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 experiences 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 frameworks 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. Complex 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 intersectionality 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 Case 1: Leo White The White family is an African American family that lives in the urban center of a midsize northeastern city. John and Melinda White are the parents of three children: Leo, 13; Kate, 11; and Tabatha, 9. The family lives in a small two-bedroom apartment. The apartment is located in a community that has many single-family houses that have been converted into two, three, or more apartments. The landlords often attend to only the most egregious of needed repairs, leaving many of the houses in disrepair. The neighbors know and look after one another on the Whites’ street. However, neighboring streets have recently been subjected to gun violence. This violence has been of great concern to the White family and their neighbors. John and Melinda White both have jobs in the service industry. John is a cook at a fast-food restaurant, and Melinda is a certified nursing assistant, providing home care for elderly clients.
knowledge regarding differing 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 dimensions. 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 (Gallardo, 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 accountable 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 professions 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 continually 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 exploring the cultural humility approach, as evidenced from their professional organizations’ recent publications and public information (APA, 2017; NASW, 2015; Ratts et al. 2015).
CASE SCENARIOS
The Whites do not own a car and rely on the bus system in their city. As a result, John and Melinda must be up and out of the house by 5:00 AM to get to their jobs on time. They have put Leo in charge of making sure he and his siblings get up, eat, and get out the door to get to school by 7:30 AM. Leo takes his responsibilities seriously, getting up at 5:30 to make sure he is ready in enough time to help his younger sisters get up and ready for school and to ensure their safety on the way to school. Leo comes home right after school to make sure he is home with his sisters and to get dinner started, as his parents are unable to get home until 7:00 PM. Leo helps his sisters with their homework and often doesn’t start his homework until much later, causing him to stay up past 12:00 AM on many school nights. Leo has recently been falling asleep in class and has not been performing
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Book Code: PCUS1526
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