CULTURAL HUMILITY AND CULTURAL SAFETYby Simon Moss

CULTURAL HUMILITY

Introduction

In the workplace, and in life generally, you will often need to interact with clients or colleagues from diverse communities and cultures. Academics might need to supervise candidates from diverse ethnic, economic, or religious communities, for example. Candidates might need to interact with respondents from diverse regions. Health practitioners, and indeed most employees who offer services, may need to assist clients from diverse communities and cultures. These clients may have developed values, beliefs, or preferences that diverge significantly from your perspectives. So

how can you accommodate these diverse individuals most effectively? how can you circumvent the complications that such differences can elicit?

Cultural humility

In previous decades, academics and practitioners tended to advocate the concept of cultural competence—knowledge and skills that enable individuals to respond most helpfully to diverse peoples. In recent years, however, many academics and practitioners have identified complications with the notion of cultural competence and have instead championed an alternative perspective: cultural humility. Cultural humility was first embraced by mental health practitioners but had since been applied to other health practitioners (Chang, Simon, & Dong, 2012), service employees, teachers (Cruess, Cruess, & Steinert, 2010), and people in general. This document outlines the features, benefits, and practice of cultural humility.

Cultural humility versus cultural competence

To enhance the capacity of service employees—including supervisors and health practitioners—to accommodate diverse cultures, many organizations have introduced a range of initiatives, such as training programs, to promote cultural competence. These initiatives and programs were designed to impart knowledge and skills about other cultures. In addition, participants of these programs learn

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how to adjust their behaviour and foster an atmosphere that accommodates these cultures. Nevertheless, in recent decades, this approach gradually attracted many critics (e.g., Fisher-Borne, Cain, & Martin, 2015; Hunt, 2001; Tervalon & Murray-García, 1998; Yeager & Bauer-Wu, 2013). To illustrate

the first column in the following table outlines the concerns these critics raised the second column clarifies these concerns the third column presents some practices that could address these concerns

Concerns about culture

competence

Details Practices that address these concerns

The notion that you can be competent about a culture may erroneously imply that cultures are relatively homogenous

Each person is shaped by their culture uniquely

Even the extent to which they reject or embrace the norms of a culture varies across individuals and is thus heterogenous

When interacting with clients from a specific culture, do not assume they share the values, beliefs, or preferences that you believe typifies this culture

Ask questions about their values, beliefs, and preferences if applicable

Ask these individuals the extent to which they share the values, beliefs, and preferences of their culture

The notion that you can be competent about a culture may erroneously imply that cultures do not change appreciably over time

Most cultures—that is, the values, beliefs, and perspectives of communities—are dynamic

They shift continually over time as a consequence of many historical, social, economic, and political events

When interacting with clients, do not assume your previous knowledge about a culture is still relevant now

The notion that you can be competent about a culture may erroneously imply that people tend to

Each person belongs to a dynamic blend of many ethnic, occupational, religious, and other communities

Therefore, no practitioner can understand the

When interacting with clients, ask these individuals to specify the groups, communities, or cultures to which they identify most closely;

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belong to only one culture or community

culture of a person, because culture is multidimensional—and cannot be reduced to ethnicity for example

that is, which groups, communities, or cultures most affect their values and behaviors.

The pursuit of competence may diminish the inclination of individuals to concede their incompetence

People who strive to pursue cultural competence may be reluctant to ask members of other cultures about their perspectives

That is, these individuals may not acknowledge limitations in their knowledge

Hence, the pursuit of cultural competence could actually increase the likelihood of misconceptions

Ask questions about the cultural practices, beliefs, and values of the client

That is, at times, assume the role of a learner rather than expert

The notion of cultural competence might imply your goal is to obtain knowledge about a culture rather than adopt a specific mindset

The knowledge that you acquire before an interaction does not guarantee a productive interaction

Adopt a mindset in which you embrace discussions or information about cultures—including information that deviates from your preconceptions or preferences

The third column of the previous table epitomises some of the features of cultural humility. In particular, to adopt cultural humility, service employees, such as supervisors and health practitioners, should

recognize that many of their assumptions and knowledge about the culture of clients may be limited, misguided, and biased

ask questions to understand the clients better—such as their hopes, fears, and preferences— and to override misguided assumptions

develop a mindset in which they are mindful, attentive, and empathetic rather than presumptuous (Hook et al 2017; Hook & Watkins, 2015)

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How to develop cultural humility

Soon after the notion of cultural humility surfaced, researchers and practitioners began to clarify how individuals can develop this mindset. The following table outlines some practices that service providers, supervisors, and other employees can apply to demonstrate cultural humility.

