By: Danika S. Perry, PsyD
In recent years, multiple terms have been used to describe approaches to addressing cultural differences that fuel social injustices. Cultural humility has had the most profound impact on my developing identity and journey as an early career psychologist (ECP). Cultural humility involves a lifelong commitment to reducing power differentials through perpetual self-evaluation and active engagement in respectfully learning from others, for the purpose of developing trustworthy working relationships and community partnerships (Yeager & Bauer-Wu, 2013; Mosher, Hook, Captari, Davis, DeBlaere & Owen, 2017). As fundamental, as this process might seem, I largely avoided it until two years ago – my avoidance influenced by my lived experiences and core beliefs.
Despite the typical rigors of graduate school (El-Ghoroury, Galper, Sawagdeh, and Bufka, 2012), my journey was complicated by my awareness of my experience as different. During my doctoral-level training I was one the only African American female in my cohort. While overwhelmingly grateful for the opportunity, I was aware of my developing belief that I did not belong and my presence in the program was perhaps the fulfilment of recruiting a culturally diverse cohort.
Perhaps this belief was rooted in some of my early childhood experiences involving racial differences. I recall becoming aware, confused, and agitated as I sat on classroom carpet in second grade as we learned about the Civil Rights Movement in America. Like puzzle pieces aligning together, my childhood awareness of racial discrimination began to formulate upon experiencing tension when my mother vehemently responded to being ignored by the white store associate at the catalog center of a department store. Notably, my mother held a number in her hand signifying that she was next in line.
My parents devoted themselves to rearing my brother and me in a world where we were not excluded because of our race or ethnicity. They were the first in their families to pursue higher education and made countless sacrifices in order to realize their dreams of attaining an upper middle class lifestyle. Nevertheless, they remained aware of the existing worldview that did not always value our presence among the white majority. My parents exposed me to several activities in which I was the only Black girl. My mother also took special care to ensure that my brother and I were involved in extracurricular activities that were predominantly Black so that we would have a majority experience, helping us to embrace our Black heritage, traditions, and contributions to society. Unfortunately, there were times when I was criticized by my Black peers as not being Black enough, and I began to question my own authenticity as an African American female, as well as the authenticity of others. Nevertheless, I knew that my parents’ rural upbringing during the early 1950’s which involved cotton sharecropping and laboring in America’s southeastern fields for meager earnings was a part of my genetic makeup.
In my doctoral training, I struggled with not having the language or framework by which to communicate my complex identity to my majority white faculty, and I often assumed that it was of no relevance or perhaps a roadblock for them. Inasmuch, I certainly lacked the confidence to enlighten or challenge the perspectives of my supervisors. Amidst what, at times, was a competitive atmosphere, I wrestled with seeking close connections with my white cohort members for several complex reasons. I didn’t want to be the representative Black female, and I did not want to take the risk of disputing my beliefs of being an outcast and inadequate. I shied away from developing bonds with ethnically diverse members of my cohort because I was not aware of their own cultural identity or acculturation process and was concerned that an attempt to initially align on the basis of shared diversity might be perceived as shallow and an attempt to develop ingroup and outgroup experiences. There were also microaggressions and implicit biases that I experienced and, regretfully, engaged in throughout my pre- and postdoctoral training, as well as in my role as an ECP. As a whole, I largely engaged in behavior that supported my existing beliefs about the meaning of being a Black Woman in America, until I had an encounter with Carmelita Foster, PhD, who at the time was a psychology Resident (i.e. predoctoral intern) at Nemours A.I. DuPont Hospital for Children.
At the second year mark of my early career journey, I met Carmelita, and her initial, “Hi I’m Carm!” “It’s so nice to meet you…where did you get your hair done?” was so engaging and safe. Carmelita encouraged me to expose my vulnerabilities as she openly acknowledged her desires for growth and development as an African American psychology trainee. It was through our transparent and in-depth conversations that I recognized my experience of questioning my value as Black female psychologist was no longer a mystery or illusory, but so authentic and essential that it needed to be revealed. It was Carmelita who informed me about Dr. Robin DiAngelo’s book, “White Fragility,” which helped me to understand that my oppression was cultivated by my own fears and due to me feeling inept at addressing the fears of my White counterparts when discussing racism, privilege, and power.
