An Interview with Psychologist Stephen Oross
Stephen Oross, Ph.D. is an Associate Professor of Psychology at Kutztown University of Pennsylvania. He specializes in experimental psychology and cultural humility in healthcare.
Ryann Thomson: Thank you for joining us for this installment of The Seattle Psychiatrist interview series. I'm Ryann Thomson, a research intern at Seattle Anxiety Specialists. And I'd like to welcome with us Psychologist Stephen Oross. Dr. Oross is an Associate Professor of Psychology at Kutztown University of Pennsylvania. He is a scholar in the field of experimental psychology, and has published several articles within his career, including, “Studies of Brain Activity Correlates with Behavior in Individuals with and without Developmental Disabilities”. As well as “The Impact of Acuity on Performance of Four Clinical Measures with Contrast Sensitivity in Alzheimer's Disease”. As well, Dr. Oross has had extensive experience working with the World Health Network as well as previously having completed a visiting fellowship at Massachusetts General Hospital. Before we get started, can you please tell us a little bit more about yourself? What made you interested in experimental psychology and what led you to become a professor?
Stephen Oross: Well, thank you, Ryann. Certainly. I actually became- It's a longer story, but I'll condense it. I actually became interested in psychology and decided to be a psychologist as a sophomore in high school. And largely it was due initially to an interest in clinical, child clinical to be specific. I had read some books on autism. I had an aunt who had been diagnosed with mental retardation. And so, when I went to college, my plan was to be a child clinical psychologist. And so, I did my undergraduate work, and while doing that, did a bunch of volunteer and then some paid work interacting with individuals with different developmental disabilities, including some time as a residential house manager at a group home for children with autism. So, I honestly thought that was the direction I was going to go. But as an undergraduate, I also began doing some research with a couple professors at the University of Dayton. And some problems with the clinical end that I saw and the excitement I had with research led me to pursue the experimental degree.
I went to Vanderbilt University for my experimental psychology PhD. I stayed there, did a couple of postdocs, one in sensory perception, one on mental retardation and developmental disabilities. And stayed there actually even longer than that as a research faculty member. While doing that, I had the opportunity to do some teaching. And I supervised a student as she worked on her PhD. I was the doctoral advisor. And those experiences led me to believe that while I wanted to do some research, my interests were more aligned with teaching. So, I did stay in a research position for a number of years before coming to Kutztown and then beginning the path I'm on now that led me here.
Ryann Thomson: Really interesting. That's great. I'm glad you had such a different variety in your background before you came here. That's really nice to hear.
Stephen Oross: Yeah, actually I think it's important to do that. I think it's been beneficial in thinking about how to teach.
Ryann Thomson: So, to begin, I wonder if many people have heard the term cultural humility. And could you possibly define what that is and why it's so important when we're treating clients?
Stephen Oross: Yeah, cultural humility, you're absolutely right. Not as many people are familiar with it as I would expect. But it was introduced in the late 1990s. I believe it was 1998, by Melanie Tervalon and Jen Murray-Garcia in a journal article. And what they were trying to do was to respond to some national mandates to improve multicultural education among physicians. And what they identified was a multidimensional approach with three primary components. The first was to emphasize the importance of self-reflection and lifelong learning. And I'll come back to this point. But second was a recognition that in healthcare settings including mental healthcare settings, there's an imbalance of power. The care provider dominates the services and the care that's needed. And often the patient or client gets ignored at some level. Certainly we're paying attention to the symptoms, but not always looking at their background, and the mindset and experiences that they bring to the healthcare setting.
And lastly, they identified the importance of institutions, not just individuals, but institutions to model these principles of reflection, and lifelong learning, and acknowledgement of power imbalances. So, it's a very dynamic process. And it emphasizes the fact that when people enter into healthcare settings, there's a lot of unknowns about them. And what we need to do is to acknowledge the differences, and the similarities, and the perspectives that people bring. Why it's important, it's clear. There's lots and lots of data to indicate that healthcare providers bring a number of biases into treatment. Some of these biases are explicit and some are implicit biases. But the biases that people possess can negatively affect the care that's provided and the adherence to the treatment plan on the part of the patient. And cultural humility is an approach to try to get past these biases and to incorporate the knowledge that patients have into their treatment.
