Cultural Competency Training: Importance and Critiques
A current UC Berkeley student, who chooses to remain anonymous, is in a session with a counselor at the Tang Center, the hub of university health services. She tells her counselor that her mother disowned her, and that she now lives on her own with no financial, emotional, or family support. Her counselor merely responds by saying that it is okay that she was disowned by her mother because “it’s natural for young adults to move out of their parents’ place once they are capable of being independent.” Confused and disheartened, this student is shocked by this response, as she comes from a cultural background that emphasizes familial structures and “togetherness,” where many people might stay with their immediate families their whole lives. Reflecting back on this moment, she expresses, “I guess it just felt like my emotions about losing my family [were] completely disregarded because it was natural in America [for young adults to be independent from their families.]” Her experience exemplifies the issue of lack of cultural awareness among mental health care providers.
A person’s culture has a heavy influence on their mental wellbeing. One’s culture can be influenced by a combination of race, ethnicity, religion, nationality, and sexual orientation. The US has seen an increase in the diversity of its population in recent years accompanied by an increasingly diverse array of patients in the U.S. healthcare system, specifically those seeking mental healthcare. Many existing disparities in mental healthcare are associated with particular cultural groups. According to the National Alliance on Mental Illness, minorities such as African-Americans, Hispanic Americans, and Asian Americans utilize mental health services at a much lower rate in comparison to Caucasian Americans and those who do get care, receive it at a much poorer quality. It is important to acknowledge these disparities as a clinician in order to deliver effective treatments, and cultural competency training has been implemented to alleviate these issues.
Lack of cultural competency can have many effects, including increasing occurrences of microaggressions against patients. A study on ethnic and racial microaggressions shows that in the event of not discussing a possible microaggression a therapist had towards a patient, there was an overall lower “working alliance” between the two. Instances such as these show that microaggressions stemming from a lack of cultural competence can make a treatment less effective. In contrast, a study by Brigham Young University found that providing cultural competency education has generally led to positive results.
Although there are cultural competency training programs in place, there are challenges and critiques associated with current approaches. One of these approaches is an “expertise-based” approach, where healthcare professionals educate themselves on different cultures and the values associated with them. However, this approach has the potential of stereotyping patients. Qing Zhou, an Associate Professor at the UC Berkeley Psychology Department, says that it is important to understand the complexity of culture. Zhou emphasizes that, “Culture is not static. Part of cultural competency training is to understand that culture is a multidimensional and also a dynamic construct.” It is therefore important to look at the context of a person’s life and how their cultural structures influence them as an individual. “It is important to have that conversation [with clients] to show that you appreciate and that you want to know about their culture,” Zhou adds. She suggests that there are different ways to propose the question of culture to clients, such as asking, “How has your childhood and family [values] been affecting you in the environment you are exposed to now?” In a TEDx talk, Professor Jessica Dere also suggests that rather than trying to have an expertise on cultures, providers should “take a stance of informed curiosity” in order to better engage with their knowledge about the wide variety of cultural differences.
In addition, there is a push for mental health providers to also acknowledge their own biases against certain groups rather than only focusing on the cultural differences of their patients. In their book on cultural competence in health, authors Crystal Jongen, Janya McCalman, Roxanne Bainbridge and Anton Clifford note that cultural competency training has only implemented a focus on the patients’ culture rather than also assessing racial biases of those trained. The “Implicit Association Test” developed by scientists Mahzarin Banaji, Tony Greenwald, and Brian Nosek is one way to address and uncover one’s own unconscious biases. Incorporating tests like these in competency trainings can help providers become aware of potential biases and acknowledge them so that they can better serve their patients.
This student was so doubtful of her counselor’s ability to understand her situation, familial values, and cultural background, that she became unmotivated to continue with counseling and eventually ceased it altogether. Her experience is one of many which shows that lack of cultural competency can lead to ineffectiveness of treatment. This issue must be addressed until her experience is no longer representative of all mental healthcare.