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Fundamental contradictions in cultural competence.



What could possibly be amiss Verb 1. be amiss - interpret in the wrong way; "Don't misinterpret my comments as criticism"; "She misconstrued my remarks"
misapprehend, misconceive, misconstrue, misunderstand, misinterpret
 with the idea of cultural competence cultural competence Social medicine The ability to understand, appreciate, and interact with persons from cultures and/or belief systems other than one's own  (CC), that is, social workers possession of "a knowledge base of their clients' cultures" and ability to provide "services that are sensitive to clients' cultures" (NASW NASW National Association of Science Writers
NASW National Association of Social Workers (Washington, DC)
NASW National Association of Social Workers
NASW National Association for Social Work (UK) 
, 2000a, p. 9)? After all, CC sounds as inviting and benign as an Indian samosa sa·mo·sa  
n.
A small fried turnover of Indian origin that is filled with seasoned vegetables or meat.



[Hindi samos
, an Irish scone Scone (skn), village, Perth and Kinross, central Scotland. Old Scone, west of the modern village of New Scone, was the repository of the Coronation Stone (see under coronation) and the , or American apple pie apple pie

typical, wholesome American dessert. [Am. Culture: Flexner, 68]

See : America
.

The social work literature is rich in its discussions of CC, and such discussions are evident in texts that discuss international social work (Healy, 2001), social policy (van Wormer, 1997), human behavior (Robbins, Chatterjee & Canda, 2006), and micro social work practice (Leigh, 1998).The most recent Council on Social Work Education The Council on Social Work Education (CSWE) is the national association for social work education in the United States of America.

The CSWE sets and maintains standards of courses and accreditation of bachelor's degree's and Master's degree programs in social work.
 (CSWE CSWE Council on Social Work Education
CSWE Certificate in Spoken and Written English
CSWE Center for Student Work Experience
) (2008) Educational Policy and Accreditation Standards mandate schools (accredited by CSWE) to educate students at the bachelor's and master's levels on 10 core competencies, two of which emphasize the influence of culture on identity and human development (core competencies 4 and 7, respectively). Although the notion of CC has received some critical commentary (see, for example, de Anda, 1997, for a range of opinions), the place of CC in the U.S. social work curriculum appears relatively uncontested.

In this article, we hope to show that, although the notion of CC has been espoused with the worthiest of intentions for social work practice, education, theory, and research, there are conceptual tensions at its center. Our intention is to not discredit the enormous amount of work on CC that has been developed over the years. We do not recommend ignorance of global history and national and international current conditions that include genocide, slavery, oppression, racism, and gross health disparities

Main article: Race and health


Health disparities (also called health inequalities in some countries) refer to gaps in the quality of health and health care across racial, ethnic, and socioeconomic groups.
; the literature on CC that educates social workers about these issues is to be applauded. Rather, we wish to highlight some aspects of the underlying conceptual framework For the concept in aesthetics and art criticism, see .

A conceptual framework is used in research to outline possible courses of action or to present a preferred approach to a system analysis project.
 of CC that run contrary to established social work principles and practice and that we believe have been only modestly addressed previously. More specifically, our concerns lie with the CC literature that recommends practice standards concerning, or purports to educate social workers about, the values, worldviews, personality traits, and norms of racial and ethnic groups. The contradictions we identify extend to the epistemological foundations of CC, the rights and dignity of the individual, and the very question of whether a social worker can ever be culturally competent. Moreover, we are by no means alone in our desire to critically examine the conceptual underpinnings of CC; we encounter voiced reservations about the tenability ten·a·ble  
adj.
1. Capable of being maintained in argument; rationally defensible: a tenable theory.

2.
 of CC in the arenas of practice, teaching, and professional meetings (Johnson & Munch, 2006).

CC has become an established feature of social work and is found in formal (for example, NASW, 2007; U.S. CSWE publications [for example, Armour, Bain, & Rubio, 2006]) and informal social work parlance. It could be argued that CC has become entrenched within the very culture of social work and appears to have been embraced by many in the profession. This might lead to reticence in challenging the concept of CC for fear of appearing insensitive to cultural issues or even being anti--social work values. However, the established status of CC should not imply immunity from critical analysis. Indeed, there is all the more reason for this investigation; if what the social work profession takes for granted is on less than coherent and rigorous grounds, then an attempt at reassessment or remedy might be not only beneficial, but also imperative.

First, in this article, the discussion focuses on the historical context within which CC emerged. Second, a conceptual analysis of terminology related to CC is undertaken. Third, contradictions noted in the CC literature are examined through the lens of ethics and current identity politics from the field of philosophy juxtaposed with social work values, practice, education, and research. We wish to enhance and deepen the current discussion of CC by incorporating the work of Kwame Anthony Appiah Kwame Anthony Appiah (1954-) is a Ghanaian-American philosopher, cultural theorist, and novelist whose interests include political and moral theory, the philosophy of language and mind, and African intellectual history.  (1994, 2003,2005) and Charles Taylor
Charlie and Chuck are common familiar or shortened forms for Charles.


Charles Taylor may refer to: Political figures
  • Charles G.
 (1991, 1994), two of the most prominent philosophers whose works address collective identities and group rights. Although we conducted a literature review on CC using well-regarded databases (for example, Social Service Abstracts and PsychINFO, using key words such as "cultural competence" and "cultural humility"), this article does not constitute an overarching literature review of CC; rather, it is a conceptual presentation of the tensions we have identified in the CC literature.

