Peer Perspectives

Cultural Humility and Empathy — Steps on the Journey of Cultural Competence

By Lisa M. Eible, DSW, MSW, LCSW, and Jack B. Lewis, DSW, MSW, LCSW

Years ago, when we were working in a major urban hospital, we shared a client. At that time, I was the medical social worker working with the family and the coauthor was the emergency department (ED) social worker. Our client was a Japanese woman married to a man who was admitted for complicated medical issues. She was demonstrating symptoms of psychological distress and it was unclear whether she was suicidal.

There was reluctance to bring her to the ED for further evaluation, as EDs are settings that present challenges to in-depth assessments even under the best of circumstances. Additionally, we were sensitive about the ED’s capacity to be culturally competent, as we were aware of the differences between the hospital culture, our client, and ourselves. However, the family insisted that she be evaluated. Her anxiety was palpable in the chaos of the busy ED setting, where everything is intensified and compounded with the stress of her husband’s significant medical admission.

Communication between us—the medical social worker and the ED social worker—offered some continuity between the care systems and allowed for preparation for her arrival. When she entered the ED, the social worker took her to a calm area to ensure respect for her privacy and immediately offered her a cup of tea. This moment of sensitivity appeared to calm some of her anxiety and allowed for an effective assessment. In discussing this case over the years, we agree that something occurred with the client during the offering of tea. While this action helped us to center this client, we struggled to characterize it. We knew it had something to do with cultural competence, but neither of us was particularly familiar with Japanese culture and hardly felt competent. We are not suggesting that the provision of tea made the setting or us culturally competent, but we noticed that this simple act seemed to tap into something familiar for this client.

The Journey
Of all the social work values, cultural competence is perhaps one of the most complex. When has one achieved cultural competency? How is cultural competence measured? Can one ever be fully culturally competent? Is cultural competence sometimes just avoiding significant cultural offenses? Our experience is that cultural competence is a journey, not a destination.

There is never a point at which one, despite training, experience, or interest, can achieve full competency in another person’s culture. Culture, with its complexities and nuances, is far too multifaceted to be simplified to a specific demonstration of understanding. Social work is particularly complex in that our practice is not separate from cultural competence. The ability to engage with another person, the building of a relationship through empathy, is at the heart of social work practice and effectiveness cannot be separated from elements of cultural competency.

Cultural Humility
We began exploring the concept of cultural humility, which seemed to fit with the case above and many of our cases in which there were racial or cultural differences. Then, in 2015, the National Committee on Racial and Ethnic Diversity added cultural (as well as intersectionality) to the definition and operationalization of cultural competence. Cultural humility “refers to the attitude and practice of working with clients at the micro, mezzo, and macro levels with a presence of humility while learning, communicating, offering help, and making decisions in professional practice and settings” (NASW, 2016, p. 16). According to Tervalon and Murray-Garcia, “Cultural humility incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances … and to developing mutually beneficial and nonpaternalistic clinical and advocacy partnerships with communities on behalf of individuals and defined populations” (1998, p. 117).

Further, Moncho (2013) notes, “To practice cultural humility is to maintain a willingness to suspend what you know, or what you think you know, about a person based on generalizations about their culture. Rather, what you learn about your clients’ culture stems from being open to what they themselves have determined is their personal expression of their heritage and culture.”

Recent Trends
Coupled with the NASW inclusion of cultural humility in the concept of cultural competence, recent years have seen a trend in the feminist and cultural social work literature to see the social worker as expert in the social work processes but not expert in the client experience. The expert is seen as a continuous learner in this construct. Theoretical approaches such as relational-cultural theory (Jordan, 2017) and the recent work of Brené Brown (2018) have espoused approaches that recognize cultural differences and offer a progressive approach to the worker-client relationship. In such approaches, there is a recognition of traditional power imbalances and careful attention to empathy.

Jordan defines empathy as “a complex cognitive‐affective skill that allows us to ‘know’ (resonate, feel, sense, cognitively grasp) another person’s experience” (2010, p. 103). Brown articulates the intricacies of empathy: “Empathy is not connecting to an experience, it’s connecting to the emotions that underpin an experience” (2018, p. 140). Further, Brown notes “We can’t practice empathy if we need to be knowers; if we can’t be learners, we cannot be empathetic” (2018, p. 145). Such an approach aligns well with the imperfect nature of cultural humility.

We believe that the concept of cultural humility is at the heart of cultural competence. We propose that cultural humility and empathy are inextricably tied. When working cross-culturally in particular, empathetic social work practice cannot be effective without the presence of cultural humility. The willingness to be a cultural learner, risking shame, and accessing vulnerability are at the core of empathetic practice.

Cultural humility allows for a process where clients articulate their experience, inclusive of culture, and the social worker is the learner of that experience. “One of the signature mistakes with empathy is that we believe we can take our lenses off and look through the lenses of someone else. We can’t. … What we can do, however, is honor people’s perspectives as truth even when they are different from ours” (Brown, 2018, p. 143).

The expertise of social work practice includes the social worker’s growth and learning as part of the professionalism of the field. Cultural humility offers a methodology to cross-cultural work through the acknowledgment of the individualized nature of culture and the personal and professional obligation in social work to remain on the journey of cultural competence.

— Lisa M. Eible, DSW, MSW, LCSW, is a consultant with more than 27 years of social work experience. She has advanced certificates in cultural competence and trauma.

— Jack B. Lewis, DSW, MSW, LCSW, is a tenure track assistant professor of social work at Stockton University principally assigned to the MSW program. He has more than 30 years of social work experience as a clinician, administrator, and educator.

References
Brown, B. (2018). Dare to lead. New York. Penguin Random House.

Jordan, J. (2010). Relational‐cultural therapy. 1st ed. Washington, DC: American Psychological Association.

Jordan, J. (2017). Relational-cultural therapy. 2nd ed. Washington, DC: American Psychological Association.

Moncho, C. (2013, August 19). Cultural humility, part I — What is ‘cultural humility’? The Social Work Practitioner. Retrieved from https://thesocialworkpractitioner.com/2013/08/19/cultural-humility-part-i-what-is-cultural-humility/.

National Association of Social Workers. (2016). Standards and indicators for cultural competence in social work practice. Washington, DC.

Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125.