Cultural Humility

The better we understand how identities and power work together from one context to another, the less likely our movements for change are to fracture.

-Kimberle Williams Crenshaw

Cultural humility is the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspects of cultural identity that are most important to the [person].” (Hook et al., 2013, pg. 354). In the assigned video, the presenters describe cultural humility as having three components:

1. Lifelong learning and critical self-reflection

This component stands in contrast to a measure of cultural competence that would assume that culture can be understood in a static way. Imagine that a friend said to you, "I get you now! I know everything I need to know about you because I know you identify as x ethnicity or race and you are from y place and time and you believe z ideas about what's important and how the world works." How would you feel toward a friend who said that to you? Or a teacher, or a supervisor, or a colleague, or a judge? Cultural humility means knowing we will never fully understand another human being.

Cultural humility also means that even when we think we know what we know about another person, or family, or community, we continue to question ourselves. Let's say you and your partner are going to see a social worker to get help with parenting a child with autism. The social worker says, "I know you are thinking that because your child is diagnosed with autism, she is not ever going to form meaningful human connections. But I'm here to tell you that, based in the latest research, she can make big strides if you commit to intensive behavioral training. You need to stop thinking of your child as disabled and start thinking of her as differently abled."

All of that might sound empirically supported and politically correct, but is it culturally humble? Is it open to the other? Here, the social worker is pushing existing beliefs and not finding out where you, as a couple, are at with your daughter. Even though this example is exaggerated, in smaller ways we are all capable of shifting from being open to pushing our competence. As student-learners, you may feel extra pressure to show your knowledge. Humility is not ignorance; it is the ability to learn.

2. Recognizing and challenging power imbalances for respectful partnerships

Being culturally humble means that we avoid participating unwittingly in oppression. We are open to recognizing when we, and others around us, silence others' voices. What if your field supervisor, a male, asks you, a female, to get him a cup of coffee while you are getting client files? How would you feel? Can you respectfully seek respect? What would you say? Take a moment to think about what you would say, and how you would say it.

Or what if staff at your practicum site gossip about a certain dreaded client? "He always comes in here with a chip on his shoulder. He should stop playing the victim and start taking responsibility. He expects to get his kids back without doing any of the work, and he's continually playing the race card, acting like that's why he lost custody." How do you feel reading these words? Do you want to rush to the client's defense? Do you feel there might be some truth in these words, and feel guilty for thinking so? Being culturally humble means seeking a respectful partnership with your colleagues as well as your clients. Imagine, again, what you might say. Can you acknowledge everyone's reality at the same time?

Which of the three responses below is the best demonstration of cultural humility, and why?

Response 1“I’ve worked with a lot of clients who act like that at my previous site. The only way I could get through to them was to agree at first that they were victims, then show them how they were part of the problem, too. Do you think that might work with this client?”

Response 2“I hate to say it, but I feel like there’s some racism in how you’re talking about this client. I mean we don’t really know what his life experience is. Not that he doesn’t need to make any changes, but shouldn’t you find out his story before you judge him?”

Response 3“I feel uncomfortable with how we’re talking about this client. I recognize that I’m new at this and you all have been working in this field much longer than I have. And I can see how frustrating it is to work with clients who don’t take full responsibility for their actions. I just wonder if there’s a way to confront his self-defeating choices while still respecting him and where he may be coming from. If he sees himself as a victim there must be reasons for that, and if we can understand the reasons maybe we can help him stop being a victim. Excuse me for giving you all feedback, but I would like to hear how you feel about it.”

3. Institutional accountability

We will devote more time to this component of cultural humility next week, when we focus on social justice. For now, we will explore how to observe institutional practices through a culturally humble lens. To embody cultural humility is not merely a micro or mezzo affair. We are not only trying to be open to the other as an individual, or to speak up when interactions between micro systems (like staff and clients) are biased or oppressive. We are also noticing when policies themselves are not loving or kind. Humility is grounded in recognizing the intrinsic value of each human being and each family, and when that value is not upheld, we feel the violation. The following example from the author's experience illustrates a breakdown in institutional empathy that may more powerfully affect people who because of their cultural disadvantages, have come to expect neglect from the organizations in their lives.

