Instead, we invite you to think of competence as a process through which someone gains sufficient knowledge, judgment, and skills to carry out a task without doing harm. According to scholar practitioners, cultural competence involves three aspects: (a) developing awareness of one’s own cultural values, traditions, and biases; (b) learning about the cultural values, traditions and worldviews of others; and (c) developing a set of culturally informed interpersonal skills (Mio et al., 2012; Sue et al., 2019; Vasquez, 2007). Accordingly, cultural competence is a continuing, life-long process of learning and relearning about ourselves and others as complex and layered cultural beings. In turn, this process strengthens our therapeutic alliance, increases the effectiveness of treatment, and deepens our ethical awareness and sense of personal ethical responsibility (see Arredondo et al., 1996; Casas et al., 2016; Fouad & Arredondo, 2007; Vasquez, 2007, 2009).
The Impact of Cultural Competence on Treatment
Our cultural competence influences the experience that clients have in therapy. For instance, Smith and Trimble (2016) conducted a meta-analysis focused on therapists’ cultural competence and its connection to clients’ experiences in treatment. They concluded that
Diverse clients tend to see therapist multicultural competence as highly related to, yet distinct from, other positive counselor attributes. In addition, culturally diverse clients are moderately more likely to prematurely discontinue treatment when their therapists do not demonstrate multicultural competence. Client outcomes improve when their therapists are able to competently attend to and value the varying experiences of culturally diverse clients (p. 64).
More recent decades have seen an increase in scholarship describing and centering the role of culture in treatment outcomes. For instance, the evidence-based practice movement in psychology frames evidence as the “best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA, Presidential Task Force on Evidence-Based Practice, 2006, p. 273). This expansive description of evidence underscores the pivotal role of culture in psychotherapy outcomes. To illustrate, meta-analyses provide support for the effectiveness of culturally adapting psychotherapies for different groups (see Benish et al., 2011; Bernal & Domenech Rodríguez, 2012; Griner & Smith, 2006; Smith & Trimble, 2016; Zane et al., 2016).
The abundance of evidence supports the need to consider the client’s culture and our own cultural competence in the therapeutic process—not doing so can result in unintentional harm to clients (Vasquez, 2009, 2012; Sue, 2019). Thus, the inclusion of cultural factors in psychotherapy is not just a desirable practice, it is a fundamental ethical responsibility outlined in standards.
The CPA Code of Ethics Standard II.10 encourages psychologists to:
“evaluate how their own experiences, attitudes, culture, beliefs, values, individual differences, specific training, external pressures, personal needs, and historical, economic, and political context might influence their interactions with and perceptions of others, and integrate this awareness into their efforts to benefit and not harm others” (2017b, p. 19). Standard IV.15 requires that psychologists “acquire an adequate knowledge of the culture, social structure, history, customs, and laws or policies of organizations, communities, and peoples before beginning any major work there, obtaining guidance from appropriate members of the organization, community, or people as needed” (p. 33).
APA Ethics Code Standard 2.01b, Boundaries of Competence, states:
Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies (2017b, p. 5).
Several psychological associations in the US have published documents that articulate and augment our ethical responsibilities within different cultural worldviews. Pope, Chavez-Dueñas, and Adames (in press) report that:
members representing the four Ethnic Minority Psychological Associations (EMPAs) in the United States including the Asian American Psychological Association (AAPA), Association of Black Psychologists (ABPsi), the National Latinx Psychological Association (NLPA), and the Society of Indian Psychologists (SIP) met with the APA Ethics Committee at the 2011 annual APA convention. During this meeting the EMPAs and APA agreed to review whether the ethics code addresses issues of culture adequately, appropriately, and knowledgeably. Specifically, the EMPAs shared their thoughts on how the ethical code both “assists or hinders their work as Psychologists of Color” with the goal of broadening knowledge on “how culture intersects with ethical dilemmas” (APA, 2012a, para. 15). Several EMPAs have developed and published their own set of ethical commentaries. (see SIP, 2014), guidelines (see NLPA, 2018), or standards (see ABPsi, n.d.).
CULTURAL COMPETENCE AND PROFESSIONAL GUIDELINES
A focus on the role of culture in psychotherapy as practiced and regulated by state or provincial licensing laws is a relatively recent phenomenon. Historically, the field of mental health has been slow at recognizing the significance of culture in psychological science, practice, and ethics (see Hall, 1997; Guthrie, 2004; Pickren & Burchett, 2014; Sue et al., 2019; Vasquez, 2007, 2012). The first mention of culture as a factor in therapy took place at the Vail Conference of 1973 (Korman, 1974). Sixteen years later, in 1990, the APA published its first guidelines that addressed culture titled, The Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations (APA, 1990). That same decade, the CPA approved and published their Guidelines for Non-Discriminatory Practice. Since then, both APA and CPA guidelines have been revised. In 2003, the new APA guidelines were published with a new title, The Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change (see APA, 2003) and in 2017 they were revised once again (see APA, 2017b). The CPA guidelines were updated in 2001 and in 2017.
The 2017b version of the APA Multicultural Guidelines more broadly addresses the importance of attending to various identities and
encourage psychologists to consider how knowledge and understanding of identity develops from and is disseminated within professional psychological practice. Endemic to this understanding is an approach that incorporates developmental and contextual antecedents of identity and how they can be acknowledged, addressed and embraced to engender more effective models of professional engagement (APA, 2017b, p. 6).
Similarly, the 2017 CPA Guidelines for Non-Discriminatory Practice
promote non-discriminatory care in therapeutic work with clients, as well as to provide guidelines for evaluating the extent to which one’s work falls within the parameters of non-discriminatory practice. As our society and culture become more diverse, and as we become more aware of specific diversities, it is important that psychologists gain an awareness of the need for non-discriminatory practice. As the need arises, guidelines can be developed for use of specific diversities (CPA, 2017b, p. 1).
The APA Guidelines on Race and Ethnicity in Psychology (2019c) more specifically focus on race and ethnicity
and describe how clinicians, educators and researchers can develop racial and ethnocultural responsiveness and discuss the importance of understanding bias and recognizing the influence of race and ethnicity in society (APA, 2019c).
These guidelines encourage psychologists to understand and consider the role of culture in practice, research, consultation, and education.
