how can multicultural competence be an ethical issuehow can multicultural competence be an ethical issue

WebThough rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. But when you attend a session on the DSM-5, CBT [cognitive behavior therapy] theory and practice, family therapy, etc., I have seldom seen any attention at all [paid] to how these sessions relate to multicultural issues. Cultural Competence 2023, American Counseling Association. Cultural competence, like ethical relativism, opposes the imperialism of clinicians enforcing their views on others.1518 Cultural competence educators are themselves cultural agents engaged in the training of students to their new culture. This type of evaluation should explore the range of corrective actions needed, from the removal of frank bias to the discussion of health beliefs and negotiation of a shared model of care. Multicultural Competence: 8 Ways This chapter presents several recommendations for ethical multicultural counseling. 13. I would also suggest participation in organizations whose missions are focused on multicultural issues. Cultural competence has had a largely unarticulated moral agenda. It calls for counselors and other mental health professionals to consider not only issues of diversity and culturally appropriate counseling strategies, but it requires counselors to tap into their own social consciousness regarding where a society and all its institutional structures education, business, health arenas have failed to provide equal opportunities and access to all its citizens. Health is determined by many factors outside the traditional healthcare setting. We accomplish this by using and teaching these competencies to others. Ethical Issues The challenges can be many: believing there isnt enough time to seek continuing education, personal resistance to stepping out of ones own comfort zone, lacking knowledge of where to start when it comes to learning new skills [and] lack of research on best practices with clients of diverse backgrounds who are facing a variety of concerns. Kennedy Inst Ethics J. Acad Med. Cultural Competence It has to start in training at the university level. Mastering multicultural awareness, knowledge and skills requires the doing the intentional practicing and experiencing of these aspects in our everyday work with our clients and students. I dont believe its reasonable, or even possible, to learn all of the nonverbal differences that exist between cultures. In short, if we are to be the central helping profession, it is our moral duty to refocus our thinking and practice. Multicultural Competence The main impediment is our tepid embrace, as physicians, of patient-centeredness.6 The process of enthusiastic engagement with the human beings who are our patients will facilitate culturally competent medical care. In the one-course model, there is a stand-alone course in multicultural counseling, and in the infusion model, multicultural counseling competencies are infused throughout the curriculum and included in each course that counseling students take as part of their degree program. Can they be taught, or must they be learned through experience? Perhaps our certification groups should focus more on this very important area in counseling. Fred Bemak is a professor and coordinator of the counseling and development program at George Mason University and director of the Diversity Research and Action Center. Part of facilitating multicultural competency is knowing what you do not know and growing with your client learning together in some cases. The value of respecting other cultures requires that health care providers embrace an essentially pluralistic perspective that allows for cultural differences. A model to enhance culturally competent care. Third, people reside in different countries. The Ethics of Cultural Competence Crandall SJ, George G, Marion GS, Davis S. Applying theory to the design of cultural competency training for medical students: a case study. Editorials of Laura Weiss Roberts, MD, MA, Addressing Race and Racism in Medical Education, Climate Change Education and Sustainability in Academic Medicine, The Role of Academic Medicine in Firearm Injury Prevention. Western bioethics and the personal ethical commitments of many medical trainees will place limits on the extent to which they will endorse pluralism and accommodation. Ethical Issue Paper on Multicultural Competency What advice would you give to counselors to address some ofthose challenges? The tension arises because the ethics of cultural competence specify a set of principles as moral goods: (1) the importance of culture in people's lives, (2) respect for cultural differences, and (3) the need to minimize negative consequences arising from cultural differences. 1998;8:42353. The profession has done a fair job in terms of getting its members to recognize that people are culturally different. We even teach in counseling programs to ask your client to tell you about his or her culture so that you can learn about [it]. Richard Henriksen Jr. is an associate professor of education in the Department of Educational Leadership and Counseling at Sam Houston State University in Texas. Acquiring multicultural competence can occur in small steps [such as] identifying a social issue or cultural factor we feel passionate about or seeking community resources to begin building a list for clients. For more information, please refer to our Privacy Policy. Academic Medicine79(4):347-350, April 2004. Davidhizar R, Bechtel G, Giger JN. In the future, I hope we can utilize some of the excellent skill-based work that Im sure is being done in counselor education across the country and work to enhance and emphasize the skills involved in becoming multiculturally competent. Confronting culture in medicine's culture of no culture. Throughout my time as a student and professional, I have seen an excellent focus in counselor education on building multicultural awareness through recognizing privilege, the many isms that exist, identity development, the importance of social justice and overall helping students to