6 - Cultural Humility in Psychology

Summary

Cultural competence is often defined as the way that one understands, acknowledges, and works with people from different cultures or belief systems. It is the ability to shift focus from one’s own personal perspective and consider another person’s cultural background, worldview, and lived experience. As a graduate student, you will build upon these skills when culturally relevant training and development is integrated into psychology graduate coursework. Furthermore, this chapter focuses on multiculturalism and the ability to recognize and expose bias. In addition, we will review considerations for necessary development in psychology practice, science, and advocacy to be anchored in a multicultural perspective. Emphasis must be placed in graduate studies to develop well rounded psychologists who have developed skills in cultural humility, multicultural growth and engaging in self-reflection.

In a day and age when racism, xenophobia, and bigotry are at an all-time high, cultural competency, cultural humility, and multicultural growth are of the utmost importance in our field. As a psychologist, it is inevitable that you will work with people who are different from you – not just in race, ethnicity, sexual orientation, gender identity, or ability status, but in ideology, values, and beliefs. The world we live in is ever evolving, changing, and advancing, as is our understanding of individual differences and intersectional identities. As a professional you must know how to be responsive to those that you work with, be aware of what may be offensive, and be conscious of your own biases as they may manifest. As a graduate student, you have an outstanding opportunity to grow in your understanding and application of multiculturalism and cross-cultural psychology. But be aware that to engage in this process, and to do so successfully, there likely will be moments when you feel uncomfortable, you confront biases or stereotypes you did not realize you had, and you discover “blind spots” revealing your ignorance on topics or issues well outside of your own lived experience. That’s okay. These moments of discomfort, shame, or even embarrassment can be where growth most occurs. So, come prepared with an open mind and an eagerness to learn. Challenge yourself to embrace cultural competency and implement new skills that will enhance your ability to promote equity, diversity, and inclusion. It is not only a great way to ensure that your work as a psychological scientist, teacher, or practitioner is best able to benefit all people in society; it is a social responsibility and an ethical duty to treat all people with respect. This chapter includes a brief description of key terms used to discuss your own personal journey related to cultural humility and offers advice for how you can make necessary strides in your graduate school experience.

1. Cultural Competency

As a graduate student, you may receive training in “diversity” that will provide you with greater awareness, new knowledge, and develop skills that are a core part of your professional and personal development. All psychologists interact with people: as students, mentees, research participants, or as patients. Thus, deepening your learning toward cultural competence is essential for all graduate students in order to succeed in your career, and to ensure the broadest impact of your work as a psychologist in the world around you. Cultural competence has been defined as the ability to understand and interact with people from cultures or belief systems different from one’s own (DeAngelis, 2015). This theory has been a key aspect of psychological practice and scholarship for many years; however, implementation of this concept to create equitable and inclusive places has trailed behind. Many psychologists that are involved in social justice work view cultural competence as an important element in combating systemic racism and socioeconomic disparities in health and mental health care. It is the understanding that different cultural beliefs positively impact the quality of care and interventions used in treatment.

Within health service psychology (i.e., clinical, counseling, and school psychology sub-disciplines), training in cultural competence has become an integral part of graduate curricula. Recently, the American Psychological Association (APA) made it a requirement for accredited programs in these areas to specify and implement a plan for integrating diversity into both didactic and experiential training. These requirements are not mandated to graduate training in other areas of psychology; however, more work is needed to ensure that all psychology students receive this type of instruction during graduate school.

The majority of the cultural competence training emphasizes learning the patterns of thoughts and belief systems in other cultures, thereby reminding you to constantly reflect on your own thoughts and actions, and work on adapting theories, concepts, and interventions to meet the expectations of other cultures (Chui & Hung, 2005). In the health service psychology areas, research thus far has shown that 85 percent of graduate students report their graduate school provided multiple courses in diversity and 83 percent report supervised clinical experience with diverse populations. This is a drastic improvement from past decades where graduate students felt ill-equipped in their knowledge of cultural competency.

2. Multiculturalism

Another concept to be aware of is multiculturalism. Multiculturalism promotes the value of diversity as a core principle and insists that all cultural groups should be treated with respect and as equals (Fowers & Richardson, 1996). It highlights humanity, tolerance, human rights, and authenticity. A huge part of multiculturalism is observed in culture and pays particular attention to honoring differences and amplifying diversity. Central to multiculturalism is the promotion of cultural equity within psychology.

Multiculturalism deserves special attention within our field. Reports suggest that only 5 percent of psychologists in the APA identify as Asian and Hispanic, 4 percent identify as Black/African American, and 1 percent identify as biracial/multiracial (Freeman, 2019). In addition to low representation, for many decades there has been a lack of urgency for a multiculturalist perspective in psychology (see “Even the Rat Was White” by Robert Guthrie, 2004). However, this has begun to change. Active learning about multiculturalism is required for healthy and helpful interactions with diverse populations, facilitating broader impacts in research, teaching, and practice. Adopting the principles of multiculturalism also promotes a stable, cohesive environment for both you and the population you’re working with. Imagine how belongingness is enhanced when someone understands your cultural values and does not find them offensive, odd, or unacceptable.

