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Forging Spiritual and Cultural Competency in SpiritualCare-Givers: A Response to Fukuyama and Sevig andAndersonMarsha Wiggins Frame PhD aa University of Colorado at Denver , Denver, CO E-mail:Published online: 17 Oct 2008.

To cite this article: Marsha Wiggins Frame PhD (2004) Forging Spiritual and Cultural Competency in Spiritual Care-Givers: AResponse to Fukuyama and Sevig and Anderson, Journal of Health Care Chaplaincy, 13:2, 51-58, DOI: 10.1300/J080v13n02_04

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Forging Spiritual and Cultural Competencyin Spiritual Care-Givers:A Response to Fukuyamaand Sevig and Anderson

Marsha Wiggins Frame, PhD

KEYWORDS. Multicultural chaplaincy, religion, spirituality

In their articles, Anderson and then Fukuyama and Sevig make con-vincing cases for the need for health care chaplains to become competentin spiritual and cultural diversity. As a United Methodist clergywomanfor nearly 30 years, and as a counselor educator for the past 10 years, I

Marsha Wiggins Frame is Associate Professor and Chair of Counseling Psychologyand Counselor Education, University of Colorado at Denver, Denver, CO (E-mail:mframe@ceo.cudenver.edu).

[Haworth co-indexing entry note]: “Forging Spiritual and Cultural Competency in Spiritual Care-Givers:A Response to Fukuyama and Sevig and Anderson.” Frame, Marsha Wiggins. Co-published simultaneouslyin Journal of Health Care Chaplaincy (The Haworth Pastoral Press, an imprint of The Haworth Press, Inc.)Vol. 13, No. 2, 2004, pp. 51-58; and: Ministry in the Spiritual and Cultural Diversity of Health Care: Increas-ing the Competency of Chaplains (ed: Robert G. Anderson, and Mary A. Fukuyama) The Haworth PastoralPress, an imprint of The Haworth Press, Inc., 2004, pp. 51-58. Single or multiple copies of this article areavailable for a fee from The Haworth Document Delivery Service [1-800-HAWORTH, 9:00 a.m. - 5:00 p.m.(EST). E-mail address: docdelivery@haworthpress.com].

http://www.haworthpress.com/web/JHCC 2004 by The Haworth Press, Inc. All rights reserved.

Digital Object Identifier: 10.1300/J080v13n02_04 51

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applaud the intersection of spiritual and cultural diversity with pastoralcare.

Anderson’s five dimensions of spiritual and cultural competency area useful beginning for the journey toward chaplains being equipped toprovide pastoral care to a variety of persons from a wide range of reli-gious, spiritual, and cultural contexts. The cases he provides illustratewell the complex web in which chaplains often find themselves.

Fukuyama and Sevig are accurate when they speak of spirituality andreligion being embedded in culture, and in their careful descriptions ofcultural diversity and delineation of the distinctions between religionand spirituality. The themes in their article parallel closely my ownwork (Frame, 2003). In response to Anderson’s steps and Fukuyamaand Sevig’s key points on the journey, I offer specific strategies andtools that may assist chaplains in acquiring spiritual and cultural compe-tency.

SELF-AWARENESS

One of the strengths of clinical pastoral education (CPE) is experien-tial learning with its emphasis on integrating cognitive and emotionalaspects of training with theological reflection. Thus, issues related tothe self-of-the-chaplain are prominent. Becoming competent in work-ing with persons from diverse spiritual, racial, ethnic, and cultural back-grounds requires intensive self-reflection. Indeed, competency in thisarena is predicated on spiritual care providers’ confronting their ownracism and their religious/spiritual biases. Essentially, this process isakin to repentance in that it involves practicing metanoia, that is, turn-ing around and going a new way. For Caucasians, confronting racisminvolves challenging the ways that they consciously or unconsciouslymaintain the attitude that people of color are inferior or that thesegroups’ differences are unacceptable (Batts, 1998). For people of color,it means acknowledging internalized racism and the self-deprecationthat may accompany it. Addressing religious/spiritual bias involves ex-

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amining ways in which spiritual care providers may use their own reli-gious or spiritual worldview as the standard against which all others aremeasured. It means giving up the notion that our beliefs and practicesare the only path to the divine. Moreover, coming to terms with oneselfand one’s own spiritual and cultural web requires recognizing the waysin which being a member of the dominant culture confers power andprivilege that is not available to marginalized groups. For example,when White professionals of either gender enter a hospital or otherhealth care setting, they are less likely to be viewed with suspicion thantheir counterparts who are people of color. When representatives ofJudeo-Christian religious groups practice their faith in public, usuallythey are not seen as peculiar or heretical. Thus, power and privilege op-erate to exclude and penalize those who are in the minority in terms ofrace, ethnicity, culture or spiritual perspective.

