Cultural Humility vs. Cultural Competence: A Lifelong Journey
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For decades, social workers have debated the merits of two similar concepts considered essential to empathetic practice: cultural competence and cultural humility. Both terms refer to how social workers tailor treatment and interventions to suit the individual needs of their clients and the communities in which they participate.
In recent years, researchers have recognized the shortcomings of cultural competence alone and emphasized elevating cultural humility – now considered an indispensable skill across many disciplines of human services and medicine. Voices across the human service and healthcare community have taken up the cause of recognizing the two concepts not as opposing forces but rather as pieces to the same puzzle.
The notion that a social worker or any medical practitioner would ever be able to compile a comprehensive index of cultural insights – so as to summon the perfect one at a client’s most dire time of need – is unrealistic. That’s cultural competence. A social worker should instead focus on honing their capacity for cultural humility, which allows them to form meaningful bonds with clients guided by empathy and a keen sense of one’s limitations.
Cultural Humility and Cultural Competence at Work Together
Understanding this distinction, many social workers are proponents of a pivot in the cultural humility vs. cultural competence dynamic, one that reimagines the dueling constructs as overlapping paths to the discovery that have no endpoint. Cultural competence is more aptly viewed as a process; a journey, not a destination. And cultural humility is the mindset that fuels the journey.
Indeed, the longstanding struggle between cultural competence and cultural humility in social work doesn’t have to be an either/or proposition at all, but rather a matter of “and/with,” as Ella Greene-Moton, Ph.D., and Meredith Minkler, Ph.D., concluded in a 2019 article in the journal Health Promotion Practice.
“Cultural competence is not something we achieve or fail to achieve but rather a reminder to continue to strive to know more about communities of all types with which we work or interact,” the authors wrote. “Together with the concept and embodied practice of deep cultural humility, it provides health educators and other public health professionals with some of our most important tools in working with diverse individuals, groups and communities in today’s complex world.”
What is Cultural Competence?
Popularized in the late 1980s by renowned theologian Terry L. Cross, Ph.D., the concept has grown in acceptance to occupy what some would deem a problematic foothold in the healthcare industry. Then, as now, it’s believed that in cases where racial or cultural differences might act as a barrier to treatment, practitioners of this method can overcome them by demonstrating proficiency in a range of cultures and ethnicities.
By the early 2000s, cultural competence had taken root in the mainstream, meriting the founding of Kaiser Permanente’s Institute for Culturally Competent Care. The University of Michigan began offering classes on the topic in 2002. And eventually, online classes that initially targeted medical personnel responding to disaster relief scenarios shifted to include behavioral health professionals, such as social workers.
Why Cultural Competence Isn’t Enough
Detractors of cultural competence find the term itself to be a misnomer. Competence suggests an outcome, a tangible and achievable end goal. It’s not quite akin to the academic benchmark of mastery, but it doesn’t leave much room for growth or divergent thought. The client-clinician relationship suffers as a result, shifting the power dynamic too far in the favor of the latter. And it can produce unfortunate circumstances where prejudice leads to missteps in a client’s care.
Taking the criticism a step further, Greene-Moton and Minkler assert that cultural competence is inherently flawed because it promotes a “top-down” approach in which “one entity (often including some highly educated and privileged members of a given racial or other group)” are being used to decide “what content should be included and which benchmarks or criteria should be used to assess competence for their group(s).”
“It also places individuals and whole communities in a ‘one size fits all’ box and fails to recognize intersectionality – the notion that individuals represent multiple and intersecting dimensions of diversity,” said Dr. Jill Manit, PhD, Clinical Assistant Professor at Sacred Heart University.
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The Emergence of Cultural Humility in Social Work
About a decade after cultural competence became a widely accepted methodology, public health physician Melanie Tervalon and health educator Jann Murray-Garcia recognized its flaws and refined the concept by emphasizing education and empathy. Tervalon and Murray-Garcia introduced cultural humility in 1998, and in the ensuing years, it has garnered a devoted following across many disciplines.
So what is cultural humility? Tervalon and Murray-Garcia define it as “a lifelong commitment to self-evaluation and critique, to redressing power imbalances… and to developing mutually beneficial and non-paternalistic partnerships with communities on behalf of individuals and defined populations.”
