Cultural Competence Revisited

See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/271755310 Cultural Competence Revisited Article in Journal of Ethnic & Cultural Diversity in Social Work · April 2013 DOI: 10.1080/15313204.2013.785337 CITATIONS READS 21 205 2 authors, including: Ann Marie Garran University of Connecticut 12 PUBLICATIONS 48 CITATIONS SEE PROFILE All content following this page was uploaded by Ann Marie Garran on 27 March 2015. The user has requested enhancement of the downloaded file. 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To cite this article: Ann Marie Garran & Lisa Werkmeist er Rozas (2013): Cult ural Compet ence Revisit ed, Journal of Et hnic And Cult ural Diversit y in Social Work, 22: 2, 97-111 To link to this article: ht t p: / / dx. doi. org/ 10. 1080/ 15313204. 2013. 785337 PLEASE SCROLL DOWN FOR ARTI CLE Full t erm s and condit ions of use: ht t p: / / www.t andfonline.com / page/ t erm s- and- condit ions This art icle m ay be used for research, t eaching, and privat e st udy purposes. Any subst ant ial or syst em at ic reproduct ion, redist ribut ion, reselling, loan, sub- licensing, syst em at ic supply, or dist ribut ion in any form t o anyone is expressly forbidden. The publisher does not give any warrant y express or im plied or m ake any represent at ion t hat t he cont ent s will be com plet e or accurat e or up t o dat e. The accuracy of any inst ruct ions, form ulae, and drug doses should be independent ly verified wit h prim ary sources. The publisher shall not be liable for any loss, act ions, claim s, proceedings, dem and, or cost s or dam ages what soever or howsoever caused arising direct ly or indirect ly in connect ion wit h or arising out of t he use of t his m at erial. Journal of Ethnic & Cultural Diversity in Social Work, 22:97–111, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 1531-3204 print/1531-3212 online DOI: 10.1080/15313204.2013.785337 Cultural Competence Revisited ANN MARIE GARRAN and LISA WERKMEISTER ROZAS Downloaded by [University of Connecticut] at 05:32 13 June 2013 University of Connecticut, West Hartford, Connecticut, USA In 2001, the National Association of Social Workers (NASW) adopted 10 discrete standards of culturally competent practice which undergird our commitment to diversity and social justice. The concept of intersectionality is newly emerging in social work, though, causing us to reflect on our current conceptualizations of cultural competence. According to this construct, in order to understand one aspect of the self, such as race, we have to understand how gender, ethnicity, sexuality, social class, and other markers influence one another. The authors present the concepts of cultural competence, social identity, and intersectionality in order to deepen our anti-oppression, social justice approach. KEYWORDS intersectionality, cultural competence, social identity, social justice INTRODUCTION This ever present excess of my seeing, knowing, and possessing in relation to any other human being is founded in the uniqueness and irreplaceability of my place in the world. (Bakhtin, 1990, p. 23) Social work has always been known as the profession that has dedicated itself to working with the marginalized, oppressed, and excluded populations in any given society, and therefore has always included guidelines for working with such populations. As defined in the National Association of Social Workers (NASW) Code of Ethics, one of our deepest core values has always been social justice, and the guiding ethical principle that accompanies it defines our charge as challenging social injustice (NASW, Address correspondence to Ann Marie Garran, PhD, MSW, School of Social Work at the University of Connecticut, 1798 Asylum Avenue, West Hartford, CT 06117, USA. E-mail: [email protected] 97 Downloaded by [University of Connecticut] at 05:32 13 June 2013 98 A. M. Garran and L. Werkmeister Rozas 2008, p. 5). Similarly, the International Federation of Social Workers (IFSW) has social justice as one of its four main ethical principles. Within this principle is challenging discrimination and unjust policies and practices as well as recognizing diversity and inequality (IFSW, 2004). The social work principles to “respect the inherent dignity and worth of the person” and “recognize the central importance of human relationships” (NASW, 2008, pp. 5–6) form the basis of the profession, and as such, social workers have an ethical responsibility to render services to oppressed populations in order to uphold this mandate. With the addition of Standards for Cultural Competence in Social Work Practice in 2001 (NASW, 2001), social workers now have an obligation to deliver culturally competent services. The standards define cultural competence as the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each (p. 7). The Council on Social Work Education’s (CSWE) Educational Policy and Accreditation Standards (EPAS) also acknowledge the importance of cultural competence by requiring competencies in engaging in diversity (2.1.4) and advancing human rights and social and economic justice (2.1.5). Both of these competencies are expected to appear throughout the curriculum as well as manifest themselves in the policies and practices of the organization. While cultural competence has been difficult to measure on an organizational level, the implicit curriculum, which communicates the values of social work on multiple levels, helps create a learning environment that promotes social justice and diversity, in accordance with EPAS standards (CSWE, 2012). The construct of cultural competence is one that is described and perceived in multiple (Boyle & Springer, 2001; Cheung & Leung, 