BACKGROUND

From its very beginnings, social work has, in varying degrees, paid attention to matters related to race and ethnicity (see, for example, National Conference on Social Welfare Proceedings, 1874-1982). Settlement houses--before their decline during World War I--and the New Deal provided increasing evidence of social welfare's concern with the needs of ethnic and racial minorities (Trattner, 1998). Much of the recent discussion on race and ethnicity in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area.  arose from the acknowledgment of Eurocentric bias in the teaching of public school students about history, literature, and social science (Gould, 1995). Social work education began to address racial and ethnic disparities and culture during the U.S. civil rights movement of the 1960s (Rothman, 2008). Given the prominence of this movement in the United States in the 1960s and 1970s, discussions of culture tended to be focused on race and ethnicity, and diversity was usually taken to be synonymous with synonymous with
adjective equivalent to, the same as, identical to, similar to, identified with, equal to, tantamount to, interchangeable with, one and the same as
 acknowledging differences in skin color. This historical emphasis can still be seen in current literature on CC, although broader definitions, including, for example, sexual orientation sexual orientation
n.
The direction of one's sexual interest toward members of the same, opposite, or both sexes, especially a direction seen to be dictated by physiologic rather than sociologic forces.
 and physical differences, exist (NASW, 2007). Efforts to correct pathology-laden, stereotyped characterizations of oppressed racial and ethnic minority groups led to the development of social work textbooks that devoted chapters to African Americans, Asians, and Hispanics, for example, and ultimately promoted strengths-based characterizations.

The interest in CC is not limited to the profession of social work and extends to counseling (American Counseling Association, 2005) and nursing (Denboba, 2005/2006). On a macro level in relation to health, for example, the mission of the U.S. National Center for Cultural Competence (NCCC NCCC National Civilian Community Corps (AmeriCorps)
NCCC Nottinghamshire County Cricket Club
NCCC National Cervical Cancer Coalition
NCCC Niagara County Community College
NCCC National Council of Corvette Clubs
) is to increase the capacity of health care and mental health programs to design, implement, and evaluate culturally and linguistically competent service delivery (Goode, 2001).The creation of the NCCC was prompted by research showing that health disparities are associated with race, wealth, age, and gender (see, for example, Mental Health: A Report of the Surgeon General The U.S. Surgeon General is charged with the protection and advancement of health in the United States. Since the 1960s the surgeon general has become a highly visible federal public health official, speaking out against known health risks such as tobacco use, and promoting disease , 1999; President's New Freedom Commission on Mental Health, 2003). In addition, the promotion of health and mental health programs that implement and evaluate culturally and linguistically competent service delivery systems can be seen on an international basis (for example, Victorian Transcultural Psychiatry Unit [Australia], 2007).

To tease out what is encompassed in the term CC, definitions of culture, competence, and CC are needed. The term "culture" is elusive. Definitions presented in Table 1 show the huge areas of social life to which culture refers (definitions of the terms that are irrelevant for our purposes--for example, refined taste---are excluded). Culture encompasses a group's social history over generations, rituals, beliefs, behaviors, and material artifacts. NASW (2000b, 2007) includes the subjective experiences of people within specific cultures. Competence involves abilities and skills, and the specific ones required of CC are discussed later in this article.

The tenets of CC have been found in the social work literature for nearly 40 years under different, though similar, terminology. Because of space limitations, we cannot list every definition of CC; Boyle and Springer (2001) purported that there are possibly hundreds. However, the definitions of CC in Table 1 are illustrative of the definitions commonly found in the social work literature. Noticeable in the definitions of CC over time is the growing recognition that society might be best understood as an entity comprising many cultures rather than two--that is, minority and majority (Norton, 1978).

CONTRADICTIONS IN THE IDEA OF CC

We identify four major contradictions in formulations of CC. (1)The first is epistemological--that is, related to questions of knowledge and the manner in which the knowledge is obtained. We argue that the emphasis on a priori a priori

In epistemology, knowledge that is independent of all particular experiences, as opposed to a posteriori (or empirical) knowledge, which derives from experience.
 knowledge of cultural difference not only is limited in terms of its accuracy, but also is contrary to the modern social work practice of learning from the client. (2) The second contradiction concerns the merits of classification systems used to describe cultural differences; these appear to stereotype and may not reflect the uniqueness of the individual. (3) Oversensitivity to cultural group differences, which are the result of the aforementioned classification of group norms, may lead to a privileging of group rights that is at odds with social work's core value of individual self-determination. (4) Last, we identify contradictory evidence as to whether CC, which is ill defined, can ever be determined, far less achieved. We discuss these in turn and show that major tenets of CC are self-contradictory or in contradiction with other social work values. The strengths and limitations of the various positions, as well as those in our own thinking, are discussed in the order that they appear.

Contradiction 1: Knowing about Cultures

The first contradiction relates to the means by which the social worker learns about the client's life, culture, and situation--a question that is epistemological. Knowing about describes a process that involves the social worker gathering information about the cultural group to which the client belongs. NASW (2007) has stipulated that social workers are required to "develop specialized knowledge and understanding about the history, traditions, values, family systems, and artistic expressions of major client groups served" (p. 21).The current literature on CC suggests that there are discrete pieces of information about cultural groups that the social worker can learn and then competently apply to work with clients. The delineation of behaviors, rituals, and thinking of various ethnic and racial groups, as seen in the literature used by social workers (for example, Anderson & Carter, 2003; McGoldrick, Giordano, & Garcia-Preto, 2005), strongly suggests that there are characteristics of groups that, if known before meeting the client, would enhance the helping relationship. For example, Anderson (2003b) described African Americans as valuing mutual aid and religion and having "relatively egalitarian social-class and gender relationships" (p. 13); Ewalt and Mokuau (1995) wrote that Pacific Islanders hold group-oriented values that are in contrast to "Northern European-American individualistic values" (p. 168).