Ryann Thomson: So, in your experience, what are some barriers that the Western medical system and mental health field face when trying to implement this idea? And how should professionals go about trying to address the challenges effectively?
Stephen Oross: Sure. There are potentially a lot of barriers to implementing what seems like a fairly simple concept in many ways. One barrier, for instance, is that academic training, whether it's in medical profession, or a psychologist, or psychiatrist, really does emphasize becoming an expert on a topic or a domain. In some sense we know we don't know everything, but we still act like we know everything and have been trained to think that way. It's potentially a problem to get providers to recognize the fact that we don't know everything, and we have to provide care and conditions where there's uncertainty. Both uncertainty on our end about perhaps the type of treatment that might be called for and uncertainty about the patient's responses and their actions that would affect how well treatment works. So, that's one.
A second that's very prominent is time. Much of the training that's occurring, it's happening for professors in academic settings, physicians in a more applied settings, mental health providers really looks at a very time limited training program. I know I have to go through a series of trainings, but they're once a year and they're kept maybe an hour long, roughly. And cultural humility is not an approach that can really be taught in a single, very time limited session. It's a ongoing process. This is the lifelong learning component that is emphasized. You are trying to develop a mindset that is awareness about yourself and awareness of the individual you're working with. But that knowledge, and the awareness, and how it impacts interactions is going to be continually changing. So, you can get an orientation to cultural humility, but you really have to be practicing it on a regular and continual basis. And I think a lot of the training is capped to be short because of the other time demands that are placed on individuals. And that can be a barrier.
One other from my perspective is that it is often the case, quite often, particularly mental health care, that we're talking about an individual providing the care rather than a team. And if you have individuals rather than a team that's working collectively, it is more likely that certain biases can creep in. So, cultural humility, training and awareness becomes especially important in that context. How you can effectively train or educate people to work on cultural humility varies. I mean, I did just a quick search and there are lots of institutions that talk about training cultural humility. And I noticed that many of them have a big emphasis on self-reflection for the provider, thinking about the provider's cultural background, and ideas, and expectations.
But there's not as much that I could find talking about power imbalances, and certainly even less on how do you make an institution become aware of the cultural background and biases that are inherent in that institution. So, I think the training efforts can be done, but it's got to be a bigger, more collective effort to highlight the three primary principles of cultural humility. And we have to as providers then start recognizing that we have to live with uncertainty. Rather than always thinking we're an expert, we have to recognize that while we know a lot and certainly can bring that to bear in treatment programs, we don't know unless we search for it like cultural humility wants. We don't know how well each of the clients will respond to a treatment plan. What are their other activities from their religious beliefs, their cultural beliefs, their fact of their people possessing different genders, different sexual orientations, how all that is going to affect treatment.
And we have to, when we accept that uncertainty, recognize that we're not going to be all knowing. We're going to have things we're not aware of. But if we recognize that, and work with individuals and allow for input from the people we're working with, we can help to mitigate these power imbalances. We can gain more information on the types of approaches that clients are willing to bring to treatment, what they might adhere to, what they might not want to adhere to in a way that isn't often captured when there's a a unidirectional, here's the treatment, here's what you do independent of the client. I think that's what we really have to consider.
Ryann Thomson: Yeah, I really liked the team aspect, because I know you personally have a unique experience as you're a heart transplant recipient. So, I know you've talked about having a team approach to your personal healthcare. So, looking back on that experience as well as professional, do you see any more of these strategies being invented? And if not, what can they do for patients in the future to better that?