learn to see outside oftheir own worldview. They must abide by the rules, regulations, customs and laws of their country. Read on for their thoughts about the state of multiculturalism within counseling. Multicultural competence is an essential component of the clinical mental health counseling field and has increasingly become a focus for the profession in order to address disparities in mental health services. Social justice counseling discourse pushes the envelope even further. This multi cultural competence leads to enhanced and effective communication between people that can strengthen relationships. Classroom activities may not accomplish the task at hand. Research and clinical experience has shown that many clients drop out of counseling because they dont feel comfortable with their counselor. Kennedy Inst Ethics J. 12. And I knew that in order to get the importance of culture in our profession and in the lives of our clients, you had to have skin in the game. He is researching nonverbal skills in counseling as they relate to multicultural effectiveness and, along with Ryan William Green and Sarah N. Baquet, presented on that topic at the ACA 2013 Conference & Expo in Cincinnati. 15. In this sense, cultural competence and Western medical ethics are largely mutually supportive movements. 1997;72:105662. 1998;8:389401. Current research on cultural competence focuses on sensitivity to cross-cultural differences and the ability to adapt to other cultural environments (e.g., Hansen, Pepitone-Arreola-Rockwell, & Greene, 2000), or reflective awareness of cultural influences on one's thoughts and behaviors (Chao, Okazaki, & Hong, 2011). I think there is real value in knowing how to open a dialogue with a culturally different client such that you are able to explore and learn from their own unique worldview, rather than drawing from learned generalizations of their culture. 1998;9:11725. Their Web site states that cultural competence is important: An alternative answer is that it is a matter of basic ethics: Culturally competent care is a moral good that emerges from an ethical commitment to patient autonomy and justice. Fundamentalism is the view that all cultures endorse certain shared fundamental principles (e.g., human rights), which are specified in various ways and upheld across cultures. Such behavior is no longer optional or supererogatory, as was the case in the 1980s when practitioners who promoted these principles were thought to be culturally sensitive. Finally, we need to constantly attend to diversifying our profession and expanding our experiences, whether this involves recruiting students of color and males into our counseling programs or practicing in settings that might challenge us culturally. Part of dealing with discomfort and knowing where to start is the realization that you are not alone and that the profession has only fairly recently started operationalizing multicultural competence. Breast cancer patients perceptions of their husbands support in a cross-cultural context. However, Western bioethics and the personal ethical commitments of many medical trainees will place limits on the extent to which they will endorse pluralism and accommodation. The curriculum in the course my first few years consisted of theories and strategies for counseling African American clients. Acad Med. How can multicultural competence be an ethical issue Everything is global, and we are recognizing the intersectionality of individuals identities. With limited information, we need to be aware that we cannot generalize our limited knowledge to entire cultural groups. As all counseling is now defined as multicultural, all of us need to make that central in our educational efforts. If that environment includes poverty, racism, sexism, ableism or other form of injustice, we have two obligations. 18. The AMCD multicultural competencies have been established as the baseline for counselor training and provide a shared and universal foundation of awareness, knowledge and skills. 1978;88:2518. I believe the greatest challenge is learning how to step outside of your own worldview. Macklin R. A defense of fundamental principles and human rights: a reply to Robert Baker. Generally, culturally competent care will advance patient autonomy and justice. And what do you think the answer should be?. However, it has confused and perhaps misled people in making us believe that we can make counselors culturally competent by way of the classroom. The mettle of moral fundamentalism: a reply to Robert Baker. It is better to think that there is evidence of competency because competent implies that they are complete, finished. Individually, we each need to make a commitment to learning and change, but this is not enough, as we cannot do all this alone. How do counselors go aboutstanding in anothers shoes? Supervisors must start the conversation with their supervisee and not be afraid to confront their own fears of not knowing all the answers in approaching a supervisee from a different culture. We need to get it on the table rather than brushing over it. An important starting point is to clarify the values of cultural competence. Where is counseling as a profession in terms of multicultural competence? What it means for me in becoming a multiculturally competent supervisor is being aware of diversity, race, ethnicity and LGBTIQQ concerns as they relate to the supervision process. In your opinion, what is thesolution to that knowing-doing gap? In practical terms, some of the ways counselors can do this is through client and community advocacy. This is a huge step when contrasted with past decades when focused multicultural research and practice were discounted and marginalized in the mainstream literature and, subsequently, in training and practice. The truth is that you need both. First, the universal culture is our way of being dictated by the fact that we are members of the human species. Mary Bradford Ivey is courtesy professor at the University of South Florida. Social justice counseling is about advocacy and empowerment. For example, what is the culturally competent response to a patient's request of a clitorectomy for their child? Ethical multiculturalism: an evolutionary concept analysis Question: How can multicultural competence be an ethical issue as it relates to professional standards regarding competence to practice? How is multiculturalcompetence achieved? 