Do We Need Multicultural Counselling?
Here is a scenario: a Chinese woman in Australia decided to seek counselling therapy because her doctor has recommended this treatment for her prolonged “sadness”.
The Chinese woman often felt weak with low motivation, found herself brooding unusually more, and lost weight due to low appetite. The woman was confused as taking medicine and exercising regularly did not help. The counsellor aided the woman with navigating her emotions but did not make much progress. After a few sessions, the woman wanted to discontinue the counselling service as she claimed, that “just talking about her feelings did not cure her illness” and that the “sessions went nowhere and were tiring.”
Observation and Understanding of Interests
In Chinese traditions, physical and mental health are understood holistically. Physical and mental health disorders are understood as irregularities with the bodily meridian system. The meridian system is a circulation system much like our cardiovascular system, and Chinese practitioners believe that qi (air/lifeforce) flows throughout the body. The physical body is understood as a microcosm in tune with the wider universe, and everything is in balance with nature as designed. Even the mind and the body are seen as the part that requires balance. Hence, treating mental health disorders meant treating the physical body; treating the body would realign the “mind”.
The “therapy” in Chinese culture seems very different from the Western perspective of therapy. Although the explanation above may sound like a form of physical therapy, in some cultures the approach to psychotherapy overlaps with physical therapy. The Chinese woman from the scenario expected professional advice on treating physical health. Although the counsellor may have understood her symptoms as signs of depression, the woman understood it as irregularities with her physical health. The woman did not expect “talking” as a form of treatment and cancelled the service due to a misunderstanding.
What should the counsellor have done in this scenario?
Multicultural Counselling and Cultural Competency
An ambiguous answer to the question above depends on your understanding of therapy. If therapy means for the practitioner to empathise with the client, give insights and guidance, and offer space to explore the self, then you are most likely using a Western approach. However, if therapy means much broader to you, like involving consolation, moral counsel, education, confession, purification, clarification, spiritual guidance, remission of sins, or discovering one’s nature as a human being, perhaps you might understand different therapy approaches from different cultures.
The concept of therapy or “healing” can vastly differ from culture to culture. Multiculturism is not only about race, ethnicity, age, sexual orientation, religious beliefs, or socioeconomic status, but it’s also about multidimensional aspects of worldview, cultural identity, social norms, interactions with others, emotional and physical boundaries, and even positive and negative lived experiences.
As you can see from above multicultural counselling can be very diversified and even complex. However, this is why it’s important to start building up your cultural competency.
Cultural competence in mental health services is the awareness, strategy, and practices needed by organisations and professionals to provide for multicultural populations high-quality care that is safe, culturally centred, evidence-based, and equitable (Dreachslin, 2012). It is about providing a culturally sensitive service and reducing the social disparities in healthcare. The definition may differ from organisation to organisation, but they all have these similarities (Constantinou et.al, 2022):
- Respectfulness
- Empathy
- Diversity awareness
- Reflection on own biases
- Knowledge about social determinants of health, ethical, and human rights approaches
- Attentive listening
- Understandable communication
- Individual-needs-based care
- Finding solutions with the patient
- Professional work with interpreters
Culturally Diverse Approach for Practitioners
By now, we can acknowledge that cultural competency is important, but how do we practice that knowledge? The most basic skill required by all professions is communication and cross-cultural communication is the most crucial skill to develop especially in a multi-cultural country like Australia.
Cross-cultural communication is simply communication between individuals or groups from different cultures. The definition can even be extended to the study of how culturally diverse groups of people communicate. This study goes beyond just learning about a second or third language, it is about learning the verbal and non-verbal communication styles and understanding communication between two different cultural contexts.
For example, the expression of time and place differ in grammar structures across different cultures. The expression of time and place is often placed at the end in English (unless emphasising):
“I had a delicious taco on Tuesday.”
In some other cultures, the expression usually goes at the beginning of the sentence and, when directly translated, reads as such:
“On Tuesday I had a delicious taco.”
Another example, different cultures may have different styles of receiving instructions. There are cultures that need context before the action:
“If the number shows 5, press and hold the button.”
Some cultures read the instructions fully before the action:
“Press and hold the button if the number shows 5.”
Although the above example doesn’t seem to make much of an impact in communications, it demonstrates that cross-cultural communication isn’t just about learning another language. It requires understanding and a certain degree of adaptation to the target culture’s schema (Warren, 2005). It means to understand the language but also the conscious worldview from the perspective of the target culture.
It can be daunting to work in the healthcare field when you know there’s so much to learn about cultural diversity. But there are many resources out there to help you start cultivating that multicultural competency. Here’s a short list of some examples you can provide in enriching multicultural training sessions (Dreachslin, 2012):
- Include a broad and inclusive definition for culturally diverse groups. The aim is to address the different characteristics and values of a variety of groups and understand the needs of these groups.
- Cultural competency is an ongoing and developmental process, it cannot be covered in a single training program or courses. There’s much more to discover than a single training program or course! As you study further and cultivate your cultural awareness and sensitivity, you will discover the intricate beauty of complex cultures.
- Following the point above, training should aim to be more specific to profession-related disciplines. Sometimes, having topic-focused training more related to your field of healthcare could be more beneficial than covering a wide range of topics.
- Instead of theories, training should focus on knowledge of skills and facts on practical applications of cultural competency.
- Cultural competency knowledge and skills can be included in other types of training. Many healthcare organisations will have ongoing professional training, and integrating cultural knowledge and skills can be an effective strategy that reveals overlooked aspects of your service.
- Feedback and self-assessments are great ways to become more culturally competent. Professional development requires constant feedback and assessments, and cultural competency can be trained similarly.
- Following the point above, feedback is more effective if they are shown with empirical data. It could be difficult to implement, but having evidence could give a better understanding of the progress and effectiveness of cultural competency training.
Cultural competency training should be followed by support from your healthcare organisation. Supports could include cultural information materials, interpreters, translated materials, etc. Knowing is only useful when it is put into practice, and having the support can accentuate cultural competency.
Article by Matthew Jung
References
Constantinou, C. S., Andreou, P., Constantinou, C. S., Andreou, P., Nikitara, M., & Papageorgiou, A. (2022). Cultural Competence in Healthcare and Healthcare Education. MDPI – Multidisciplinary Digital Publishing Institute.
Dreachslin, J. L. (2012). Diversity and Cultural Competence in Health Care: A Systems Approach. John Wiley & Sons, Incorporated.
Palmer, S., & Laungani, P. D. (Eds.). (1999). Counselling in a Multicultural Society. SAGE Publications, Limited.
Warren, T. L. (2005). Cross-cultural communication: Perspectives in theory and practice. Taylor & Francis Group.
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