What is cultural competence?
When addressing racism within health care, the term cultural competence—the ability to understand, appreciate, and interact with people from cultures or belief systems different from your own—has become commonplace, starting in the 1990s, and when it comes to the addressing of mental health, lack of cultural competence is one off the biggest barriers to continued treatment.
Traci S. Williams, PsyD, board-certified clinical psychologist with Healthy Wealthy Roots, says that for her, cultural competence “is a way of being able to align with and communicate to clients, ‘I see you. I understand what has shaped you.’”
Jasmine Reed, PsyD, clinical psychologist with Ubuntu Psychological Services and Arameh Anvarizadeh, OTD, OTR/L, FAOTA, and associate professor of clinical occupational therapy at the University of Southern California, emphasizes the need for terms that incite more action, leaning towards phrases like cultural humility, responsiveness, and fluidity.
“Moving past [competency] to humility is a lifelong commitment and reflective journey to self-evaluation and critique to address power imbalances,” Dr. Anvarizadeh says. “You will never be an expert, but our role is to be lifelong learners and to come to a space to learn, to ask questions, and to know it’s okay to feel uncomfortable.”
Regardless of how you label it, connecting with a provider that can empathize with your experiences can be crucial in reaching mental wellness.
The importance of cultural competence and responsiveness in mental health care
Dr. Reed believes cultural competency fits into mental health care for many reasons, ranging from different communication styles to respecting someone else’s lived experience. Dr. Williams says understanding fostered between a client and therapist leads to stronger bonds and increased therapeutic efficacy.
Trust is essential for all client-provider relationships, but the history of medical racism is a barrier specific to marginalized groups. In fact, studies suggest that medical distrust leads to worse overall health and that diversity within health care settings contributes to improved patient outcomes.
Dr. Reed says not meeting the needs of marginalized clients due to a lack of cultural competency can cause lasting harm. “This [lack of training in cultural competency] can lead to misdiagnosing, missing potential safety issues, devaluing the experience of the client, or perpetuating potential negative experiences minority clients may already experience in a Eurocentric world,” she says.
What is health care’s responsibility?
Less than 2 percent of American Psychological Association Members are Black. The APA currently boasts more than 146,000 members, and while the association issued an acknowledgement (and apology) in regards to the racism inherent in the practice of psychology, and put in place steps to create more equity and inclusion initiatives—in particular focusing on the advancement and acceptance of new members, the fact remains that very few members are currently Black.
And while the association acknowledges the extreme disparity and the longstanding history of racism within the field, this history affects both practitioners and their clients. At best, it leaves students and providers unequipped and undersupported and their clients without adequate resource options.
“A lack of cultural competence can leave clients feeling misunderstood and dissatisfied. It can disrupt the therapeutic process and impact the ability of the client to experience positive changes in their lives,” says Dr. Williams.
Education and training on cultural sensitivity and discrimination vary depending on the institution, sometimes failing to rise above a surface-level, one-time diversity or sensitivity training.
Dr. Reed talks about how nuances exist even among those with shared backgrounds, so a one-size-fits-all “solution” to discrimination doesn’t cut it. “Our traditional education falls short when it comes to bias and cultural sensitivity training because we primarily focus on training as a way of checking off a box,” she says. “To have been taught that and then believe that having diversity training is sufficient enough to undo all of the conscious and unconscious biases that we have adopted from these ‘isms’ of our culture is unrealistic.”
Often when it comes to health care settings, an in-depth analysis of biases and a willingness to self-reflect are needed to truly engage in cultural responsiveness. Without this, written diversity and inclusion statements are nothing but a performative disservice to Black practitioners and their clientele.
“Healing in the face of disadvantage requires working with a provider who understands and is empathetic towards the nuances of Black history and culture.”— Traci S. Williams, PsyD, board-certified clinical psychologist
Why is cultural competency important right now?
Some may wonder why there’s currently such an emphasis on cultural competency in health care.
Yes, this generation comes with technology that’s provided a new-age addition to a centuries-long problem of racism (e.g., being able to visually show and share things like police brutality fueled by racism and other overt racist acts). But, the need for cultural responsiveness and representation has always been present.
“As a collective, historically, Black people have endured significant oppression, dehumanization, and violence. Present-day prejudice and stigma impact the mental health of Black people,” Dr. Williams says. “Healing in the face of disadvantage requires working with a provider who understands and is empathetic towards the nuances of Black history and culture.”
How can you find a culturally competent therapist?
Because of the lack of Black practitioners coupled with barriers to accessing care, it can be tough to find a mental health provider that you connect with.
Luckily, a few Black-run and centered organizations and foundations are tackling this issue. Some examples of resources and directories include:
There is still work needed when it comes to representation and increased cultural competency within mental health care. But, with the help of these Black-led foundations, organizations, and search-based sites, finding a therapist that meets your needs is that much more accessible.
This story is a part of Black [Well] Being, examining the state of Black health and well-being in the U.S.—and those working to change outcomes for the better. Click here to read more.