Stephen Oross: Yeah, if I think about my own situation, including the heart transplant and then other aspects of personal and professional lives. I've actually been fortunate. I have to acknowledge that I come from really a position of privilege in healthcare settings. Coming in as a white male with some advanced educational training, and now with at least some money in health insurance, it really affords me an opportunity to select who I want to care for me. It allows me to have a little face validity when I talk to the healthcare professionals and question why certain things are being done. And I don't tend to have a huge power imbalance between myself and the healthcare providers.
And I found particularly in the transplant setting, interesting to think about because you have to go through a bunch of screening, obviously medical, but also psychological screening prior to being approved to get a transplant. And one example that I thought of as I was preparing thinking about this interview was that while talking to the psychiatrist, a question came up about how depressed I may be or how suicidal I might feel, and whether or not I've ever had those feelings. Because frankly, the healthcare system, if they're providing you with a transplant, something like a heart, they want it to succeed. They want to have it put in somebody who's not going to intentionally damage the gift that they've been provided.
But my beliefs on suicide are not typical for many people. So, when I was asked about that, I remember explicitly thinking, well, I could give the easy story and say, "No, I've never thought about it. I've never been depressed." Quick, easy answer, and we're out. But it would be a dishonest answer because the heart issues I had started many years prior. And when they first happened, they were sudden and surprising. And I did go through a depressed period, and that did lead me at times to think about suicide. And I went to a Catholic university, University of Dayton. I was raised as a Catholic. But I never accepted the idea that suicide was necessarily a bad thing. There are many cultures that accept suicide as a reasonable approach under some conditions. And I in fact had to debate suicide, the pro side when I was an undergraduate.
So, I remember thinking, "Going to tell them this, and this may disqualify me for the transplant," but I had to be honest. And what I appreciated was they didn't have this immediate reaction of saying, "Wait a minute, you've thought about suicide at one point?" They explored the conditions under which, why did I think that? Why did I come to this belief system? And to me, that is a reflection of the cultural humility perspective. So, I really appreciated it at that time. And it highlighted in a personal way, the importance of adopting an approach where they're willing to listen to me, they're willing to explore more deeply why I am holding certain perspectives.
So, that was a very helpful component of being prepared. The downside, I've noticed a couple occasions in a couple settings where I don't feel that providers (and I'll talk about employers a little bit as well) adopted a cultural humility perspective. So, after the original damage to my heart and I had to go to varying cardiologists, there was one in particular who my wife would accompany me because I had, at the time, was using a wheelchair and had to use a wheelchair to get around. And this one doctor in particular would always direct their questions and provide information to my wife who was sitting in the exam room and barely looked at me. Despite the fact that even though he wasn't looking at me, I was the one providing the answers.
My wife has been extremely helpful as I went through this process, but she is not as knowledgeable about the health condition I had. She wasn't as knowledgeable about the damage to the heart and what I might have to do. She wasn't as knowledgeable about the medications I may have to take or other treatment plans. And yet this physician kept insisting on talking to her as if, because I had this serious heart attack, that I was incapable of responding and taking care of myself. And that was an instance where there was certainly not a cultural humility perspective. There was no real attempt to understand what I possessed, what abilities, knowledge, background I had. It was, I'm going to dispense the information to the person who looks less impaired.
It was an instance when I was like, this person's clearly not trained in a way that I think would be conducive to better healthcare. And I left their care. It was unacceptable to me. I encounter it also, not intentionally sometimes, but with individuals who want to talk about the transplant and what the consequences have been for me. Because even though I might be asked what it's like to have a heart transplant, the conversations often turn quickly to their knowledge of transplants or their knowledge of somebody else, and not really looking at what I bring and what my perspectives are and how I'm handling this. So, it's a case where I see myself being minimized, if you will, in these discussions.
