Self-Reflection in Healthcare Cultural humility involves an ongoing process of self- evaluation. Through exploring and reflecting on their own beliefs and behaviors, healthcare professionals can improve their awareness of implicit biases and foster an approach to patients characterized by openness and curiosity about each new patient. Essentially the process and practice of self-reflection is a method of assessing your own thoughts and actions for the purpose of personal learning and development. It’s a process of learning from experience and evaluating as objectively as possible. Self-reflection is an important skill for personal growth. Without it, we walk around unconscious and often reactive to others and even our own selves. If you have ever had an emotional response to something or blurted out words that you later regretted, you can see how self-reflection might assist you in choosing more healthy responses and changing behaviors (even thoughts) that aren’t working well for you. Furthermore, self-reflection becomes more meaningful and successful if you have a process rather than just randomly thinking about a past situation. A healthcare practitioner’s clinical and nonclinical competencies are essential requirements for providing safe and effective care. As it is with the development of any skill, competence is not a static state, which is achieved at a particular point in time and that requires no further attention. Rather, achieving and maintaining competence requires ongoing self-reflection and is best described as a habit that is underpinned by lifelong self-evaluation and learning. Reflective practitioners anticipate challenging situations in clinical practice and create pre-emptive strategies and contingency approaches to deal with them in advance. Self-reflection is a useful practice for counselors and therapists. Self-reflection can help counselors or therapists understand themselves better and how they personally impact their work. Self-reflection can help counselors or therapists in understanding and engaging with clients. Finally, self-reflection can help counselors or therapists understand their professional role as clinicians and maintain professional and ethical standards. Consider the following self-reflection questions regarding diversity. ● Do I have the resources to understand my patient’s diverse values, beliefs, and behaviors? ● Am I able to customize treatment to meet their social, cultural, and linguistic needs? Trinh, a 17-year-old first-generation American of Hmong descent, is graduating first in her high school class. Her school counselor has encouraged her to apply to top-level colleges, several of which are hours from home. When Trinh asks about some nearby colleges, the counselor simply tells her that they are “well below her abilities,” even though one is highly regarded. She is accepted by the top-level colleges to which she applied, including two Ivy League schools. Despite generous financial aid packages, Trinh does not receive offers from these schools. Past the deadline to apply to the local 4-year colleges, Trinh decides to go to the local community college and live at home. Her counselor tries to persuade Trinh to reconsider one of the Ivy League schools. Trinh tells the counselor that she must stay home to help care for her younger siblings and translate for her parents during doctor visits. The counselor engages Trinh in a role play to help her tell her parents that she needs to make her own decisions and go away to college. ● What might be some of my own biases? ● How do I identify with myself and others? Attending to Diversity Scenario
Although school counselors do want their students to succeed, what underlying values might have clouded the counselor’s judgment in working with Trinh? Trinh had given the counselor signals that she was not ready to move hours away when she asked about local colleges. Perhaps the counselor, working from a belief that individualism is preferred, ignored these clues, hoping not to play into Trinh’s “separation anxiety.” If the counselor had viewed her client as being both Trinh and her family rather than only a young woman needing to be more independent, she could have worked with the family to make a decision that addressed both Trinh’s needs and those of her family. By ignoring Trinh’s cultural background and her sense of responsibility to the family, the counselor could not help in an informed way. As this case demonstrates, clients come from a larger multidimensional context that pervades all aspects of their lives but is often invisible to them, much like water in the fish tank is to the fish until the water is removed (Parker & Fukuyama, 2007). Some have suggested the metaphor of an iceberg to describe culture: The “objective culture,” or the small, observable part of the iceberg, consists of institutions such as “education, government, the law, religion, and artifacts like art, music, foods, customs, and holidays,” whereas “subjective culture,” the more significant, hidden portion of the iceberg, is composed of “language (verbal and nonverbal), the meaning of time and space, values and morality, definitions of reality and perception, ways of thinking and knowing, myths and legends, death and afterlife, and universal existential human needs” (Parker & Fukuyama, 2007, p. 14). Understanding subtleties in cultural differences, expectations, and worldviews can be further complicated when differences in language or interactional patterns also enter the therapeutic process. Given the diversity within the U.S., counselors must develop cultural humility as they work with individuals whose life experiences vary in myriad ways based on many intersecting dimensions of diversity. A primary component of cultural humility is self-awareness. As a counselor, thoroughly exploring one’s identity is extremely important. Counselors can uncover their beliefs, values, and implicit biases by knowing and understanding themselves. Implicit bias is unconscious and unintentional (van Nunspeet, Ellemers, & Derks, 2015). Implicit biases are beliefs or stereotypes that unconsciously affect our understanding, actions, and decisions. Additionally, “implicit biases, by contrast, are attitudes and beliefs about race, ethnicity, age, ability, gender, or other characteristics that operate outside our conscious awareness and can be measured only indirectly” (Saban, 2022). These biases resulted from combinations of factors, including an individual’s early experiences and learned cultural biases. Thus, ongoing critical self-reflection that understands the existence of implicit biases within everyone is necessary. The evolving process of self-reflection is crucial to counselor competence. Tarver and Herring (2019) found that students’ perceptions of developing culturally competent critical self-reflection are characterized by working through resistance, exploring personal biases, and developing empathy. Thus, the professional development of mental health practitioners should seek to integrate opportunities to work through resistance, explore existing biases, and develop empathy. Counselors might find it helpful to take an implicit association test. These tests are widely available (see Resources section) and provide instantaneous feedback for the practitioner that may lead to meaningful reflection and growth (Project Implicit, 2011).
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Book Code: SWTX1425
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