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Cultural humility in Christian clinical psychology programs

Cultural humility: what it is, why it matters and how to foster it.

By Carissa Dwiwardani, PhD, and Amanda Waters, MA

In recent years, there has been a burgeoning of literature on cultural humility as a complement to multicultural competence (Hook, 2014; Hook, Davis, Owen, Worthington Jr., & Utsey, 2013; Hunt, 2001; Murray-Garcia, Harrell, Garcia, Gizzi, & Simms-Mackey, 2014; Owen et al., 2014; Tervalon & Murray-Garcia, 1998; Wooldridge, Dwiwardani, & Prasad, 2014). Therapists' cultural humility (as rated by clients) has been found to be a predictor of clients' perception of progress in therapy (Hook et al., 2013; Owen et al., 2014). However, little has been written on ways to foster cultural humility in the training of psychologists. While some has been published in the medical literature (Cruess, Cruess, & Steinert, 2010; Murray-Garcia et al., 2014), less has been written in the area of psychology training (Wooldridge et al., 2014). In this article, ways to foster cultural humility in Christian clinical psychology programs are offered. The approach taken in this article assumes an integration of Christian beliefs, and we propose that the integration of faith provides the foundation for and enriches the teaching of cultural humility. The construct of cultural humility is consistent with biblical teaching: Jesus' act of accomplishing salvation for Christians is described as an act of humility (Philippians 2). We propose that learning is enhanced when clinicians-in-training are invited to integrate their values that are consistent with those of the profession's.

Why Cultural Humility: A Christian Perspective

The value of humility is emphasized throughout the Bible and draws on the Christian ethic of valuing all people because each person is created in the image of God (Genesis 1:27). Jesus as fully God and fully man humbled himself and died on the cross (Philippians 2:8). Because of this sacrifice and demonstration of grace, the exhortation follows: go and do likewise. Paul stressed a right understanding of the self, not thinking “more highly than he ought to think, but to think with sober judgment, each according to the measure of faith that God has assigned” (Romans 12:3). He further encouraged the early church, “Put on then, as God's chosen ones, holy and beloved, compassionate hearts, kindness, humility, meekness, and patience” (Colossians 3:12). These instructions come with rewards—Proverbs 22:4 promises riches and honor and life for humility and fear of the Lord. Jesus promised that “Whoever exalts himself will be humbled, and whoever humbles himself will be exalted” (Matthew 23:12).

Defining Cultural Humility

Cultural humility is distinguished from cultural competence in its point of reference. Cultural competence focuses on the knowledge and awareness of other cultures or experiences (Kumas-Tan, Beangan, Loppie, MacLeod, & Frank, 2007; Racher & Annis, 2007) while the practitioners themselves are left unexamined (Hunt, 2001). This reinforces the belief that the dominant group is the “normal,” a blank slate that does not have a culture (Hunt, 2001). As such, knowledge and awareness of other groups are most useful for clinical encounters when coupled with cultural humility, characterized by an ongoing process of openness to the other and self-examination within the practitioner (Hook et al., 2013; Tervalon & Murray-Garcia, 1998). This posture assumes that there are two sets of values, assumptions and worldviews in the clinical dyad: the client's and the service provider's (Hunt, 2001). Cultural humility motivates clinicians to (a) remain aware of the power difference inherent in clinical encounters, (b) engage in continuous self-reflection and learning and (c) maintain respectful curiosity of clients' worldview, values and experiences of the clinical encounters (Hunt, 2001; Tervalon & Murray-Garcia, 1998). Cultural humility values others and their cultures, emphasizing the shared humanity of all people (Roberts, 2007).

Though the character of the practitioners is important, humility does not make too much of the self (Peterson & Seligman, 2004; Tangney, 2000) or one's own values, assumptions and worldviews. Peled-Elhanan (2002, as cited in Ellis & Walton, 2012) described cultural humility as “being willing to hold back your ideologies, or your truth, or your personal and national narrative, and make room in yourself for the truth and narrative of other” (p. 144). In being aware of our cultural characteristics and the experiences that shape them, we are reminded of the limited nature of our vantage point.

