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ContentsIntroduction...........................................................................................................................................................4

Who should read this resource?........................................................................................................................4Why was this resource created?........................................................................................................................4This resource is designed to help you................................................................................................................4

Language and communication...............................................................................................................................5Common language and communication style concerns.....................................................................................5Speaking and listening.......................................................................................................................................5Writing...............................................................................................................................................................7Group setting.....................................................................................................................................................7

Managing language and communication concern..................................................................................................8Speaking and communication style....................................................................................................................8Rapport building................................................................................................................................................8Cognitive strategies...........................................................................................................................................9

Language support and resources.........................................................................................................................10Online resources..............................................................................................................................................10Online proofreading tools................................................................................................................................10

Orientation to the Australian context: Society and culture..................................................................................11Basic healthcare and social services.................................................................................................................11Healthcare system...........................................................................................................................................11Medicare..........................................................................................................................................................11Centrelink........................................................................................................................................................12Housing............................................................................................................................................................12

Australian culture and social norms.....................................................................................................................13Value and social norms....................................................................................................................................13Mental health and help-seeking behaviours....................................................................................................16Intervention styles...........................................................................................................................................16Physical closeness............................................................................................................................................17Group behaviours and assertiveness...............................................................................................................18Dress codes and concept of time.....................................................................................................................18

Managing differences and challenges..................................................................................................................19Scenarios..........................................................................................................................................................20

Prejudice and discrimination................................................................................................................................21Support resources............................................................................................................................................22

Conclusion............................................................................................................................................................22

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IntroductionUnless an alternative reference is provided, the research this handbook referred to is:

Jones, L., O’Connor, E., & Boag-Hodgson, C. (2017). Enhancing workplace learning for international students in psychology. In G. Barton and K. Hartwig (Eds.) Professional learning in the work place for international students: Exploring theory and practice (pp 183-202). Bonn: Springer

Ho, N.K.N. (2016). An Exploration of the Experiences of Culturally and/or Linguistically Diverse Trainee Psychologists in Australian Postgraduate Programs (Unpublished master's thesis). Griffith University, Queensland, Australia

We also acknowledge the funding provided by OLT grant, A cross-disciplinary approach to improving international work placements ID14-3837 from the Innovation & Development Program, 2014-2016.

Who should read this resource?This resource was developed for postgraduate psychology students from Culturally and/or Linguistically Diverse (CALD) backgrounds (both domestic and international) who are studying in Australia. The resource may also be useful to other students and the supervisors of psychology students.

Why was this resource created?Psychology requires well developed sensitivity to the nuances and subtleties of language and nonverbal communication. International and CALD students often experience some difficulties in English language competence and communication skills in Australia, especially for those who are from non-English speaking countries. Their English language competence may affect their confidence about going on placement.

In psychology, it is also particularly important to understand the local context and systems relevant to your professional practice. International students have indicated that they require more support to learn about systems in Australia, such as the healthcare systems. Additionally, awareness and knowledge of Australian culture and social norms is important when working with clients on placements. This handbook will introduce you to each of these areas. While this resource serves as an introductory tool, you may need to consult your course convener or supervisor for further information.

This resource is designed to help you

Understand the common language and communication concerns among international and CALD students speaking English as a second language

Learn about ways to manage language concerns in practising psychology

Identify relevant language support and resources

Improve your awareness and knowledge of Australian culture and social norms

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Develop your own strategies to explore and understand cultural or societal differences when on placement.

Language and communicationCommon language and communication style concernsInternational or CALD students may experience some difficulties in English language communication. The extent of these difficulties and any related concerns is often related to the level of experience students have with English generally and the breadth of exposure to communication in Australian contexts.

Speaking and listeningSome international students may struggle to follow discussions in class and to communicate in spoken English (Ng & Smith, 2009). When working with clients, international students may struggle with the comprehension of English, especially the understanding of the subtle cues, nuances, or underlying meanings in specific local contexts or social values (Brown & Landrum-Brown, 1995). Some students experience concerns about language when working as a psychologist in their second language (Trepal et al., 2014), and report fears of being laughed at for their accent and feeling embarrassed about their own English. Furthermore, students worry about asking questions for clarification on placement, because the clients might attribute this to their ability to understand English. These concerns may contribute to students feeling nervous and stressed when providing psychological services and may affect their confidence about going on placement.