I see it institutionally. Most recently at my university at Kutztown University in several ways. I won't belabor the point. But one I thought was particularly relevant when you asked the question concerns the need for medical notes when you have sick days. As a heart transplant patient, I'm immunosuppressed. I'm going to get sick. Varying types of bugs are going to affect me. The team knows this. We've gone through what I'm supposed to do, how to treat the symptoms. At what point should I contact the team? At what point do I wait it out? But Kutztown University and probably others, has a policy that if I'm sick for three days or more, I have to provide a note where I've gone to see a doctor. Well, I don't necessarily see a doctor in three days. My team knows that, that I know I'm going to be sick. It happens, it drags out for a few days. I don't necessarily have to see a doctor.
But the institution has decided that three-day policy that I have to have a doctor note. Little attempt to understand anything about the individual in this case. They're not looking at it as, why do you not have a note? Why does your team allow this? No real dialogue about the conditions and the background that I bring that might affect how and what kinds of demands they want to place on me. So, when we talk about institutional accountability with the cultural humility perspective, I think these are some of the kinds of examples that I've encountered anyway.
Now, how do you get people to be more aware of cultural humility and what ways should people train for this in the future? I'm sure we'll talk more about this. You certainly have to get people to engage in the self-reflection and the lifelong learning component. You have to get healthcare providers to recognize that they need to learn more about themselves so they know what their backgrounds and biases might be. And then they have to be interested in learning and continually learning about the individuals they're working with. And there are some training programs to do that, but I think that's a huge step, the self-reflection and lifelong learning approach. The power imbalances, we know they're there. There's certainly training to make people less willing to have those imbalances.
I am not a 100% sure what kinds of training can be available at the institutional level. The medical institutions I've interacted with most, as far as I can tell, really haven't done any kind of institutional accounting for cultural biases and adopting a cultural humility perspective. I can say that I felt that my transplant team did do that, but in other healthcare settings, both with myself and other family members that I've went to, I don't see a lot of that at the institutional level. So, looking for specific training programs for each of these three components is going to be crucial. And it's hard to mandate how that's done because it has to be a very personal reaction on the part of the providers. And every institution has a slightly different background and mission. So, the awareness that cultural humility is a perspective that should be adopted, a willingness to go look at what other types of efforts have been made at other institutions would be a first step.
Ryann Thomson: So, within this conversation, I know I personally have heard more about cultural competency. And I think you're touching on some of the ideas that differ cultural competency and cultural humility. So, how does knowing the difference and implementing both, I would say, enhance treatments of patients?
Stephen Oross: Sure. And I think that's a good point to bring up here. The perspectives that have often been taught in institutions are ones that call themselves looking at cultural competence. And there's nothing wrong with this. It's just that cultural competence approaches are training efforts to make people more aware of cultural differences, but they really think of the training as an endpoint. And what I mean is there's a set of facts that are taught in the training about people who have differing types of backgrounds. It is, in some sense, a training to teach about the belief system that is assumed to be held by individuals from different backgrounds.
There's little in cultural competence training that emphasizes looking for, well, in some sense being taught generalizations rather than stereotypes. Being taught in cultural competence, that this is a starting point for understanding individuals. But you need to interact more carefully, understand the nuances that each individual brings. Not all individuals from varying backgrounds are identical to one another. We tend to think when we say cultural competence, something really along the lines of race or ethnicity. But we have to broaden that perspective, especially if we're talking mental health to consider diagnoses. And one of the problems with diagnosis and mental health is we all know two different individuals identified with the same diagnostic label aren't necessarily acting the same way, don't necessarily show the same symptomology. So, it really is a setup where we need to learn more about the individual patients.
Ryann Thomson: So, you touched on bias earlier-
Stephen Oross: Oh. Yeah, sorry.
Ryann Thomson: Oh, sorry. If you want to keep going, go again.
Stephen Oross: Well, just briefly. There have been a few surveys in other experimental analysis of cultural competence training. And it works. People get more knowledge about different backgrounds. But it has been shown that it tends to promote stereotypes. And that's something that cultural humility will try to break down by the fact that you're going to be looking for the individual perspectives, belief systems within a framework of their cultural background. I'm sorry to cut you off there.
