At some point in your training, you’ve likely heard about cultural competence: learning about various cultural groups and how to interact with clients from different backgrounds. Cultural competence provides an important framework for considering culture in a clinical setting, but it leaves a lot to be desired.
On a basic language level, the term cultural competence implies that there is an endpoint to learning, and that it's possible to be competent in any culture, erasing the nuance that exists within every group. Cultural competency training can easily cross over into stereotyping and not leave room for the vast differences that exist within any group and between individuals. It is important to have basic knowledge about various cultural groups, but that’s not enough — cultural humility provides a framework to fill in some of the gaps.
So, what is cultural humility?
Culture can form from race, ethnicity, language, food, values, the arts, traditions, skills, stories and so much more — and every individual has a culture. This is different from a traditional view of culture that is othering, painting culture as what minority ethnic and racial groups have and that offers a decontextualized picture of traits and traditions.
Cultural humility is a framework to help clinicians work with any individual from any background — an attitude with which one can approach clinical work and working with others in general. Cultural humility acknowledges that every individual has their own unique culture arising from a variety of sources and that may change based on their context.
It brings in the idea that the clinician themself has a cultural context, and that this must be acknowledged and brought to light in order to balance power dynamics and allow for ongoing learning and reflection. Cultural humility requires clinicians to acknowledge any biases they hold in order to effectively counter them and work with clients. Overall, it is an attitude of flexibility and humility.
Where to start: with you
Before you can begin to acknowledge and understand another person’’s cultural context, it’s important to acknowledge and understand your own.
Consider the following factors that may affect your culture and identity:
Race/ethnicity, gender, family structure, location, spirituality/religion, sexual orientation, skin color, language, age, citizenship/immigration status, level of education, ability, neurodiversity, mental health, body size, housing.
Think about other major influences on the way you see the world such as the arts you enjoy, the stories you’ve been told, the foods you eat, rituals you’ve been taught.
If any of these surprised you, or you haven’t thought about them before, that’s probably an area where you have privilege and may have some blindspots.
Listen and learn from your client
First and foremost, remember that your client is the expert in their own life and knows more about their culture and their life than you ever could. Approach your client with curiosity, admitting what you don’t know, providing true empathy, and challenging any assumptions you may hold.
Name the power dynamics in the room — the fact that you are the clinician and they are the client creates a power dynamic from the get go. Identity factors can serve to further enhance this dynamic or to balance them. It is also important to acknowledge the damage done by mental health care systems in the past and to understand the history of race and racism in the U.S. and elsewhere.
It is likely that in doing this work, you will make mistakes and missteps because you are human. So when you inevitably do, call it out, apologize, and repair the relationship if possible. If naming these dynamics and owning mistakes feels hard for you, remember that it is probably even harder to name for your client — as the person in power, this falls on you. By practicing cultural humility, you can empower your clients to find their voice, help lower the power differential, and open up challenging conversations.
Continuing to learn is such an important part of staying culturally humble. You will never reach a place of knowing everything there is to know, so be okay with that and stay open to ongoing learning and growth. Learn from your mistakes, clients, colleagues, friends, and training.
If this has sparked a desire to learn more, here are some books about where to begin:
How to Be an Antiracist by Ibram X Kendi
Me and White Supremacy by Layla F. Saad
So You Want to Talk about Race by Ijeoma Oluo
Counseling the Culturally Diverse By Sue, Sue, Neville and Smith
Cultural Humility: Engaging Diverse Identities in Therapy by Hook, Davis, Owen, and DeBlaere
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