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Critical approaches in psychology and social work criticizing the current mainstream psychotherapy discourse have been gaining more ground in recent decades. Yet, little empirical research has, to date, explored therapy in regular practice to identify the discursive resources employed during the clinical encounter and the way such discourses create and maintain power differences and the boundaries of the therapeutic interaction. This paper is rooted within a post-structural perspective based on Foucauldian analysis which sees power as dispersed throughout the social field and emphasizes the multiple ways in which power differences are created and maintained through accepted forms of discourse and knowledge. Data were drawn from a large study of mental health intakes in clinics in Israel working with culturally diverse populations. We conducted critical discourse analysis on a single dyad including transcription of a recorded intake session and post-intake interviews with the client and the therapist. Based on existing critique of psychotherapeutic discourse for its individualistic and apolitical view, we explored how the hegemonic psychotherapy discourse is negotiated in real practice, the ideology it carries, and the power differences it perpetuates. We shed light on the way this discourse conceals social injustice and contributes to the disempowerment of the client and ultimately to a poorer quality of services.

Background:The contrasting social status of ethnic groups differentially impacts the mental health of their members. This may be the case in Israel despite its egalitarian ideology. However, studies are a few and limited in scope.Aim:To study mental health disparities between immigrant and second-generation disadvantaged and advantaged Jewish groups.Methods:Data were extracted from the Israel World Mental Health Survey. This included the Composite International Diagnostic Interview and the General Health Questionnaire. We compared 547 first-generation immigrants born in North Africa/Asia and 708 born in Europe/America; and 707 second-generation immigrants of North African/Asian origin and 449 of European/American origin.Results:The prevalence rate of common mental disorders in the preceding year was approximately double for respondents of North African/Asian origin compared with their European/American counterparts following adjustment for socio-demographic confounders. Inmigrants: North African/Asian 12.4%, SE = 1.5; European/American 6.4%, SE = 1.0 (AOR = 2.1, 95% CI 1.4–3.4). Second generation: North African/Asian 10.1%, SE = 1.2; European/American 5.4%, SE = 1.1 (AOR = 1.7, 95% CI 1.1–3.2). Significant differences in emotional distress mean scores were observed only among second-generation respondents: North African/Asian respondents reported higher emotional distress ( M = 18.7, SE = 0.5) compared with European/American ( M = 17.3, SE = 0.4) (Wald F = 13.31, p < .001).Conclusions:Results showed disparities in the mental health measures in both generations. It is likely that social causation factors, such as restricted opportunities in the context of higher aspirations, partially account for the findings.

Minorities face particular social strains, and these are often manifested in their overall mental health. In Israel, just under a quarter of the citizens are Arab Palestinians, yet very little has been published exploring the spectrum of mental health issues prevalent in this population.

Therapists are faced with the challenge of developing effective ways to advance cross-cultural engagement with a rapidly growing diverse client population. In this qualitative study, we characterized the way clients and therapists described the quality of working alliance during the mental health intake and examined whether these descriptions vary as a function of their social identities. We conducted in-depth interviews with Ashkenazi (socially advantaged group; n = 22) therapists and their Mizrahi (socially disadvantaged group n = 29) or Ashkenazi (n = 26) clients immediately following their intake session in four mental health clinics in Israel. We performed a thematic analysis. Overall, interrater reliability among three raters who coded the narratives was high (kappa = 0.72, therapist; 0.70, client). Across all client and therapist interviews, we identified eight central themes detailing different qualities of the working alliance: (1) feeling understood, (2) feeling comfortable, (3) openness and cooperation, (4) trust, (5) empathy and identification, (6) frustration and disappointment, (7) anger and hostility, and (8) emotional disengagement. On average, clients reported 2.56 (standard deviation = 1.17) and therapists described 2.65 (standard deviation = 1.45) themes in each session. Overall, concordant and discordant dyads described similar themes with few exceptions. In particular, being part of a discordant dyad may affect the client's interpretation of non-verbal communication as well as the therapist's evaluation of the client's openness and trustworthiness. Although less frequent, when anger and hostility were described by therapists, these characterized the interaction with Mizrahi clients. We discuss implications to care including the need to promote a culturally humble approach to providing care for minorities.