Practice DetailsContemplate your personal biases

Identify your own stereotypes and biases around specific cultures and communities—such as people of specific classes, faiths, ethnicities, sexual orientations, and income brackets

Challenge the unconscious tendency of many people to perceive their own cultures, values, beliefs, and knowledge as superior or correct

Consider how your own positions of power or privileges might have shaped these stereotypes and biases (Mosher et al., 2017)

Contemplate your professional biases

Recognize that some of your biases and misconceptions might emanate from your discipline or field

For example, many training programs impart insights about differences across cultures—but this information might amplify the disparities or overlook the variations within cultures (Patallo, 2019)

Embrace opportunities to learn about specific cultures and diverse cultures in general; conceptualize this learning as a lifelong journey

Learn about the experiences and effects of oppression, migration, and other dynamics that typify many diverse cultures

Learn about the history, values, rituals, and norms of specific cultures, ultimately to appreciate the complexities and challenges of cultures

Do not depend on one source; recognize that every member of a culture may develop a unique perspective

Do not inflate the knowledge you have gained

Recognize that, despite extensive exposure to a community or culture, your knowledge and insight is still limited; that is, knowledge should foster humility rather than conceit (Hook et al. 2016 ; Abbott et al., 2019)

Similarly, do not overestimate your knowledge and insight about a community merely because you have served or assisted other members of

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this community beforeRecognize you might need more time to develop trust, rapport, and alliance

Many service providers, such as health practitioners, incorrectly assume that some communities, cultures, and minorities are inherently wary rather than trusting

According to some research however, in practice, some minorities are more trusting than is the dominant culture until they attempt to access various services (Diala et al., 2000)

But, because of stereotypes and discrimination, these services are often not as helpful as anticipated, culminating in cynicism rather than trust (Diala et al., 2000)

These considerations imply that, after some time, trust might resurface and the alliance may improve

The level of trust is thus malleable rather than an inherent feature of cultures or communities

Because of the potential of this mistrust, demonstrate some of the hallmarks of trust and respect, such as confidentiality

In health settings, for example, you might clarify and underscore the confidentiality of these conversations to a greater extent than usual—given that shame and fear might be more pronounced in diverse cultures because of unpleasant experiences in the past

You may show respect by, at least initially, addressing these individuals formally, such as “Mr” or “Ms”

Recognize that behaviour that seems to indicate mistrust might simply indicate differences in communication or priorities

To illustrate, in many cultures around the world, clients do not tend to disclose or discuss emotional symptoms, even to mental health practitioners

Instead, they tend to disclose somatic or physical symptoms of mental health problems, including depression

That is, they may have learned to orient their attention more to physical symptoms, rather than emotional symptoms, when speaking to health practitioners.

Occasionally, assume the role of a learner—in which your client helps you understand their culture

Acknowledge that your knowledge and insight about the relevant cultures might be limited

Encourage the clients to impart this knowledge and insight

You might ask questions like

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“What would you like me to know about this community? What are some misconceptions that may be common in the media?”

“What do people in this community tend to feel about mental health problems? How have these beliefs shaped your opinions?”

Do not assume their culture dominates their identity

Although you should embrace the cultures of your clients, do not inflate the significance of these cultures

For example, the religion, sexual orientation, or ethnicity of a person may not be a central part of their identity (Burckell & Goldfried, 2006)

Do not, therefore, devote undue attention to these characteristics

Consult with relevant peers

If uncertain of how to proceed, you may occasionally consult other professionals or colleagues who are members of this community or culture

But do not assume that members of a community or culture appreciate the experiences and perspectives of all other members

Benefits of cultural humility

Many researchers and practitioners have promulgated the benefits of cultural humility. That is, cultural humility helps both the

clients feel they can explore the implications of their culture—such as how their culture might affect their confidence in the workplace—called cultural opportunities

service providers, such as supervisors or health practitioners, feel at ease when discussing matters that relate to culture—called cultural comfort (Hook et al 2017).

In addition, when service providers exhibit cultural humility, they recognize the limitations in their knowledge about cultures. Consequently, they become more receptive to information about cultures, enhancing their knowledge and insight over time (e.g., Abbott, Pelc, & Mercier, 2019). Indeed, many studies have substantiated the benefits of cultural humility. That is, cultural humility in service providers

improves the therapeutic alliance between health practitioners and clients (Hook et al. 2013)

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improves the likelihood that clients will benefit from interactions with mental health practitioners (Hook et al. 2013)

diminishes the likelihood they may offend or insult the client inadvertently (Davis et al., 2016)

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CULTURAL SAFETYIntroduction

Cultural humility, although often beneficial, does not address all the prejudices and injustices that societies have perpetrated on diverse communities. In contrast, cultural safety is a complementary perspective that could partly address some of this discrimination.

Cultural competence

Like cultural humility, the discussion of cultural safety emanated from dissatisfaction with the notion of cultural competence. Admittedly, the notion of cultural competence is multifaceted. Scholars have applied many definitions, and invoked many theoretical perspectives, to delineate this notion. Nevertheless, scholars originally conceptualised cultural competence as a set of behaviours, attitudes, and policies that enable individuals, organizations, or systems to work effectively with diverse cultures (for a review, see Curtis et al., 2019). This broad definition overlapped with a variety of other terms, such as cultural sensitivity, cultural awareness, cultural respect, cultural adaptation, and transcultural competence.