Wendy, international student

Even fluent English speakers may have difficulty understanding some accents used in Australia or have difficulties with Australian slang.

Julie, international student

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I feel I have no confidence mainly because I feel that I’m not an English speaker.

And there are some occasion in the session where my English expression, kind of, you know, a bit absurd ‘cause I don’t know the right term or something like that for example, in the beginning I said rather than

family of origin, I said original family.

ReflectionTo what extent do you worry about your English skills in working with clients? What are the things you worry about?

So far, what strategies have you used or considered using to improve your spoken English? How could you apply these strategies while on placement?

International or CALD students may also experience challenges in explaining psychological concepts or terminology to clients and this may lead some students to worry about being perceived as “not professional”. It is helpful to remember that all new psychologists experience some uncertainty or difficulty in explaining complex information.

Clare, international student

Often we dwell on weaknesses without also thinking about our strengths. A study on trainee family therapists from a non-English speaking country (Morris & Lee, 2004) reported that although international trainees faced challenges regarding language, clients positively responded to the efforts these trainees devoted to accommodating different accents. Further, the clients appreciated the additional questions these trainees asked (e.g., asking

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It’s hard to say whether it’s the language or just I am a new therapist. You know we need to learn how to say things. Sometimes, it’s easy to

blame you [it] on your language.

further questions for clarification and understanding), instead of assuming too much about the client.

WritingThe writing involved in psychological practice is diverse and complex. For example, report writing is a required competency in psychological practice, involving highly prescriptive forms of writing, dense with technical terms and statistical information, behavioural observations, diagnostic reasoning, treatment plans, or recommendations. These reports may be used by a number of stakeholders including other health practitioners or professionals from other disciplines (e.g., lawyers, teachers). There is an expectation that trainees will develop these complicated skills. International and CALD students (and all students!) may struggle to develop their writing skills during their placement and may doubt their own abilities to improve their writing.

ReflectionTo what extent do you worry about your English writing skills in psychological or academic reports?

So far, what strategies have you used or considered using to improve your English writing? How could you apply these strategies while on placement?

Group settingSome international and CALD students may experience challenges with language in a group setting. Some students will become quieter or remain silent. This is sometimes due to delays in thinking in a second language and rehearsing words in their minds before saying them, difficulties understanding everything that has been said, or it can be due to feeling shy or uncomfortable in a group setting.

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Gail, international student

Managing language and communication concernMany international and CALD students find ways to progress through their communication concerns as they learn, adjust and improve their language skills across their training. International students also use a variety of ways to cope with the challenges they encounter.

Speaking and communication styleIf you are concerned about your use of English, your accent, or your different communication style you could try activities to help you understand non-verbal postures and facial expressions, to supplement your comprehension of the verbal content.

An international student who spoke native English reported being self-consciousness in the way they talked and their mannerisms, and so they modified their pronunciations to match the Australian communication style. Participants also spent extra time practising pronunciations or rehearsing. They copied words from supervisors or peers and used resources/games to complement language in therapy sessions.

Your university may have a conversation club to provide opportunities to practice your English or there may be a social group or club you can join to help you observe and learn from others.

Rapport buildingTo build rapport with mainstream Australian clients, past students have reported speaking honestly about English as a second language and explicitly stating the need to ask questions for clarification at times, which helped relieve the pressure on them.

Some students used Australian slang or made fun of their own accents or English to break the ice with clients, such as saying “if I say something rude, it must be a linguistic mistake.”

Another student suggested being open, inviting clients to ask questions about the trainee, showing understanding of local cultures, sharing previous clinical experiences with Australian clients, and inviting corrections if misunderstanding occurred, all of which also helped initial rapport-building.

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I do have my own opinions and I want to speak out, but I’ll be like ‘oh maybe they already talked about that and I just missed that’ so I just

won’t say it.

What are your strategies for building rapport and inviting questions from your clients?

Some international and CALD students not only acknowledged language difficulties but also used this on placement by stating that everyone had a weakness and that they could acknowledge weaknesses and share their vulnerabilities with others. An international student said, “My English is less than perfect so I can almost use it in therapy that… it’s okay not to be perfect.”