However, over the past 100 years of professional social work's history, social workers have moved away from approaches that deem the social worker expert in understanding and solving a client's problem and toward a style that attempts to elicit the client's view of his or her need, problem, and circumstances. The latter mode values the client's knowledge and expertise and uses the client's strengths in finding a solution that is mutually agreed on (for example, Berg & DeJong, 1996; Cowger, 1994; Saleebey, 2005). Instead of adopting a position of knowing about the client, modern social work practice stresses learning from the client--that is, listening and giving prominence to the client's story, a narrative that is unique. Especially important are learning from, and hearing, perhaps anew, the voices of underrepresented and marginalized clients--about whom the NASW (2000a) Code of Ethics urges social workers to pay special attention. The paradigm suggested by the phrase "learning from" does not assume that the social worker can know another culture to which he or she does not belong; indeed, quite the opposite. (On a related note, it is possible that an individual from a particular culture might not be that familiar with it.) Also, philosophically, the belief that the social worker can know another's culture runs counter to postmodern, more specifically, social constructionist con·struc·tion·ist  
n.
A person who construes a legal text or document in a specified way: a strict constructionist.
, approaches to knowledge that have appealed to social workers of late (see, for example, Payne, 2005, chaps. 1, 2, and 8; and Williams, 2006, for general overviews of the application of postmodern thought to social work). At the heart of social constructionist thinking as applied to social work is the premise that knowledge about a person or culture is unobtainable without the contribution of the those studied; knowledge cannot be learned, abstractly, by the helping professional, as if human behavior were regulated by universal laws (Blundo & Greene, 1999).A social situation is best understood, according to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 social constructionism For the learning theory, see .
Social constructionism or social constructivism is a sociological theory of knowledge that considers how social phenomena develop in particular social contexts.
, by eliciting the unique experiences of the people who are in that very situation (Blundo & Greene, 1999).

Furthermore, the very literature that describes common characteristics of specific cultural groups relies on "nonempirical literature"--social scientists have long questioned the existence of national stereotypes (Agbayani-Siewert, 2004; Terracciano et al., 2005)--and often includes caveats such as the following: "We learn about culture primarily not by learning 'facts' of another's culture, but rather by changing our attitude. Our underlying openness to those who are culturally different is the key to cultural understanding" (McGoldrick et al., 2005, p. 5). Much is alluded to in the quotation. First, it is suggested that gathering information about cultures might not be the best way to learn about a culture; instead, an open attitude is of utmost importance (Yan &Wong, 2005). Dean (2001) proposed a model in which "maintaining an awareness of one's lack of competence is the goal rather than the establishment of competence,' such that "the client is the 'expert' and the clinician is in the position of seeking knowledge.., there is no thought of competence--instead one thinks of gaining understanding (always partial) of a phenomenon that is evolving and changing" (p. 624). Dean's arguments emphasize one important ingredient of CC--the centrality of self-awareness and, Dean implies, by extension, that social workers need to be aware of and overcome their biases and prejudices. Tervalon and Murray-Garcia (1998),physicians who were also grappling with CC, observed that "an isolated increase in knowledge without a consequent change in attitude and behavior is of questionable value" (p. 119).

Second, the placement of quotation marks quotation marks
Noun, pl

the punctuation marks used to begin and end a quotation, either `` and '' or ` and '

quotation marks nplcomillas fpl

 around the word "facts" in the McGoldrick et al. (2005) quotation in the preceding paragraph raises the possibility that descriptions of cultures may not be accurate. One way in which portrayals of cultures can be inaccurate is in their generalization. As Anderson (2003a) noted, "if generalizations of group differences do not accurately describe the norms and behaviors of particular individuals and families within the group, [ethnic-sensitive practice] may not be applicable or it could erroneously stereotype those clients" (p. 44). Seeley (2004) concurred: The tendency to generalize "is especially troubling in clinical theory and practice because it frequently entails reducing the rich world of cultural variation to a small number of overly inclusive categories, such as 'Asian,' 'Hispanic,' and 'African American'" (pp. 122-123).To illustrate the propensity to over-generalize, Asian and Pacific Islander Pacific Islander
n.
1. A native or inhabitant of any of the Polynesian, Micronesian, or Melanesian islands of Oceania.

2. A person of Polynesian, Micronesian, or Melanesian descent. See Usage Note at Asian.
 populations are frequently discussed together in a single chapter (for example, Green, 1998). It is worth remembering that, taken together, Asian and Pacific Islander peoples constitute more than half (60 percent) of the world's population (United Nations Population Fund The United Nations Fund for Population Activities (UNFPA) began funding population programs in 1969. It was renamed the United Nations Population Fund in 1987, but kept its original abbreviation. , 2005). Nonetheless, extended family loyalty among these groups is contrasted with the nuclear family found in Eurocentric cultures (Green, 1998). Yet, in the empirical literature, differences between ethnic groups are not neatly bifurcated. For example, Agbayani-Siewert's (2004) research on the cultural similarities and differences between Filipino American The Filipino American (Fil-Am for short) community is the largest Asian American group in the United States and the largest Southeast Asian American group. Filipino Americans are also the largest subgroup of the Overseas Filipinos.  and Chinese American Chinese Americans (Chinese language: 美籍華人 or 華裔美國人) are Americans of Chinese descent. Chinese Americans constitute one group of Overseas Chinese and are a subgroup of Asian Americans.  college students' (n = 713) attitudes toward dating violence Dating Violence is defined as the perpetration or threat of an act of violence by at least one member of an unmarried couple on the other member within the context of dating or courtship.  revealed that the students' respective views were very different; "Filipino students were found to be more similar to white students than to Chinese students" (p. 39).

Statements of broad brush are not only stereotypical but are, in our opinion, outdated. In addition, the result of accepting these caricatures may lead to a false notion of one's own expertise (Tervalon & Murray-Garcia, 1998). Although anecdotal, an interesting possible reason why CC has become so popular is that the concrete information on beliefs, characteristics, and practices of various cultural groups that the literature on CC provides alleviates social workers' level of anxiety about attempting to grasp myriad, ever-changing cultures (observation made by discussant dis·cus·sant  
n.
A participant in a formal discussion.