Ryann Thomson: No, it's okay. I didn't know if you were finishing that. So, earlier you touched on both of these points, but implicit bias within the mental health diagnosis. And education, obviously holding a really important point. But how do you ensure educational programs and training can at least mitigate or try to mitigate this bias, and make accurate diagnosis and assessments of patients? Or is that even possible?
Stephen Oross: Well, this is a big question. Let's start with a couple simple points and then build up to this. When we're talking about biases that people bring to providing services, largely talking healthcare here, we have both explicit and implicit biases. So, explicit biases are, we already have certain beliefs about people who come from different backgrounds. And we know this, we hold them, we can state what those beliefs are. Before we've even met the individual. We have certain expectations. And that type of work, I mean that type of bias has certainly been shown to provide a means for having unequal healthcare treatment based on your cultural, and ethnic, and racial, gender, sexual orientation backgrounds.
So, that part can be often taught with some formal training to have people aware of their biases, provide information to show where the biases are misleading, present alternative approaches to thinking about individuals. The implicit biases are a little more tricky because they are ones that people are not aware that they're holding. And if they're not aware that they're biased, it's very difficult to make them aware of the need for training and for changing their perspectives. But in studies that have attempted to look at this, there's been a few studies I remember that were talking about roughly two thirds of individuals who were providing services holding biases. Not that they were aware of it, but they were implicit biases that were negatively affecting groups that are typically underrepresented or marginalized. And these biases can impact what types of treatment programs and plans are recommended for patients.
So, we've seen health treatment disparities, for instance, between White and Black as one example, men and women. Different types of recommendations, different treatment options. One, as I remember prominently because I'm also diabetic, is that individuals who are Black when they experience neuropathy, the condition that a nerve damage that follows diabetes often, individuals who are Black were much more likely than White patients to have to be amputated to have a foot or leg amputated. Whereas White patients were more likely to have more extensive treatments designed to try to restore blood flow to the affected leg or limb. And that's a bias perhaps impacted by an implicit bias of who will follow treatments, what will work, the money, and the time efforts, the diligence in treatment. So, we know that populations who are underrepresented or marginalized are going to be affected by implicit biases. In mental health, this may not be something that individuals at the varying psychiatric institutes want to hear. But they're particularly vulnerable to the implicit biases. And partly I would argue that's because of the DSM itself.
There is a belief that is commonly held that the DSM has a standardized diagnostic criteria. And it does have diagnostic criteria and it can be quite standardized in some instances, little less standardized in others. But there's a tendency to not recognize the fact that the benefit of at least some of the standardization that's present in the DSM matters if providers pay attention to the DSM, and don't use their own judgment that might be more likely to be affected by biases. There are a number of providers have reported in different sources that , yeah they're aware of the DSM-5, they were aware of the changes that came out in DSM-5 compared to previous editions. They have a copy of it. But they argue that they rarely refer to it, that after a certain period of time they know how to diagnose individuals from their own backgrounds.
And the DSM is there, I remember in particular reading one report, where this provider was saying the DSM there is there really just to head off arguments from clients about diagnoses. And that really bothered me when I started reading these types of reports, because that's a perfect scenario for implicit biases about mental health challenges to creep into diagnosis. The DSM, some people and a growing number I would argue, suggest that there are concerns about how reliable the diagnostic categories are used and defined in the DSM. And if we don't have a careful system of diagnosing and identifying treatment plans, the individual biases that we all possess have a greater potential to come into play. We might think certain groups are going to be less compliant and we'll recommend one type of treatment for one group compared to a different treatment for others.
