Being culturally responsible means being able to identify bias in yourself and others. It means being sensitive to systems that contribute to the positive and negative reinforcement of that bias. Being culturally responsive entails being competent enough to guide clients through the process of negotiating the similarities and differences between cultures – and recognizing the effects that those boundaries have on the lives of the individuals we serve. If we come from a privileged background, it means we are sensitive to, and have a raised consciousness about, the lines and differences related to that socio-economic position. It means confronting our own personal fears, challenging our own ignorance, engaging in exploration of issues that cause us pain, and being able to identify both interpersonal and intrapersonal resources that can be leveraged in the service of growth. It means having an implicit understanding that “if there is smoke, there is probably fire.” It also means that we don’t assume the reason why the fire burns. It is the process of acknowledging that there is no “one size fits all” solution – and that we should create a new therapy for every individual client. And finally, it means continuing to grow through experience – consultation in particular.
If there is anything that keeps a therapist up at night, it’s the potential for a malpractice suit… misdiagnosis, diagnostic errors, and/or delayed diagnosis are at the forefront of our concerns. “What if I get it wrong?”
Braun & Cox (2005) suggest some measures that can be implemented to reduce likelihood of getting into this legal or ethical dilemma. Informed consent can help clients understand benefits, and allow the clinician to properly set expectations around the services that are covered… especially with regard to termination since additional sessions are likely to be expensive in some cases. Furthermore, clients need to be aware that counselors can no longer ensure privacy of disclosure because managed care organizations (MCOs) may require sensitive information. The release of this information may precipitate changes in treatment and outcome due to the fact that MCOs typically determine the type of treatment that should be employed and/or would be covered. We would also need to familiarize ourselves with “brief therapy models” in order to be competent at providing services through MCOs. (Braun & Cox, 2005, p. 426) If we intend to work with this specific client population we need to be well versed in all of the above considerations before we even consider taking a client that intends to utilize them as a 3rd party payer.
Although I do not consider it to be a personal deficit, historically, there is a general mistrust and underutilization of the medical and mental health communities as it relates specifically to people of color. Adequately addressing this climate of mistrust demands that we engage in an “honest and thorough self-examination of conscious and unconscious attitudes about race and the legacy of racism in the United States.” (Suite, La Bril, Primm, & Harrison-Ross, 2007, p. 883) Furthermore, Suite and associates (2007) suggest we “keep at arm’s length assumptions of cultural homogeneity and offer contextually based mental healthcare.” They define contextually based mental healthcare as “extensive and critical interpretation of the historical, cultural, spiritual, political, social and philosophical underpinnings of racism in medicine and draw connections on how these factors impact the self-identities of communities and individuals therein.” In my opinion, it is absolutely imperative that we attempt to understand how individual people of color perceive mental healthcare as an institution, as well as rebuild trust in the institution as a whole by delivering culturally sensitive options at every step of the therapeutic process.
Braun, S. A., & Cox, J. A. (2005, Fall). Managed mental health care: Intentional misdiagnosis of mental disorders. Journal of Counseling and Development : JCD, 83(4), 425-433. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=916199881&sid=10&Fmt=3&clientId=4683&RQT=309&VName=PQD
Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007, Aug). Beyond misdiagnosis, misunderstanding and mistrust: Relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association, 99(8), 879-885. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1319356711&sid=10&Fmt=3&clientId=4683&RQT=309&VName=PQD