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Visions Journal

A reminder that this article from our magazine Visions was published more than 1 year ago. It is here for reference only. Some information in it may no longer be current. It also represents the point of the view of the author only. See the author box at the bottom of the article for more about the contributor.

Clinicians Supporting Youth

Navigating the ever-changing waters of the 21st century

Shimi Kang, MD, FRCPC

Reprinted from the "Culture" issue of Visions Journal, 2014, 9 (4), p. 31

One of my young patients, who was just 10 years old, was struggling with low self-esteem and school frustration that led to depression and anxiety symptoms. When I asked him what he thought led him to feel this way, he said one thing (among many others) was being told he had a “pencil-holding deficiency.” This caused him to have messy printing and trouble with written output. Written output is important, but as a doctor with “chicken-scratch writing,” to me this seems a big burden for a young child to carry.

I asked my research assistant Sajan, a 21-year-old student at the University of British Columbia, how often he wrote with a pencil or pen. In my two years of working with him, I’d never seen him hold a pencil or pen, as he took all his notes directly into his cell phone or computer. He said, “About once every 12 days—I do everything electronically.” Shocked, I explained why I had asked the question, to which he replied, “Your patient needs to type. Kids these days are growing up in a completely different culture. I’m only 21 and I’m already outdated.”

Culture is an extremely broad term that can apply to everything from aspects of ethnicity and language to age group and activities one is engaged in. Cultural identity is evolving, dynamic and an undeniable part of every human being. A child’s “culture” of being a video gamer may feel stronger to a child than the culture of being of a particular ancestry.

Professionals would be well equipped to apply a cultural lens with all youth they work with. But this lens may not be what you think. It’s not adapted for one specific cultural group. The 21st century is marked not only by break-neck-speed technology, but by global connectedness and the fall of authoritarianism. As we’ve seen with the fall of authoritarian political regimes in the Arab spring or in the “flattening” out of corporations, the 21st century is marked by a cultural shift from “top down” authoritarianism to a more “flat” collaborative approach.

Just like educators are embracing the collaborative classroom where teachers and students have shared responsibility, helping professionals must also move from an outdated approach of lecturing, directing, and instructing, to a 21st-century position of motivating and co-operative partnership. This is the world our patients are growing up in and expect to experience when they walk through our doors.

In my book, The Dolphin Way: A Parent’s Guide to Raising Healthy, Happy, and Motivated Kids Without Turning Into a Tiger,* I identify three styles of interpersonal interaction: Dolphin, Tiger and Jellyfish. Tiger clinicians push and direct their clients, while Jellyfish clinicians provide no direction or advancement of goals. In this day and age, I recommend the approach of the Dolphin clinician.

The Dolphin clinician moves interactions from an authoritarian clinician–passive patient (“I am an expert on your life”) to a shoulder-to-shoulder partnership (“You are the expert on your life and I can help you with some of your struggles”). Dolphin clinicians align as guides. They support yet also gently nudge the person toward clear goals for better health and well-being. This all happens within a professional healing culture of being empathic, person-centred and adaptable. The Dolphin techniques incorporate many strategies based on motivational interviewing but also include lifestyle and relationship tools I’ve developed over years of clinical practice.

Let’s look at the issue of teen marijuana use. The Tiger clinician may say, “You really need to stop smoking pot. It is bad for your asthma and anxiety.” The Jellyfish clinician may say, “What’s going on with the marijuana use?” and allow the youth to go on about how much they enjoy smoking pot and how frustrated they are with their parents who are advocating for more control. The Dolphin clinician, however, will first establish a shoulder-to-shoulder stance of equality and teamwork: “I can see you really enjoy smoking pot, but it also seems to be causing some problems in your life. If you like, I may be able to help you with this.” They may then explore—in a non-judgmental way—the benefits and drawbacks of marijuana use to point out the discrepancy of the positives and negatives of use and how they apply to the person’s personal goals and the issue at hand.

In a world of an ever-growing generation gap, it is easy to be in shock of a young person’s actions and behaviors. To combat this, Dolphin clinicians try to be curious, not judgmental. They do not direct or instruct but rather guide their patients to find their own personal solutions. They are playful in their approach, yet serious about moving forward on issues of health and well-being. For example, the Dolphin clinician may say, “Wouldn’t it be great if you didn’t have to smoke pot to reduce your anxiety? Because it really seems to be affecting your asthma and love of playing soccer?”

In over 10 years of working with teens and families from a variety of ethnicities, socio-economic classes and walks of life, I have found that looking for specific cultural tips is less helpful than applying universal human tools. For example, even though one may not speak the same language as their patient, appealing to fundamental human values of respect, autonomy, empathy, and humility are highly effective in any language even through a translator.

We humans, we are more similar than we are different. We all want to be understood and heard. And we all want to move forward in life—even angry adolescents. So, regardless of the cultural group we are interacting with, a collaborative approach that balances empathy and direction, and autonomy and expectation, will likely work. After all, regardless of our culture, we are all human.

About the author

Dr. Kang is a psychiatrist and author. She is a  Clinical Associate Professor at the University of British Columbia; the Physician Lead for Child and Youth Mental Health, Vancouver Coastal Health; the founder of the BC Provincial Youth Concurrent Disorders Program; and co-founder of the Youth, Culture, and Mental Health Fund for the BC Mental Health Foundation 

* The Dolphin Way: A Parent’s Guide to Raising Healthy, Happy, and Motivated Kids Without Turning Into a Tiger. (Penguin Random House, April 2014.

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