Background: Mental health challenges are widespread among adolescents undergoing significant physical, emotional, social, and academic changes. However, rates of formal help-seeking remain low, particularly among those from ethnic minorities. Aims: This study investigated the determinants of intentions to seek formal mental health help among Palestinian adolescents in Israel, focusing on mental health literacy (MHL) and trust in formal sources of information. Methods: A total of 178 adolescents (Mage = 16.24 ± 1.24 years, 61.8% female) completed measures assessing intention for formal help-seeking, psychological distress, MHL, trust in formal sources of information, sociodemographic, and clinical characteristics. Results: Findings revealed low levels of intention to seek formal help and psychological distress, alongside average or above-average levels on all MHL dimensions and trust in formal sources for information. Our analysis identified socioeconomic status (β = .17, p < .05), psychological distress (β = .18, p < .05), trust in formal sources of information (β = .28, p < .001), and two MHL dimensions: knowledge of where to seek information (β = .25, p < .01) and attitudes that promote recognition or appropriate help-seeking behavior (β = .16, p < .05) – as the main determinants of intention for formal help-seeking. Conclusions: This study underscores the critical role of trust in formal sources of information and MHL in seeking formal help among adolescents from ethnic minorities. Interventions aiming to improve access to mental health-related information, address and enhance attitudes, and foster trust in formal professionals and institutions may contribute to an increased tendency for formal mental health help-seeking among this population and others.

Background: Mental health literacy (MHL) has been related to health behaviors and outcomes. However, studies examining MHL as a barrier and facilitator to service use are limited, especially among minority groups. Aims: This study examined MHL as a barrier and facilitator to mental health service use among the Palestinian Bedouin minority in Israel. Methods: Twenty-five Bedouins (15 women) from southern Israel participated in semi-structured, in-depth interviews. The participants were recruited by publishing an ad on social media about the study, then through a snowball technique. The data were analyzed thematically using ATLAS.ti.9, and the intercoder reliability was 92%. Results: We identified four major themes in the interviews: (1) MHL as a barrier to service use, due to lack of knowledge about professionals in the field, mental health services, or reasons and risk factors for mental health problems; (2) traditional attitudes that acted as barriers to service use, including a preference for informal treatment, a lack of faith in mental health treatment, aversion to discussing private feelings, and the perception that mental health is a luxury; (3) MHL as a facilitator to service use by enabling accurate identification of mental distress and suggesting practical avenues for seeking help; and (4) ways to improve MHL that should be culturally sensitive and under the government agencies' responsibility. Conclusions: Interventions aimed at increasing the use of mental health services among Bedouins and reducing racial/ethnic disparities should increase knowledge in culturally adapted ways, especially regarding professionals and services, and change negative attitudes such as mental health treatment as ineffective or bonus.

Abstract. Background: A substantial number of people with cancer endorse suicidality when compared with the general population. Thus, oncology healthcare workers may experience the death of a patient to suicide over their careers. Aims: To explore the impact of patients' mental health distress and suicidality on oncology personnel with a secondary aim of exploring how personnel cope with these types of events. Method: We interviewed 61 healthcare professionals (HCPs) at two cancer centers. The grounded theory method (GT) was used. Results: The impact of patients' mental health distress and suicidal ideation on oncology HCPs included sadness, depression, worry and concern, and feeling emotionally overwhelmed. The impact of patient suicide on HCPs included trauma, guilt, and surprise. Oncology personnel reported a change in practice, including communication style, being attuned to patient cues, and changing the physical environment. Coping strategies included colleague support, seeking professional help, and setting boundaries between their work and home life. Limitations: It is likely that HCPs who participated in the study represent those who are more willing to discuss issues related to suicide. Thus, the impact of patient suicide on healthcare providers may be even more pronounced among the general oncology HCP community. Conclusion: Given the higher risk of suicide among cancer patients, it is necessary to increase awareness about the impact these events may have on HCPs. Professional guidelines can highlight the need for a balance between ensuring the availability of informal support and more formal methods of help.