Running a culturally competent service

I co-run a person-centered generalist counselling service that has a specialist focus on those who are GSRD – that is, their gender, sexuality or relationship styles are diverse (or divergent) from cisgender, heterosexual, monogamous etc. Clients who want to come to counselling don’t need to be talking about any of these topics, but should they wish to, we hope to meet them with a higher level of cultural competency than most counselling services in the UK. The service is based in a small city in the midlands that is lucky enough to have at least two universities (and other colleges) offering courses in counselling, which means we get a lot of enquiries from trainees who want to do a placement with us. This counselling service has always had a specialist GSRD focus, and the one thing we knew was that we needed culturally competent counsellors. To do this, we applied a somewhat unconventional method of sifting through applications: we created a series of vignettes.

 

Since we started this approach, we have had 12 applications to the service. Four have gone to interview, and two have been taken on. Two others are not yet at the stage in their course of being ready to see clients and are completing our in-house training sessions to help them become culturally competent counsellors. I want to share some of the responses with you. I haven’t sought permission from any except our current trainees, so I will portmanteau the responses rather than quoting verbatim- and ‘quotes’ are paraphrases.

 

There are five vignettes for applicants to follow. The first asks for thoughts and responses to a bearded client with a name usually considered female, such as ‘Elizabeth’. The next asks how a bisexual client’s identity might be linked to her impulsivity and difficulty making decisions. The third asks for your first and second internal responses to a man telling you he is in multiple ethical relationships. The fourth is a woman who identifies as a submissive who hesitatingly tells you she enjoys receiving pain, and are asked how you feel about this relationship, and how you react internally and externally, and finally there is a 17 year old who is genderqueer and has just come out to their mum. you had seen them for a number of sessions and not known this. where do you go? All these are required answers, with an optional last space for other thoughts. This is our entire application process. We require nothing else until we get to interview (which is in part a 30 minute triad where applicants meet a trans client). We select people out based on their answers. We don’t require everyone to be very competent at all answers, but we look for at a minimum, a lack of judgement based on the responses, and some level of understanding that our client group requires a level of competency that might be different to mainstream counselling.

What interests me is the sheer number of respondents who feel that ‘simply being person-centered’ is enough. There are many responses especially to the first question that state things like ‘this is a client like any other client’. And of course, in one way, they are. But in other ways they are not. They will have unique ways of being in the world. And just responding about the client requires you to make linguistic decisions. Do you choose ‘he’ for the beard? ‘she’ for the name? ‘they’ (or another gender-neutral pronoun) for the ambiguity of the situation? Most responses assume ‘female’. Some responses (including our two trainees) speak of a possible trans identity or genderfluidity, and a willingness to understand and know the client’s experience, some speak to the possibility of a cis woman with an endocrine imbalance, but many, when asked what it would be important to ask, gloss over this completely. It seems that gender has become the elephant in the room. Of course, it is the client’s right to talk about what they want to talk about, but (and I have cheated a bit here) in our service, clients are asked for their pronouns at their assessments. This is a basic component without which counselling cannot proceed authentically, but respondents seem to ignore this in the hope that that will be ok.

For the bisexual and impulsive client I am really pleased that the large majority of respondents don’t make any immediate connection between sexuality and decision-making, although there is a sizeable minority who theorise that the client is ‘confused’ about her sexuality, or that somehow, feeling attracted to ‘both’ genders is out of the client’s control (unlike compulsory heterosexuality?).

Moving on to the multiple relationships question, I loved that one of my trainees immediately assumed that the client was a gay man, and then immediately caught that assumption. That ability to reflect honestly in the application was one of the first indicators that may me feel I wanted to interview him. My other trainee immediately noticed that she would want to be taking care to make good use of supervision when working with a relationship style outside of her own. Other responses tended to comment that ‘if the client doesn’t have a problem with his relationship style, why does he feel the need to talk about it? perhaps this IS a problem, after all’ (paraphrased). This smacks of ‘why do gays have to flaunt themselves?’. Another typical responses to this question is ‘why does he feel the need to have multiple relationships?’, to which I have the question ‘why do you as the counsellor feel the need to (presumably) only have one at a time?’. Somebody suggested that they would tell the client that that information wasn’t relevant to the session. So much for not judging…