Policies in Covid-19

As this is written the novel coronavirus pandemic is peaking. Hospitals are struggling with the balance between public safety and the psychological and social impact of separating loved ones. An issue came to the attention of a rural hospital ethics committee. One unit was designated as being for patients with Covid-19. No visitors were allowed. An elderly woman brought her husband to the emergency room. He was suffering from acute cardiac issues. The only available intensive care bed was on the designated Covid-19 unit, which did not yet have any patients. The attending physician in charge of the unit did not allow the woman to visit her husband, ostensibly to protect her from contracting Covid-19 and then potentially transmitting it to others in the community. With no other patients on the unit and given she had already had close contact with her husband, even if he did have Covid-19 her risk and the community’s risk would not increase if she had visited him. But in the general sense of alarm and fear of making exceptions to brand-new policies, she was barred from visiting. Her husband died without getting a chance for either of them to say goodbye.

After the fact, the ethics committee made recommendations to individualize the policy and to use technology such as Facetime to allow patients and their loved ones to connect as much as possible. Often, institutional policies are not designed to further oppress already marginalized populations, but they can still have that effect.

· Which populations do you think would be most affected by a rigid no-visitation policy?

· Could age, income, educational background, more collectivist cultural background, or language barriers have an impact?

· How would you design a visitation policy that would keep people safe from a highly transmittable virus while still honoring the need for communities to support each other and mourn together at a time of loss – especially those communities with fewer resources?

Cultural humility here means being attuned to the differential impacts of organizational policies and asking questions that shine light on those impacts. We often think of different types of institutions as having missions that are either supportive of human rights and diversity, or harmful. The reality is that all organizations, including those that are tasked with protecting, educating, and healing, are part of a society in which inequality is endemic. Think about your practicum site as if it were a person. If it is practicing cultural humility, then it too is engaged in lifelong learning and critical self-reflection, so that it too can recognize and challenge power imbalances to create respectful partnerships.

Intersectionality

Crenshaw (1991), a feminist lawyer and researcher, sought to understand why women of color experienced forms of oppression, especially intimate partner violence and sexual assault, beyond either gender discrimination or racial discrimination. She coined the term intersectionality to name the ways in which both types of discrimination combined to disadvantage women of color. She identified three ways that this happened: structural intersectionality, political intersectionality, and representational intersectionality. Structural intersectionality involves ways that society limits access to economic and social resources especially for women of color, such that their ability to escape abusive situations is much more limited than either men of color or white women. Immigration law further keeps women of color who have uncertain status from being able to leave abusive partnerships.

Political intersectionality denotes the ways that anti-racist and anti-sexist political agendas often invalidate each other and fail to account for the specific experiences and needs for legal and policy protections of women of color. Crenshaw calls on progressive movements to become more aware of the voices of women of color and understand how their experiences get lost when the sole focus of an advocacy organization is on race or gender. Representational intersectionality means the ways that mainstream culture erases aspects of the experiences of women of color by reducing them down to either gendered or racial experiences alone. When all three types of intersectionality are combined, it is easy to see how oppression of women of color continues unrecognized in its unique dimensions.

Today, the concept of intersectionality has expanded to include other identities beyond gender and race. Further, a constructivist view of identity leads us to consider not only the relationships between social systems and people oppressed along multiple dimensions, but also the ways that those intersecting identities can complicate all relationships, including that of social worker and client.

Since identity is socially constructed, the ways in which we think about ourselves, others, and the groups to which we belong are all co-determined by our multiple memberships, our roles in those groups, how we are perceived by other group members, and how we may merge with or differentiate ourselves from those ascribed roles.

Identity is not only socially constructed: it is socially maintained. Through countless verbal and nonverbal interactions, we reinforce each other's multiple identities. Think of your identity as a student-learning at your practicum site. You bring certain expectations to that role, and so does your field instructor and your colleagues there. Members of the organization may greet you in ways that seek to demonstrate that you are welcome, but also that you do not have expertise. Without being disrespectful, they are conveying the meta-message that you will be accepted so long as you know your place.

Let's say we add another identity, that of being transgender. If staff members are aware of your trans identity, they may be confused about what meta-messages to convey. You are very likely to be more of an expert on trans issues than anyone else in the organization, unless serving the LGBTQ community is part of its mission. So now, you are both expert and novice. What's more, the staff are now trying to make you feel welcome in two ways: as a practicum student, and as a trans individual. However, different staff members may feel differently. Some may not like having a student around, because they feel the organization has enough work on its hands. Others may harbor conscious or unconscious negative attitudes toward trans people. Some will feel welcoming of one aspect of your identity but not of others. How do you decode these messages? How do you respond?