Limitations of cultural competence

Despite the breadth of this notion, many researchers and practitioners regarded cultural competence as primarily a capability that individuals develop. That is, they assumed that cultural competence entails knowledge about other cultures as well as skills and attitudes to work effectively, empathically, and compassionately with other cultures. Thus, they presumed that practitioners and employees can develop cultural competence—like they can develop some other capability, such as the ability to perform trigonometry. The following table outlines some of the adverse consequences of this perspective.

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Problem DetailsDifferentiates people from themselves

When practitioners or employees learn about cultural competence, they perceive themselves as fundamentally distinct from members of diverse communities. Hence, they might inadvertently marginalise or alienate members of these communities

Homogeneity of cultures When practitioners or employees learn about cultural competence, they may tend to homogenize some diverse cultures. They might, for instance, learn a few insights about a community—and then assume the majority of members share these characteristics. Hence, they might overlook the distinct needs and circumstances of each person.

Dismiss the forces that promote injustice and disadvantage

When practitioners or employees learn about cultural competence, they often, albeit inadvertently, ascribe the challenges that communities experience to the deficits or shortcomings of these communities. They might overlook how governments, institutions, and practices have engendered and exacerbated these challenges. They could minimize the impact of disparities in power on the capacity of communities to achieve their goals.

Diminished reflection When practitioners or employees learn about cultural competence, they sometimes overestimate the capacities to interact appropriately with diverse cultures. They may, therefore, not reflect enough on the effects of their behaviour, attitudes, or society on diverse communities.

Key features of cultural safety

The notion of cultural safety evolved to counteract many of these concerns. This notion primarily evolved in the health sector but has been extended to other fields. Like cultural competence, researchers have proposed many definitions to characterise cultural safety. Nevertheless, the essence of cultural safety is that individuals and organisations should strive to foster equity across cultures in health and other settings. The following table outlines some of the key features of

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organizations, practitioners, and employees who embrace cultural safety, as defined by Curtis et al. (2019)

Feature ExampleSensitivity to culture and disparity in power is integrated into the organization or sector

Sensitivity to culture and disparity in power shapes all policies, procedures, and practices of organizations and industries—and is not merely confined to workshops.

Cultural safety is thus systemic rather than merely the purview of individuals.

Practitioners and employees contemplate disparities in power

These individuals might, for example, consider how members of an Indigenous community might not disclose all their symptoms, because they are concerned this disclosure could affect the rights or support they receive from the government

Practitioners and employees thus consider how historical, social, and political forces may amplify these disparities in power

These individuals might, for example, realize that successful managers like to justify their privilege and thus promulgate the belief that problems in communities can be ascribed to deficits in these communities and not injustice. Hence, these managers may be reluctant to address inequities.

Practitioners and employees question their own biases, assumptions, and perspectives about other cultures

They might realize they like to believe the world is fair—and therefore tend to blame communities that are experiencing challenges on deficits rather than injustices.

Practitioners and employees listen to the perspective of clients

Similar to the notion of cultural humility, practitioners and employees attempt to enable members of diverse communities to express their preferences and to determine whether they feel safe

Practitioners and employees do not perceive themselves as competent

These individuals reflect upon their practices continually rather than believe they have achieved some expertise in cross-cultural settings

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References

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Burckell, L. A., & Goldfried, M. R. (2006). Therapist qualities preferred by sexual-minority individuals. Psychotherapy: Theory, Research, & Practice, 43, 32–49.

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Cruess, S. R., Cruess, R. L., & Steinert, Y. (2010). Linking the teaching of professionalism to the social contract: A call for cultural humility. Medical Teacher, 32, 357–359.

Curtis, E., Jones, R., Tipene-Leach, D., Walker, C., Loring, B., Paine, S. J., & Reid, P. (2019). Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition. International Journal for Equity in Health, 18(1), 174

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Diala, C., Muntaner, C., Walrath, C., Nickerson, K. J., LaVeist, T. A., & Leaf, P. J. (2000). Racial differences in attitudes toward professional mental health care and in the use of services. American Journal of Orthopsychiatry, 70, 455–464

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Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60, 353–366

Hook, J. N., & Watkins, C. E. (2015). Cultural humility: The cornerstone of positive contact withculturally different individuals and groups? American Psychologist, 70, 661–662.

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Mosher, D. K., Hook, J. N., Farrell, J. E., Watkins, C. E., Jr., & Davis, D. E. (2017). Cultural humility. In E. L.WorthingtonJr., D. E.Davis, & J. N.Hook (Eds.), Handbook of humility: Theory, research, and application (pp. 91–104). New York, NY: Routledge/Taylor & Francis Group

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