A Mental Health Clinician’s View of Cultural Competence Training

Abstract

Let me first congratulate the authors on excellent contributions to a relatively unsettled and unsettling area. Most clinicians and faculty members accept that we should be practicing and teaching cultural competence, but how should it be done? These papers add considerable substance to a field dominated by platitudes. While illuminating many of the consternating dilemmas, the authors are remarkably forthright about the mixed results of sincere efforts to teach cultural competence. Should we focus on specific cultures, on unique individuals, on the clinician’s biases, or on the system? As the U.S. speeds toward diversity and multiculturalism, these issues require extensive exploration. We are fortunate to have the current authors as intrepid guides. For this commentary, I have been asked to consider some of my own experiences as a practicing psychologist, psychiatrist, and services researcher over the past four decades. Tolstoy described his life as one of obsessional devotion to work and duty interrupted by rare emotional epiphanies, such as the birth of a child, which profoundly changed his understanding of people, relationships, and meaning. So it has been with my understanding of cultural competence and mental health. In the following, I describe some of the moments of awareness. As a young person growing up in rural Florida, I never encountered African Americans in the segregated schools I attended but worked with them during the summers on farms. I was often shocked to hear about their lives, dominated as they were by poverty, lack of opportunity, and general resignation to American Apartheid. Later at college in the Northeast, I encountered race riots that left the inner cities all around our small college in flames. My African-American classmates shunned those of us who were white. In addition to these shock waves, the feminist movement, the anti-war protests of the 60 s, and the entitlement of Ivy League elitism—all surrounding me daily—were equally foreign. None of these quite