The submissive masochist gives perhaps the most intriguing responses. My all-time favourite response has been something like ‘I would feel the client’s pain’. Other responses have been around safeguarding, concern about safety, feeling anger and upset for the client. Judgemental responses have included ‘I would like to know why the client chooses to stay in this type of relationship rather than work through her abusive past’ (no abuse is detailed as part of the vignettes). Positive responses have been around recognising the client’s hesitation as a fear of being judged, and not wanting to judge. Internal feelings and responses TO the client involve feeling that this is violent and controlling and TELLING the client that, that it’s ‘not right’ to be in this style of relationship and that person would work to ‘get the feelings of hurt to surface’, but other internal and external responses have been about recognising that this is not the counsellor’s own personal preference (no-one has thus far said ‘yeah – I get it’), but that consenting adults can consent. Some have mentioned that they would like to check out whether there was informed consent and as long as there was, then all would be fine.

In the genderqueer scenario, responses range from merely ‘thanks for telling me’, to long and considered thoughts about wondering whether the counsellor had missed anything in the six previous sessions; whether they could have acted differently; how to make the space as safe as possible for the client to continue; a desire to explore exactly what a genderqueer identity might mean, rather than rely on a label as a placeholder.

Finally, the final thoughts for our applicants aren’t obligatory. two people have chosen not to respond so far. But many of the other ten gave honest and thoughtful answers, about how these scenarios had caused applicants to think about topics they wouldnt have considered, how they would wish to have further training, something that it seems is not (or not really) covered. It was good to note that even in the sometimes clumsy responses from people (because none of us is an expert across all responses at all times), that people had a genuine desire to try, and to get things right, and to further their knowledge. It was disappointing to see intimated that from those who are current students (I am certain of at least six looking for a trainee placement), there is no real training on these topics at their institutions. Students who claimed knowledge often did so from their own vantage points (usually as gay or lesbian or having a G/L family member, and this gave them an insight into other minorities), but no-one mentioned having any knowledge from their courses.

All in all, this is a really interesting process for us, and has proven very useful in helping to ascertain whether someone would be a good fit for our service. It suggests that there are many trainees out there however, with significant ‘blindspots’ in their understandings, which will probably go unchallenged up to and including the moment when a GSRD client walks into their counselling room. Whilst some of these applicants will clearly rise to the challenge and make good use of supervision and self-reflection, my concern rests with a number of people who judged my theoretical clients as somehow ‘lacking’ and weren’t afraid to tell the clients that they were making that kind of judgement.

 

 

References:

Davies, D. (2007) Not in Front of the Students Therapy Today Vol 18 (1) http://www.therapytoday.net/article/show/1573/not-in-front-of-the-students/

Davies, D and Barker, M J (2015) How gender and sexually diverse-friendly is your therapy training. The Psychotherapist (61) https://issuu.com/ukcp-publications/docs/61_the_psychotherapist_autumn_2015/8

 

 

Theraputic abuse and red flags

So much wisdom here.

Counselling in Northumberland

I have written a number of times on the need for better regulation of counselling and psychotherapy in the UK. Given our position, where anyone, regardless of qualifications can call themselves a coach, counsellor or psychotherapist, information is vital to allow clients to protect themselves. At a bare minimum clients need to know that a potential therapist is qualified, insured, and a member of a regulatory body. For me there is almost a protective desire to try to empower clients. I am reminded of how Carl Rogers (one of the founding giants of counselling) described the difference in power between therapist and client;  A client enters into the counselling relationship vulnerable and incongurent, and meets with the therapist, who is authentic and congruent. That vulnerability is a part of the process, but also easy for the unscrupulous to exploit.

It is with this in mind that the idea of…

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We expect, and need, better than this from the BACP

Very pleased to see a sane response to this ridiculous ethical dilemma. It my view, the dilemma is should Marna and her supervisor be in practice with such unexamined and sex negative beliefs.
If anyone wishes to read the original article here is a link:
http://www.bacp.co.uk/docs/pdf/15887_therapy-today-march-2017.pdf pages 20-21.

Counselling in Northumberland

The in-house journal of the British Association of Counselling and Psychotherapy is Therapy Today. It is sent to every member of the organisation as well as being hosted online. The BACP have been quick to remind people that reading it counts as CPD, and so it seems safe to assume it promotes it’s beliefs, attitudes and outlook towards ethical practice.