Noun 1. discussant - a participant in a formal discussion
adducer - a discussant who offers an example or a reason or a proof
 following the delivery of a paper on CC by Johnson & Munch, 2006).The emphasis on understanding difference may also have the unintended consequence For the 1996 novel by John Ross, see .

Unintended consequences are situations where an action results in an outcome that is not (or not only) what is intended. The unintended results may be foreseen or unforeseen, but they should be the logical or likely results of the
 of distancing the connection between client and social worker (Gould, 1995), because the assumption of adequate knowledge of difference could either blind or deafen the social worker to what the client is saying or, worse, alienate or offend the client.

The question that arises is whether clients' views of what constitutes CC are similar to those held by social workers. It is interesting that in Davis's (2007) study of clients' and professionals' (N = 186) views of what CC entails, clients' responses, in the main, described generic social work practice (for example, respect for the individual, written service plans, prompt service).These findings support Hendricks's (2003) contention that "culturally competent social work practice is, in most respects, simply good practice" (p. 76).Weaver (1999) appeared to concur; in her discussion of CC as it relates to Native Americans, Weaver observed that "skills for culturally competent social work with Native Americans are not radically different from those generally required for practice" (p. 221). Pope-Davis, Liu, Toporek, and Brittan-Powell (2001) noted the need for further research to examine clients' perspectives of what makes for multicultural counseling competence. An avenue for further research might be the following: Agencies that follow NASW's (2001) Standards for Cultural Competence in Social Work Practice might form client advisory boards whose mission is to review the meaningfulness of the standards and provide feedback on their existence in agency practice.

Contradiction 2: Collective Identities

How should the social worker look at the respective identities of groups and the individuals within them? The Canadian philosopher Charles Taylor (1994), in his essay "The Politics of Recognition" offered a penetrating analysis of the major issues involved in approaching and attempting to answer such a question. Taylor's exposition is highly relevant to social work because his major focus is on marginalized and oppressed groups.

Taylor (1994) argued that to be truly human, a person must be given the opportunity to discover his or her own identity and to have it, to the furthest extent possible, acknowledged by others. This universal right to recognition as a human being worthy of respect--a notion that has long-standing historical credence, and is, as Hunt (2007) noted, explicit in modern times in the U.S. Declaration of Independence and the United Nations' Universal Declaration of Human Rights--stresses what people have in common, namely our capacity for self-determination and the right to reach our full potential. According to Taylor (1994),"due recognition is not just a courtesy we owe people. It is a vital human need" (p. 27). Unfortunately, individual members of minority groups (be they characterized by race, ethnicity, sexual orientation, gender, and so on) are either unrecognized or misrecognized by the larger society. To be treated as though invisible or, in the case of misrecognition, seen in a derogatory manner, denies a person the chance to develop a positive sense of self. In response to this injustice, members of oppressed groups have united and lobbied for recognition of their differences (for example, inherent characteristics or life choices) that exist over and above personhood per·son·hood  
n.
The state or condition of being a person, especially having those qualities that confer distinct individuality: "finding her own personhood as a campus activist" 
. After all, it is these differences that the majority cannot tolerate.

Kwame Anthony Appiah (1994), professor of philosophy at Princeton University Princeton University, at Princeton, N.J.; coeducational; chartered 1746, opened 1747, rechartered 1748, called the College of New Jersey until 1896. Schools and Research Facilities
, noted that today's Western cultures emphasize individual identity and authenticity of self, but simultaneously there is increasing attention to "large categories" for example, racial and ethnic groups. The recent emphases on difference, celebration of diversity, and value of "other" cultures that have often been missing from academic curriculums, social policy, and research lead to a challenging anomaly. Taylor (1994) identified the apparent paradox thus: Respecting all people on the basis of their humanity stresses what is common among people. Respecting all cultures on the basis of difference, on the other hand, is a discriminating--in the sense of discerning--process. Universal respect for the dignity of the individual is open to the charge of color-blindness, whereas respect for differences between cultures involves color, race, and ethnicity. As Gutmann (1994) pointed out, a tension arises when we try to give one, that is, the universal or the particular, precedence over the other.

A disadvantage in using difference to self-identify is that such labeling, even for those considered privileged--for example, white people--brings with it possibly negative stereotypes in view of a lack of well-developed, alternative notions of racial identity. For example, a Welsh woman's identity might be stereotypically associated with Britain's historical oppression of its colonies, yet her experience is one of being oppressed by those in the neighboring British country, namely, the English. Another disadvantage associated with privileging difference over commonality is that some members of oppressed groups do not wish for an outward characteristic--physical attributes such as, for example, skin color in Verb 1. color in - add color to; "The child colored the drawings"; "Fall colored the trees"; "colorize black and white film"
color, colorise, colorize, colour in, colourise, colourize, colour
 the case of some classifications of race--to be the basis for their identity. Appiah (1994) argued that such categorization might bring with it a "life script" (expected modes of belief and behavior) that can be unduly inflexible and might be at odds with autonomy. Collective identities are not under the control of the individual (Appiah, 2003, 2005; see, especially, chap. 5). Appiah, who is a gay man of Ghanaian descent, goes as far as saying that the burden of adhering to a collective identity might result in a "kind of tyranny" (Appiah, 1994). Restated, Appiah is pointing to a group's reinforcement or even creation of its own stereotype, perhaps as a way of strengthening group identity. Long term, Appiah favors a world in which the individual does not need to choose from what he considers to be a limited range of collective identities currently available. However, Appiah concedes that the calls for recognition of difference (for example, gay, black) might be a necessary first step toward the creation of well-developed, multifaceted, personal identities.