As you think about these different identities, picture an actual intersection. The vehicles are your own multiple identities and those of anyone with whom you come in contact. Traffic may be heavy or light, well-regulated by signals or in a free-for-all. Some drivers will be more skilled, some less. Traffic cops are on hand and they may look the other way with certain violations by certain individuals or may profile certain drivers they have been taught to suspect. When drivers are skillful, signals are clear, police are impartial, and everyone follows the rules, does everyone get where they need to go? Not really – in our society, some vehicles (identities) have more "right of way" than others. As you enter an intersection, a space in which your identities will interact with the identities of others, is your goal simply to avoid a crash, avoid getting pulled over, or to renegotiate the traffic rules?

Now, let's shift to thinking about clients. Can you bring the same sensitivity to these nuances of social construction that you are learning to bring to your own experiences? Which identities are obvious to you, and which may be hidden from view? Are there inner conflicts among identities that need to be resolved, or is the best focus more on conflict between client identities and those of other people in their lives? Or are certain client identities being discriminated against at school at work, or in public spaces?

Think About This

Let's consider this example:

A university professor identified as gay but only her closest friends knew. She was an excellent mentor to her students, but she had trouble climbing the ladder of academic success because she avoided roles on committees and collaborative research, all to protect her identity. Feeling like an underdog, she went out of her way to advocate for students, but all the time she put into this made it difficult to do her own research. 

She constantly faced the gender bias against her as a woman in the sciences. She suffered greatly from depression because she internalized negative messages about her productivity as a faculty member, she could not afford to be open about a very important part of who she was, and she had no outlet to pursue a meaningful relationship with another woman.

As a social worker aware of how group memberships and identities are socially constructed, how would you help this professor affirm herself, find social support for constructing positive identities, and negotiate the intersections of her identities as a professor, a lesbian, and a scientist? There is no way to answer this question abstractly, because the answers lie in how she would respond to the process of exploring these identities and their social environment.

Practice Exercise

Constructing Identities

By understanding your own overlapping and conflicting identities, you can better know how to navigate intersectionality in your clients. Make a list of all the groups to which you belong in Column 1 below. Groups include formally organized groups, like your work unit, your cohort in the social work program, the yoga studio where you take classes, or the church to which you belong. Groups can also include belief systems, people with a certain skill, or cultural identities that do not have a time and place where they meet. Your extended family, of course, is a group of groups. You may be a member of several family subgroups based on living together, being more closely related, or being close in worldview. There are also group memberships that are based on intrinsic attributes, like gender identity or sexual orientation. And don’t forget social media. If following a certain politician or musical artist on Instagram is a part of how you define yourself, include that too.

Under “Qualities” put down a few adjectives or phrases that both fit with being a member of this group, and fit with how you see yourself. Finally, under “Intersections,” add other groups to which you belong and that you feel interact with this group in strong ways. A great example would be your own gender identity. Here’s what these rows of your chart might look like:

Once you have completed at least six rows of the chart, try to create a single paragraph that brings your identities together into a single description. The point here is not to succeed at integrating everything, but to appreciate how complex the process is and in how many ways you are pulled together and apart by these combined influences. You can also use this method to understand your clients – be they individuals, families, groups, communities, or organizations. The chart may help you analyze and synthesize the client scenario you use for your written assignment this week. You can also place your own identity chart side-by-side with that of your client, to more fully understand how each of you may perceive the other and the helping relationship.

Summary

We complete our focus on engaging diversity and difference this week, but as we go forward to consider advocacy for social justice, we will of course keep the ways that difference is socially constructed and used to deny human rights close to our hearts. By closely examining these two concepts and practicing applying them to hypothetical scenarios, we have encouraged you to integrate both cultural humility and appreciation of intersectionality into your engagement, assessment, and intervention with clients.

We also explored how awareness of these concepts can help you navigate different ecological levels beyond your relationships with individual clients: your own role as a student-learner within the practicum site; the ways that client identities are perceived by employees of the agency; and the ways that clients may need advocacy when institutions can fail to account for intersecting identities or fail to fulfill their mission in a culturally humble manner.

References

Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43 (6), 1241-1299.

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(3), 353-366.