It was therefore  worrying and disappointing to see featured an ethical dilemma around viewing pornography which seemed to be written with no knowledge or understanding or either sexuality or good therapeutic and supervisionary practices. It is difficult to create believable hypothetical scenarios, however, if it is done, it is important that they reflect not only best practice but the values and beliefs of the organisation.

The Dilemma (All people are imaginary)

Marna is a counsellor who rents a room from a larger counselling agency. Another room within the same building…

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Pink Therapy is changing!

As my plan to share the load for the running and development of the organisation, by creating a franchise where some of my colleagues would take on the administration of the face-to-face courses has stalled, I’m now moving ahead with other plans.

We will be winding down our face-to-face training programme after the current advertised workshops are complete.  So book now or miss your chance!

We will be continuing to run our two-year  Post Graduate Diploma in Gender, Sexuality and Relationship Diversity Therapy (GSRD) which is largely delivered online and we will be delivering online Continuing Professional Development to reach out to people unable to travel easily to London or who don’t have the time to commit to a full specialist vocational training. In fact our PG Diploma is close to having recruited a full cohort, with just a couple of places remaining.

One of the new projects is that I will be increasing the Clinical Associate team. 

Up until now the Clinical Associates team was a small group of highly experienced therapists based in London who met three times a year and were recruited to try and keep a balance in gender and theoretical model.  They got a privileged position on the website and paid an increased membership fee for being an associate (alongside their directory membership); they also got a discount on undertaking our training events and reduced conference fee. They became the faculty for our training workshops and courses and were a great think tank.

I am now seeking to recruit more Clinical Associates especially outside of London.  The organisation has been accused of being too London-centric and I think this is an opportunity to do something about that.  I am keen to demonstrate there are a wider range of GSRD-experienced therapists across the UK (and beyond).

Joining the new Associates team will be by invitation

Apologies in advance if you would like to take up this role but don’t receive an invitation yet. The criteria are largely that you are:
• accredited by us,
• have attended significant training with us,
• are faculty on our programmes
• have contributed to the field through publications, training etc.
I am also keen to ensure the majority are from outside of London and that we continue to reflect the diversity of GSRD identities.

The new Associates will be invited to attend an annual networking meeting and be expected to continue to commit to professional development in this rapidly changing area of work. There will also be a separate membership fee to reflect the elevated profile and provide some additional income for the organisation.

Dominic Davies
Founder and CEO
7 February 2017

UK organisations unite against Conversion Therapy

[My comments at the end of this statement]

Major UK healthcare organisations have united to write a statement firmly against Conversion Therapy. The following organisations have signed the statement:

  • The British Association for Counselling and Psychotherapy
  • The British Association for Behavioural and Cognitive Psychotherapies
  • The British Psychoanalytic Council
  • The British Psychological Society
  • The College of Sexual and Relationship Therapists
  • GLADD – The Association of LGBT Doctors and Dentists
  • The National Counselling Society
  • National Health Service Scotland
  • Pink Therapy
  • The Royal College of General Practitioners
  • The Scottish Government
  • Stonewall
  • The UK Council for Psychotherapy.

Major UK organisations have been working against Conversion Therapy for a number of years, publishing a Memorandum of Understanding against the practice (2015) and updating the document to warn against conversion therapy in relation to gender identity and sexual orientation (including asexuality).

Aware of concerns regarding the future of Conversion Therapy in the USA, and pleased that Malta has banned the practice and that Taiwan has drafted legislation to ban the practice, we are publicising the following statement in solidarity with like- minded healthcare organisations in the USA.

“We the undersigned UK organisations wish to state that the practice of conversion therapy has no place in the modern world.  It is unethical and harmful and not supported by evidence.

Conversion Therapy is the term for therapy that assumes certain sexual orientations or gender identities are inferior to others, and seeks to change or suppress them on that basis.

Sexual orientations and gender identities are not mental health disorders, although exclusion, stigma and prejudice may precipitate mental health issues for any person subjected to these abuses. Anyone accessing therapeutic help should be able to do so without fear of judgement or the threat of being pressured to change a fundamental aspect of who they are.”

Janet Weisz, Chair of the Memorandum of Understanding group, and Chief Executive of the UK Council for Psychotherapy, said:
“We have always been clear that sexual orientation and gender identities are not mental health disorders. Any therapy that claims to change these is not only unethical but it’s also potentially harmful.

