Culture as a construct is difficult to define. Definitions of culture often refer to a set of contexts, specifically man-made elements of the environment (e.g., institutions, values, and traditions), that form a part of the collective experience among members of a society or group and that are also trans-generational as a consequence of social learning (Betancourt & Lopez 1993). Some psychologists consider ethnoculturalism as the “fourth force” in psychotherapy (Betancourt & Lopez 1993, p.629). Implicit in this is the notion that culture is a factor in influencing behaviour. To be a culturally competent psychologist, therefore, it is important to plan and implement psychological practice and research that respects group identities, local communities, indigenous values, and national and cultural differences.
Cultural competence is not about being politically correct. Cultural competence has real world consequences for individuals that, in relation to psychology, are typically vulnerable or in need. The national enquiry into the ‘stolen generations’, where Aboriginal and Torres Strait Islander children were removed from their families (Human Rights and Equal Opportunity Commission 1997), for example, inferred that health workers participated in the calculated effort to assimilate out of existence indigenous individuals and cultures, an example of genocide. This apparent lack of cultural competence by health workers, psychologists among them, has contributed negatively to indigenous individuals’ psychological and physical health through mourning the loss of culture (Eisenbruch 1991), stress associated with interacting with a foreign culture (Westerman 2004), and trans-generational abuse (Atkinson 2002).
Cross-cultural psychology endeavours to explicitly acknowledge the need for cross cultural awareness and competence in the discipline of psychology. Cross-cultural psychology is “the systematic study of relationships between the cultural context of human development and the behaviors that become established in the repertoire of individuals growing up in a particular culture” (Berry, Poortinga & Pandey 1997, p.x). The goals for cross-cultural psychology include investigating the generalizability of existing theory and research results, investigating other cultures in order to identify unique cultural experiences in behaviour, and the integration of this research to establish a more universal discipline of psychology (Berry, Poortinga, Segall & Dasen 2002). An investigation into behaviour as it occurs in another culture reduces ethnocentrism (Betancourt & Lopez 1993) and enhances the discipline of psychology.
Cross cultural research findings have observed that cultural explanations of mental illness held by psychologists are strongly correlated with shaping their response to individuals with affective problems and the subsequent course of those problems (Jenkins 1988). Also, in relation to affective problems, an individual’s immediate social environment appears crucial to its sequence and prognosis (Harding, Zubin & Strauss 1992). Finally, findings also suggest that members of minority groups defined by race and ethnicity are vulnerable to patterns of misdiagnosis due to a bias by clinicians’ to over-pathologize their problems (Good 1992). In the United States, for example, psychologists, regardless of race, have been found to diagnose more severely, and attribute more violence, dishonesty, and dangerousness to, patients that are black (Loring & Powell 1988). Policy clearly has a role to play.
The American Psychological Association (APA), often the policy guide for the Australian Psychological Society (APS), has made the inclusion of course components that pertain to multicultural issues, encouraging cultural competence, compulsory across training (American Psychological Association 2011) although in reality they are not compulsory as core or primary courses (Hills & Strozier 1992). Also, cultural competency is not mandatorily assessed in relation to gaining registration in the United States (Sue 1998) and what assessment occurs during training differs from that done in relation to other training areas (Altmaier 1993). In addition to training, the APA Office of Ethnic Minority Affairs (1993) has published guidelines to assist with the provision of culturally aware psychological services for the practising psychologist. Training and practice constitute the areas upon which cultural competence policies are defined, as they are for Australian psychologists.
To be registered as a psychologist in Australia one must complete an Australian Psychology Accreditation Council (APAC) accredited and Psychology Board of Australia approved course (Australian Psychology Accreditation Council 2011). APAC is the accreditation authority responsible for accrediting education providers and programs of study for the psychology profession (APAC 2011) whilst the Psychology Board of Australia functions as a subsidiary of the federal governments Australian Health Practitioner Regulation Agency (AHPRA) (Psychology Board of Australia 2011). Finally, the APS, like the APA in the United States, is a voluntary organization that endeavours to represent psychology and psychologists in Australia. Despite this, the Psychology Board of Australia has adopted the APS Code of Ethics (2007) for the profession (Psychology Board of Australia 2011).
Ethnoculturalism is recognized as important to the discipline of psychology and, as such, APAC (2010) has nested cultural competency within training for the discipline. Courses must encourage knowledge and understanding of: intercultural diversity and indigenous psychology; how the science and practice of psychology is influenced by social, historical, professional, and cultural contexts; the cultural bases of behaviour and organisational systems; issues for minority or marginalised groups; limitations of psychological tests with particular reference to cultural issues; and interpersonal skills in communicating effectively with clients, other psychologists, other professionals, the community, individuals, small groups, and agencies from varied cultural, ethnic, religious, social, and political backgrounds (APAC 2010). Training eventually gives way to practice. The APS Code of Ethics (2007) references ethnoculturalism in a more general way through three general ethical principles.
