________________________________________________________________ Cultural Humility in Healthcare
Although the intent to understand the diversity within the United States is meant to be helpful to healthcare profession- als, 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 iden- tity. Complex identities include a multitude of dimensions of diversity, such as race, ethnicity, socioeconomic class, LGBTQ status, dis/ability, religion, regionality (e.g., southern, northern, western, eastern regions of the U.S.), age, gender, religion, etc. 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 experiencing much discrimination (Kuran et al., 2020). On the other hand, the intersection of a multitude of dimensions that are privileged within one individual may result in experiencing much opportunity. Moreover, the intersection- ality of dimensions of diversity results in an infinite number of individual identities that are difficult, if not impossible, to categorize (Kuran et al., 2020). Multicultural counseling and cultural competency frameworks have been further criticized for focusing on having healthcare professionals gain knowledge regarding differing racial and ethnic groups and assuming that there is an end point in cul- tural training, where the healthcare professionals’ competency 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 end point and to be deemed competent. 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 only be realized through working toward a more equitable society (Salahshurian et al., 2024).
It is important to note that the healthcare professions are committed to cultural competency and increasingly under- stand the need to adopt a cultural humility framework as well. Healthcare professions incorporate cultural competency and cultural humility within their ethical and educational guidelines for competent practice (APA, 2017; ASCA, 2016; NASW, 2021). The professions share some commonalities within their guidelines for culturally sensitive practice. There is a need to continually develop an understanding of the diversity of patients and to commit to lifelong learning. CASE STUDY: JAMES CHOI James Choi is a 25-year-old Korean American, a new college graduate who recently accepted a job as a fund-raiser at the Humane Society. He was adopted when he was 8 months old into a middle-class White family. He seeks therapy because he feels that he is not achieving as much as he would like with his career. James is feeling anxious and has some symptoms of depression. His family physician has prescribed an antidepressant and encourages James to participate in mental health therapy. He is seeing Denise, a clinical psychologist who works in a large mental health counseling practice. Denise is a 30-year-old White woman. She is a recent graduate who has learned a bit about Asian American culture in her graduate coursework. On James’s first visit, Denise asks him what brings him to counseling. James explains that he is disappointed in himself for not achieving more in his career. He explains that he has been feeling anxious and depressed and identifies the antidepressant that he is taking. Denise nods in understanding and remembers that Asian American families often have high academic standards and family members have a difficult time seeking therapy, concerned about losing face. As a result, Denise compliments James on being brave enough to seek therapy. James seems confused by Denise’s response but manages to say thank you. James then proceeds to tell Denise that his parents encouraged him to seek therapy, as they thought that he was showing signs of depression. Denise is surprised that an Asian family would encourage their son to seek counseling but knows that she may have been stereotyping based on his ethnicity. Denise continues with the questions, as she does want to know more about his feelings regarding not achieving as much as he would like in his career as well as his symptoms of anxiety and depression. She asks James why he is feeling that he is not achieving as much as he should be. James shrugs and says he thought he would be at a higher position after completing college. Denise knows that Asian Americans often expect high achievement from their children, so she asks James how his parents feel about his success thus far. James surprises her again when he says his parents are extremely proud of him and think he has landed a great first job. Denise is baffled and asks James to share more about his disappointment given his parents’ support and his success at both graduating from college and getting a job so quickly. She remembers again to be careful not to stereotype. When the session concludes, she asks James to schedule another session so they can explore his concerns further. James says he will on his way out and thanks Denise for her help. Yet, he never returns to counseling.
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