“Therefore, this practice has no place in the modern psychotherapy profession. The public must know that they can access therapeutic help without fear of judgment.

“It is great to see so many parts of the psychological and medical profession both in the UK and abroad uniting on this key issue.”

Helen Morgan, Chair of the British Psychoanalytic Council, said:
“Forcing a particular view or prejudice upon a patient has no place in therapy and all competent therapists will implicitly understand and appreciate this.

“Psychotherapy aims to liberate people so they can live fuller, more meaningful and more satisfying lives – and patients meeting a psychotherapist should be able to assume that this is always the case in therapy.

“I am pleased to support moves against conversion therapy and I would urge professional colleagues – wherever they may be – to do the same.”

Professor Helen Stokes-Lampard, Chair of the Royal College of GPs, said:
“The Royal College of General Practitioners is proud to support this statement. As medical professionals, we are highly trained to treat our patients regardless of their sexual orientation – not because of it.

“Being gay or trans is not a disease, it is not a mental illness and it doesn’t need a cure. Any proclamations to the contrary risk causing harm to our gay and trans patients’ physical and mental health and wellbeing, as well as perpetuating discrimination in society.”

Peter Kinderman, President of the British Psychological Society, said:
British Psychological Society is very proud to endorse, support, and stand by this statement. I am proud to live in a country that is able to celebrate the full range of loving human relationships and to offer each one of us equality under the law. Many of us have experienced a great deal of persecution and discrimination as a result of our sexual orientation, and our role must be to combat such prejudice, not to add to it. When people are distressed, for whatever reason, we have a duty to reach out and help. But that must not entail regarding our sexual orientation as any form of pathology. I am very happy to be a party to this statement, and I hope it goes some way to contribution to a more caring and equitable society.”

Dr Andrew Reeves, Chair of the British Association for Counselling and Psychotherapy, said:
“BACP strongly believes that anyone seeking therapeutic help, regardless of their gender and sexual diversity, should have access to unbiased and informed therapists who provide ethically skilled therapy. We agree that there is no place in our society for conversion therapy, which is unethical, harmful and not supported by evidence.”

I’m pleased we’ve managed to make this statement.  I’m saddened we’re not yet at the point of producing the more inclusive MoU2 but I do believe we’re not too far off it. There is a story there, but I’m not currently at liberty to discuss it! 

All too often those of us working with Gender Sexuality and Relationship Diverse (GSRD) clients hear about poor practice from other therapists.  Social Media and the consulting rooms of my colleagues who work a lot in this area is replete with the lived experience of GSRD people who have been encouraged by their therapists to assimilate into the heternormative, cisnormative majority rather than having their identities recognised and understood.

It seems that it’s still not acceptable in modern Britain to be bisexual, asexual or have a non-binary identity.  This is not good enough and I am pleased that there are people concerned about this issue to sit around a table and address it.  I have hopes that in the not too distant future, therapy training courses WILL be training therapists to know how to respond to clients who come from GSRD backgrounds.

Dominic Davies
16 January 2017

       

 

 

     

 

 

                           

       

 

Backlash Kink Olympixxx

Oh I’m loving the sound of this!

Law and Sexuality

screen-shot-2016-10-04-at-22-46-47

Ever wondered what fisting volleyball looks like?  Well…you might be in luck.  The feminist pornographer Pandora Blake and obscenity lawyer Myles Jackman have united civil liberties campaigners including the Open Rights Group, NO2ID and Big Brother Watch in a protest against the risk posed to personal privacy and sexual freedom by the Digital Economy Bill currently before Parliament.

The Backlash Kink Olympixxx will feature surreal and satirical games including Fisting Volleyball, a Spanking Relay Race and Squirting Waterfight in a playful parody of the sexual acts that are legal to perform in real life, but illegal to represent, possess or publish under UK sex laws.

The Kink Olympixxx will be held outside Parliament between 12-2pm on Monday the 17th October 2016. There will be speeches from the organisers and civil liberties organisations including Privacy International, Index on Censorship and the English Collective of Prostitutes.

