Rethinking cultural competence: Insights from indigenous community treatment settings

Abstract

Multicultural professional psychologists routinely assert that psychotherapeutic interventions require culturally competent delivery for ethnoracial minority clients to protect the distinctive cultural orientations of these clients. Dominant disciplinary conceptualizations of cultural competence are "kind of person" models that emphasize specialized awareness, knowledge, and skills on the part of the practitioner. Even within psychology, this approach to cultural competence is controversial owing to professional misgivings concerning its culturally essentialist assumptions. Unfortunately, alternative "process-oriented" models of cultural competence emphasize such generic aspects of therapeutic interaction that they remain in danger of losing sight of culture altogether. Thus, for cultural competence to persist as a meaningful construct, an alternative approach that avoids both essentialism and generalism must be recovered. One means to capture this alternative is to shift focus away from culturally competent therapists toward culturally commensurate therapies. Indigenous communities in North America represent interesting sites for exploring this shift, owing to widespread political commitments to Aboriginal cultural reclamation in the context of postcoloniality. Two examples from indigenous communities illustrate a continuum of cultural commensurability that ranges from global psychotherapeutic approaches at one end to local healing traditions at the other. Location of culturally integrative efforts by indigenous communities along this continuum illustrates the possibility for local, agentic, and intentional deconstructions and reconstructions of mental health interventions in a culturally hybrid fashion.

“Shattering culture”: perspectives on cultural competence and evidence-based practice in mental health services

“…Transcultural Psychiatry 52 (2) and Gone (2012), who argued that this approach is unlikely to yield useful cultural information, we actually found the opposite. For example, a White female primary care physician we interviewed strongly resisted documents instructing clinicians to use the "ethnic food pyramid" when evaluating the dietary habits of her patients.…”

“…Wendt and Gone argue that this approach, which effectively counters the tendency to overessentialize and improperly apply group-based cultural characteristics to individual patients who depart from group norms, "may come at the cost of the ability to identify any culturally distinctive tactics or strategies at all" (2012, p. 210). Wendt and Gone's (2012) strategy to combat this polarity is to question the cultural neutrality of the process-oriented approach and to explore innovative, locally controlled treatment programs in indigenous community settings as an alternative way of examining the cultural problematic present in medical encounters. By focusing on real-world cases of treatment modalities and interventions, they found that many putatively emic treatment modalities actually are a hybrid combination of general psychotherapeutic practice and locally determined, culturally tailored treatment.…”

“All my relations”: experiences and perceptions of Indigenous patients connecting with Indigenous Elders in an inner city primary care partnership for mental health and well-being

“…42 For many Indigenous patients, the legacies of colonization have left a deep epistemological chasm that cannot be easily traversed by health care professionals, no matter how well intended or culturally competent. 43 Participants repeatedly emphasized the importance of shared histories of colonial oppression as a "common ground" for building trust and openness with the Elders, enabling them to establish therapeutic alliances they had not previously experienced with health care providers. In this way, relational experiences of trust with the Elders seemed to lessen epistemic mistrust that previously acted as an obstacle to care.…”

Cultural Psychiatry: Research Strategies and Future Directions

“…This notion has been taken up by indigenous health researchers, planners and advocates in Canada and extended to provide a general model for improving the quality of health care [90][91][92]. Research is needed to identify when and how particular models of service and modes of clinical intervention improve access to care, the clinical alliance, and outcomes for specific groups [93].…”