On Multicultural Competency

Multicultural competency involves a curiosity for others’ experiences and the systems they inhabit, an awareness of possible biases, and a suspension of right-wrong values. It requires humility on the part of the psychologist; an openness to learning and to not knowing, and inviting and empowering clients to be the expert on their lives.

In practice, I strive to communicate a tone that is collaborative and experimental (“I’d like to share an ACT strategy with you. It works for some people. Can we try it?” “Would it be possible to take this principle and apply it to your life?”) as opposed to dogmatic and authoritarian (“You are feeling depressed.” “You need to do this or you won’t feel better.”).

As a multiculturally competent therapist, I am striving to more deeply understand my client’s perspective. These are shaped by a multitude of factors — ethnicity, career, gender-femininity/masculinity, religion, sexual orientation, upbringing, or geography. And in the early stages of therapy, I am just trying to learn and appreciate these intersecting parts and “contradictions” in my clients’ lives. A big part of therapy is about identifying and sorting what is within us. Making space for my clients to simply be and to observe that together is a part of engaging in that process. Those of a more scientific mind may loosely consider this the diagnostic stage. Or, “what is the actual problem here?”

Many of my clients identify as a minority on the basis of their ethnicity, sexual orientation, and sexual identity. Some may not feel comfortable with a spotlight shining on their selves, and may even want to be told how to be if only so they do not have to sit in this discomfort. And yet, I believe it’s my work to help you to bring your self forward, courageously, and examine that person, together, with compassion. Or, very simply, “why do you care about <this>?” and “Is <this> truly what you want?”

I eschew labels and diagnostic categories when they do not add depth or quality in understanding the actual problems driving my clients’ symptoms. In my nonwhite clients in particular, psychiatry and clinical psychology can be limited in the lack of a cultural framework to explain, without pathologizing, the underlying issues to their problems. These client’s relationships are not simply “codependent,” and their family relationships are not simply “enmeshed.” The expectations to maintain these types of relationships may be steeped in cultural norms, values, and traditions.

You are not your “anxiety,” your “depression,” or your “panic”; or whatever derogatory associations (“weak-minded,” “a failure”) some people may assume in a person dealing with these challenges. I am especially careful not to use pathologizing language. While diagnostic categories may be relieving to some, I know they also have the unintended effect of reducing a person to a disorder. And, as a doctor (in psychology), I know that my words have power, and that if I offer any of my clients a diagnosis, it will only be when I have enough information on the person to offer this diagnosis, after a lot consideration for the person’s context, not just their symptoms, and the systems in which their issues arise.

I know enough to know that I have cultural blind spots. I have thought about my own preconceptions, and continue to do so through readings and a desire to learn. Credit to the many people who have shaped me, including my clients, through meaningful conversation and a willingness to engage me in my learning.

As a person of color, and someone who has an interest in improving mental health access and utilization in minority communities, I have met with many clients over the years who have shed the stigma of mental illness. To my folks of color, you are not damaged or weak or turning against your family for seeking counsel in addressing your issues. There may be a spirit within you that is wanting to be free, of pain, of obligation, of expectation. If you are seeking out help, you are choosing your needs above all others. Often, this act of seeing your needs as important is an (disruptive) act of self-love. Kudos to you if you are here.

As a postdoctoral fellow at Yale University, at a community mental health center, I worked with formerly homeless men who were dealing with severe mental illness and substance issues. You may be wondering — What do I know about being formerly homeless? About being a poor, black person amongst the privileged, often white, students at Yale University? I don’t. And thankfully, that was not required. We talked about their ongoing confrontations with police officers and mental health workers, and I learned about their sense of displacement, lacking a sense of citizenship, and over-identifying with the view that they would not amount to anything because of the circumstances they were in. We would talk about their resilience and resourcefulness, despite being viewed as a “case” in a “system” that was more dehumanizing than empowering. They made it to their psychotherapy and navigated their triggers and stressors. I chose to see these men as people first. That open and inviting space, I later realized, was so important in helping them recapture a sense of agency over their lives, and recognize their power within larger, potentially oppressive systems.

While my clients today are not homeless — far from it — some certainly enter psychotherapy feeling invisible, disregarded, and disempowered. For those folks, this sort of space is for you.