Myles Jackman, an award-winning specialist…

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Reporting from Beijing

A couple of months back, I received an invitation from the Beijing LGBT Center to participate in the National Psychologist’s Conference  first ever forum on LGBT psychology.  It was a wonderful opportunity to present some of our work in Gender, Sexuality and Relationship Diversities and I was going to be sharing the platform with a local Chinese psychologist and media personality and Dr Lee Beckstead from Utah, who has been doing a lot of work around Sexual Orientation Change Efforts (SOCE).
My schedule went through at least six different iterations as the Centre keep finding other significant events for me to be involved in and they applied to the British Embassy for a grant to sponsor my visit.  I was somewhat pessimistic whether this might get granted given my decision to publicly decline our former Prime Minister David Cameron’s invitation to attend his LGBT Garden Party but fortunately that didn’t seem to count against me.

I arrived last Friday afternoon (the August Bank Holiday weekend) and on Saturday morning at the equivalent of 2am GMT, I began a day’s training of the psychologists and volunteers at the LGBT Centre.  There were around 20 people attending the training in person and a live video link to a bunch of other psychologists across China.  I was very impressed with how a small organisation handled the technology so smoothly and efficiently.

I also brought some books with me to present to the centre so they can get access to some of the information we find useful in our trainings.

The training went well with consecutive translation provided by some volunteers and my presentation slides had been translated into Chinese in advance.  After what was a very tiring day of training a big group of us went out for dinner and got to know each other a bit better. One of the interesting differences between Chinese dining and British dining is they often start with sweet things and end with soup (this particular restaurant was famous for a delicious pear soup, which we drank as as a tea throughout the meal)!

 I fell into bed at about 8.30pm China Time dosed with sleeping tablets and melatonin and slept soundly for seven hours!

On Sunday morning accompanied by Atchoo, one of the volunteers at the centre, I went to find a tailor as I had this fanciful idea to have a suit made whilst here.  I’d done some research on the Internet and found an article written several years ago about the top 10 tailors in Beijing.  The person I saw is Feifei and since the article appeared, two other businesses have opened alongside her all using similar names!

It was fluke we happened to walk into the original Feifei.  She very carefully took note of my scoliosis distorted frame and made some very careful measurements and told me to come back for a fitting the following day!

Atchoo took me for some lunch and then off to the National Psychologists Conference at the Beijing International Conference Centre.  An enormous and impressive building.  About 2000 psychologists from across China attend this conference and so we’d anticipated a good turn out of around 200 for our forum.  In the end we had about 30 people attending.  The convener of the whole conference welcome us and opened the session by saying how important it was that this subject is being addressed and he remained for the forum despite there there being two major figures in Chinese Psychology  presenting elsewhere in the building (and probably taking away most of the potential audience).


The first presenter was a bit of a local celebrity psychologist, she has a TV show and huge social media outreach and was exceptionally pretty.  The convener had invited her to present and she had the first hour and a half of the session, leaving 30 mins each for Dr Beckstead and myself.  She focussed a lot on her work with young gay men who are conflicted about being gay and the challenges they face.

Around 90% of LGB people in China are not able to come out to their parents and most would be expected to marry and produce children. Many families will only have one child (the policy has changed but that’s more relevant for future generations)  This can create a lot of tension within the marriage if the wife discovers at some point that she’s married to a gay man.  There have been quite a few articles in the press about women feeling tricked into marriage by duplicitous gay men.  Domestic Violence/Intimate Partner Violence is also quite a big issue here where I suspect the frustration of feeling obligated to marry and repress one’s sexuality creates immense marital tensions.

There are very few out LGBT psychologists in China.  Most of the volunteer therapists at the Center are not LGBT which is one of the things which struck me as a difference between LGBT Counselling organisations in the UK and here.

After the Forum, we went for dinner in this incredibly exciting four floor 24 hour restaurant.  The hustle and bustle was incredibly exciting at first but by the end of the meal the noise and shouting were playing against my jetlag and I needed my bed!  Bedtime by 8.30pm again! IMG_0012

On Monday Lee Beckstead and I went to the Forbidden City accompanied by Eddy had been our interpreter the day before.  It was very helpful to have someone who knew how to navigate things and Eddy was great fun.  The city is a vast series of palaces dating from around the 15C.  Most of the rooms are closed but we weren’t able to enter those which were ‘open’, but just peer through the doors or windows at the immense throne inside.