3. Cultural Humility and Multicultural Growth

Although the terms “cultural competence” and “multiculturalism” have been used frequently within psychology, a more recent construct preferred in discussions regarding diversity is “cultural humility.” Cultural humility reflects the process of gaining cultural competence and multicultural awareness, knowledge, and skills, but also reflects a recognition that one is forever striving to learn, to address areas of ignorance, and to be consistently open about what one doesn’t know. Cultural humility also reflects the fact that due to countless possible forms of intersectionality (i.e., possessing many different identities simultaneously), it is always necessary to value lived experiences and differences more than to assume a comprehensive understanding of others’ experience. A focus on cultural humility will teach you to embrace the process of reflection and make it a priority during your years of studying and work in psychology. Cultural humility also can be conceptualized as the development and implementation of diversity competence as a psychologist. It is the awareness of the impact of one’s culture and diverse experiences that shapes an individual’s experiences and perspectives. This includes the impact of power, privilege, and oppression (Fisher-Borne et al., 2015) and can be developed when scientists, teachers, and practitioners understand their own culture, privilege, and bias. These dynamics can impact one’s interactions with others (Fisher-Borne et al., 2015). Because we each have a lived experience, we see the world around us based on that worldview.

In certain instances, when biases are created, whether implicit or explicit, it can affect the way we encode, interpret, and respond to stimuli around us. Biases are the attitudes or stereotypes that affect people’s understanding, actions, and decisions. This includes both negative and positive perspectives and thoughts that occur at times without full awareness. Biases can limit the capacity to relate to another person. At times biases also lead to marginalizing or diminishing another person’s experience. Unchecked biases limit our tolerance and acceptance of differences. So while it may initially feel uncomfortable to explore your biases, judgments, and perspectives, it’s critical to the process of gaining cultural humility.

The process of cultural humility teaches us to recognize these biases, reflect upon them, and recognize that we must understand one another’s “truth” without imposing our own biases to undermine, or rewrite, that truth. Indeed, it is in the acknowledgment of one’s own cultural biases, stereotypes, and prejudices where the true work of gaining cultural humility begins.

For some, the process of developing cultural competency, the awareness, knowledge, and skills of multiculturalism, and introspective experience reflecting cultural humility began long before graduate school. For others, the journey is just beginning. Either way, graduate school training should include a goal to make great strides in these areas. Because diversity is ever changing and evolving, so must be your understanding. Research from the US Department of Health and Human Services indicates that progress in these domains improves relationships between people from diverse identities and backgrounds (Substance Abuse and Mental Health Services Administration, 2014). Research also suggests that many foreign countries do not see Americans as harnessing cultural sensitivity and acceptance (Murray-García & Tervalon, 2014), suggesting that there is room for continuous improvement in relationships with people from other cultures characterized by respect, consideration, and open-mindedness.

As you begin your graduate school journey, ask yourself:

1. 1. How were you raised to treat someone of a different race?

2. 2. What comes to mind when you meet someone of a different background than you?

3. 3. What are your identities with regard to each area of diversity (gender identity, gender expression, race, ethnicity, religion, sexual attraction, sexual behavior, sexual identity, social class/socioeconomic status, physical ability, geographic upbringing, neurodiversity) and how might your identities allow you to experience the world differently than someone with different identities?

4. 4. What limitations do you have in understanding others given your own unique experiences?

4. Graduate School is a Growth Opportunity

You will develop a greater appreciation for cultural humility in graduate school, and increase your own cultural competence and multicultural awareness, knowledge, and skills as well. But it’s not easy. A few tips are below. Overall, remember that cultural humility is a process, not a destination. During your time in graduate school, take every opportunity to grow in multiculturalism. Be mindful of the attitude and perspective that you have during this time. Be open and accepting of biases that you will discover in the books and theories that you will learn. Explore the inequities inherent in psychology and question why they persist. Challenge the status quo. Are you ready to look inward?

1. 1. Developing cultural humility requires introspection. You will be surprised to learn how much your own ideas, assumptions, and automatic beliefs about what seems true may not be true for everyone. In other words, you will begin to recognize the important role of lived experience in shaping our perceptions, beliefs, and behaviors and creating multiple truths. It is important to recognize that these are all equally valid and important perspectives that can coexist. Thus, what may seem “obvious” or “peculiar” or “confusing” to you may be remarkably ambiguous, profound, or certain to someone else. Your job when discovering these moments of unique points of view is not to determine who is “correct,” but rather to realize that all perspectives are valid, informative, and allow for greater dialogue to occur. In short, your job is to listen and to better understand what you don’t know, and could not have known before.

