Sign up for alerts

Spring 2008 | Vol 11 No 3

Focus

Cultural competence on the front lines

The need for cultural competence in practice reflects the realities that health care practitioners face every day in their work with clients with mental health and substance use issues.

CrossCurrents recently asked you to send us your thoughts on how you see culture, specifically, issues of ethnicity and race, manifest in your work. Here’s what some of you had to say:

I have had clients from cultures that do not accept women as therapists or that allow only a therapist of the same sex as the client. It is also important to be aware of religious rituals, for example, those involved in Ramadan, when doing home visits or group therapy.
— addiction therapist, Ottawa, ON

It is important to be aware of dietary requirements or restrictions related to culture or religion and to respect them, for example, in residential treatment.
— alcohol rehabilitation counsellor, Brookline, Massachusetts

We have an Aboriginal client who speaks of his interaction with “spirits.” We are treating him for schizophrenia, but we need to respect the strong Aboriginal connection to spirits. We must keep in mind that the goal is to treat the illness not to medicate the client’s cultural beliefs.
— concurrent disorders specialist, Edmonton, AB

In one-on-one therapy, I am often aware of differences in communication and around boundary issues and self-disclosure. I have a client in whose culture avoiding eye contact is a sign of respect, not detachment or discomfort. I’ve witnessed different levels of comfort with self-disclosure – clients’ comfort with how much both they and I disclose within the therapeutic setting.
— addiction counsellor, Windsor, ON

I had a client who was a recently widowed older Italian woman. She would only wear black, which is a gesture of respect and grieving. However, I found myself judging her for doing this, to the point of wanting to tell her to try to wear colour for a day. I had to stop myself.
— community mental health nurse, Hamilton, ON

Racism is an experience we continue to struggle with in our work. We deal with countless cases of youth whose issues have not been properly diagnosed. We recognize the oversight involved in mis-diagnosing the psychological impact of experiences of devaluation, dehumanization and loss of the individual’s community.
— social worker, Halifax, NS

We had a black youth who was a practising Rastafarian. He maintained a scruffy, unkempt look, which when combined with him being a black man, was threatening to some of our white female staff, who had to check their personal biases. This shows how issues of race, culture and gender are intertwined.
— youth outreach worker, Toronto, ON

Sometimes our agency policies conflict with the cultures of our clients. We have a policy that youth must save a certain percentage of their earnings. This assumes that one’s earnings belong to the worker, which is not true in all cultures. Some youth tell us they cannot save the specified amount because they must send money home to support the family. Clients have been discharged for not complying with policy.
— youth outreach worker, Toronto, ON

We see kids involved in fire setting. We need to be aware that fire is used in socially and traditionally sanctioned ways in rural Native communities, so recommending that the child not be involved with fire is unrealistic when fire is a way of life. Recommendations have to shift to ways of supervising and training the child to use fire as safely as possible.
— child psychiatrist, Thunder Bay, ON

I have had to examine how some of the theories informing my clinical practice apply across cultures. For example, I have worked with clients in whose culture it is common practice to “give” children to grandparents to raise for several years as an act of respect. It made no sense to criticize this cultural practice but it did seem helpful to discuss children’s attachment needs.
— mental health counsellor, Hamilton, ON

Clients who immigrated in their teens or early adulthood may be hit with depression after having postponed grieving the loss of their country of origin. It may occur years later, after they have worked hard to build lives in Canada.
— psychologist, Kitchener, ON