Cognitive strategiesCognitive strategies were also used by students to challenge their perceived difficulties with language and its impact on rapport-building. A student said, “It was my perception of my English. It was never a real difficulty that clients couldn’t understand me or they make any kind of complaints.” Another student engaged in self-talk to shift their focus from self to clients in therapy sessions, “it’s not about you, it’s about the client.”

ReflectionHow might you cope with your language and communication concerns?

Which of the above methods may work for you?

My plan to deal with this challenge is to

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Language support and resourcesThis is a place for you to record your institution's support resources.

Online resourcesq Academic Phrasebank (University of Manchester)

www.phrasebank.manchester.ac.uk/

q Expanding your vocabulary with the academic word list (University of Nottingham) www.nottingham.ac.uk/alzsh3/acvocab/index.htm

q The academic word list (Victoria University) www.victoria.ac.nz/lals/resources/academicwordlist/most-frequent

q Collocation Dictionary (Oxford) oxforddictionary.so8848.com/

Online proofreading toolsq Grammarly www.grammarly.com

q PolishMyWriting www.polishmywriting.com/

q Ginger www.gingersoftware.com/

q Slick Write www.slickwrite.com/

These online proofreading tools are free of charge. They are useful in checking simple grammar, punctuation, spelling and style, especially when the writing/reports contain confidential information. They will not correct conceptual information and may have limited capabilities to deal with the complexities of professional psychological writing.

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Orientation to the Australian context: Society and cultureBasic healthcare and social services

Wendy, international student

Healthcare systemThe Australian healthcare system provides access to a wide range of services, largely publicly funded. For most people living in Australia, their first contact with the health system when they become sick is a visit to a general practitioner (GP). The GP may write them a prescription, order diagnostic testing, or refer them to a specialist (e.g., psychologist) or a hospital.

Health providers include medical practitioners, nurses, allied health and other health professionals in the public or private settings, including clinics, hospitals, and government and non-government agencies. Private sector health service providers include medical practices, pharmacies and private hospitals.

MedicareMedicare covers universal access to free treatment in public hospitals and subsidies for medical services and pharmaceutical services, and is available to Australian citizens and permanent residents.

Most medical practitioners working in private medical practices charge a fee for their services. The Medical Benefits Schedule (MBS) sets a fee for each service. This is the limit or highest price that will be covered by Medicare. When a service, pharmaceutical or procedure costs more than this limit, the patient typically pays the gap directly or through private health insurance. GPs play a gate keeping role in this system and generally specialist services or treatments can only be covered by Medicare with a GP referral.

What is a Mental Health Care Plan?Medicare rebates are available for psychological treatment by registered psychologists under the Australian Government's ‘Better Access to Mental Health Care’ initiative. This scheme provides assistance to people with mental health problems and increases access to psychologists with a more affordable cost. To access a psychologist through this initiative, people need a mental health care plan.

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…to learn about the Australian systems, the healthcare system, something like Centrelink, Medicare, because I know nothing about that. And housing system because... where do clients go, and where do they

live, like with no jobs, and where do they get their money from?

A mental health care plan is available to patients if they visit their GP, paediatrician or Psychiatrist and have been diagnosed with a mental disorder. A Mental Health Care Plan allows patients to get the Medicare rebate for up to 10 individual or 10 group appointments per calendar year for psychological services.

Psychologists are free to set their own fees for the services they provide. When a psychologist’s fee for a session is in excess of the Medicare rebate, the ‘gap’ payment is the responsibility of patients.

What is Bulk Billing?Bulk billing is when a health professional accepts the Medicare benefit as full payment for a service. This means that the Medicare benefit or rebate is the same amount as the fee. Patients cannot be charged additional costs such as a booking or administration fee, or be charged for consumables such as bandages. As a result, there is no direct expense for the patient.