2008; Lum, 2011), often ambiguous ways and needs to be more focused in order to deliver services that are not only more culturally congruent, but that consider the influences of power and privilege on interactions with clients and colleagues alike (Abrams & Moio, 2009). Standards, knowledge, and research about cultural competence have proliferated in recent years (Ponterotto et al., 2001; Abrams & Moio, 2009; Lum, 2011), but those have not always translated into a worker’s ability to work more effectively with her clients. Equally important to social work has been the principle of respecting the dignity and worth of a person. Together these principles create a framework for how social workers are to be educated, so that we can provide appropriate, quality, and ethical care to our clients. What must be explored, however, is the evolution of the understanding of how best to equip social workers with the skills necessary to realize these values, particularly when working cross-culturally. Downloaded by [University of Connecticut] at 05:32 13 June 2013 Cultural Competence Revisited 99 Until now, the framework used to educate most workers in the helping professions about working with “difference” has largely been dominated by the notion of cultural competence—a view that has been adopted by most social work professionals. More recently, however, there have been some valuable questions raised about its utility and totality (Johnson & Munch, 2009; Pon, 2009). Few would argue that the idea of cultural competence has done a great deal to bring important issues of difference to the fore. However, unlike other helping professions, social work has the unique ability and call to understand the importance of situating the subject of difference within the context of larger socio-political-structural forces that exist in every society. It is important to examine whether or not social work has indeed used its own positionality to its advantage. Social work’s understanding of cultural competence has been grounded largely in social theories of social identity (Moffat & Miehls, 1999; Eriksen, 2001; Hardiman & Jackson, 2007; Sensoy & DiAngelo, 2012). With a more complete understanding of the importance of social identity, social workers have sought to understand the complexities of clients’ (e.g., families, individuals, community groups) life experiences as well. Professional and culturally competent social work practice suggests that we consider all aspects of the client’s social identity (Miller & Garran, 2008). We do this by careful consideration of the client and the client’s life circumstances, not only from within the lived experience of the client, but also from the history and power structures of the community or group of which our client is a part. This article uses the concept of intersectionality to underscore the need for an enhanced view of cultural competence by highlighting the important contributions that an analysis of power and privilege offer. Particularly helpful when working in multicultural settings, intersectionality is defined as “the reality that we simultaneously occupy both oppressed and privileged positions and that these positions intersect in complex ways” (Sensoy & DiAngelo, 2012, p. 115). Using this concept is essential in creating a more comprehensive view of cultural competence. Social workers should understand the meaning that each aspect of social identity has for themselves as well as their clients, and appreciate the social advantages and disadvantages carried by each domain of identity (Miller & Garran, 2008). SOCIAL IDENTITY Embracing the concept of social identity marked an important launching-off point (Solomon, 1976; Green, 1982; Pinderhughes, 1989) for social workers in the continued quest for a more thorough understanding of cultural competence. This concept has deepened social work’s perspective on cultural competence (Lum, 2011). Social identity describes how we see ourselves in relation to others, as well as the very ways that we position, align, Downloaded by [University of Connecticut] at 05:32 13 June 2013 100 A. M. Garran and L. Werkmeister Rozas differentiate, and categorize ourselves. Individualized aspects of the self are collectively constructed and shared in the formation of one’s social identity. While some aspects of our social identity are chosen, others are imposed by outside forces (Miller & Garran, 2008). It is important that social workers know how to utilize social identity, including multiple identities, to further our ability to advocate for social justice. Making a genuine commitment to cultural competence requires that social workers seek to promote the understanding, acceptance, and appreciation of cultural differences. This commitment has also meant social workers must acknowledge and ultimately combat the existence of systems of power that form the foundation of many of the domains of social identity to be discussed here. Given that the social work profession holds central as its mission a commitment to social justice, it is critical that we seek to understand the ways that understanding identity and power intersectionally enhances service delivery. Information about Culture Multiculturalism, cross-cultural competence, and cultural awareness are all terms that have been used to describe social work’s efforts to acknowledge difference and to acquire knowledge in order to enhance service delivery for clients. The term cultural competence represents one of the latest efforts on the part of social work to explain our commitment to fostering social justice while working in culturally diverse environments (Lum, 2011). The general practice of cultural competence has concerned itself