I remember exhaling completely for what felt like the first time when Dr. Dana E. Crawford, a Pediatric Psychologist at Montefiore Medical Group, articulated the role of prejudice, bias, and racism in the provision of clinical care when she shared her Culture-Based Countertransference Model. This model entails identification of affective, behavioral and cognitive responses to culturally sensitive issues with patients and provides a systematic framework for reducing clinician bias and repairing ruptures with clients and colleagues. I found my voice after meeting Dana; she was an exemplary model for me, and she provided a compass to navigate what appeared to be the most treacherous paths of addressing aspects of culture with my patients and colleagues.
The torch carrying my passion about culturally competent care was fueled by my anger surrounding the lack of responses towards developing a diversity-based vision statement for the Nemours Behavioral Health Division. The reticence was due to the need for a safe space to understand our individual and collective cultural identities as well inherent biases. Inopportunely, I desired instantaneous forward movement. I was infuriated and puzzled when it seemed like our actions did not appear to match our collective mission to foster inclusiveness and a growing diversity pipeline. I recall being confused and frustrated when I listened to my pastor preach about the importance of not being conformed to a pattern of choosing sides based upon race or political party, but to let love lead. As much as I honor and respect my Pastor, I truly thought he was missing the mark. I was convinced that he didn’t fully understand the brevity of the state of the nation. In spite of my skepticism, I began to notice a shifting happening within me. Instead of communicating my anger to my colleagues I desired a different approach. As much as I desired to be heard, understood, and valued, I was alerted to the importance of adopting vulnerability and humility.
Unexpectedly, I was freed to acknowledge my behaviors, feelings, and thoughts which could no longer be worn as a badge of honor, but instead contributed in part to fears which resulted in a diversity vision. As soon as I recognized the exchange of culturally cultivated anger for cultural humility fear began to settle in again. I began to ponder if my desire to understand or lean into the discomfort of those in power invalidated my experiences as a woman of color and those who are racially/ethnically marginalized. I questioned if I was settling for the status quo. The foundation beneath me that allowed me to push back that fear was my identity as a believer and my most authentic self. It has helped me to confront my biases and fears of addressing microaggressions by connecting with individuals who I assumed devalued me, and have experienced the overwhelming joy and precious gift of being with others as they have shared their vulnerabilities with me that we might grow together, and misunderstandings and assumptions would be crushed.
Listed below are suggestions that I have developed along this journey of cultural humility:
- It is okay to acknowledge that cultural development is perpetual, in order to reduce bias and to promote further growth.
- Read, consult, engage and learn from others, including patients/clients and trainees.
- Identify areas of privilege as well as areas of oppression within your life, family, or history.
- Inquire of others whom you interact with consistently yet do not share the same privilege or oppression how these identities impact marginalized and disenfranchised groups.
- Determine if there are existing areas of anger, fear detachment/avoidance, silence or complacency, and assess the impact of those feelings and behaviors.
- Remember that judgment hinders growth regardless of whether it is self-judgment or judgment of others.
- Find your anchor to help steady your response and course during turbulent times of inequality and disenfranchisement.
- Always reflect on why you chose to pursue a career in psychology with the specific interest or population you interface with.
Crawford, D. (2012). Therapists’ Awareness, Identification, and Management of Culture-based Countertransference. (Electronic Thesis or Dissertation). Retrieved from https://etd.ohiolink.edu/
DiAngelo,R. White fragility: Why it’s so hard for white people to talk about racism. Boston: Beacon Press.
El-Ghoroury, N., I. Galper, D., Sawaqdeh, A., & L. Bufka, L. (2012). Stress, coping, and barriers to wellness among psychology graduate students. Training and Education in Professional Psychology, 6,122-134. 10.1037/a0028768.
Mosher, D. K., Hook, J. N., Captari, L. E., Davis, D. E., DeBlaere, C., & Owen, J. (2017). Cultural humility: A therapeutic framework for engaging diverse clients. Practice Innovations, 2(4), 221–233. https://doi-org.ezproxy.pcom.edu/10.1037/pri0000055
Yeager, K. A., & Bauer-Wu, S. (2013). Cultural humility: essential foundation for clinical researchers. Applied Nursing Research, 26(4), 251–256. doi:10.1016/j.apnr.2013.06.008