For more informationq Mental Health Care Plan Info Sheet

www.health.gov.au/internet/main/publishing.nsf/content/mental-ba-gpsamp

q Health Care System and Health Policy in Australia http://www.commonwealthfund.org/grants-and-fellowships/fellowships/australian-american-health-policy-fellowship/health-care-system-and-health-policy-in-australia

CentrelinkCentrelink is an Australian Government program and is managed by the Department of Human Services. Centrelink's main service is the disbursement of social security payments. Centrelink delivers a wide range of government payments and services for citizens and residents, including families, carers, parents, retirees, the unemployed, students, people with disabilities, Indigenous Australians, and people from diverse cultural and linguistic backgrounds, and provides help in an emergency. A list of Centrelink payments and services available at www.humanservices.gov.au/customer/services/centrelink

HousingIn the 2010 Survey of Income and Housing, it was reported that an estimated 67% of households owned their homes (with or without a mortgage), 24% of households rented from a private landlord and 4% rented from a state or territory housing authority.

Government or non-government organisations provide public and community housing to assist people who are unable to access suitable affordable housing. Under these arrangements, rent is generally set below market levels and is based on the income of the household. Often, people from vulnerable backgrounds will access assistance through a social worker or other support worker to submit the appropriate applications to gain access to housing options. There are often waiting lists in capital cities and other emergency housing (e.g., men’s and women’s shelters) are required to support people while they wait for housing to become available.

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For more information http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1301.0~2012~Main%20Features~Home%20Owners%20and%20Renters~129

https://www.qld.gov.au/housing/public-community-housing/

Australian culture and social norms

Debbie, international student

One of the most challenging parts of living in another country is knowing and understanding the cultures, values, and norms there. There are a range of differences between your own culture and the Australian culture. The following section is designed to help you start to think about what are the similarities and what are the differences between your culture and values, and the Australian culture and values.

Value and social normsMost international students reported that their culture emphasises values different to or even conflicting with Australian values, such as being more family or community-orientated, including thinking about how issues (e.g. personal behaviour or mental health) would impact on the family unit or the community as opposed to the individual. These values may affect how we think and act (e.g. what is appropriate to say or do in a situation?).

Western or Australian societies generally emphasise individualism, assertiveness, rationalism, and science. Such values contradict the values of collectivism, obedience, and spiritual emphasis that are commonly held in non-Western societies.

The following are two examples demonstrating how differences in values and norms may affect our interpretation and understanding of clients’ presenting problems.

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…when you first come here the way things are taught, the way things are done are quite different, so kind of adapting to that whilst juggling that

uni stuff really does put a lot of pressure on you…

Example 1

A 20-year-old client, who studies a full-time degree in university, reported feeling useless because he still lives with his parents and believed that he should have moved out to live independently.

It is common in Australia that young adults in their early to mid 20s move out of their parents’ home. These young people may be studying at university/other tertiary institutes or have recently entered the workforce. The sense of pride or value associated with this transition to living outside the family home is related to the individualism and independence Australian society emphasises. However, in some cultures such as Asian cultures, young adults generally live with their parents until they get married, regardless of their age.

ReflectionWhat is the social norm regarding the appropriate age/circumstances for moving out of one’s parent’s home in your culture? What cultural or social value underpins this practice?

ReflectionWhat are the parenting practices in your culture? What is the underlying cultural or social value driving such practice?

Can you think about other examples illustrating the different cultural or social norms between your culture and the Australian culture?

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Example 2

An international student working with children and parents in her placement found Australian parenting practices were quite different from her own culture. Her placement organisation promotes positive parent child interaction and encourages parents to “get down to the child’s level and play with them”. However, she reported difficulty encouraging these parenting practices in her own country because “it’s almost like, that crosses the boundaries of having different ranks, I can’t be the same level, I’m the parent”.

Culture and values self-report scaleThe following is a self-report scale examining nine areas of culture and values. Rate how similar or different your culture is to the Australian culture for each area of culture.

Very

sim

ilar

Sim

ilar

A litt

le

diffe

rent

Very

di

ffere

nt

to Australian culture

1 2 3 4

Life and fate vs Personal choice, free will, self-determination ☐ ☐ ☐ ☐Rational (e.g. science, mind, matter) vs Emotional value (e.g. heart, faith, spirit) ☐ ☐ ☐ ☐Dependence vs Independence ☐ ☐ ☐ ☐Individualism vs Collectivism ☐ ☐ ☐ ☐Self-centred vs Family-centred ☐ ☐ ☐ ☐Harmony/compliance vs Self-assertiveness ☐ ☐ ☐ ☐Values of conformity and obedience vs Independence and initiative ☐ ☐ ☐ ☐The hierarchical approach vs The horizontal approach of societies ☐ ☐ ☐ ☐Status of women vs men ☐ ☐ ☐ ☐

Reflect on each of the above areas and think about how this might impact on your work as a psychologist in Australia.

