. If they’re letting us see that, then at least there is some scope for letting us make some change. “

Indigo Psychological Services can be found at #28 Street 460, Phnom Penh, near the Russian Market. Appointments can be made on 023 222 614.

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