Practitioner Reflexivity as a Key to Cultural Appropriateness

The cultural self as locus for assessment and intervention with American Indians/Alaska natives

The author compares mental health services from Anglo-American and Native perspectives, focusing on the cultural self as a suggested locus for greater credibility and increased use of these services. Cultural competence is recommended as a model for community-specific policy for the design and implementation of services to increase the probability of generalization to various tribal settings. Cultural competence of Anglo-American providers with this population is discussed.

Cultural Humility in Community-Based Participatory Research [Video] by Vivian Chavez

“More than a concept, Cultural Humility is a communal reflection to analyze the root causes of suffering and create a broader, more inclusive view of the world. Originally developed by Doctors Melanie Tervalon and Jann Murray-Garcia (1998) to address health disparities and institutional inequities in medicine, Cultural Humility is now used in public health, social work, education, and non-profit management. It is a daily practice for people to deal with hierarchical relationships, changing organizational policy and building relationships based on trust. The film tells stories of successes and challenges, and the road in between, when it comes to develop partnerships between community members, practitioners and academics. It encourages us to realize their own power, privilege and prejudices, and be willing to accept that acquired education and credentials alone are insufficient to address social inequality. Potential audiences are health and social service professionals, students, providers, organizers and policy makers in public health, social work, medicine, psychology, nursing and education.”

Patrolling your blind spots: Introspection and public catharsis in a medical school faculty development course to reduce unconscious bias in medicine.

Cultural competence education has been criticized for excessively focusing on the culture of patients while ignoring how the culture of medical institutions and individual providers contribute to health disparities. Many educators are now focusing on the role of bias in medical encounters and searching for strategies to reduce its negative impact on patients. These bias-reduction efforts have often been met with resistance from those who are offended by the notion that “they” are part of the problem. This article examines a faculty development course offered to medical school faculty that seeks to reduce bias in a way that avoids this problem. Informed by recent social–psychological research on bias, the course focuses on forms of bias that operate below the level of conscious awareness. With a pedagogical strategy promoting self-awareness and introspection, instructors encourage participants to discover their own unconscious biases in the hopes that they will become less biased in the future. By focusing on hidden forms of bias that everyone shares, they hope to create a “safe-space” where individuals can discuss shameful past experiences without fear of blame or criticism. Drawing on participant-observation in all course sessions and eight in-depth interviews, this article examines the experiences and reactions of instructors and participants to this type of approach. We “lift the hood” and closely examine the philosophy and strategy of course founders, the motivations of the participants, and the experience of and reaction to the specific pedagogical techniques employed. We find that their safe-space strategy was moderately successful, largely due to the voluntary structure of the course, which ensured ample interest among participants, and their carefully designed interactive exercises featuring intimate small group discussions. However, this success comes at the expense of considering the multidimensional sources of bias. The specific focus on introspection implies that prior ignorance, not active malice, is responsible for biased actions. In this way, the individual perpetrators of bias escape blame for their actions while the underlying causes of their behavior go unexplored or unaccounted for.

Listening to Diversity Stories: Principles for Practice in Community Research and Action

Three broad Diversity Principles for Community Research and Action are described and offered as community psychology’s contribution to the growing literature on multicultural competence in psychology. The principles are applicable to multiple dimensions of diversity including race, ethnicity, gender, sexual orientation, religion, disability, and social class. The diversity principles are illustrated with examples from the twenty-two diversity stories in the AJCP Special Issue on Diversity Stories in Community Research and Action. Each of the three diversity principles (Community Culture, Community Context, and Self-in-Community) are associated with a fundamental assumption, a process emphasis (descriptive, analytic, and reflective), a core question to engage, an orienting stance (informed compassion, contextualized understanding, and empowered humility), and three areas of focus. Taken together, the principles suggest the value of the overarching stance of connected disruption. It is suggested that applying the principles to community work in diverse settings will facilitate the process of bridging differences and enhance the relevance and effectiveness of our work.