Knowing one’s own spiritual and cultural set suggests the need forchaplains of all cultural groups and religious/spiritual worldviews toclaim their heritage and the values associated with it. For people ofcolor, this assignment may be accomplished more easily than forWhites because the latter often believe they have no particular culture orethnicity–that these terms apply only to people of color (Giordano &McGoldrick, 1996). One way of getting in touch with one’s cultural andreligious/spiritual history is for seasoned chaplains as well as those intraining to create cultural (Hardy & Laszloffy, 1995) and spiritual(Frame, 2001) genograms. These family maps provide graphic illustra-tions of the cultural and spiritual roots and patterns that impact individu-als and families. They also serve as excellent learning tools aboutmulticultural and multispiritual functioning. Through building culturaland spiritual genograms, participants attain visceral self-awareness ofwho they are and the myriad of influences that have shaped them. Thisbroadened perspective is a critical step in achieving multicultural andmultispiritual competency.

The importance of acknowledging the limitations of one’s competencyand seeking assistance should not be overlooked. Such awareness does notcome without a struggle that demands deep introspection, firm account-ability, and on-going emotional support. Being aware of one’s limits often

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results in the necessity for spiritual caregivers to seek assistance from othersskilled in working within a particular cultural, ethnic or religious community.

KNOWLEDGE OF OTHERNESS

Another aspect of becoming competent in spiritual and cultural realitiesinvolves the ability to learn about and embrace difference. Part of this learn-ing is didactic and cognitive. It requires reading and research to gain infor-mation about races, cultures, religions, and spirituality different from one’sown. Helms and Cook in their book, Using Race and Culture in Counselingand Psychotherapy (1999) describe the sociopolitical histories of various ra-cial and ethnic groups and provide exercises whereby readers can becomemore culture-sensitive. McGoldrick, Giordano, and Pearce (1996) in theiredited volume, Ethnicity and Family Therapy provide a wealth of informa-tion about a wide range of ethnic groups’ values, beliefs, practices, and howthey respond to psychological interventions. Richards and Bergin (2000) dis-cuss the religious and spiritual belief systems of Christian, Eastern, and Eth-nic spiritualities and assist psychotherapists and spiritual care givers inworking with these populations. Amassing literature and gathering facts,however, is not sufficient. Learning about difference must also be experien-tial. It involves cultivating relationships with persons of divergent religions,races, ethnicities, and cultures. It means intentionally immersing oneself inthe festivals, rituals, celebrations, and routines of those who hail from differ-ent traditions from our own. Learning about difference experientially meansattending conferences and gatherings sponsored by racial, ethnic, religious,and cultural groups that are unfamiliar to us and by so doing beginningto be able to take another perspective.

SKILL ACQUISITION

Being competent to address religious/spiritual and cultural diversityrequires not just self-awareness and knowledge, but the ability to act

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professionally and communicate effectively with persons differentfrom ourselves. For example, many spiritual care givers and counselorshave been trained in attending behaviors including minimalencouragers (MmHumm) and reflections of feelings. However, thesecommunication styles either may not exist in nonwhite cultures or mayfeel ingenuine (Helms & Cook, 1999). In addition, some caregivers usea nondirective communication style when some patients might prefermore directive approaches (Borrego, Chavez, & Titley, 1982). Lan-guage, too, may create communication difficulties. When English is apatient’s second language, she or he may resort to “language switching”(Helms & Cook, 1999, p. 193) in a crisis. That is, the patient may needto speak in his or her first language to be delivered from the stress-re-lated paralysis of being caught between two languages. Chaplains whoencourage clients to speak their first language and later translate facili-tate communication across cultural differences. Likewise, patients whoengage in glossolalia (speaking in tongues) during spiritual ecstasy mayneed to be encouraged to express themselves and then interpret for thechaplain if this practice is not within his or her tradition. In these ways,spiritual care givers may pay attention to communication styles attrib-uted to different cultures or spiritual practices.

ASSESSING BARRIERS

Regardless of spiritual care providers’ and patients’ backgrounds, of-ten there will be contextual and relational barriers that must be notedand addressed. Social and economic class, position of power in the insti-tution or the society, gender, sexual orientation, physical, and mentalability and other differences can be viewed as barriers to providing pas-toral care to patients and their families. Such obstacles may create is-sues of trust in both the spiritual care provider and the recipients of thatcare. At times, it may be appropriate to address the discomfort concern-ing difference with patients and their families. Open acknowledgement

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frequently is the first step toward improved communication and mutualunderstanding.