Appiah (1994) continued, "it seems to me that one reasonable ground for suspicion of much contemporary multicultural talk is that it presupposes conceptions of collective identity that are remarkably unsubtle in their understandings of the processes by which identities, both individual and collective, develop" (p. 156).What Appiah might have had in mind is that the process through which identities are formed is, to use Taylor's (1991) terminology, dialogical; it is only within a wider social context, in which people transact, that identities are created, changed, and extinguished. For this reason, cultures are always in flux, hard to pin down, grasp, and understand, because no definitive culture is "out there" ready for analysis (G. D. Gross, 2000). But more important, cultures do not emerge in vacuums; cultures usually develop within the wider global environment in which Eastern and Western cultures often overlap, and where, for example, postcolonial countries make their own policies in response to the earlier oppression endured. The result might be a mixing of cultures--those of both former oppressed and oppressor OPPRESSOR. One who having public authority uses it unlawfully to tyrannize over another; as, if he keep him in prison until he shall do something which he is not lawfully bound to do.
     2. To charge a magistrate with being an oppressor, is therefore actionable.
, and future identification of the origins of specific beliefs and practices might prove impossible.

Further complicating the notion of identity is the fact that people do not belong to just one group, but many. The concept of intersectionality refers to the interrelationships between race, ethnicity, and other identities (Yuval-Davis, 2006). A social worker helping a client who is Hispanic, female, lesbian, and poor would be considered culturally competent if he or she takes into account the ways in which these identities intersect and, on that basis, tries to identify ways in which the woman's identities affect her life and create an intervention that is in keeping with them. The accepted notions of intragroup difference and diversity within diversity go some way to acknowledge the multiple identities that exist among Hispanics. However, the addition of the categories of gender, sexual orientation, and poverty, while allowing for all of their diverse expressions, leads to an almost infinite set (mathematics) infinite set - A set with an infinite number of elements. There are several possible definitions, e.g.

(i) ("Dedekind infinite") A set X is infinite if there exists a bijection (one-to-one mapping) between X and some proper subset of X.
 of combinations of characteristics. And, of course, the more multidimensional the social worker tries to make this picture--with the inclusion of ability, age, history, religion, and the specific challenge or need about which the client requests the social worker's involvement--the lower the chance of knowing the client's culture in advance. What, then, is the utility of trying to know or learn about the client's culture in any way other than by inviting the client to tell us what cultural factors are salient for her or him?

We find it deeply ironic that social workers (for example, Kirk, 2005) have been highly critical, and in our opinion, correctly so, of sweeping classifications in psychiatry (American Psychiatric Association, 2000), but appear willing to accept grand generalizations of ethnic and racial groups. The following teaching example is illustrative. In one of the first author's MSW (MicroSoft Word) See Microsoft Word.  practice classes, a student presented her work with a young African American African American Multiculture A person having origins in any of the black racial groups of Africa. See Race.  female client who resided in a shelter. In terms of possible interventions, students suggested linking the client to a local church and making contact with family members and fictive fic·tive  
adj.
1. Of, relating to, or able to engage in imaginative invention.

2. Of, relating to, or being fiction; fictional.

3. Not genuine; sham.
 kin. At odds with these suggestions, however, was the student's bio-psycho-social assessment, which revealed the client's absence of religious affiliation and lack of ties with family based on her choice. Nonetheless, students persisted in wanting to intervene along the aforementioned lines. Further discussion revealed that students' suggestions stemmed from readings on racial and ethnic diversity that depicted religion and strong family bond as major characteristics of African Americans. Grand narratives, however appealing they might be, do have weakness. As Hodge and Nadir (2008) observed, in relation to religion, that if someone were to look for a grand narrative for either Christianity or Islam, that person would be sorely disappointed.

The problems for social work in accepting some of the characterizations, of broad stroke, found in the literature on CC (for example, Green, 1998; McGoldrick et al., 2005) are, in our view, twofold. First, literature has the possible unintended result that practitioners will squeeze clients into broad categories to which they do not belong. As Miller's (2007) qualitative study of African American gay men's relationship with the black church poignantly described, the expected supportive religious environment (implied in much of the literature on CC) was sadly absent for these men because of the homophobic beliefs on the part of some pastors and congregations. Second, the profession, in adopting CC, might be unwittingly maintaining the status quo [Latin, The existing state of things at any given date.] Status quo ante bellum means the state of things before the war. The status quo to be preserved by a preliminary injunction is the last actual, peaceable, uncontested status which preceded the pending controversy. . For example, if mutual aid and the reliance on extended family are seen as accepted norms in Hispanic families (see, for example, the discussion in Sue, 2006, p. 136), social workers might refrain from promoting social policy and macro practice to assist these groups. As Rothman (2001) pointed out, locality development in the form of mutual aid should not be advocated if the effort to solve a societal problem places further burden on populations who are already stressed and lacking resources. The physical, psychological, and financial strains of mutual aid within ethnic and racial minority populations might contribute to these groups' continued disempowerment. Both E. R. Gross (1995) and Uehara et al. (1996) correctly observe that the focus on cultural traits and differences might obfuscate the sociopolitical so·ci·o·po·li·ti·cal  
adj.
Involving both social and political factors.


sociopolitical
Adjective

of or involving political and social factors
 forces that maintain inequality and domination.

In relation to group identity, Taylor (1994) did not conclude that a multiplicity of cultures should be maintained for its own sake. At first glance, Taylor's position appears reactionary and blinkered blink·ered  
adj.
Subjective and limited, as in viewpoint or perception: "The characters have a blinkered view and, misinterpreting what they see, sometimes take totally inexpedient action" 
. His balanced consideration of these questions suggests otherwise. First, in agreement with Appiah and Gates (1997),Taylor pointed to the ever-changing nature of cultures and the melding of beliefs and practices across the globe. If a specific culture were to be artificially maintained, Taylor foresaw an end to the transactional nature of cultural development. Second, external maintenance of a culture removes from its members their ability to determine their culture's development (Habermas, 1994).An interesting case example is Quebec (Taylor, 1994). One question that arises in terms of the maintenance of culture is whether parents who speak French should be legally mandated to send their children to French-speaking schools to maintain that aspect of French culture in Canada.

