Saturday, January 13, 2007

Can't we all just get along?

"Cultural competence" is currently quite the topic of interest in mental health services, especially in California. A lot of people here are peeing themselves over making sure that their agencies are "culturally competent." In my never-ending quest for a Better Job, I keep coming across ads that devote more space to the agency's interest in "cultural competency" than to the description of the actual job.

I disagree with the entire concept of "cultural compentency." How do you know when you are "culturally competent"? There is no exam to take, no set of prohibitively expensive workshops to attend, no embossed certificate to hang on your wall. And who gets to decide which "cultures" one must be "competent" in? Most of us aren't even "competent" in our own culture--let alone able to describe exactly our own cultural influences.

"Cultural competency," I think, implies a mysterious package of skills. I would rather be culturally aware. I think it's important to know at least basic things about other cultural groups, especially as may affect therapy. But we should learn from our clients as much as they learn from us. And we must be prepared to be wrong--and accept it when we are.

Once I was the only lesbian on staff and the only Jew, secular or otherwise. So my caseload kept getting padded with lesbians, Jews, and lesbian Jews. I'm not religious at all and was never even a bat mitzvah, so I'm not sure what really qualified me to be Super Jew Therapist. It was our practice to ask clients during their intakes whether they wanted their therapist to have any particular characteristics, such as gender, ethnicity, or sexual orientation. Maybe five percent of my intakes indicated some preference. The rest said, "I don't care. I just want someone who can help me."

Certainly, there are cases where therapist-client matching is a great idea, if not a necessity. A client who speaks little English is probably best served by a therapist who can speak his or her native language. A client who has extreme difficulty trusting white men should probably not be placed with a white male therapist. My move to California was precipitated, in part, by paternalistic heterosexism; and when I became depressed as a result, I specifically sought a lesbian therapist. Though I'd had an excellent straight male therapist in the past, I didn't want a straight man listening this time.

Recently I read a comparison of treatment-related philosophies from the 1970s and today. I think the context was how managed care has shifted psychology's priorities. There was this whole list of factors which were pretty much diametrically opposed, including length of treatment, emphasis on thoughts vs. feelings, and case conceptualization. One of the pairs was "individual differences" (the 70s) and "diversity" (today). At first I was quite confused. How were these mutually exclusive? And then it dawned on me:

Individual differences emphasizes the uniqueness of the individual, rejecting the homogeneity of the group.
Diversity emphasizes the homogeneity of the group, rejecting the uniqueness of the individual.

(And all of a sudden, this interview made a whole lot more sense.)

Racism sucks. Sexism sucks. Homophobia, bi-phobia, and transphobia suck. Anti-Semitism sucks. Ageism (though completely legal under federal law unless you're over 40) sucks. Ableism sucks. Dude, discrimation sucks.

However, it's impossible to talk about "diversity" without endorsing stereotypes. There's nothing inherently bad about stereotypes. What's bad is assuming you know everything about your 10:00 intake... at 9:59.

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