501 SelfWork: Cultural Humility: What It Takes To Walk In Someone Else’s Shoes

Dr. Margaret focuses today on the vital importance of what’s termed “cultural humility” as she responds to a listener voicemail, pointing out that as she’s a white person, her advice comes from a place of privilege in the US.

Do you have to have walked in someone else’s shoes, carried the same load as they have, lived a life very similar to theirs – to truly understand them? Or to offer something helpful to them?

I received a very open and honest voicemail this week that addresses this question.

Certainly. with the United States as keenly and at times violently divided as our citizens are, it might be hard to find anyone who’d answer “yes” to that question. Yet, when I think about the people I’ve seen through the years as a therapist, I’d hope that at least many – if not most – of them have walked out of my office feeling as if something has been lifted from them. Or that they’ve gleaned some type of perspective that’s helpful. Sometimes, my experience or style is not a good fit for someone, and I refer that person to someone who might be better.

But I was very struck by this young woman’s comment and wanted to share with all of you.

 

How I began practicing cultural humility…

I want to fill in a little history. When I first started blogging, I felt relatively comfortable as an “expert” in my subject. I was going through feelings of empty nest – and I thought it might help others and myself to be as honest as I could be about the transitions I was going through. I was writing as a psychologist but also simply as a mom, although I certainly realized – and mentioned often – that my experience wasn’t universal. Not every parent – and maybe not even most – experienced what I did. Some experienced much worse. Some not at all. I only had the one child so that was a factor.

But when I began writing about mental health and mental health, I felt it was different. Yes – I was an “expert” by social media standards. At that point, I’d been in practice for over 20 years. I’d worked in a community clinic setting and a free health clinic, in schools, and in private practice. I’d trained in hospital settings in grad school in Dallas, so a major metropolitan area. But I recognized several other things as well. I’m white. I’ve never been poor. I had supportive parents  (although not a perfect family.) I was well-educated. But I remember like it was yesterday, when I began talking more openly – and especially when I began the podcast, I was cautious. What was I nervous about? I was afraid that I’d be judged for being 62. And for all the other things I just mentioned.

Also, I don’t live in a part of the country where there’s significant diversity. So, the great majority of my clients have been white. 1/3 men, 2/3 women. I felt vulnerable in an odd way – I didn’t want listeners (or readers for that matter) to attack me for a reason I had no control over. But I also knew that that might happen.  You put some message out there –  and you don’t really know how it might be perceived.

I never was attacked . Not that I haven’t received criticism. Or been ridiculed for my own commenting on websites where I guess comments from older folks weren’t welcome. That’s happened too.

Yet, when I received this message, I had to smile. We were in agreement actually. Because I realized that what this listener might not know – and maybe I hadn’t talked about it before or enough – was that I’ve tried to present my work online and in my practice with what’s called “cultural humility.”

This listener’s message…

So what did this listener say in her message?

It was a response to something I’d said about reaching your potential.

Of course, first – I want to thank her for letting me know that her overall response to me has been that she finds me a compassionate person.  And I am grateful to her for commenting respectfully.  But she makes an excellent point – I’m not sure what episode or post she’s referring to when she says that she doesn’t think I can talk about what is the actual “potential” for – especially – people or women of color, to use her words.

Why? Because of the privilege I’ve enjoyed as being white. It sounds as if her fight has been long and hard as a black woman – and she’s understandably tired of that uphill battle to reach “the potential you claim we all have.”  She uses the word “demoralized” which is a term I often use when thinking about what brings people into therapy. They’ve lost or can’t find their way out of something that’s causing them pain or worry. So, they’re hoping that I can shed some light on that issue and help in some way. So she’s demoralized.

