Cultural Humility in Behavioral Health _ ________________________________________________________
cultural, ethnic, and class backgrounds and with a myriad of strengths (Obiakor & Algozzine, 2016). Recognizing and reflecting on one’s own possible biases, religious values, and family values may help to limit the influence of those biases on patient interactions. WHITE IDENTITY White identity theory was first developed by Helms in the 1980s and 1990s as a tool for White healthcare professionals to “create meaning about their identities as Caucasians, par- ticularly in terms of how they think about, respond to, react to and interact with patients from different racial/ethnic groups” (Chung & Bemak, 2012, p. 67). In other words, the theory’s formation was based on the idea that White people are so immersed in the dominant culture that they are unaware of the influence of that dominant culture’s ethnocentric images and ideals. Being White makes it easier to assimilate into the dominant culture and to partake in unearned privileges many White people enjoy but do not acknowledge. Most White people perceive themselves as unbiased, but such self- perception may truly impede one from taking responsibility for one’s own prejudices (Sue & Sue, 2021). White healthcare professionals have a special responsibility to understand their own privileges, biases, racism, and discrimination so that they may develop a positive relationship within counseling sessions. Self-Assessment Quiz Question #8 9. When exploring one’s own beliefs about White identify, it is important to acknowledge that: A) Most White people perceive themselves as biased. B) White identity theory was first developed to discount the idea that White identity exists. C) National surveys often ask White people questions about their racial identity. D) Being White makes it easier to assimilate into the dominant culture. Healthcare Consideration : National surveys do not have a historical track record of asking White people meaningful questions about their racial identity (Schildkraut, 2017). Healthcare professionals should promote research that includes questions about racial identity. ASSESSMENT AND TREATMENT It is important for healthcare professionals to approach every individual patient with a cognizance of the possible various intersecting identities within the patient, but without a ste- reotype of the patient based on preconceived notions of these intersecting identities (e.g., race, ethnicity, LGBTQ status). Implementing the practice of cultural humility may flummox healthcare professionals as they approach patients in a clinical setting (Schildkraut, 2017). The following example from Wyatt (n.d.) illuminates some key elements of providing patient care with cultural humility. An interracial couple, an African American father and a White
mother, come into therapy because their child was kicked out of school for fighting and the father was called into child protective services for spanking the child. When they entered the office, the father was very angry and the mother was getting extremely upset, trying to calm him down. The White therapist suggested meeting with the father alone first. When he met with the father, rather than trying to silence his rage, he joined with him by stating, “It sounds like you’re furious with the situation that’s happened; you’re tired of it.” The father was able to calm down at that point, as the White therapist was allowing him to be angry in his presence and was acknowledg- ing that there might be a reason for his anger. The therapist then asked the father if his disciplining method had anything to do with wanting to protect his child. The father responded that, yes, he was afraid his child, “a Black kid,” was at risk of going to prison if he was fighting at school. The father did not want that for his child and was frightened. By providing room for the father to express his rage and his fear, the therapist was able to make the clinical session more meaningful. Healthcare professionals who practice cultural humility also recognize that particular assessment tools and treatment proto- cols may not be appropriate for all patients. Historically, many therapeutic strategies employed in patient care were developed without empirically supported research with ethnic minorities (Sue & Sue, 2021). To this day, most evidence-based practices have not been tested with people of different ethnic and racial backgrounds, despite the evidence that using culturally adapted interventions significantly improves patient outcomes across a variety of conditions (Alegría et al., 2016). There is progress in some areas. For example, of 36 new programs added to the National Registry of Evidence-Based Programs and Practices of the Substance Abuse and Mental Health Services Administra- tion (SAMHSA) since 2015, 14 were developed with ethnically and racially diverse patients. But only two of these programs include descriptions of culturally adapted treatment. However, healthcare professionals should not rely solely on manualized treatment protocols to guide their interventions, as such an approach can fail to appreciate patients’ unique experi- ences and the effect of differing social environments. Rather, when employing a research-based therapeutic practice, health- care professionals should adapt the approach in accordance with the patients’ values, experiences, and preferences while understanding the influence of the broader societal context (Sue & Sue, 2021). For example, consider that a combination of pharmacological and nonpharmacological treatment is recommended in well-researched, evidence-based guidelines as initial therapy for treating certain mental disorders. Some patients may have a preference for starting with nonpharma- cological treatments, based on values or beliefs which hold negative connotations toward pharmaceuticals. Other patients may prefer pharmacological treatment as the first-line therapy and have no interest in cognitive or other nonpharmacological modalities, due to held beliefs which view psychotherapy in a negative manner. In either case, the practitioner must work to bridge the gap between research-based interventions and the
76
EliteLearning.com/Psychology
Powered by FlippingBook