Abstract: The concept of White privilege was first introduced into the social science field in 1988. Multicultural counseling competency has been a recent focus of counseling psychology, with self-awareness being an important component. White counselors awareness of White privilege may be included in the component of self-awareness, although this has not been specifically addressed by prior research. For this study, eight White counseling psychology doctoral students, interns, and licensed psychologists were interviewed to elicit information about how they became aware of White privilege, how being aware of White privilege has impacted their work with clients from ethnic minority populations, and what training programs can do to ensure White counselors become aware of White privilege. A standardized interview protocol was used and interviews were audio-taped. The coding process revealed 13 categories, some with subcategories and themes. The 13 categories were: Definitions of White privilege, observing racism targeted at ethnic  minorities/friends/acquaintances, training experiences working with persons from ethnic minority populations, training experiences that increased awareness about White privilege, how awareness of White privilege impacts their counseling with persons from ethnic minority populations, how awareness of White privilege impacts counseling with majority clients, how awareness of White privilege impacts their counseling with clients representing other forms of diversity, lack of awareness of White privilege negatively affected work with clients, definitions of multicultural competence, awareness of White privilege as a multicultural competency, next steps to further enhancing self-awareness of White privilege, suggestions to increase trainees’ awareness of White privilege in training programs, and emotional reaction related to awareness of White privilege. Generally, the participants’ responses supported previous literature about self-awareness and provided new information about the importance of an awareness of White privilege as a multicultural counseling competency.

Linking the teaching of professionalism to the social contract: A call for cultural humility

Abstract: Professionalism, which is fundamental to medical practice, must be taught explicitly. It is the basis of medicine’s relationship to society, which most observers call a ‘‘social contract.’’ The social contract serves as the basis for society’s expectations of medicine and medicine’s of society. It therefore directly influences professionalism. The role of the healer is universal, but how professionalism is expressed will differ between countries and cultures due to differences in their social contracts. When professionalism is taught, it should be related to the different cultures and social contracts, respecting local customs and values.

Bridging the Gap: A Curriculum to Teach Residents Cultural Humility

Background and Objectives: Family physicians are expected to provide culturally sensitive care. However, teaching about cultural diversity and measuring educational outcomes can be challenging. We describe a diversity curriculum based on the concept of cultural humility, which includes participatory didactic and structured learning activities. Methods: Two classes of second-year family medicine residents participated in a yearlong diversity curriculum. Self-assessment and observational data were collected before and after the curriculum. Results: Observational data showed that residents increased patient involvement during office visits. Ratings by announced and unannounced simulated patients indicated that residents were attentive to the patient’s perspective and social context. Resident ratings indicated high satisfaction with the learning activities. Self-assessment data did not show significant changes in residents’ perception of their ability to work with particular patients. Conclusions: Participatory learning activities that focus on cultural humility are a promising approach for diversity education.


Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education

Abstract: Researchers and program developers in medical education presently face the challenge of implementing and evaluating curricula that teach medical students and house staff how to effectively and respectfully deliver health care to the increasingly diverse populations of the United States. Inherent in this challenge is clearly defining educational and training outcomes consistent with this imperative. The traditional notion of competence in clinical training as a detached mastery of a theoretically finite body of knowledge may not be appropriate for this area of physician education. Cultural humility is proposed as a more suitable goal in multicultural medical education. Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-physician dynamic, and to developing mutually beneficial and non-paternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations.

Addressing Privilege and Oppression in Counselor Training and Practice: A Qualitative Analysis

Abstract: This qualitative study explored how 16 counselors conceptualize and address issues of privilege and oppression in the counseling session as well as how they perceive their training with respect to these constructs. In an effort to bridge multicultural training and counselor practice, implications for counselor training are provided based on the clinical and academic experiences counselors reported. Additionally, future research directions are included.

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