The APS Code of Ethics (2007) is based on the respect for the rights and dignity of people and peoples; propriety; and integrity. In the first general principle, respect for the rights and dignity of people and peoples, (APS Code of Ethics 2007) psychologists are encouraged to have positive regard for diversity and uniqueness of individuals and their right to linguistically and culturally appropriate services. Acknowledging the particular needs of indigenous Australians, the APS has also published guidelines for the provision of psychological services for, and the conduct of psychological research with, Aboriginal and Torres Strait Islander individuals (APS 2003b). Whilst there are no other specific ethnocultural guidelines, there are guidelines for other groups such as women (APS 2003a), and groups defined by sexual orientation (APS 2000). The Code of Ethics frames practice.
Essentially there are three types of psychologists; clinical psychologists, applied psychologists, and research psychologists (Nairne 2009). Clinical psychologists diagnose and treat psychological problems; applied psychologists extend psychological principles to practical, non-clinical, problems; and research psychologists conduct research to elucidate essential principles of behaviour and cognizance (Nairne 2009). Whilst registered psychologists can arguably do little in regards to their initial training content, ongoing professional development and supervision are two areas where cultural competency can actively be developed and maintained. In addition to this, if involved in research, a culturally competent approach could be nested within it. So, it is in the areas of professional development, supervision, and research where the cultural competence of the practicing psychologist may be developed and honed.
Continuing professional development (CPD) is a requirement for annual renewal of psychology registration (Psychology Board of Australia 2011). Identifying professional development to enhance cultural competence initially requires an assessment by the psychologist of their needs in relation to culturally competent awareness, knowledge, and skills (Pedersen 2011). Once an assessment is made, the psychologist can actively address deficits. CPD can then be identified that further develops an awareness that culturally learned assumptions exist and interact with those of a patient; develops meaningful information and insight into the patient’s unique cultural context; and finally develops a skill set that can facilitate patient change (Pedersen 2011). Early career psychologists may find the identification of necessary CPD daunting. Supervision, then, may assist in accurately identifying CPD needs in relation to cultural competency.
Supervision is mandatory for psychologists (Psychology Board of Australia 2011) and can play an integral role in regards to cultural competency skill acquisition and expertise (Sue & Sue 2008). Supervision may be defined as a process whereby a more experienced clinician mentors or imparts specialist knowledge to a clinician, or group of clinicians, less experienced (Bernard & Goodyear 2004). Formative and summative assessment of cultural competency can assess the degree of supervisee cultural competency and guide further cultural competency training (Hays 2008). A supervisor, therefore, needs to encourage the development of cultural awareness, the reduction of bias, and developing strategic interventions in relation to future patients (Sue & Sue 2008). Psychologists need to integrate cultural competence into their professional undertakings in recognition of the increasing diversity of their social context (Sue & Sue 2008).
For applied and clinical psychologists, interactions with patients are central to their provision of service. In relation to this patient / psychologist interaction, Pedersen’s (2011) Triad Training Model underscores the need for cultural competency and, by extension, its development through supervision and CPD. Pedersen (2011) suggests that when two individuals communicate there are actually three conversations occurring simultaneously. There is the uttered exchange; the psychologist’s own internal dialogue; and finally the internal dialogue of the patient (Pederson 2011). Cultural competency is imperative, according to Pederson (2011), as the greater the cultural difference between the psychologist and patient, the less likely the psychologist will accurately ‘hear’ the internal dialogue, positive and negative messages, of the culturally different patient. Research too, then, needs to become more sophisticated, expanding the utility and generalizability of any findings.
Psychological research, in regards cultural competency, is lacking in three areas: diversity amongst researchers; appropriate ethnocultural studies; and culturally appropriate assessment instruments (Gil & Bob 1999). Firstly, the lack of diversity may be addressed by actively recruiting students from diverse backgrounds as co-researchers (Casas & Thompson 1991) as well as striving for a culturally diverse research team matched to that cultural group being investigated (Atkinson, 1993). Secondly, cultural groups identified for research should be engaged in the development of research questions and that subsequent research should be monitored by members of these groups for community relevance and general quality (Casas & Thompson 1991). Finally, assessment selection should consider cultural orientation, particularly as instruments are often Eurocentric (Dana 1996), and that any translations be accurately assessed in regards to their meaning (Brislin 1993).
CPD, supervision, and research are three areas that the psychologist can actively develop cultural competence. The development of cultural competency is not a finite exercise but, rather, a lifelong process of learning. Being a culturally competent psychologist encourages research that is both sophisticated and more generalizable, and relationships between psychologist and patient that are more explicitly anchored in a cultural context, enhancing therapeutic outcomes in a wider range of therapeutic settings. To be a culturally competent psychologist, therefore, it is important to plan and implement psychological practice and research that respects group identities, local communities, indigenous values, and national and cultural differences.