_________________________________________________________ Cultural Humility in Behavioral Health
Othering assumes that various oppressed and marginalized populations are different from the American “norm,” com- monly understood as a White, middle class, able-bodied, straight, male, and individually responsible for any difficul- ties they may experience. Multicultural patient care delivery and cultural competency frameworks commonly assume that the healthcare professional is White and that patients are the “other” and set out to describe what various racial and ethnic groups believe and how they act as a group. On the other hand, a cultural humility framework emphasizes self-understanding as primary to understanding others. To facilitate self-understanding, cultural humility encourages ongoing critical self-reflection, asking healthcare professionals to delve into their cultural identity and its effect on the deliv- ery of patient care. Cultural humility makes no assumptions regarding the healthcare professional’s identity and especially challenges White practitioners to explore and understand their “White identity” (Carten, 2016). Table 7 illustrates the differences between (multi)cultural competence and cultural humility frameworks.
Multicultural and cultural competency frameworks inevitably lead to the stereotyping of various racial and ethnic groups by attempting to define and categorize entire ethnicities by a few cultural traditions and practices. Examples of such stereotypes include the following: Asian Americans push their children to succeed in school and to be obedient to adults, Latina/o men have “machismo,” and African Americans are assertive (Sue & Sue, 2021). Although the intent to understand the diversity within the U.S. is meant to be helpful to counselors, it often leads to strengthening the status quo (i.e., “White” as the norm and all other racial and ethnic groups as outside that norm). Because of the desire to describe various racial and ethnic norms, multicultural counseling and cultural competency frameworks tend to overlook the diversity within ethnic and racial minority groups and also within “White” groups (Sue & Sue, 2021). For instance, Asian American and Latina/o categorizations lump together individuals from a wide array of countries, suggesting, for example, that if you are Chinese American, Vietnamese American, or Japanese American, you are similar because you are Asian. Categorizing whole regions of the world as similar is likely to present problems, as individuals from a wide array of
(MULTI) CULTURAL COMPETENCE AND CULTURAL HUMILITY (MULTI) CULTURAL COMPETENCE
CULTURAL HUMILITY
Perspectives on Culture
• Acknowledges layers of cultural identity. • Recognizes danger of stereotyping.
• Acknowledges layers of cultural identity. • Understands that working with cultural differences is an ongoing, lifelong process. • Emphasizes understanding self as well as understanding patients. • Assumes an understanding of self, communities, and colleagues is needed to understand patients. • Requires humility and a recognition and understanding of power imbalances within the patient-healthcare professionals’ relationship and in society. • Ongoing critical self-reflection. • Lifelong learning. • Institutional accountability and change. • Addressing and challenging power imbalances.
Assumptions • Assumes the problem is a lack of knowledge, awareness, and skills to work across lines of difference. • Individuals and organizations develop the values, knowledge, and skills to work across lines of difference.
Components • Knowledge. • Skills. • Values. • Behaviors. Stakeholders • Practitioner.
• Patient. • Practitioner. • Institution. • Larger community.
Critiques
• Suggests an end point. • Can lead to stereotyping. • Applied universally rather than based on a specific client’s experience(s). • Issues of social justice not adequately addressed. • Focus on gaining knowledge about specific cultures.
• A “young concept.” • Empirical data in early stages of development. • Conceptual framework still being developed.
Adapted from Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34, 165-181.
Table 7
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