Cultural humility can be defined as: “a practice of self-reflection on how one’s own background and the background of others impacts communication, interpersonal relationships, teaching, learning, research, creative activity, engagement in leadership, etc.” (University of Oregon Division of Equity and Inclusion, 2024). That definition is relatively vague, as cultural humility is a term utilized in several contexts and situations. One might conceptualize that being a culturally humble person is to work toward understanding their own background and the background of others, and understanding how these experiences shape and impact theirs and others’ engagement with, and perceptions of, themselves, others, and the world around them.
What does this have to do with psychotherapy? As human beings who are part of various and intricate systems (familial, cultural, economic and financial, educational, judicial, etc.), we all have our own backgrounds, experiences, and history that we bring along with us throughout our lives and into the therapy space – both as clients and clinicians. In addition to this, these systems now and throughout history are marinated in white supremacy and oppression (Winston, 2020). This, importantly, applies to the field of psychology and psychotherapy as well (Winston, 2020).
White Supremacy and Oppression within the Mental Health System in the United States
There is much too much to write about the topic of white supremacy and oppression within the mental health system in the United States for the purposes of this webzine, and I have included further reading materials around these topics above the references section.
To begin, approximately 86% of psychologists in the United States are white (Perzichilli, 2020). Perzichilli (2020) summarizes that “compared with people who are white; Black, Indigenous and People of Color (BIPOC) are less likely to have access to and seek out mental health services, are less likely to receive needed mental health care, are more likely to receive poor quality mental health care, and are more likely to end services prematurely.” This disparity is not only reflected in areas of race and ethnicity. Mongelli et al. (2020), researched various factors including race, ethnicity, sexual orientation, gender identity, socioeconomic status, disability status, and immigration status and noted that marginalized communities experience an increased likelihood of experiencing the following barriers to mental health care access and treatment: lack of insurance coverage, lack of community based interventions, unequal access to evidence-based practices, stigma, language barriers with available providers, and geographical maldistribution of providers.
Again, what does cultural humility have to do with psychotherapy? Everything.
What Does Having a Culturally Humble Therapist Mean?
First and foremost, I am aware that as a cisgender heterosexual able-bodied white female, I am writing this webzine from a nuanced and privileged perspective, and recognize that the information above is lived experience for many, and is certainly not news. Having a culturally humble clinician means that your therapist is aware and has a firm understanding of the oppression and white supremacy that exist in the mental health system and systems at large, as well as ongoing reflection about how their own intersection of identities impact and inform their interactions with others, in particular, their clients.
The CDC (2022) summarizes that one practices cultural humility by:
- Examining their personal history/background and social position related to gender, ethnicity, socio-economic status, profession, education, assumptions, values, beliefs, biases, and culture, and how these factors impact interpersonal interactions
- Reflecting on how interpersonal interactions and relationships are impacted by the history, biases, norms, perception, and relative position of power
- Gaining deeper realization, understanding, and respect of cultural differences through active inquiry, reflection, reflexivity, openness to establishing power-balanced relationships, and appreciation of another person’s/community’s/population’s expertise on the social and cultural context of their own lives (lived experience) and contributions to public health and wellbeing.
- Recognizing areas in which they do not have all the relevant experience and expertise and demonstrate a nonjudgmental willingness to learn from a person/community/population about their experiences and practices.
How Do I Know If My Therapist or Provider Values and Practices Cultural Humility?
My number one suggestion to support you in connecting with a clinician that meets your needs is to interview your prospective providers. Yes, interview! You have every right to ask questions and interview anybody you are considering working with and adding to your health and wellness team. This pertains especially to your mental health provider. Oanh & Zane (2014) found that “when mental health clients felt like a cultural element was important in their care, but did not perceive it to be present, they were less satisfied with aspects of their treatment.” This goes to show just how important cultural humility is within the therapeutic relationship.
Some things to ask your potential providers as you interview could be:
- How comfortable do you feel discussing aspects of intersecting identity (race, culture, immigration status, gender identity, etc.) and systemic oppression with clients that you work with?
- How do you go about examining your own personal history, background, and social position related to intersecting identities (race, culture, immigration status, gender identity etc.) and how these factors impact your therapeutic work with clients?
- How do you go about reflecting on how therapy interactions and relationships are impacted by history, biases, norms, perception, and position of power?
- How do you go about deepening your understanding and respect of cultural and identity differences?
- What types of therapy styles or modalities, authors or ideas do you use to address client’s distress and suffering around systemic oppression they experience?
For further reading, please check out the following research and resources:
Scientific Racism and North American Psychology
The Influence of Race and Ethnicity in Clients’ Experiences of Mental Health Treatment
Narrative, Poststructuralism and Social Justice – Current Practices in Narrative Therapy
Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications
References
Centers for Disease Control and Prevention (2022). Principle 1: Embrace cultural humility and community engagement. Global Public Health Equity Guiding Principles for Communication. Retrieved from https://www.cdc.gov/globalhealth/equity/guide/cultural-humility.html.
Mogelli, F., Georgakopoulos, P, & Pato, M. T. (2020). Challenges and opportunities to meet the mental health needs of underserved and disenfranchised populations in the united states. Focus: The Journal of Lifelong Learning in Psychiatry. Retrieved from https://focus.psychiatryonline.org/doi/10.1176/appi.focus.20190028.
Oanh, M. L. & Zane, N. (2014). The influence of race and ethnicity in clients’ experiences of mental health treatment. Journal of Community Psychology, 41(7), 884-901. Retrieved from https://onlinelibrary.wiley.com/doi/10.1002/jcop.21580.
Perzichilli, T. (2020). The historical roots of racial disparities in the mental health system. Counseling Today. Retrieved from https://ct.counseling.org/2020/05/the-historical-roots-of-racial-disparities-in-the-mental-health-system/https://ct.counseling.org/2020/05/the-historical-roots-of-racial-disparities-in-the-mental-health-system/.
University of Oregon Division of Equity and Inclusion (2024). What is cultural humility? The basics. Retrieved from https://inclusion.uoregon.edu/what-cultural-humility-basics.
Winston, A. S. (2020). Scientific racism and north american psychology. Oxford Encyclopedia of the History of Modern Psychology: Oxford University Press. Retrieved from https://doi.org/10.1093/acrefore/9780190236557.013.516.
