To fully understand the young person, the family and their social ecology, the cultural context needs to be taken into account.

AMBIT strongly supports the idea of Cultural consultation as an appropriate way to approach transcultural working, and The Therapist's Mentalizing Stance is well adapted for use in culturally-diverse settings, with it respectful not-knowing and inquisitive stance.

What is culture?

'Culture' can be broadly defined as a system of shared meaning. It patterns and constructs the relationships through which we come to know ourselves. Our very notions of personhood, our motivations, cognitions and emotions are given meaning through culture. We are, however, seldom consciously aware of this.

This is not to say that cultural patterns are given or fixed. It is only in the performing of these shared meanings that culture is constructed. Thus, on the one hand culture constructs us and on the other we construct it. Meanings are constantly open to reworking and renegotiating and so 'cultures' are always emerging and subject to change.

Cultures within Cultures

Within the context of multicultural societies, cultures exist within cultures and in a hierarchical power relationship. Institutions, such as the NHS and the models and theoretical frameworks they are based on, as well as the practitioners that operate within them are rooted in culturally constructed normative ideas about health and dysfunction. Minority cultural groups within this social context are often left to negotiate these differences and may at times experience the involvement of these institutions and practitioners as an imposition and as in conflict with their values and beliefs, even though, as various governmental reports and directives clearly suggest, the onus of this should not fall on 'users' but rather on institutions to guard against discriminatory practices.

The impact of culture

The potential strain of living 'in between' cultural spaces has in the past been referred to as 'culture conflict', and has been alluded to as one possible explanation for disproportionately higher rates of certain mental disorders and suicide and self-harm in ethnic minority adolescents. In practice, this viewpoint has often led to the construction of 'minority cultures' as being the source of the problem, as opposed to the relationship and difference between cultures.

Minority families and adolescents, who are navigating these differences, often become embroiled in this polarizing dynamic of cultures. Health professionals working with cultural minority adolescents, therefore, need to keep in mind these multiple contexts and hold multiple views of 'the problem' and 'solutions'. It is important to be aware that, whilst cultures may pattern people's lives, meanings are subject to reworking within the broad cultural framework. The work of the health professional may then be geared towards improving the ecological 'fit' between the cultural contexts in which the YP moves.

Manualizing approaches to culture

AMBIT's stress on the need to Respect local practice and expertise extends to a reticence to dictate how teams should best work in different culturally-influenced settings, but local attempts to manualize their work will be helpful to others. There may a wide range of SpecificEthnoSpiritualTheories in a local setting (we do not presume to define them here) that a local team could record, along with their experience of how best to work with these.