2000;10:23960. Although we have come a long way in disseminating research about multiculturalism in counseling, we still have a long way to go, she says. Many patients have a health belief-system that associates disease with feeling sick and is oriented around brief episodes of illness. Successfully completing a multicultural counseling class or attending a diversity workshop are not endpoints in ones development as a culturally competent counselor. Summary: Todays model of healthcare has persistent challenges with cultural competency, and racial, gender, and ethnic disparities. Nonverbal communication is very closely linked with our emotional selves, and because of this, I believe it should be a critical area of focus for counselors. WebAsk an expert. Galanti GA. An introduction to cultural differences. While all of this is good, we still dont seem to know how to assess multicultural competency beyond subjective self-report processes. Part of stepping out of our comfort zone involves establishing peer networks to discuss client and professional issues in a safe way. I would strongly disagree with this and would want to expand multiculturalism to all courses. Why is cultural competence important? Once you master the skill of riding a bike, you will always be able to ride a bike, or so the theory goes. It includes being aware of, gaining knowledge and acquiring skills so that a counselor can be effective when providing therapy to their culturally diverse clients. What is the profession doing well and, conversely, where does it need to put more effort? To be an ethical and effective counselor, one must continuously push to learn more about others and oneself. This awareness frequently helps clients understand issues more fully and can take away feelings of guilt and self-harm. WebMulticultural competence is an essential ethical issue in counseling as it relates to professional standards regarding competence to practice. 1 How can multicultural competence be an ethical Brooks says counselors should view multicultural competence in a similar fashion to a professional certification. Second, our students and clients expect us to be knowledgeable because it is critical to our ethical practices as counselors. What responsibility do counselors have to find ongoing continuing education on multiculturalism, and how do they go about doing that? Examination of the literature reveals a strong mandate, for example, to remove barriers of access to medical care and to eliminate health disparities. Knowledge will set in as we practice what we have learned about multiculturalism and multicultural competencies. Cultural competence educators must be comfortable discussing this tension to help their trainees process their own feelings on these topics. All of this is really a process of gaining increased evidence of competency. Cultural Competence The ethics of cultural competence The true nature of the process by which one develops multicultural counseling competency is indeed challenging because it entails first developing global literacy. may email you for journal alerts and information, but is committed This means that we as professionals have to start challenging our teachers and workshop leaders. What responsibility do counselors have to find continuing education on multiculturalism, and how do they go about doing that? The type of counselors and experiences they have as trainees ultimately provide a model for the public that counseling could be useful to them, no matter their background or concern. In my own experience, addressing the habit has involved focusing on developing my own mindfulness and curiosity. Language barriers are obvious examples, but accommodation has far-reaching and complicated ramifications and requires an ongoing learning process and flexibility. Dr. Paasche-Orlow is assistant professor of medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. . Multicultural Competence Enter your email address to subscribe and receive an email anytime a new article is posted at CT Online. Though rarely stated explicitly, the essential principles of cultural competence are (1) acknowledgement of the importance of culture in people's lives, (2) respect for cultural differences, and (3) minimization of any negative consequences of cultural differences. Cultural competence curricula have proliferated throughout medical education. It involves asking questions to best meet client needs. Why is becoming multiculturally competent as a counselor so important? Multicultural competence is an essential component of the clinical mental health counseling field and has increasingly become a focus for the profession in order to address disparities in mental health services. How can Multicultural Competence be an Ethical Issue Other counselors believe they are automatically competent about multicultural issues in counseling because of their own backgrounds, heritage or exposure to those from other cultures. This will be the work of the future to move from politically correct rhetoric to fully understood and [to] implement meaningful training, practice, supervision and research. That was the dialogue of 20 years ago. Your message has been successfully sent to your colleague. How are multiculturalism and multicultural competencies taught in counselor education? In my opinion, although the acceptance of the multicultural competencies as a baseline for training has significantly advanced the field, there are still some serious gaps. Becoming a multiculturally competent counselor is important because problems that clients present [with] emerge from various cultures that impact them. Acad Med. Baker R. Negotiating international bioethics: a response to Tom Beauchamp and Ruth Macklin. For example, every counselor I know is aware and supportive of the multicultural