Expanding on the concept in a social work context, Marcie Fisher-Borne, Jessie Montana Cain and Suzanne L. Martin – authors of a 2015 study published in the journal Social Work Education – wrote, “Cultural humility seeks to cultivate self-awareness on the part of providers and acknowledges the ways in which cultural values and structural forces shape client experiences and opportunities.”
“As such,” the authors continued, “this approach accounts for structural inequalities and the complexities of culture in a way that is absent from many of the existing cultural competency models and strengthens our social justice commitment as social work practitioners.”
Put another way, cultural humility is about looking inward and reckoning with your blind spots and biases. And cultural humility in social work requires practitioners to dedicate their lives to knowledge and self-improvement; important tools in a counseling context, yes, but also virtues that touch all vocations.
Learning how to practice cultural humility is a critical step in a social worker’s development. It requires practitioners to open themselves up to their clients as a means of understanding them, recognizing that no two individuals are the same regardless of their membership in a cultural group. Then, and only then, can an effective course of treatment begin to blossom.
Understanding the cultural humility vs. cultural competence debate equips social workers with the ability to provide compassionate care for a diverse range of clientele, meeting a crucial demand in a time of civil unrest. But many experts contend this is a debate that does not require a choice.
Cultural Humility: A Life of Learning Instead of Knowing
In her bestselling 2018 book entitled “Dare to Lead: Brave Work. Tough Conversations. Whole Hearts.,” distinguished clinical social worker and author Brené Brown, Ph.D., extolled the virtues of empathy, which has long been a driving force in both her writing and fieldwork.
“Empathy is not connecting to an experience,” Brown wrote. “It’s connecting to the emotions that underpin an experience.”
Empathy is also critical to understanding the cultural humility vs. cultural competence debate. It explains the shortcomings of cultural competence and informs the mechanisms by which social workers can learn how to practice cultural humility.
Cultural competence appeals to the academic side of behavioral health professionals. It promotes skill-building and the pursuit of a goal. It also emphasizes acquiring knowledge about a wide range of cultures and worldviews, which can lead to an over-reliance on learning from articles and books instead of lived experiences.
Cultural humility shifts the power balance in the relationship between client and practitioner, envisioning it as more of a partnership. But it’s not enough for the client merely to be heard; their input must be valued and respected and used to guide a course of treatment that suits their individual needs. The client is treated as the expert on their own story and the social worker does not presume to know better.
“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,” Brown wrote. “We can’t. … What we can do, however, is honor people’s perspectives as truth even when they are different from ours.”
According to Brown, the key to being an effective social worker is approaching the role not as a knower but as a continuous learner. That’s a pivotal distinction.
In summarizing the passionate discourse over cultural competence vs. cultural humility, Fisher-Borne, Montana Cain and Martin wrote, “both cultural competence and cultural humility are similar in their aim to address existing disparities in how care is delivered but differ greatly in their approach.”
“The cultural humility approach explicitly acknowledges power differentials between provider and client and asserts that problems do not often arise ‘from a lack of knowledge but rather the need for a change in practitioners’ self-awareness and attitudes toward diverse clients,’” they added.
How to Practice Cultural Humility: The Future of Social Work
Cultural humility is so much more than a methodology; it’s a way of life. At a time when racial injustice and partisan politics have conspired to fracture the country, social workers have an opportunity to be leaders on the path to healing. But race mustn’t be considered interchangeable with culture.
As Fisher-Borne, Montana Cain and Martin wrote, “a commonly voiced critique of cultural competency is that the term culture is often conflated with or used as a proxy for non-white racial identity. A focus solely on race and/or ethnicity often ignores disparities that exist in regards to other aspects of identity.”
The traits associated with cultural humility – empathy, attentiveness, vulnerability – can help rid society of the racism polluting our public discourse. Cultural competence laid the groundwork for this reckoning. Cultural humility is the future.
With these values at the forefront of its premier online Master of Social Work program, Sacred Heart University prepares the next generation of compassionate social workers. Whether you’re seeking a role in direct clinical or direct community care, Sacred Heart’s field experience model will enable you to apply empathetic social work skills in a hands-on environment.
Learn more about how to practice cultural humility in Sacred Heart University’s CSWE-accredited Master of Social Work online program.