WILLINGNESS TO LEARN

Certainly an attitude of openness and receptivity is a prerequisitefor success in multispiritual/cultural interaction. Care-givers’ genu-ine respect for difference can create a “transitional zone” betweencomfort and discomfort. However, I disagree with Anderson (thisvolume) regarding the strategy of inviting the patient to “teach him[the chaplain] more about valued traditions and beliefs.” It seems tome that it is the duty of the chaplain to learn about cultural and reli-gious difference in another setting and not to place that burden on hispatient. Indeed, Arredondo et al. (1996) state specifically that onestrategy for becoming more multiculturally competent is to “acceptthat it is your responsibility to learn about other cultures and implica-tions in counseling and not to expect or rely on individuals fromthose cultures to teach you” (p. 24). Moreover, it is extremely tiringand an energy drain when patients and other care recipients mustshoulder the burden of educating persons of other cultures aboutthemselves. Such an obligation becomes an albatross and a hin-drance to cultural competency. Instead, seeking support from othersfrom one’s own culture who also are learning can be helpful. In addi-tion, engaging a mentor from another culture who is also working onmulticultural/spiritual competency is useful for reciprocal benefits(Arrendondo et al., 1996). Consulting with professionals from cul-tures and religious/spiritual traditions different from one’s own, es-pecially indigenous healers, can expand competency in these areas(Helms & Cook, 1999). For example, curanderos in Mexican cultureare folk healers who are trusted for assistance with maladies thathave psychological components (Falicov, 1996). American Indiantraditional healers use spiritual legends and practices to bring pa-tients into harmony with their environment (LaFromboise, 1988).The Asian Indian tradition of Ayurveda relies on the unity of body,mind, and spirit (Das, 1987). Collaboration with such healers may

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bring about wholeness for patients and families undergoing thestress of an illness.

In conclusion, Anderson, and Fukuyama and Sevig, have soundedthe call for spiritual care providers to take seriously the need to be-come competent when working with patients and others from differ-ent backgrounds and traditions. The challenge, then, is to be intentionalabout gaining self-awareness, knowledge, and skills to increase cul-turally and spiritually effective practice. This work involves diligentand often painful self-reflection, active engagement with disparateworldviews, willingness to suspend one’s need to be right or to func-tion as an expert, consultation and supervision with skilled trainersand mentors, and most of all, a commitment to change. The invitationhas been extended. Who will respond?

AUTHOR NOTE

Marsha Wiggins Frame is Associate Professor and Chair of Counseling Psychologyand Counselor Education at the University of Colorado at Denver. She is also an or-dained United Methodist minister and has served churches in the Florida Conferencefor over 13 years. Her research interest lies in the intersection of spirituality and coun-seling. Recently, she published a textbook on this topic entitled, Integrating Religionand Spirituality into Counseling: A Comprehensive Approach.

REFERENCES

Arredondo, P., Toporek, R., Brown, S., Jones, J., Lock, D. C., Sanchez, J., & Stadler,H. (1996). Operationalization of the multicultural counseling competencies. Al-exandria, VA: American Counseling Association.

Batts, V. (1998). Modern racism: New melody for the same old tunes. Visions TrainingManual. Arlington, MA: Author.

Borrego, R. L., Chavez, E. L., & Titley, R. W. (1982). Effect of counselor technique onMexican-American and Anglo-American self-disclosure and counselor perception.Journal of Counseling Psychology, 29, 538-541.

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Das, A. K. (1987). Indigenous models of therapy in traditional Asian societies. Journalof Multicultural Counseling and Development, 15, 25-37.

Falicov, C. J. (1996). Mexican families. In M. McGoldrick, J. Giordano, & J. K. Pearce(Eds.), Ethnicity and family therapy (2nd ed). (pp. 169-182). New York: Guilford.

Frame, M. W. (2003). Integrating religion and spirituality into counseling: A compre-hensive approach. Pacific Grove, CA: Brooks/Cole.

Frame, M. W. (2001). The spiritual genogram in training and supervision. The FamilyJournal, 9, 109-115.

Giordano, J., & McGoldrick, M. (1996). European Families: An overview. In M.McGoldrick, J. Giordano, & J. K. Pearce (Eds.), Ethnicity and family therapy (2nded). (pp. 427-441). New York: Guilford.

Hardy, K. V., & Laszoffy, T. A. (1995). The cultural genogram: Key to training cultur-ally competent family therapists. Journal of Martial and Family Therapy, 21,227-237.

Helms, J. E., & Cook, D. A. (1999). Using race and culture in counseling and psycho-therapy. Needham Heights, MA: Allyn & Bacon.

LaFromboise, T. D. (1988). American Indian mental health policy. American Psychol-ogist, 43, 388-397.

McGoldrick, M., Giordano, J., & Pearce, J. K. (Eds.), (1996). Ethnicity and family ther-apy (2nd ed). New York: Guilford.

Richards, P. S., & Bergin, A. E. (2000). Handbook of psychotherapy and religious di-versity. Washington, D.C.: American Psychological Association.

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