Taylor (1994) was certainly hopeful that an understanding, through dialogue, of cultures can be enriching, despite the immense effort that that understanding demands. And following Gadamer (1975), Taylor saw huge benefit in pursuing this learning. This learning, forTaylor and Gadamer, takes place in the form of honest and sincere communication and includes a wide-ranging appreciation of the humanities, which might not be sufficiently incorporated (in the form of literature and art) in social work education (Garcia & Bregoli, 2000; G. D. Gross, 2000).

Contradiction 3: Group Rights

The CC literature addressing the duties of the social worker in relation to group and individual rights is most ambiguous. On the one hand, the social worker should show "respect for diversity in all its forms" (NASW, 2007, p. 18) and be sensitive to the practices of diverse cultures. On the other hand, "cultural competence builds on the profession's valued stance on self-determination and individual dignity and worth" (p. 18). Indeed, historically, social work has given preeminence to the dignity and sanctity of the individual and not to cultures. Such a view is in keeping with social work's early Judeo-Christian roots, as well as philosophical (for example, Kantian) schools of thought that place ultimate value on the person's self-determination. The primary focus on the value of individuals and not the wider society is also clearly seen in NASW's (2000a) Code of Ethics: "Social workers' primary responsibility is to promote the well-being of clients. In general, clients' interests are primary. However, social workers' responsibility to the larger society ... may on limited occasions supersede To obliterate, replace, make void, or useless.

Supersede means to take the place of, as by reason of superior worth or right. A recently enacted statute that repeals an older law is said to supersede the prior legislation.
 the loyalty owed clients" [italics added] (p. 7).

Although NASW (2007) recommends in its practice standards on CC that social workers use a strengths-based perspective on micro and macro levels, there is the following caveat: "This does not imply a universal nor automatic acceptance of all practices of all cultures. For example, some cultures subjugate sub·ju·gate  
tr.v. sub·ju·gat·ed, sub·ju·gat·ing, sub·ju·gates
1. To bring under control; conquer. See Synonyms at defeat.

2. To make subservient; enslave.
 women, [and] oppress op·press  
tr.v. op·pressed, op·press·ing, op·press·es
1. To keep down by severe and unjust use of force or authority: a people who were oppressed by tyranny.

2.
 persons based on sexual orientation" (p. 18). Social work has a long history of questioning the powers of the state, laws, and cultural practices both nationally and internationally. Social work has frequently pointed to the negative effects that the wider society can have on clients' development and quality of life. The far-from-benign qualities of the larger society are seen in the stigmatization stigmatization /stig·ma·ti·za·tion/ (stig?mah-ti-za´shun)
1. the developing of or being identified as possessing one or more stigmata.

2. the act or process of negatively labelling or characterizing another.
 of various ethnic groups, hate crimes, and homophobia. Social workers often adopt the important role of mediator between clients and society. However, the manner in which the respective group and individual rights of those in a particular culture can be reconciled is not fully explicated in the CC literature. This leads to the following ethical question: Can a cultural group demand the right to self-determination no matter what it does to individuals within it?

We find it inconceivable that the social work profession could justify the protection of group rights when the consequence is the denial of an individual's inherent worth--for example, institutional racism An editor has expressed concern that this article or section is .
Please help improve the article by adding information and sources on neglected viewpoints, or by summarizing and
 found in U.S. courts, murder of women on the basis of adultery in India, female genital mutilation genital mutilation The destruction or removal of a portion or the entire external genitalia, which may occur in the context of a crime of passion or as part of a cultural rite. See Bobbittize, Cutter, Female circumcision, Self-mutilation.  in parts of Africa. In accordance with social work's principles and values, it appears that the profession cannot ethically adhere to adhere to
verb 1. follow, keep, maintain, respect, observe, be true, fulfil, obey, heed, keep to, abide by, be loyal, mind, be constant, be faithful

2.
 cultural relativism Cultural relativism is the principle that ones beliefs and activities should be interpreted in terms of ones own culture. This principle was established as axiomatic in anthropological research by Franz Boas in the first few decades of the 20th century and later popularized by , which might justify privileging group rights at the expense of the individual's worth. This stance is evident in NASW's (2000a) Code of Ethics: "Social workers should act to prevent and eliminate domination of, exploitation of, and discrimination against any person, group, or class on the basis of race, ethnicity" (p. 27).

The reader might surmise that we would give priority to the individual no matter the circumstances and never attention to groups. Not so. The despot's control over his or her people and the persecution of an individual by a group are both morally repugnant REPUGNANT. That which is contrary to something else; a repugnant condition is one contrary to the contract itself; as, if I grant you a house and lot in fee, upon condition that you shall not aliens, the condition is repugnant and void. Bac. Ab. Conditions, L. . However, the bases for intervening in both cases are grounded not only in the principles of the value of humanity and the right to personal self-determination (notwithstanding the individual in question's not harming others), but also in social justice.

As Taylor (1994) noted, the challenge is to engage with those from one's own and other cultures without compromising democratic principles; for social work, this means dialogue while maintaining social work's core values (Congress, 2004). In direct practice, assessments require asking the client about the ways in which his or her culture affects his or her lived experience within it. On a macro level, social workers can assist members of oppressed groups who are themselves criticizing harmful and oppressive practices within their own cultural groups (Association of Women's Rights The effort to secure equal rights for women and to remove gender discrimination from laws, institutions, and behavioral patterns.

The women's rights movement began in the nineteenth century with the demand by some women reformers for the right to vote, known as suffrage, and
 in Development, 2008).