with the accumulation of information about the particular norms, behaviors, and practices that exist within a particular cultural group, which should not be limited to ethnicity but rather any social group (e.g., people with disabilities, people who identify as queer, people with different economic backgrounds). The perception is that once these culturally specific practices are recognized, a social worker’s sensitivity to her client will increase. Although this is a common understanding of cultural competence, a definition of cultural competence that is often cited in the literature does not make reference to acquiring information about the culture: “Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations” (Cross, Bazron, Dennis, & Isaacs, 1989). Similarly, the Culturally and Linguistically Appropriate Services (CLAS) standards offered by the United States Department of Health and Human Services, Office of Minority Health (2001) and a definition of cultural competence by Betancourt, Green, and Carrillo (2002) are devoid of a clear emphasis on the acquisition of knowledge about a culture that is needed to work more effectively crossculturally. These definitions do not offer any kind of measurable constructs Cultural Competence Revisited 101 Downloaded by [University of Connecticut] at 05:32 13 June 2013 or outcomes that would allow for an understanding of how one actually acquires or achieves cultural competence (Boyle & Springer, 2001). A common framework for cultural competence that is often cited (Ponterotto & Alexander, 1996) is one that requires that the worker have knowledge, awareness, and skill. Perhaps this is why so many practicing professionals have focused on the acquisition of knowledge, because this framework allows for some quantifiable and measurable outcomes of a worker’s proficiency. Solomon (1976), Green (1982), and Pinderhughes (1989) are credited with expanding our study of racial and ethnic groups and for introducing the idea of culturally competent practice. Pinderhughes offers the following definition of cultural competence to social work: Cultural competence demands that clinicians develop flexibility in thinking and behavior, because they must learn to adapt professional tasks and work styles to the values, expectations, and preferences of specific clients. This means that practitioners must choose from a variety of strategies that are useful for the range of cultural groups and social classes, levels of education, and levels of acculturation that exist among clients. (p. 163) This definition is more nuanced than others that follow, and implies the need for acquiring necessary cultural information in order to choose a useful strategy, as well as the importance of the worker’s reflexivity (Miehls & Moffat, 2000). By introducing the role the worker’s reflection on her own cultural makeup plays in the client/worker dynamic, Pinderhughes made room for the consequences of power to be brought into the conversation of cultural competence. Pinderhughes refers to power as “an often unspoken but central dynamic in cross-cultural encounters” (p. 109). She writes further, stating that “power is a stance that undergirds certain . . . societal values: status, perfection, possession, achievement, competition, independence, and so forth” (p. 112). While this acknowledgment of power is essential when examining the interpersonal dynamics of cross-cultural work, and takes into consideration the macro-level socio-political forces, it must also pull together how they both impact an individual’s positionality. While Pinderhughes alludes to this dynamic, it is not made explicit as a stand-alone concept in her early work. Power, along with the concept of privilege, must be included in our understanding of social identity, culture, and ultimately, cultural competence (Abrams & Moio, 2009). What intersectionality brings to the discussion is how power and privilege complicate and expand the normally one-dimensional and static construction of an individual’s identity by acknowledging the larger social structural forces that help shape it. 102 A. M. Garran and L. Werkmeister Rozas Downloaded by [University of Connecticut] at 05:32 13 June 2013 Intersectionality Davis (2008) defines intersectionality as “the interaction between gender, race, and other categories of difference in individual lives, social practices, institutional arrangements, and cultural ideologies and the outcomes of these interactions in terms of power” (p. 68). Brah and Phoenix (2004) contend that the various aspects of one’s social life cannot be teased apart or stand on their own. Because people are seen within the context of a dynamic social structure, the role that power and privilege have in shaping the lived experience of any individual (whether they be targeted or dominant) is crucial to understanding the often shifting creation of a social consciousness that either helps expand or limit a person’s opportunities (Dill & Zambrana, 2009). The fact that the concept of intersectionality has become a hallmark in feminist theory (Yuval-Davis, 2006; Mehrotra, 2010) speaks to how crucial it is to a discipline whose primary focus is a population who currently and historically has experienced exclusion via various tools of oppression. It is not difficult to draw a similar correlation to social work, a field whose longstanding legacy is one of service and advocacy to the underprivileged and oppressed. Intersectionality weaves together two prime tenets of social work: advocacy for social justice and respecting the dignity and worth of a person. Regardless of whether a social worker works with individuals, families, communities, or policies, advocacy for social