These are the conditions that have to be overcome. And the educational settings, again, I think first and foremost, we have to have awareness of the three principles of cultural humility. Of those, while all are important, I think one that is commonly missed is the self-reflection and the lifelong learning approaches. And there are some training materials out there to facilitate that. But it has to be emphasized that one time training is not going to be sufficient to do this. So, I think the field is right for the varying efforts that have been made across different institutions to facilitate understanding of cultural humility. I think the time is right for an overview, what is everybody doing? And can we pull out best practices that have worked in different institutions and share them more widely. At this point, I still see this being largely run on a center-by-center or provider-by-provider basis, rather than as widespread training as it probably should be.
Ryann Thomson: Yeah, I've definitely heard some of the changes DSM has tried to make for culture, and race, and things. It's obvious they're trying, but at the same time, how much changes can you make before... There's only a certain point, if that makes sense. Like you said, you have to recognize your bias and self-reflect on those. Definitely a major point, I think. That's important.
Stephen Oross: Well, especially when the DSM changes over time. So, if I'm a clinician and I've been providing mental health services for a number of years, am I actually paying that careful of attention to the changes that are introduced in subsequent additions of the DSM? I mean, there are many who are diligent and are well paying attention for this. But we know from self-report and a few studies that there are individuals who really are not paying that much attention to the changes. And if they're not, the efforts to become more culturally aware in the DSM are going to be ignored. And it's going to, again, make it likely that biases come into play in treatment plans.
Ryann Thomson: Well, I want to jump to this technological advancement we've had because of the COVID-19 pandemic. So, telehealth has obviously, especially mental health, telehealth has grown. And in a way has allowed us to enhance our cultural humility, and especially with treating individuals. So, can you speak to how telehealth plays an important role and how our biases can be expanded with increased uses of technology within mental health diagnosis? Or in a way, can it negatively affect?
Stephen Oross: Yeah, it's an interesting question to address because the technology is so varied that can be applied to providing healthcare services. We can talk about a simple technological advance, the telehealth, as you mentioned. I conduct a number of my sessions with clinicians through telehealth now. Some I have to go in person, but many I can do. Essentially they're a Zoom meeting at some level. And it works. There are concerns, I think about the technology because it's an unusual situation for most people to be conducting health interviews or health sessions through a camera and through a monitor. And I think there's potential there for people to act differently when they're in telehealth settings than they might when they're in person, on both the clinician and the patient end. You're sitting pretty still stable looking at a camera. Whereas in a in-person facility, you're moving around, you might be able to observe things about body movement that you're not going to pick up necessarily with a telehealth interview.
On the other hand, the integration of artificial intelligence can provide some background information about an individual's cultural and background. And that could be useful for writing reports or preparing for visits from the clinicians. I’ve heard, you know, when you start talking about technology, we've already heard of lots of wild ideas. So, I've been hearing more and more about digital twins, this idea that there would be, in essence, a virtual representation of you. And the digital twin would somehow be coded with information about me. And clinicians could interact at times with the digital twin. They could try out different treatments and see how the body in this virtual person responded.
I have a hard time thinking about how that's really going to work because it's simply going to be based on the input that creates this digital twin. And if we're not adopting a cultural humility perspective very well, we're going to miss information that should be incorporated into the twin. Virtual reality therapy we use already in mental health treatment in some cases and it has been proven effective. But how far that can go is still a little unclear to me. I think there's another issue though with technology that we're not really addressing.
The benefits are often proposed to be ones that are going to help people who are underrepresented or marginalized. And the problem is we already know there's healthcare disparities for these populations. We already know lack of money, lack of easy access to facilities, lack of freedom to select different care providers because of healthcare insurance restrictions. We already know that exists. We also know that providing technology through the internet, for instance, not everybody has equal access to the technologies, the internet access, the cameras, the monitors that might be needed to use telehealth.
And so, we saw some of that with COVID-19, where there was an effort to push both educational and health services online. And understandably so. But there were large numbers of groups who were marginalized to begin with, who became further marginalized because of lack of access to the technology that's needed to do this. So, if we're going to push technology into the telehealth kind of world or the virtual reality type of world, and hope that it helps us better understand individuals, it has to start with making sure there's full and unencumbered access to the technology for individuals. And I don't think that exists right now.
