Cultural Humility in Healthcare ________________________________________________________________
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 coun- selor 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. Given the vast diversity within the United States, both healthcare professionals and 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 healthcare professional, completely exploring one’s own identity is of extreme importance. It is through knowing and understanding oneself that counselors and healthcare professionals can uncover their beliefs, values, and, moreover, their implicit biases . Implicit bias is defined as an unconscious and unintentional bias (Greenwald et al., 2022). Individuals may not be aware of their implicit biases (Greenwald et al., 2022). These biases are the result of 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. Repeated and evolving processes of self-reflection make healthcare professionals’ implicit biases explicit and, therefore, subject to examination and change (Greenwald et al., 2022). In addition to under- standing their own implicit biases, healthcare professionals, especially those from dominant societal groups (e.g., White, heterosexual, male), need to explore their own racial, ethnic, sexual, and class identity. Individuals from dominant cultural paradigms often consider themselves without racial, ethnic, sexual, or class identity as they have privilege; their identities are considered the norm. However, without deep exploration of intersecting aspects of personal diversity, it is difficult to understand oneself and where biases might insert themselves into healthcare professional relationships (Brown et al., 2021). SELF-REFLECTION AND SELF-CRITIQUE Self-reflection and self-critique are ongoing, lifelong processes that allow healthcare professionals to continually refine their understanding of themselves and their actions and reactions within counseling contexts and to continually broaden and deepen their cultural understanding through introspection (Salahshurian and Moore, 2024). Through ongoing self- reflection and critique, the healthcare professional develops a better understanding of the dynamics within and outside
the healthcare arena and of the ways these dynamics affect the patient’s life, the healthcare professional’s life, and the interac- tions between healthcare professional and patient. Self-reflection is defined as deliberately paying attention to one’s own thoughts, emotions, decisions, and behaviors. It is important for healthcare professionals to be able to self- reflect in “real time” as they deal with the variety of situations encountered in an ever-changing healthcare environment (Gupta, 2023). Self-critique is the process of critically examining oneself to continually refine their understanding of themselves and their actions and reactions and to continually broaden and deepen their cultural understanding through introspection. Self-reflection and self-critique are best incorporated into practice on a reflexive basis. That is, the ongoing process of self- reflection should result in an automatic process or reflection as an integral part of practice. (Salahshurian and Moore, 2024). RESPECTFUL PARTNERSHIPS Developing respectful partnerships is key to providing health- care services with cultural humility and, more generally, to developing a relationship within the counseling setting that allows work to begin and to continue in a productive fashion. Respectful partnerships include discussing and addressing such difficult topics and issues as race, socioeconomic class, gender, sexual identity, and disability. These discussions are uncomfortable for many; they bring up feelings, often passion- ate, associated with “isms,” group identification, prejudice, quotas, and affirmative action. Yet these differences between healthcare professional and patient are a presence in the room and, when ignored, have the potential to interfere with an honest and open exchange (Minarik, 2017). Healthcare professionals often attempt to take the emphasis off race, class, gender, and other areas of difference by deny- ing the effect these aspects of diversity have on patients (e.g., “The only race I know is the human race”), or by trying to show that they understand the patient’s experience because they, too, are a member of an oppressed group. For example, the African American patient may not feel that the healthcare professional, as a bisexual Jewish woman, understands subtle racial insults from personal experiences. Some healthcare professionals imply that because they personally do not dis- criminate against oppressed groups, no personal or societal problems exist associated with race, class, LGBTQ status, or disability; this attitude negates the experience the patients may have in the larger society, where they experience various degrees of marginalization based on their intersecting identi- ties (Minarik, 2017). Respectful partnerships are developed when the healthcare professional facilitates a dialogue that illustrates an under- standing of and attends to the complex dynamics related to privilege, oppression, and marginalization present within the patient/healthcare professional relationship and embedded
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