Using cultural humility to try and walk in someone else’s shoes…

Maybe it would be helpful to talk about this idea of having to walk in someone else’s shoes before you can understand their real struggles – or why they believe or feel the way they do. Let me first say… I think her statements about my race blocking me from completely understanding hers or any black or brown, Asian or Latino person’s world is completely correct. And I talk about that fact openly with any of my clients who aren’t white. I ask them to educate me about what their world has been like, so I can understand as best I can.

For example, years ago I  didn’t know what code switching was, until a young Black corporate woman told me – and even gave me some memorable examples that we laughed together about. But I knew the practice wasn’t at all funny at their core or in their needed use.

Cultural humility versus cultural competence…

So, this brings us to the point of focusing on what cultural humility is and how it differs from what’s termed “cultural competence.”

There are all kinds of offerings and courses on cultural competence – which teach anyone in the helping professions or teachers or really anyone.  Cultural competence courses are structured learning programs designed to build awareness, communication skills, and equitable interactions with individuals from diverse backgrounds.  The idea is that if you learn what different people from different backgrounds and cultures respond to best – what context they might have that you don’t for certain language or action – what familial or cultural expectations they might have that aren’t in your own history – what emotional responses mean in certain cultures that are different than your own – these courses then are trying to help people learn how you’ll be perceived and how your own perceptions could be off or even wrong. To help you be involved more respectfully. More judiciously.

If you’ve traveled much in your lifetime, you know this to be true. That what is culturally acceptable in one country isn’t in another. And vice versa.

But then there’s something else called “cultural humility.”

Let’s talk for a moment about the difference.

The best research article I found – and the clearest – was one from the National Center for Biotechnical Information –  I’m going to quote their summary or their abstract.

“… trainings are designed to expose providers to different cultures and expand their understanding of the beliefs, values and behavior thus, achieving competence. Although this intention is commendable, training providers in becoming competent in various cultures presents the risk of stereotyping, stigmatizing, and othering patients and can foster implicit racist attitudes and behaviors. Further, by disregarding intersectionality, cultural competence trainings tend to undermine provider recognition that patients inhabit multiple social statuses that potentially shape their beliefs, values and behavior.”

“To address these risks, we propose training providers in cultural humility, that is, an orientation to care that is based on self-reflexivity, appreciation of patients’ lay expertise, openness to sharing power with patients, and to continue learning from one’s patients. We also briefly discuss our own cultural humility training. Training providers in cultural humility and abandoning the term cultural competence is a long-awaited paradigm shift that must be advanced.”

Here’s the chart focusing on the differences between cultural competence and cultural humility…

This chart is from that same article.

Feature [1, 2, 3, 4, 5, 6, 7, 8]	Cultural Competence	Cultural Humility
Focus	Knowledge and application: Learning norms, values, and practices of different groups.	Self-awareness and process: Examining personal biases and committing to lifelong learning.
Goal	Mastery: Aiming to become an expert in cross-cultural interactions.	Curiosity: Accepting that one cannot know everything and adopting the stance of a learner.
Approach	Provider-centered: Prioritizing the professional’s acquired knowledge and skill set.	Client-centered: Positioning the individual from another culture as the expert on their own life.
Mindset	“I understand your culture”.	“I am open to learning about your unique experience”.

 

For any of you who’ve listened to SelfWork for a while, you can probably guess my preference. I don’t think you have to choose one or the other. You can take courses aimed at becoming culturally competent. But then – along with that learning – realize that no course can help you “understand” a culture completely. That can take years. It’s nuanced.

That’s why discussion and conversation matter. Not texts or tweets that can fly out of your mouth and onto the phone or internet in seconds. Having humility. Acknowledging your own limitations in understanding. Asking questions. And opening yourself to empathy. Not necessarily agreement. But empathy.

I want to thank this young woman once again for her comment.

 

By the way… 

Send me a message about what your own mom was like!! You can record by clicking below and ask your question or make a comment. You’ll have 90 seconds to do so and that time goes quickly. By recording, you’re giving SelfWork (and me) permission to use your voice on the podcast. I’ll look forward to hearing from you!