Contradiction 4: Cultural Competence Is Achievable

Perhaps one of the most serious objections to the incorporation of CC into social work education and effective social work practice is doubt as to whether CC is humanly possible. Armour et al. (2006) argued that "there are no experts" in the field of CC, and "there is no end stage of 'having arrived' in relation to cultural competence" (p. 26). As discussed earlier, intersectionality refers to the many and overlapping identities that a person or group can have--the result of which is an almost infinite combination of characteristics. This alone presents enormous, if not insurmountable, difficulties for the development of CC, if this area of study continues to try to describe traits and habits of specific cultural groups. The result of embarking on an enterprise that aims to document such combinations might reveal no more than ephemeral minutia mi·nu·ti·a  
n. pl. mi·nu·ti·ae
A small or trivial detail: "the minutiae of experimental and mathematical procedure" Frederick Turner.
 in which the practitioner becomes bogged down. Nevertheless, in agreement with Hendricks (2003), Armour et al. (2006) argued that there are stages or "levels of cultural competence" In addition, NASW (2000a) stated that social workers should be "able to demonstrate competence in the provision of services that are sensitive to clients' cultures and to differences among people and cultural groups" [italics added] (p. 9).

There is obvious lack of clarity in the CC literature as to whether cultural competency can be achieved. First, as discussed previously, modern social work theory that includes social construction theory (simply defined as a school of thought that posits that what we take as knowledge is created through human interaction and does not reflect an objective truth [Payne, 2005]) questions whether the social worker can know another's culture. As Manoleas (1994) noted, there is "irony [in] seeking a degree of objectivity within the subjectivity of difference" (p. 54). Second, Bourjolly et al. (2006) questioned whether culturally sensitive practice is a linear process. Despite this, models of CC that involve a progression, in stages, from not knowing to knowing (for example, Armour et al., 2006) suggest a linear development that is open to evaluation of that progress. NASW (2007) suggested a linear process also: Social workers "need to move from cultural awareness to cultural sensitivity before achieving cultural competence and to evaluate growth and development throughout these different levels of cultural competence in practice" (p. 20).

Beyond the scope of this primarily theoretical article is the issue of empirical research Noun 1. empirical research - an empirical search for knowledge
inquiry, research, enquiry - a search for knowledge; "their pottery deserves more research than it has received"
 on CC. This can take various forms that include the measurement of levels of practitioners' CC in response to education about it and evaluation of the effectiveness of culturally competent service delivery (Boyle & Springer, 2001). However, it is particularly difficult to evaluate because there is no clear definition of CC; its conceptualization con·cep·tu·al·ize  
v. con·cep·tu·al·ized, con·cep·tu·al·iz·ing, con·cep·tu·al·iz·es

v.tr.
To form a concept or concepts of, and especially to interpret in a conceptual way:
 lacks a coherent theory base (Williams, 2006), and "the majority of[contemporary] researchers define cultural competence as a developmental process" (Boyle & Springer, 2001, p. 57) that requires extended time. Derald Sue (see, for example, 1981, 1995,2006) is a leading scholar who has addressed CC on an organizational level, and his tripartite conceptualization of CC (awareness, knowledge, and skills) provides the foundation for instrument development designed to measure cultural competencies of individual counselors. However, Ridley, Baker, and Hill (2001) called for a refinement in Sue's measures. Geron's (2002) following assertion still carries weight: Before the effectiveness and utility of CC training is considered effective, better models and measures are needed. Despite the earlier mentioned problems, Boyle and Springer (2001) and others argued that the social work profession needs to "incorporate culturally competent methodologies into education and social service delivery systems ... [and] empirical validation An empirical validation of a hypothesis is required for it to gain acceptance in the scientific community. Normally this validation is achieved by the scientific method of hypothesis commitment, experimental design, peer review, adversarial review, reproduction of results,  of the efficacy of these efforts [is] greatly needed" (p. 69). However, even assuming that CC can be measured, it surely behooves the profession to ascertain first whether what is measured is of benefit to clients. And on this important question, the jury is yet out (Davis, 2007).

Furthermore, Tervalon and Murray-Garcia (1998) asserted that in contrast to defining CC as a discrete endpoint, physicians (and, by extension, other helping professionals) should strive for cultural humility, defined as follows:
   A process that requires humility as individuals
   continually engage in self-reflection and
   self-critique as lifelong learners and reflective
   practitioners, it requires humility in how physicians
   bring into check the power imbalances
   that exist in the dynamics of physician-patient
   communication by using patient-focused interviewing
   and care, and it is a process that requires
   humility to develop and maintain mutually
   respectful and dynamic partnerships with communities.
   (p. 118)


Social workers such as Dyche and Zayas (2001) asserted that reshaping the outcome measures of cultural sensitivity from one of competence to one of humility and empathy is needed. Indeed, NASW'S (2001) Standards for Cultural Competence in Social Work Practice also exhort social workers to maintain serf-reflection and self-awareness of one's own culture and one's biases. Involving the patient and the community as partners is proposed, and this is certainly in keeping with social work's client-centered approach. Unfortunately, "mastery of a theoretically finite body of knowledge" (Tervalon & Murray-Garcia, 1998, p. 117) is often sought in social work's and other helping professions' literature, conferences, and trainings on CC. The presentation of discrete facts about an ethnic group appears to dominate. This fosters the belief that such knowledge leads to competence and repeatedly overshadows the more fluid aspects of CC that are discussed in this article. Semantics matter; the mere changing of the term "competence" to "humility" would instantly convey expectations of openness, respect, sensitivity, and life-long self-critique that are required for enlightened practice.

CONCLUSION

In this article, we have argued that informed social work practice requires knowledge in substantive areas that include racism, structural inequalities, and health disparities. We also acknowledge that grand narratives may enhance understanding between peoples. In light of globalization globalization

Process by which the experience of everyday life, marked by the diffusion of commodities and ideas, is becoming standardized around the world. Factors that have contributed to globalization include increasingly sophisticated communications and transportation
, emigration emigration: see immigration; migration. , and blended families (not only within groups, but across ethnic and racial groups), race and ethnicity are so varied that grand narratives on culture seem less meaningful today than they did just 30 years ago. For example, Norton's (1978) dual perspective, recommending an awareness of majority and minority cultures, appears limited in view of the multiplicity of identities evident today.

