Social Psychiatry and Culturally Relevant Psychotherapy at the APA Annual Meeting

CONFERENCE REPORTER

Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych, is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is Professor of Psychiatry & Addictology at the University of Montreal. He is also Clinical Professor of Psychiatry & Behavioral Health at The George Washington University, Professor of Psychiatry & Behavioural Neuroscience at McMaster University, and President of the World Association of Social Psychiatry (WASP). He is an Assembly Representative and Past President of the Quebec & Eastern Canada District Branch and incoming Chair of the APA Council on International Psychiatry & Global Health.

Di Nicola stopped in the press room at the 2025 APA Annual Meeting to talk to Psychiatric Times about social psychiatry and culture translation in psychotherapy.

Psychiatric Times: What are you most excited about at this year’s APA? Has there been a highlight for you thus far?

Vincenzo Di Nicola, MPhil, MD, PhD, FCAHS, DLFAPA, DFCPA, FACPsych: It is important to know that when I am at the APA, I am actually at several concurrent meetings. I am a representative from the district branch in Quebec and eastern Canada, so I was at the assembly Friday. One of the things that has happened is that we have had to change the wording in the bylaws of the association, and the General Assembly had to vote on that. It was a nuanced and complex discussion, but we had to save the APA, so that we do not run amiss of your current federal government's directives. To honor that in a reasonable way, we had to change certain language. We tried to navigate the directives of the government and maintain our integrity as an association, and I think we came up with a good compromise. The good news is that we stayed together. We created unity. The vote was overwhelmingly for the bylaw change. That was an important note.

Now that the meeting has started, I just came from a lovely meeting on the global coalition of psychiatry with many other national societies at the table, like my own Canadian Psychiatric Association. Also, there were The Philippines, Australia, New Zealand, United Kingdom, and a lot of others. I am at the table because I am the Incoming Chair of the Council on International Psychiatry and Global Health. A high point there is that we had a very, very strong and unified conversation around how to fight stigma and how to promote mental health with organisms like the World Bank, because health economists have noted that the best way to promote the future is to work on mental health.

Mental health is cruel, because it affects people when they are young and that may impede them from having productive and stable lives. Even if you look at the bottom-line approach, it is very cruel that way. Whereas if you have something like type II diabetes, like I do, it comes much later in life. If you have cardiological problems or lifestyle related diseases, they come later in life. In mental illness, the emergence is between adolescence, sometimes even childhood, up to 25 to 30 years old. It is a very serious investment in the future to take that seriously. There was a consensus around that, and it was a really feel good moment.

Overall, it has been a positive experience. I am a Canadian, so what I experienced in terms of the change in government here is from afar. I see it from an international perspective, but now I am talking to my colleagues who are living through this, and seeing the adjustments that they are making. I just want to register that the context has changed in significant ways and we are all trying to adapt.

PT: You have 2 sessions this weekend pertaining to social psychiatry. What do you believe are the most pressing social psychiatric issues today? How can we make psychotherapy culturally appropriate?

Di Nicola: If I had to use 1 word to cover both symposia that I am involved with, I would use the word pluralism. Everyone recognizes the word diversity. The question is, what do you do about it? I prefer the word pluralism, which means that we open space for many different kinds of experiences. How can we honor the plurality of lives that we live? The communities, orientations, set of values, and commitments to one another. As someone that is very international, from Italy, Canada, and Brazil, it is perhaps easier for me to see this.

I think social psychiatry's challenge is to go from cruising at 35,000 feet down to the ground level. We need translational researchers. What do we mean when we talk about the social determinants of health (SDH)? How does that translate them into practice? For example, as a child psychiatrist, very few people in Montreal talk about the adverse childhood experiences (ACE) study. This is fundamental. It is like the social determinants of health for kids, but it's true for lifelong impacts, and people do not talk about it very much. I have taken the personal challenge of documenting adversity in the lives of the kids I see. When I do a first evaluation, I document them, add them up, and I discuss them with my patients very openly. I say, ‘You were exposed to this. It is kind of a mystery while you are experiencing it, but it is not that big a mystery if you start adding up all the things you have gone through.’ I want to move down from a global perspective to the ground level, so that we can translate these findings into our clinical work.

The other question you asked me was about how to make psychotherapy, or all these therapies, culturally relevant. Again, I think the key word would be pluralism, to have a sense of a genuine curiosity about other people and creating space for different ways of experiencing things. In my early work on cultural family therapy, I talked about 2 kinds of translation: cultural translation and therapeutic translation. Cultural translation is when I see someone in front of me, I listen to them, and I try to understand their culture and how they value certain things. You have to know what is culturally sanctioned, what is culturally understood as a problem, what is culturally sanctioned as a response. I call that cultural translation—really listening to other people. But that's only half the job. The other half of the job is a real conversation. I do the cultural translation and share what I can offer. Then I explicitly say, ‘What you described sounds to me like anxiety or depression or stress or trauma. What do you think about that? If you do not understand, let me explain it to you.’ It is a real conversation first, to make sure you understand what the person is saying, then sharing it in words that really show them that you have understood exactly. I call this second task therapeutic translation.

We must make a much bigger effort to go where people live, both literally and symbolically. I think sometimes we do not explain things clearly enough to people. That is part of why I have developed psychotherapy or family therapy that is culturally relevant. Once you do that for everybody, not just for the people that come from the place you know, it changes everything. But it must be sincere, because people do not like it when they think you are talking down to them. Avoid being authoritarian or condescending. It is easier to say than to do sometimes, because unwittingly, we are the carriers of our own traditions, practices, and habits.

PT: Why do you think conferences like the APA Annual Meeting are important? Do you like networking here?

Di Nicola: I am the president of the World Association of Social Psychiatry, and I am active in lots of other groups, but I still think this is my home. This is the biggest tent. The United States is a generator of ideas, a laboratory of ideas. If you want to know what is happening, what is new, what is fresh, you have to come here. Plus, I see more Brazilian friends, Italian friends, and Indian friends here than anywhere else. The APA is our home. I feel that all my interests are represented here. We are having a recruitment and retention problem right now across the board in all societies. But if I had to encourage my students, fellows, residents, and colleagues to choose key associations, I would tell them go to your local (or national group in other countries) but be sure to go to the APA.

PT: Thank you!

Dr Di Nicola is a child psychiatrist, family psychotherapist, and philosopher in Montreal, Quebec, Canada, where he is professor of psychiatry & addiction medicine at the University of Montreal. He is also clinical professor of psychiatry & behavioral health at The George Washington University and president of the World Association of Social Psychiatry (WASP). Dr Di Nicola has received numerous national and international awards, honorary professorships, and fellowships. Of note, Dr Di Nicola was elected a Fellow of the Canadian Academy of Health Sciences (FCAHS), given the Distinguished Service Award of the American Psychiatric Association (APA), and is a Fellow of the American College of Psychiatrists (FACPsych). His work straddles psychiatry and psychotherapy on one side and philosophy and poetry on the other. Dr Di Nicola’s publications include: A Stranger in the Family: Culture, Families and Therapy (WW Norton, 1997), Letters to a Young Therapist(Atropos Press, 2011, winner of a prize from the Quebec Psychiatric Association), and Psychiatry in Crisis: At the Crossroads of Social Sciences, the Humanities, and Neuroscience (with D. Stoyanov; Springer Nature, 2021).