Table 7: (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.
Note . 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. The multicultural counseling and cultural competency
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).
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 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.
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