We then still have to adopt the perspective that when you've got somebody on a camera, you still have to spend the time to think about how you're interacting with them and how they're interacting with you. How the different backgrounds are going to mesh. Whether we're willing as healthcare providers to, at some level, give up a certain degree of control and recognize that people from different backgrounds won't always accept the treatment plan that we propose. And we have to do a better job of recognizing the power imbalances, living with a little less control at some level. But understanding the client or the patient better so that we can tell them in more succinct manner, more appropriate manners why we're recommending different treatments.
The COVID situation is one example. I don't think we did a very good job with public health and convincing different populations of people of the benefits of vaccination programs. And we see that by the disparities in who's willing to get vaccinated and the percentages of people who are actively fighting or ignoring vaccine protocols. Vaccines I firmly believe are beneficial for most people. But we haven't been able to recognize that not everybody believes that upfront. And how do we either inform them better so they change their mindset? Or how do we adapt to the belief that vaccines in some people's minds are not beneficial? And we're still struggling with that.
Ryann Thomson: I feel like this whole conversation, it involves every single part of our lives. So, you can take any example from any part and just like, well, here you see it in vaccinations, or in how we approach illnesses, or if we even go to the doctor. It's literally anything you can think of. I think you can see an example of it.
Stephen Oross: I think you're absolutely right. And my understanding, my familiarity with cultural humility came a little later than when it was first introduced. But I had the belief system already in place from working with people who had developmental disabilities. And the awareness that whatever their clinical label may be, there are variations in the symptomology, and the beliefs, and the behaviors of those clients. I had that perspective. So, when I encountered cultural humility more formally, later, it was easy for me to accept it and to understand it.
And I think that afforded me an opportunity to, as you said, recognize it applies in multiple contexts, not just healthcare settings, not just mental healthcare settings, but in every aspect of our lives we're encountering different people. And we have to understand that we're going to have certain beliefs, we're going to have certain generalizations about people when we first meet them. But we have to get to know those individuals. We have to think, why did I hold my beliefs and are they valid beliefs? Should I change those beliefs? I believe as people become more aware of cultural humility and as we develop more effective training programs for this, it will affect all aspects of our life.
Ryann Thomson: Yeah, I definitely agree. Now, I know you have a class to teach in 10 minutes. So, is there anything else as a health psychology professor, you want to say to our audience? Any advice or ways to move forward from this conversation?
Stephen Oross: I think we've touched on quite a bit of this. I think really, from my perspective, one of the most important keys, I guess I would say in a multi-lock system, is that we have to give up when we're providers of services. We have to give up the idea that we are an all-knowing expert. Certainly expertise is important. Certainly academics and physicians are training to understand their domains better and better, and more sophisticated manners. Certainly there's a great deal of knowledge that's possessed by the individuals. But we have to give up the idea that we're all knowing and recognize that there is a dynamic with whomever we're working with. And they are not just a receiver of whatever treatment or information we want to provide, but there's some level, almost a negotiation with the individual that has to take place. And I think that's probably the biggest point that I think of. I'm sure others can have different perspectives. But for me that's the biggest point. Can we recognize this dynamic interaction between patient or the client and the provider?
Ryann Thomson: I like that you never really stop learning. You always have to keep learning about other people and an open mind about things. That's really nice.
Well, that is all the time we have. And I want to thank you again for talking with this about me. I learned so much and actually a lot of interesting ideas I'm going to look up after this. And I hope we can see you in the future. And I hope you have a nice day.
Stephen Oross: Thank you. It was my pleasure to do this interview. It was really interesting to think about this and how to present it in this kind of context. So, as I'm talking, we had the time limit, but I'm thinking, "Oh, I could say so much more here." I could say-
Ryann Thomson: Yeah, I know.
Stephen Oross: But I enjoyed it, so thank you for the opportunity.
Ryann Thomson: Yeah, of course. Thank you again.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.
