During the next 50 years, the United States will become a nation in which no one racial or ethnic group will be in the majority (U.S. Census Bureau, 2012). As our population evolves and continues to diversify, it’s imperative to our nation’s functioning that healthcare professionals possess the skills required to work competently with clients from a range of cultural backgrounds.
It may seem unnecessary to prove that the ability to work fluently with diverse populations would be a positive thing, but just in case you’re not convinced, there’s evidence to back it up.
A 2016 study in the Journal of Counseling Psychology found that clients who rated their counselors more highly on multicultural competency tended to report greater improvement in well being (Dillon et al., 2016).
In the edited volume, Mindfulness and Acceptance in Social Work: Evidence-based Interventions and Emerging Applications Akihiko Masuda, PhD, Matthew Boone, Ph.D., and colleagues present a chapter that addresses functional and contextual factors involved in using mindfulness-based treatments with clients across different cultural contexts.
Their insights yield some useful tips for becoming a more competent clinician.
1. Practice your perspective-taking skills.
The ability to view situations fluidly from different perspectives is one of the fundamental tools required to be a competent practitioner with any client or group. But in the case of working across cultures, perspective taking is even more important.
It allows clinicians to truly understand the way the client interacts with his environment and the way his environment interacts with him. When we can see how a client’s environment may be affecting him, we can better understand how the issues that brought him to seek treatment or assistance are expressed, maintained, and potentially exacerbated.
From there, it’s more feasible to develop and implement realistic solutions.
2. Examine your biases.
The goal of culturally competent intervention is not to be bias free, but to be effective for individuals across diverse populations of clients (Masuda, 2014). All of us have biases, as do the models we use, and the research that (hopefully) supports them.
“Judging what is clinically relevant for a given client is not always an easy task. We must be cautious not to rigidly adhere to our assumptions about various socio-cultural factors, like what constitutes a family, what defines a meaningful life, and what is the optimal amount of self-disclosure in a close relationship,” write Masuda and his colleagues (2014).
In his own practice, Masuda makes a request that clients speak up if or when they feel he’s being culturally insensitive. This approach opens the door for the clinician to be vulnerable and in turn flexible; two notable features of the acceptance and commitment therapy approach.
If a therapeutic goal is to enhance the client’s psychological flexibility, the clinician should also aim to act flexibly when personal biases or judgments emerge in therapy.
In ACT, Hayes, Strosahl, and Wilson (2012) recommend that the clinician “acknowledge the issue (privately at first [and] then to the client if that seems clinically useful); be more open with is psychologically; and focus on the values-based actions that can be taken in the service of the client.”
“When I have an occasional racially biased thought, or a sense of disconnection based on the client’s “otherness” (according to his mind), I welcome these experiences as naturally occurring phenomena. How could they not show up for a person who grew up in the United States, with its history of racial division? At the same time, I do not give them any weight, neither shaming myself for having them nor fighting their existence,” says social worker Matt Boone, who edited the volume and co-authored the chapter on multicultural competence.
3. Practice being flexible with your treatment techniques.
It’s a natural and necessary part of the therapeutic process to modify or tailor treatment methods to meet the needs of each client. Rigidly or robotically performing a protocol inhibits your ability to be available the present moment with the client and may cause you to lose sight of the function of the exercise altogether.
Further, certain words or vernacular may not resonate with all clients, and in some cases may even be grounds for downright rejection.
Mindfulness exercises, while popular, may need to be re-framed for individuals whose religious beliefs may prohibit anything that may be perceived as new age or alternative religious practice. In such cases, it’s important to remember that it is the function of the mindfulness exercise that matters, not the way the exercise looks in-session, or the language used to describe it.
4. Practice mindfulness.
Another 2016 study, which was published in the Journal of Counseling and Development, found correlations between components of mindfulness and multicultural awareness and knowledge (Ivers et al., 2016).
The article hypothesized that “qualities associated with mindfulness, such as self-awareness, compassion, nonjudgment, empathy, acceptance and emotional intelligence, relate to or could foster aspects of multicultural counseling competence.” (Ivers et al., 2016)
One example given is the characteristic of awareness, a principle in both mindfulness and multicultural counseling competence, which promotes a clinician’s ability to understand her own cultural perspectives, including prejudices and biases. The full article provides more in-depth exploration of the specific processes that can be targeted and enhanced by mindfulness to improve competence in this area.
5. Consider the role of religion and spirituality.
The psychology field has fought long and hard to distance itself from spirituality and religion. But spiritual- and religious-based practices, when present, are often inextricably linked with clients’ values, and are important defining factors of the contexts within which they live.
Once again, recalling the importance of examining function, it is not necessary to agree with client’s religious or spiritual beliefs or even to get into granular details of their specific philosophies and belief systems.
It is only necessary to extract enough information to understand the purpose religion and spirituality have in the client’s life. In doing so, clinicians can hone in on what matters and use that information to encourage values-driven actions.
Whether you work in a community mental health clinic or in private practice, multicultural competence is increasingly crucial. At the heart of the effort to maintain flexibility in treating a range of diverse clients lays a curiosity, vulnerability and openness that can improve client outcomes and encourage your own growth as a clinician and human being.