2. 2. Cultural humility is relevant for everyone, even those who have been historically marginalized. Of course, the process required to develop cultural humility is relevant not only for those with limited experience interacting with others from historically marginalized backgrounds, but also for those who themselves represent diverse identities. This work is relevant to everyone, which means first that all individuals have areas of cultural competence to develop, and second, approaching others who may appear to represent a historically marginalized identity under the assumption that they possess advanced expertise places an unfair burden on people who are engaged in advancing diversity work. Rather, it is essential for everyone to respect that we are all working toward cultural humility and simultaneously experiencing challenges and epiphanies.

3. 3. Determine when you may be most open-minded towards growth. People are most likely to grow when they are not under stress or feeling overwhelmed. So it may be important to recognize your natural tendencies to be defensive or dismissive when challenged. Your attitude can either become a roadblock and hindrance to your growth or it can thrust you into a new level of understanding. Avoiding, ignoring, and blocking out are common forms of resistance, especially if it is different from your worldview. There will be moments where difficult conversations with peers or mentors may be needed, and it is understandable if fears and anxieties arise. Use those moments to further develop ways that you can commit to learning skills that will allow the needs of historically marginalized and minoritized populations to be addressed meaningfully. Take this work with you outside the classroom. Of course, your commitment to cultural competence, multiculturalism, and cultural humility can extend well beyond the classroom or your graduate curriculum. You can think critically about your research and teaching activities. Follow thought leaders on social media who represent novel viewpoints, and attend lectures that allow you to hear about diverse perspectives. There are dozens of fantastic books and podcasts that allow people to move through the journey of cultural humility, and you can establish safe forums for discussion and growth among peers at your department or university.

4. 4. Enlist the support of a mentor. Finding a mentor is also key. The most effective mentors provide discussions and processing time to further help foster the development of cultural intelligence (Murray-Garcia et al., 2014). Mentors can also help benchmark your personal growth, and give you an objective perspective on your progress. Mentors will also help you with perseverance when you are struggling due to inevitable stumbles.

5. 5. Apply your work, everywhere. Outside of your own personal experience and the acquired knowledge you will attain from graduate school, pay attention to the systems that exist within society that further complicate or inhibit diversity and/or inclusion due to systemic racism. Challenging yourself will help you to overcome emotional hurdles, hindrances, and roadblocks that may come later during your work as a psychologist. During this time of learning and understanding, make time for self-reflection. Try to evaluate the impact of your personal power, privilege, or marginalization. Try to go outside of your social circle to expand the diversity of your peer group.

6. 6. Elicit peer support. Psychology graduate school is often regarded as a marathon, not a sprint, and it is important that you establish strong support systems to help you succeed. Creating a positive village that is inclusive of relationships with your peers and cohort is essential. Having others keep you accountable, sharing ideas and resources, enhances your development and training. For people who themselves represent historically marginalized identities, the village may include people who can help provide support when you are burdened and feeling pressured to represent not only your own emerging identity, but also the reputation of the group you may represent. In addition, as a diverse graduate student, you may feel compelled to respond to questions, provide explanations, or confront incorrect assumptions that can lead to exhaustion and frustration; moreover, the pressure to avoid reifying negative stereotypes while doing so is extraordinarily challenging. Peer support will be essential to allow you the space to be yourself and cope with these remarkable challenges.

7. 7. Take action. As you embark on your journey toward cultural humility and recognize the systemic inequities that have existed, and have been passively maintained for centuries in some cases, you may become angry, frustrated, and feel helpless. Turn that into meaningful, tangible, impactful action. These feelings are a good sign that you are becoming an ally, and your allyship is most valuable when you elevate the words of others, use your power to create change, and push for action where others may be less able, perhaps because their power has been taken away through systems that they were born into. As future psychologists you have the capability to be strong and influential agents of change. You can proactively call out systems of racism, power imbalances, and social injustice. As an exemplar of cultural humility, you can create and advocate for psychological science that will reduce structural forces and institutional inequalities (Fisher-Borne et al., 2015). Your very actions, ideas, research, and guidance regarding equitable and inclusive practices can challenge and begin to build a better world for us all (Fisher-Borne et al., 2015).

So what have you learned thus far? Cultural competence, multiculturalism, and cultural humility are more than just terms you will likely learn during your time in graduate school. They are action words that require you to rethink psychology, and perhaps your own life today. As future and current psychologists, the possibility for real change is limitless. Make a conscious decision to intentionally address issues of diversity and inclusion, from the start of your graduate school journey. Explore diversity training within your doctoral psychology program and during your studies. Create platforms for new cultural experiences so that you can be exposed to people with alternative values, beliefs, and ideologies. By approaching psychology with cultural humility you advance multicultural growth, cultural competency, and real change.