Later that afternoon I returned to Feifei for my fitting.  In around 24 hours she’s virtually made the suit and one of two shirts!  She compensated brilliantly for my particular frame and build and the garments had a few minor adjustments and we agreed I’d return on Wednesday to collect the suit!

I dashed off (well if you can call dashing in Beijing traffic jams) to a celebratory dinner thrown in Lee and my honour where we got to meet some of the key movers and shakers in the Beijing LGBT Community who support the work of the centre.  Susie Jolly a former colleague of Petra Boynton whom I know through Meg-John and who works for the Ford Foundation here, plus Fan Popo a young independent film maker who gave me some. DVD’s of his latest films.  He’ll be off to Washington DC for another film festival premiere next week.  Ajay who runs an NGO and co-ordinates the AIDS walk which takes place along the Great Wall of China which must be one of the most stunning locations for such an event. James Wang  who is coordinating the SOGIE and HIV programmes for UNDP and Andrew Speke from the British Embassy who sponsored my visit here.  It was a brilliant meal – entirely vegetarian, but where you’d not notice any absence of meat.  The dishes kept coming as did the incredible fruit tea/soup!

On Tuesday I had a supervision group the centre with about 8 of their psychologists and two people presented their clients. I was really impressed by their knowledge and contributions to each other’s case work.  They were all fairly young, mostly heterosexual, but clearly very insightful and well trained.  It was a real pleasure to hear their work and I felt I contributed very little to their clinical thinking.  Although I did get a chance to introduce them to my Sex and Gender Grid as a tool for exploring various aspects of identity and experience.IMG_0003
After lunch,  Joelle the programme manager, accompanied me to the British Embassy where Andrew had invited Iron the Executive Director of the centre and I to make a presentation to Embassy staff on LGBT Mental Health in the UK and China.  Around a dozen people attended including uding one via Video conference from Shanghai.  Iron was magnificent in how she knew how to tell the right stories, provide research and engage the audience and between us we covered a lot of ground off the cuff (the notes I’d made on my phone in preparation for the meeting had to be locked away on entry to the building for security reasons, no phones allowed inside).

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Joelle, Iron and I on the porch of the British Embassy with Susie Jolly from the Ford Foundation in the background!

Wednesday was my day off – for shopping and Eddy offered to take me around and find the things I wanted.  We also collected the suit and I’m super impressed (as was he when he learned my hand made shirt was half the price of the one he bought in a shop prior to the Forum on Sunday)!

On Thursday, I had a 10am briefing meeting with the interpreter for the WHO meeting on Friday.  Noon was Lunch with Jack Smith who was interviewing me for Beijing Time Out (we sat and ate delicious Veggie Dumplings in Ritan Park.  At 4pm interviewed by Atchoo at the LGBT Centre and 6pm I was involved in a 3 hour discussion and Q&A around Transgender issues with over 20 local community members!IMG_0022

On Friday afternoon, there was a meeting hosted by WHO Beijing and attended by some professors of psychology,senior psychologists and psychiatrists and doctors and the UNDP HIV Lead representative James Wang. The meeting was also attended by Lottie Murphy Senior Counsellor on Health at the British Embassy (it was she who signed off on my visa invitation to sponsor my trip to China). It was a hugely significant meeting looking at what China can do to bring about the end of Sexual Orientation Change Efforts (aka conversion therapy or gay cure therapy).  I shared our work in the UK with regard to the Memorandum of Understanding and learned about what they’ve been doing in China.

In China, Homosexuality was removed from their diagnostic manual of diseases in 2000 (the WHO declassified it in 1993). But since then there have been multiple accounts of people being given aversion therapy in state hospitals, where these have been challenged, they deny or state it’s talking therapies (one therapist expected the patient to attend a series of five hour talking therapy sessions).  The fees for these ‘treatments’ are also very high compared to regular therapy.

We discussed maybe getting one of the biggest psychological professional bodies to start an LGBT Psychology section to conduct research into evidence based practice and training.  They’re also considering forming a working group to explore a Chinese Memorandum of Understanding to be signed off by all their major bodies, much as we have.

 

After the meeting – it was off to dinner – again!  You can tell, I was fed very well.  Over dinner I was presented with various gifts from the Centre: some delicious teas, a Moon cake, and some sweet figurinesIMG_0321