Not only does humility protect against too much of ourselves, it protects against too little. Humility as a character trait includes an accurate assessment of oneself, not a lower view of the self (Tangney, 2000). Instead of being synonymous with self-deprecation, humility has been found to be positively related to self-esteem (Dwiwardani, 2011) and to be predicted by secure attachment (Dwiwardani et al., 2014). Cultural humility, then, does not pretend to know less or demean acquired knowledge. Instead, it holds a respectful stance toward one's own cultural identity while exercising the capacity to genuinely value, engage, and welcome others' cultures.

Cultural Humility: Teaching Methods

Cultural Iceberg

Comas-Diaz's (2011) analogy of the cultural iceberg is helpful in providing a foundation for cultural humility. Through this analogy, students learn that only 10 percent of culture is what can be seen, and 90 percent of culture comprises assumptions, worldviews and values (Comas-Diaz, 2011). Each service provider comes with worldviews and assumptions about the world that are often taken for granted. Cultural humility calls for a commitment to reflect and examine these implicit assumptions and values, lest they be imposed onto clients (Comas-Diaz, 2011). One way for students to engage in self-examination is through Hays's (2008) ADDRESSING model, which facilitates an understanding of cultural influences in their lives.

Media

In our experience, the use of media has promoted engagement and discussion, giving voice to participants' self-reflection and curiosity. For example, one YouTube video described the use of white privilege in the service of advocacy without minimizing the strength and courage of the visible minority or taking away their voice (Butler, 2011). Advocacy can also take the form of sharing memes or infographics through social networks such as Facebook, Instagram or Pinterest. In a TED Talk, Chimamanda Ngozi Adichie (2009), a writer, spoke of the danger of a single story in describing or interacting with various cultural groups. Psychologists hold positions of power in clinical encounters and their assumptions of various cultures can be empowering or disempowering to their clients. Thought-provoking videos such as Adichie's (2009) often set in motion a process of reflection on one's limited perspective and the impact they may have on one's interactions with others. We have found that utilizing the media allows increased space for vulnerability and facilitates a more open engagement with the material.

Small Groups

Holmes (2012) argues that the training of multicultural competence has for too long relied on cognitive knowledge and not enough on achieving in-depth transformation. While more research should be done on how this transformation can be fostered, we propose that practicing difficult dialogues in a small group setting may facilitate change beyond the surface. The specific process facilitated in these small groups has been described elsewhere (Wooldridge et al., 2014), illustrated by an example in which a group member's “colorblindness” emerged and was then worked through in the group.

In a multicultural psychology course, weekly small groups are facilitated by teaching assistants, who are supervised by the course instructor. These groups are undoubtedly emotionally evocative, and group facilitators are selected based on their ability to contain and remain responsive to students' emotional reactions. The goals of the small group are threefold: (a) to allow for varying assumptions, values, and worldviews about cross-cultural topics to emerge; (b) to examine the impact of one's assumptions and attitudes on others; and (c) to practice engaging in dialogues about racial and cultural issues. In Christian programs, these exercises can be designed to facilitate character development and spiritual reflections. Students have the unique opportunity to reflect on their spiritual journey and their relationship with God as they wrestle with gaining awareness of microaggressions and acts of discrimination. As students engage with the challenges and opportunities of self-examination and dialogue, growth in cultural humility is fostered.

Conclusion

Humility is a virtue that has long been studied and taught by various religious groups, and psychology would benefit from learning from these rich traditions in its study of cultural humility. In this article, we have attempted to explore ways to foster cultural humility that actively engages Christian beliefs and worldviews. We believe that programs that integrate Christian beliefs in their teaching have a unique opportunity to enhance and enrich students' learning in this area. Foundational to the Christian faith is a valuing of all people, and cultural humility facilitates authentic intrapersonal and interpersonal engagement and openness. Regardless of cultural identity, backgrounds, and religious beliefs, coherence facilitates growth in ourselves and our clients. As such, fostering cultural humility in a way that engages one's value system may provide the next step in training culturally responsive psychologists.

References

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