Mental health and help-seeking behavioursDifferences in the views about mental health and help-seeking behaviours between their home cultures and Australian/Western culture were identified by previous international students. Some cultures view mental health as a taboo and mental health is considered a forbidden topic. On the other hand, some cultures are more open to seeking psychological help.

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In Australia, mental health is not a taboo but there is perhaps a stigma associated with mental illness in the society. A news article reported that four out of ten Australians who took sick leave for depression kept it from their employers and half of them feared losing their jobs.

Mental health services are widely available, accessible, and more affordable under the Better Access Scheme and Mental Health Care Plan and therefore, encourage help-seeking behaviours. However, there are some factors that affect help-seeking among Australians, including stigma and embarrassment, problems recognising symptoms, preference for self-reliance and a sense of hopelessness.

In the Australian indigenous culture, hearing voices giving instructions is a normal cultural practice, and part of the developmental process from childhood to adulthood, and so this should not be seen as a symptom of schizophrenia. There is a low rate of accessing mental health services among Aboriginal people and Torre Strait Islanders. In part this may be because psychology and mental health services are relatively dominated by Western perspectives.

For more informationhttp://www.abc.net.au/news/2013-11-12/australians-worried-depression-will-cost-their-job:-study/5085820

http://au.professionals.reachout.com/breaking-down-barriers-to-help-seeking

Intervention stylesIn Australia, a collaborative approach is commonly adopted in psychotherapy. The client is assumed to be an expert of themselves and the psychologist is experienced in psychological theories, knowledge and skills. Therefore, both the client and psychologist work together to achieve desired treatment goals.

Some international students reported that the therapeutic style in their culture was more directive and authoritative. The psychologists are viewed as expert and prescribe treatment to clients and clients follow the treatment plan.

Supervisors mentioned that some international students find difficulty expressing rapport as it is taught in Australia.

Janet, international student

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Some students come from backgrounds that culturally may be more, more standoffish in their personal approach and that's a cultural thing. So I've had to be mindful of that but also giving feedback to those students

about how to manage that.

ReflectionWhat is the intervention style used in your culture? What is the role of the psychologist/therapist? How would that affect your rapport building with Australian clients?

Physical closenessInternational students reported cultural differences in physical closeness among people. While some students came from a “no touching” culture, some students reported a cultural norm to hug and touch people to show caring. It is not a normal practice to hug clients in psychotherapy in Australia. If hugging occurs with client, you may want to discuss this with your supervisors.

ReflectionWhat would it be like for you if you could not hug or show physical closeness to clients? Or alternatively, what if you needed to show physical closeness to clients but were not from a culture that supported or expected this behaviour?

Group behaviours and assertivenessMany international students come from cultures that value a less assertive communication style than in Australia, and they are reluctant to speak up and get involved. Sometimes they do not speak their mind in order to uphold the value of conformity in a group setting.

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I tend to be more passive, compared to Australians, who are quite outgoing, opinionative… I have to remind myself constantly to express my

views… to assert myself in the group setting when that doesn’t come naturally for me.

Lee, an international student

International students often experience cultural differences in behaviours, learning styles, and knowledge in a group setting. Some international students reported that being more often silent in group supervisions because a longer time was needed to process and follow the content of group discussion, which usually involved clients from the dominant culture.

Doris, an international student

Some students experienced challenges with language during group supervision. They reported being less vocal and more often silent due to delays in thinking in a second language and rehearsing words in their minds before saying them, and thus they could not keep up with the pace of the group discussion.

However, many students described learning to express their opinions and speak up and becoming more assertive. They recognised this as a key change for them across their placements.

Dress codes and concept of timeOther cultural differences that influenced the experiences of international students during their placements were, for example, dress codes and time management. Students experienced conflicts between accepted ways of behaving in their home culture and the norms of the workplace or Australian culture. Students learnt to be aware of the dress codes in their placement and they may explicitly ask their colleagues or supervisors.

In Australia, it is generally expected that people are on time for formal events, such as lectures, meetings and work, and also in group situations. In some cultures, the attitude to time is more relaxed (e.g., 10 to 15 minutes late is acceptable or even expected).