competencies. Other things counselors can do in their clinical work are to use assessments that account for a clients perceptions of negative societal influences and stressors in their lives. As awareness, knowledge and skills suggest, becoming multiculturally competent requires learning and practicing, as well as seeking exposure to diverse races, cultures and worldviews. Most writing on cultural competence has depicted its purpose exclusively in utilitarian terms. The author presents his view of the ethics of cultural competence and places the concepts of cultural competence in the context of Western moral theory. (Sue, Arrendondo & McDavis, 1994; Sue Danica Hays is an associate professor and chair of the Department of Counseling and Human Services at Old Dominion University. These strategies help to dismantle the notion of expert counselor and provide a model of interpersonal growth for clients. Angela Coker is an associate professor and clinical mental health counseling program coordinator in the Department of Counseling and Family Therapy at the University of Missouri-St. Louis. Counselors-in-training might be required to live in a home or community that they or someone else perceives [as being] culturally different from them. Thus, as graduates become licensed and obtain their supervisory credentials, there is usually no requirement of obtaining CEUs related to multicultural understanding. The more pieces of the puzzle you have in place, then the closer and closer you are to fully understanding that person, and the more effective you can be with your helping. 1998;76:226. This affects their psychological and, often, physical well-being. 2000;15:5038. Euro-Americans are often diagnosed with more mood disorders. How can multicultural competence be an ethical issue To probe this issue further, Counseling Today contacted several ACA members who have studied, researched or worked in the area of multiculturalism. Such a move would inextricably place it at odds with mainstream Western medical ethics. Fourth, there are regional differences in each country. More clinical research and practical techniques need to be implemented within the educational and field placement settings. Multicultural Competence This chapter presents several recommendations for ethical multicultural counseling. Health is determined by many factors outside the traditional healthcare setting. The major challenge to developing multicultural competency involves living ones life in a manner that reflects a commitment to continually expanding ones cultural comfort zone to include knowledge of and active interaction with people from diverse cultural backgrounds. Your email address will not be published. How do you see thathappening in practical terms? 6. Facilitating health care is complex enough for patients who are interacting in their primary language and do not need to adapt to different social conventions or bureaucratic procedures. Supervisors also have so many roles, including monitoring client welfare, professional development [and] being a teacher, mentor, advocate and facilitator of self-awareness and self-exploration, that we need to integrate multicultural competencies in all of these roles for our supervisees. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Stay in the loop! Explicit awareness of the medical community as a doctor culture is an important element of cultural competence education and may facilitate the student's exploration of pluralism.9,10. I think we have to have authentic, honest discussions not politically correct discussions. Kennedy Inst Ethics J. She offers the concept of ambiguity as an example. And, of course, then it extends to ACA, leadership forums and the like. 14. This is quite a challenge for many of us. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Detached mastery of particular cultures is never, in and of itself, the goal of cultural competence.4 Instead, the physician's essential purpose in learning about patients cultures is to develop tools for insight and improved working relationships with each particular patient.5 Normative conceptualizations of a given culture's health beliefs and folk illnesses can be useful tools, but they cannot substitute for good communication. You had to feel that you were part of all this. Ultimately, knowledge about a patient's own preferences should guide decision making. Other ways of staying current with respect to issues of multiculturalism are through their own research/scholarship production and professional development activities. Instead, he says, remaining multiculturally competent requires constant work, study and development as counselors move through their careers. Fifth, most people in the United States and other countriesare born into a racio-ethnic culture. Community involvement might enable the counselor to know that the person or persons first thought to be culturally different are just like them. Second, counselor educators conduct the bulk of the research. We need procedures that allow counselor educators and supervisors to observe the behaviors of students and practitioners in cross-cultural contexts and then assess the extent to which these exhibited behaviors reflect multicultural competency. Can you share a tip or two for how to do that? Supporting the moral development of medical students. She coauthored Developing Multicultural Counseling Competence: A Systems Approach with Bradley T. Erford, the second edition of which Pearson published earlier this year. The biggest challenge in attempting to become multiculturally competent involved my moving beyond viewing multicultural counseling from a very narrow racial/ethnic lens that focused exclusively on the issues and challenges facing African American clients. An essential tension appears to exist for the ethics of cultural competence, mainly between the claims of fundamentalism and multiculturalism, as indicated in the figure. In Western cultures, counselors are taught that when a client asks a question, the counselor should reflect it back, saying something along the lines of, What do you think the problem is?