Cultural Humility: Uses and Implications with Clients


By Laurel Brockenberry

M.S. Doctoral Candidate at the Virginia Consortium Program in Clinical Psychology

Multicultural competence is an ethical requirement according to the APA code of ethics (APA, 2018). Multicultural competence was initially established due to the awareness that the needs of racial/ethnic minority clients were not being properly addressed in therapy (Hook & Davis, 2019). The definition of multicultural competence consists of three main branches: (1) cultural self-awareness, (2) knowledge of the client’s cultural background and experiences, and (3) skills for adapting interventions based on the cultural background of the client (Sue et al., 1982). The field has expanded to include gender, sexual orientation, disability, socioeconomic status, and religion as diversity factors (APA, 2017).

Not only is multicultural competency an intuitively important factor in our clinical work, but client perceptions of therapists’ multicultural competency have been positively associated with gains in therapy (Owen, Leach, Wampold, & Rodolfa, 2011). However, discussions about different multicultural factors, like race, can be considered difficult topics to discuss (Sue, 2013).  Even further, microaggressions, defined by Sue and colleagues (2007, p.273) as “brief, everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group” have been associated with lower therapist-client working alliance and lower psychological well-being (Owen et al., 2011). While a focus on multiculturalism is important for both our clients and their perceptions of us as therapist, there appears to be difficulty navigating and engaging in multicultural discussion in a sensitive and supportive way. As future and early-career psychologists, how can we best navigate these topics?

Despite the prior factors impacting our connection to clients, as well as their perception of us, multicultural orientation, defined as the way a therapist engages with a client, is associated with lower racial microaggression frequency and lower negative impact of microaggressions on the clinical work (Hook et al., 2016). Multicultural orientation is different from competency in that our orientation is guided by our own value or perception about the importance of multiculturalism in our client’s lives, and not by our acquired skills or knowledge (Owen, 2013). There is a clear distinction between our way of doing via specific awareness, knowledge, and skills in relation to specific culture and our way of being via our engagement with client’s multiculturalism in the therapy room (Hook & Davis, 2019; Hook, Watkins, Davis, Owen, Van Tongeren, & Ramos, 2016).  Our cultural humility allows us to orient the therapeutic relationship on the client and the cultural aspects that are most important to them, which is a necessary characteristic to be effective in treating racially diverse clientele (Hook, Davis, Owen, Worthington, & Utsey, 2013).

The main intrapersonal characteristic of cultural humility involves an awareness of our own limitations in the knowledge of other’s cultural experiences (Hook & Davis, 2019). It may sound daunting to shift from your own cultural norms and values as your point of reference to your clients. However, it is important to consider that difficulty understanding or relating to your client’s culture could narrow your understanding of the client’s inner world and negatively impact therapeutic work (Mosher, Hook, Caparti, Davis, & DeBlaere, 2017). Given this, intrapersonal characteristics of cultural humility involve intense self-examination of cultural biases and promotion of cultural exploration and growth (Mosher et al., 2017). For example, how does your cultural background impact your choice of theoretical orientation or your clinical area of focus? How does it impact your treatment recommendations with clients? These types of reflections may occur through courses, supervision experiences, or your own personal therapy.

The main interpersonal characteristic of cultural humility involves the interpersonal framework that shifts from your cultural experiences as the point of reference to the other person’s cultural experiences as the point of reference (Hook & Davis, 2019).  This prompts a shift in power in which our exploration of multiculturalism is done with respect and upon equal grounds. With this stance, you are tuned into the unique experience of a client and rely on learning from the client (Mosher et al., 2017).   For example, you may inquire about a client’s cultural background and be open to learning more about their values in relation to culture. Through this, you may learn more about a client’s culture in relation to the importance of social connections, views regarding mental health, or any culture-specific coping strategies (Mosher et al, 2017).

Hook and colleagues (2017, p.227) describe this process of humility as “letting go of one’s desire to remain the expert professional in exchange for a transparent relationship that invites clients to talk about their experiences. . .” In some ways, acceptance that you are not an “expert” does not translate to areas, like research or academia. It may not reflect with your personal identity as a graduate school or early professional. However, there appears to be utility in “evening the playing field” between therapist and client to create richer culturally focused experiences. Given this, I encourage reflection and self-compassion around those pieces as we continue to learn and grow in our clinical work.

References

American Psychological Association (2017). Multicultural guidelines: An ecological approach to context, identity, and intersectionality. Retrieved from: http://www.apa.org.proxy.lib.odu.edu/about/policy/multicultural-guidelines.pdf.

American Psychological Association. (2018, January). APA adopts new multicultural guidelines. Monitor on Psychology, 49(1). Retrieved from http://www.apa.org/monitor/2018/01/multicultural-guidelines.

Hook, J. N., Davis, D. E., Owen, J., Worthington Jr, E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353.

Hook, J. N., Farrell, J. E., Davis, D. E., DeBlaere, C., Van Tongeren, D. R., & Utsey, S. O. (2016). Cultural humility and racial microaggressions in counseling. Journal of Counseling Psychology, 63(3), 269.

Hook, J. N., Watkins Jr, C. E., Davis, D. E., Owen, J., Van Tongeren, D. R., & Marciana, J. R. (2016). Cultural humility in psychotherapy supervision. American Journal of Psychotherapy, 70(2), 149-166.

  Hook, J. N., & Davis, D. E. (2019). Cultural Humility: Introduction to the Special Issue. Journal of Psychology and Theology, 47(2), 71–75. doi:10.1177/0091647119842410.

Mosher, D. K., Hook, J. N., Captari, L. E., Davis, D. E., DeBlaere, C., & Owen, J. (2017). Cultural humility: A therapeutic framework for engaging diverse clients. Practice Innovations, 2(4), 221.

Owen, J., Leach, M. M., Wampold, B., & Rodolfa, E. (2011). Client and therapist variability in clients’ perceptions of their therapists’ multicultural competencies. Journal of Counseling Psychology, 58, 1–9. doi:10.1037/a0021496

Sue, D. W., Bernier, Y., Durran, A., Feinberg, L., Pedersen, P. B., Smith, E. J., Vasquez-Nuttal, E. (1982). Position paper: Cross-cultural counseling competencies. The Counseling Psychologist, 10, 45–52.

Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder, A., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions in everyday life: implications for clinical practice. American Psychologist, 62(4), 271.

Sue, D. W. (2013). Race talk: The psychology of racial dialogues. American Psychologist, 68(8), 663.

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