Cultural Humility in Healthcare ________________________________________________________________
she had to be the expert and display cultural competency, which may have prevented her from being able to listen to James and discover the unique diversity in his life. CASE STUDY: LINDA ROGERS Linda Rogers is a 28-year-old White woman who has two children, ages seven and three. She and her fiancé live in a trailer park in a rural area. She comes into the county mental health clinic because she is experiencing headaches and dizziness and often has severe stomach aches. The clinic physician suggested Linda make an appointment because, upon examination, she could not find a physical reason for Linda’s headaches and stomach problems. During the intake, Linda reports that she often skips meals or eats something from the vending machine at work for lunch; she also admits to smoking. Linda also reports that she typically feels fine and tries to limit her visits to the clinic. When Janine, the African American, upper-middle-class mental health nurse practitioner, asks Linda what she feels her stomach aches are caused by, Linda seems unsure and on the verge of tears. Janine compliments Linda for coming to therapy and asks her to discuss her problems more fully. Linda states that she has a lot of stress in her life as she has two minimum-wage jobs and two kids. She states that her fiancé is supportive, but he also experiences a great deal of stress. Janine is empathetic and agrees that there is a lot of stress in Linda’s life. Janine asks Linda what she does to reduce stress. Linda states that her breaks at work give her the opportunity to smoke and that smoking temporarily relieves her stress and her physical symptoms. Janine feels strongly that smoking is a bad habit, and although it might temporarily relieve stress, Linda should attempt healthy stress relief techniques. Linda nods in agreement but acknowledges it has been difficult to quit smoking. Janine asks what Linda likes to do in her free time. Linda states that she does not have much free time between work and her kids. Janine asks Linda if she would like information about a smoking-cessation class offered at the clinic to help her stop smoking. Linda nods and accepts the pamphlet Janine offers. They spend the rest of the session brainstorming about other ways to reduce the stress in Linda’s life. Linda is engaged in the brainstorming and agrees to try to use her work breaks to walk off her stress. At the end of the session, Janine again affirms Linda, telling her she is glad that she came in and that it is wonderful she will begin smoking-cessation classes and use her work breaks to decrease her stress by taking a short walk. Linda misses the next several sessions with Janine. She shows up for a session with Janine several months later. Janine greets Linda warmly and says she has missed her at her previously scheduled ses- sions. Janine then asks Linda about her stress and her headaches and stomach aches. Linda says she is still very stressed and continues to experience headaches and stomach aches. Janine gently asks whether she attended any smoking-cessation sessions. Linda states that she doesn’t have the time or energy to attend the classes. Janine asks whether Linda has been walking during work breaks. Linda looks abashed but admits that she is still using breaks to smoke. Janine is a bit frustrated and asks Linda what she thinks they should work on in the session today to reduce stress. Linda doesn’t seem to know what to do, so Janine suggests they try other options to reduce stress. Linda agrees. The rest of the session is spent coming up with a detailed plan to reduce stress through breathing exercises and a plan to try to attend smoking-cessation sessions.
Discussion 1. Reasons James didn’t return: Denise repeatedly leaned on Asian American stereotypes (face-saving, parental pressure) that didn’t match his transracial adoption and family context, which likely felt invalidating. Her compliments and questions signaled she was fitting him into a template rather than listening to his specific career frustrations, creating a microaggression and early alliance rupture. The session also lacked collaborative agenda-setting, concrete next steps, and a clear plan for his anxiety/depression, reducing perceived value. 2. Better preparation: Review intake details (including his adoption into a White family) and plan bias checks to avoid assumptions about culture, family, or stigma. Prepare open, non-leading questions about identity, values, and career expectations; set a first-session structure (goals, confidentiality, roles, measures like PHQ‑9/GAD‑7), and have a brief, practical action plan ready (sleep routine, thought record, follow-up cadence). Skim resources on transracial adoptee experiences and first-session engagement to ground curiosity over “cultural facts.” 3. Applying cultural humility: Lead with individualized curiosity (“What, if anything, does being Korean American and adopted mean to you?”), acknowledge knowledge gaps, and invite correction. Share power by co-creating the agenda, asking permission before exploring culture, and checking understanding with reflective summaries and teach-back. Name and repair missteps in real time (“I realized I made an assumption about your family—thank you for correcting me”), and commit to ongoing learning and feedback. 4. How James likely felt perceived, and impact: He likely felt seen as a stereotype—an “Asian client” defined by presumed parental pressure and therapy stigma—rather than as a transracial adoptee with his own story. That misattunement undermines trust and safety, signals low cultural humility, and weakens the therapeutic alliance, making it unlikely he’d invest in further sessions. Case Study Continued: This case illustrates how unintentional stereotyping can hinder the development of a therapeutic relationship. Denise is aware that she may be stereotyping but is having difficulty changing her thinking about Asian Americans. James’s experiences in life are vastly different from what Denise imagines they are, and thus he feels as if he is not being understood or helped by Denise. Denise might be helped by engaging in critical self-reflection after her session with James. She might ask herself what went wrong. She might further explore her stereotypical reaction to James and how that might have alienated him rather than engaged him in working with her. Denise might have had more success if she had questioned him more about his background and his family and had engaged him as an expert on his own life as she forged a respectful partnership with him. It seems as if Denise felt
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