Cultural Humility in Behavioral Health _ ________________________________________________________
countries are very diverse. Moreover, individuals and groups within groups have a great deal of intragroup diversity. For example, a Chinese American family that has been in the U.S. for five generations is likely to be quite different from a Chinese American family that immigrated to the U.S. during the past decade. Cultural humility suggests that counselors should not assume cultural knowledge about clients; rather, they should ask clients questions about their cultural experi- ences and identities and view the client as the expert on this topic (Gallardo, 2014). Although the intent to understand the diversity within the U.S. is meant to be helpful to healthcare professionals, 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 patient care delivery and cultural competency frameworks tend to overlook the diversity within ethnic and racial minority groups and within “White” groups (Carten, 2016; Fisher-Borne, 2015) The multicultural counseling and cultural competency frame- works also tend to neglect the intersecting dimensions of diversity. By focusing on ethnic and racial groups, these models neglect the complexity of group and individual identity. Com- plex identities include a multitude of dimensions of diversity, such as race, ethnicity, socioeconomic class, LGBTQ status, dis/ability, religion, regionality (e.g., Appalachian, southern, northern, western, midwestern, eastern regions of the U.S.), age, gender, and religion among countless others. These dimensions of diversity intersect in many ways. The intersec- tionality of a multitude of dimensions that are oppressed or marginalized identities within one individual may result in that individual experiencing much discrimination (Florin, 2020; Rosenthal, 2016). On the other hand, the intersection of a multitude of dimensions that are privileged within one individual may result in that individual experiencing much opportunity. Moreover, the intersectionality of dimensions of diversity results in an infinite number of individual identities that are difficult, if not impossible, to categorize (Rosenthal, 2016). The cultural humility framework recognizes and acknowledges the layers and dimensions of diverse identities, encouraging counselors to self-reflect and understand the potential for a multitude of intersecting personal identities. Correspondingly, counselors assuming cultural humility ask clients questions regarding their intersecting diverse identities (Gallardo, 2014).
Multicultural counseling and cultural competency frameworks have been further criticized for focusing on having mental and behavioral health professionals gain knowledge regarding dif- fering racial and ethnic groups and assuming that there is an endpoint in cultural training, where the clinician is deemed competent (Fisher-Borne et al., 2015). However, culture is fluid and ever-changing, with a complex array of interacting dimen- sions. Thus, it is not possible to reach an endpoint and to be deemed “competent.” Cultural humility requires counselors to be humble by acknowledging their lack of knowledge (Gal- lardo, 2014). It is firmly rooted in lifelong, ongoing learning and reflection. The final major criticism of multicultural patient care delivery and cultural competency frameworks is that they do not present a social change/social justice perspective (Fisher-Borne et al., 2015). These frameworks assume that the lack of knowledge and understanding of oppressed and marginalized groups is commonly responsible for inadequate and/or ineffective healthcare delivery. The frameworks fail to address the power imbalances present in society and its institutions that are integral to many challenges and/or issues that patients bring to healthcare interactions. Cultural humility requires patient care professionals to recognize the power imbalances within the healthcare community and in society. Moreover, cultural humility demands that practitioners hold institutions account- able and asks that healthcare professionals work to right social injustices on community and national levels to achieve wellness for patients that can be realized only through working toward a more equitable society (Foronda et al., 2016). It is important to note that the cognate counseling profes- sions are committed to cultural competency and increasingly understand the need to adopt a cultural humility framework. Counseling professions, including social work, psychology, mental health counseling, counseling, school counseling, and marriage and family counseling, incorporate cultural competency and cultural humility within their ethical and educational guidelines for competent practice (AAMFT, 2015; ACA, 2014; AMHCA, 2015; APA, 2017; ASCA, 2016; NASW, 2021). The professions share some commonalities within their guidelines for culturally sensitive practice. The counseling professions agree that counselors need to continu- ally develop an understanding of the diversity of their clients and to commit to lifelong learning. The counseling, psychology, and social work professions in particular have been explor- ing the cultural humility approach, as evidenced from their professional organizations’ recent publications and public information (APA, 2017; NASW, 2015; Ratts et al. 2015).
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