In summary, we argue that current conceptualizations of CC suffer from four major flaws: (1) The overemphasis o·ver·em·pha·size  
tr. & intr.v. o·ver·em·pha·sized, o·ver·em·pha·siz·ing, o·ver·em·pha·siz·es
To place too much emphasis on or employ too much emphasis.
 on a priori knowledge of cultural difference is contrary to the modern social work practice of learning from the client. In cases where a priori knowledge appears to apply it is, we argue, incumbent upon the social worker to verify its relevance and validity with the clients--be they individuals, organizations, or communities. (2) Descriptions of cultural differences are, by definition, stereotypical and may not reflect the uniqueness of the individual. (3) Oversensitivity to cultural differences may lead to a privileging of group rights that is at odds with social work's core value of individual self-determination. (4) CC is so ill defined that it is unclear whether competence can ever be determined.

We believe that before the conceptualization of CC is further developed and, more important, before CC is further incorporated into social work education and practice, it is essential to address these fundamental tensions that are in contradiction to social work's historical values and principles as currently understood by the profession. As Hopps (1982), editor of Social Work's previous special issue on people of color Noun 1. people of color - a race with skin pigmentation different from the white race (especially Blacks)
people of colour, colour, color

race - people who are believed to belong to the same genetic stock; "some biologists doubt that there are important
, stated 25 years ago: "Social workers have much to accomplish" (p. 5).

Original manuscript received April 30, 2007

Final revision received January 26, 2009

Accepted February 3, 2009

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Yan, M. C., & Wong, Y. R. (2005). Rethinking self-awareness in cultural competence: Toward a dialogic self in cross-cultural social work. Families in Society, 86, 181-188.

Yuval-Davis, N (2006). Intersectionality and feminist politics. European Journal of Women's Studies women's studies
pl.n. (used with a sing. or pl. verb)
An academic curriculum focusing on the roles and contributions of women in fields such as literature, history, and the social sciences.
, 13(3), 193-209.

Yvonne M. Johnson, PhD, MSc, LCS LCS - Language for Communicating Systems  W, is assistant professor, and Shari Munch, PhD, MSW, LCSW LCSW Licensed Clinical Social Worker ,, is associate professor, School of Social Work, Rutgers University, The State University of New Jersey, 53 6 George Street, New Brunswick, NJ 08901. The authors thank Jennifer Decker, graduate research assistant, for her assistance in the preparation of this paper. Also, they thank Arnab Chakladar for his comments on an earlier draft of the manuscript. Address correspondence to Yvonne M. Johnson, School of Social Work, Rutgers University, 536 George Street, New Brunswick, NJ 08901; e-mail: yjohnson@ssw.rutgers.edu.
Table 1: Definitions of Key Terms: Culture, Competence, and Cultural
Competence

Term                  Definition

Culture               "The 'social heritage' of a community: the
                      total body of material artifacts (tools,
                      weapons, houses; places of work, worship,
                      government, recreation; works of art, ete.);
                      of collective mental and spiritual 'artifacts'
                      (systems of symbols, ideas, beliefs, aesthetic
                      perceptions, values, etc.); and of distinctive
                      forms of behavior ... created by a people
                      (sometimes deliberately, sometimes through
                      unforeseen interconnections ...) and
                      transmitted from generation to generation"
                      (Bullock & Stallybrass, 1977 p. 150).

                      More recently, NASW (20006) defined culture
                      thus: "The word 'culture' ... implies the
                      integrated pattern of human behavior that
                      includes thoughts, communications, actions,
                      customs, beliefs, values, and institutions of
                      a racial, ethnic, religious, or social group"
                      (p. 61). NASW (2007) noted that

                        "culture often is referred to as the
                        totality of ways being passed on from
                        generation to generation. The term culture
                        includes ways in which people with
                        disabilities or people from various
                        religious backgrounds or people who are gay,
                        lesbian, or transgender experience the world
                        around them." (p. 10)

Competence            "Suitability; fitness; efficiency; capacity;
                      ability; sufficiency" (Chambers Dictionary,
                      1998, p. 336).

                      "Cultural competence is never fully realized,
                      achieved, or completed, but rather cultural
                      competence is a lifelong process for social
                      workers who will always encounter diverse
                      clients and new situations in their practice"
                      (NASW, 2007, p. 12).

Cultural Competence   Early definitions

                      Dual perspective (awareness of a person's
                      membership of a minority culture as well as a
                      majority one) (Norton, 1978).

                      Social work practice with people of color
                      (Lum, 1992).

                      Ethnic-sensitive practice (Schlesinger &
                      Devote, 1995).

                      Definitions found in current literature

                      "Cultural competence refers to the process by
                      which individuals and systems respond
                      respectfully and effectively to people of all
                      cultures, languages, classes, races, ethnic
                      backgrounds, religions, and other diversity
                      factors in a manner that recognizes, affirms,
                      and values the worth of individuals, families,
                      and communities and protects and preserves
                      the dignity of each" (NASW, 2001, p. 11).

                      "A set of congruent behaviors, attitudes, and
                      policies that come together in a system,
                      agency, or among professionals and enable that
                      system, agency, or those professionals to work
                      effectively in cross-cultural situations"
                      (Cross, Bazron, Dennis, & Isaacs, as cited in
                      Armour et al., 2000, p. 69).

                      "Cultural competence in social work practice
                      implies a heightened consciousness of how
                      clients experience their uniqueness and deal
                      with their differences and similarities
                      within a larger social context" (NASW, 2007,
                      p. 9).
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Author:Johnson, Yvonne M.; Munch, Shari
Publication:Social Work
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2009
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