Paula, international student

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They talked about some practice or custom that does not belong to me. I probably need to take a bit more time to process. And when I feel like I

want to say something and then they have already gone to the next topic.

So I had to change a lot of my dressing habits which was pretty different from my culture.

Harry, international student

ReflectionConsider what expectations your placement clients, colleagues or supervisor might have about dress and time, and how this might differ from your own culture.

Managing differences and challengesInternational students grappled with the extent to which they adapted to Australian norms or not. To manage cultural differences, many students educated themselves about Australian cultures, observed people’s behaviours, and participated in local events and activities. Self-reflection occurred throughout the training to deepen their understanding of their own culture and to keep the values that are important to trainees while also accepting the Australian culture.

During placements, students constantly reminded themselves of being aware of cultural differences and not imposing their own values onto clients from the Australian dominant culture. Some students reported being open, inviting clients to ask questions about them, showing understanding of local cultures, sharing previous clinical experiences with Australian clients, and inviting corrections if misunderstanding occurred, all of which helped initial rapport-building.

International students were sometimes concerned about how people would respond to them. However, students generally experienced little prejudice and discrimination and they were able to establish rapport with clients.

Kim, international student

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The time management thing is very culturally specific because back home there is no real concept of time.

[I worried] that my clients will not like that I’m of a different race, um and whether that limits any kind of openness or rapport.

Unfortunately, some students experienced negative attitudes from clients due to their linguistic and cultural background.

Julie, international student

ScenariosThe following scenarios may potentially occur in your placements. You may discuss with your supervisor the scenarios. Now, let’s think about some of the usual ways to respond to in these situations.

Possible responses may be

Answer honestly and explore if the client has any concerns about this by using open questions, such as “What does it mean to you that I’m from [place]?”

Ask the client “Where do you think I’m from?” and then explore what makes them think that you’re from [place] and explore if the client has any concerns associated with this.

After either response it would be good to

mention some of the benefits you could bring to the therapy (e.g., “Coming from a diverse cultural background I am more culturally aware and I do not assume certain things/take things for granted.”)

state your therapeutic/practice approach (e.g., to understand each client as an individual)

if necessary, you may state that you will need to ask questions to clarify things at times to better understand the client and help the client achieve their goals.

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So there’s one client that actually specifically discussed... He just said that, “so this is the parent of a child client”, and then so he just like “oh

yeah I’m just a little bit worried how this child going to respond since you are not typical Australian.”

Scenario 1

A client asks “Where are you from?” out of curiosity.

Scenario 2

A client says “I’m not sure you could understand my situation as you’re from another culture.”

Possible responses may be

reflect the client’s concern (e.g., “It appears that you may worry about my ability to understand your situation/problems given that I’m from a culturally diverse background.”)

explore what exactly do they think you could not understand (e.g. “I am wondering which part you think I could not understand?”)

state your training and experience in psychology

show your understanding of local cultures and previous experiences with Australian clients.

TOP TIP

You may want to thank your client for being open and honest about their concerns because this is important in a therapeutic or professional relationship, and also for you to help them to achieve their goals.

The key is to first reflect the client’s concern/enquiry, second explore what is the underlying worry/concern driven that, and third clarify if they have any misunderstanding or explain how you would manage their concern. Always be open and honest!

Prejudice and discriminationIf you experience racism or discrimination during placements, please don’t feel hesitant to talk to your supervisors or placement coordinator to seek guidance and advice. Learning ways to manage prejudice and discrimination, if it occurs, is an important set of skills during your journey of being a psychologist.

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Support resourcesThis is a place for you to record your institution's support resources, like the contact details for the Discrimination Officer.

ConclusionConcerns about English language and communication style are common among international students. You are not the only one. However, previous students have found different ways to deal with this challenge, and learning from their experience may be helpful for you. After reading this handout, you should now have a better understanding of some coping strategies, as well as information about language support and other useful resources.

Take the time to think about the differences between your culture and the Australian culture. It is an ongoing process throughout your placements to learn about Australian systems and culture. After reading this resource and having considered each of the reflections in this resource, you should now have a better understanding of the Australian systems and culture, and some skills to manage differences and challenges.

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