justice is a sine qua non for ethical care in social work. Advocating for individuals’ rights, needs, and place in society occurs whether a social worker is helping a client access a particular social service or is assessing a community’s needs. Advocating for social change is inherent in an intersectional approach. Dill and Zambrana (2009) view intersectionality as a political tool, in that it is a form of activism that is rooted in the achievement of social justice. By centering the experiences of targeted populations and revealing power in all of its various individual, institutional, and structural forms, intersectionality seeks to assist communities and individuals to empower themselves (Jones & Wijeyesinghe, 2011). The second tenet essential to social work, respecting the dignity and worth of a person, permeates all interventions and interactions exhibited by social workers. There is a basic assumption that “being mindful of individual differences and cultural and ethnic diversity” (NASW, 2008, p. 5) entails recognizing and acknowledging all of the lived experiences of a person, which includes their multiple identities and how they interface with power. While social workers strive to understand differences in dominant and non-dominant cultural values and norms, they understand that “overrepresentation of children of color in the foster and child welfare system” is a societal problem that has “less to do with cultural values and attributes, and more to do with policies that shape and endorse Cultural Competence Revisited 103 patterns of disenfranchisement” (Almeida, Hernández-Wolfe, & Tubbs 2011). Intersectionality is best known for how it complicates identity without essentializing core aspects of it (Jones & Wijeyesinghe, 2011). In a sense it acknowledges the worth of a person by demonstrating the value of recognizing the whole person, with her multiple identities and complex relations to power. Since many identities as well as power relations are dynamic in terms of their social meaning and mutability, the idea that intersectionality is ambiguous and open-ended as a theory (Davis, 2008) is a perfect fit for social work. Downloaded by [University of Connecticut] at 05:32 13 June 2013 Self-Reflection Self-reflection has been one of the principle components of creating a professional self among social workers (Fook, 1999; Kondrat, 1999; Moffat, 1996). With the heralding of cultural competence, the focus of a worker’s self-awareness has been more on racial and ethnic identity and how that contributes to his or her individual beliefs, biases, and prejudices (Bender, Negi, & Fowler, 2010). Heron (2005) posits that self-reflection is crucial to “social work practice in that such reflection opens up knowledge about our identities and our location within the social order” (p. 343). However, the recognition of a social order and one’s place in it does not automatically follow with an analysis of the power structure (Heron, 2005). Engaging in self-reflection allows the worker the experience of exploring her beliefs, biases, and differences, sometimes for the first time. Often, people believe that what they have come to learn, value, and sanction are not only the “right” things but also what all others learn, value, and sanction. When a worker is involved in the process of self-reflection, she may come to experience ambiguities, contradictions, and anomalies that allow her to broaden her perspective on how others may see themselves or wish to be seen (Lay & McGuire, 2010). Another area for self-reflection is the building of awareness of one’s own racial/ethnic identity development, which includes the developmental process that accompanies such learning. This self-consciousness nurtures the identification and formation of a collective identity with a group that shares a common heritage (Helms, 1990). The utility of being aware of one’s race and ethnicity and where one is in the larger socio-political hierarchy is that it requires the individual to adopt a framework of power and privilege. In order to better comprehend certain feelings, inclinations, reactions, and proclivities to one’s group one must recognize the role of power and privilege, and how they rule the social order. Locating oneself in the social order is not enough, though. One has to be apprised of the myriad threads of power and privilege which do or do not inhabit his or her identities. 104 A. M. Garran and L. Werkmeister Rozas FROM CONCEPT TO APPLICATION While understanding the relationship among power, privilege, and intersectionality from a conceptual aspect is important, it is crucial that we find ways to apply these concepts to our work in the field. The following examples serve to illustrate how this perspective can be useful. Downloaded by [University of Connecticut] at 05:32 13 June 2013 Example 1 A first-year Spanish-speaking, Latina, lesbian MSW student was placed in a primarily Spanish-speaking agency with a Latino supervisor. She was excited about the placement and her supervisor because she thought he would be much more sensitive to cultural issues and help her through the transition of learning the theoretical concepts in English but having to practice them in Spanish. Only a few weeks into her placement, during supervision, her supervisor asked her point blank, “Do you have a boyfriend?” They had not been discussing family or her personal life and it seemed odd and inappropriate for such a question to be asked, especially out of context. Also, the assumption that she was heterosexual was presumptive. Not knowing if this was a boundary crossing or a difference in worldview, she decided to trust her feelings of discomfort and explained to her supervisor that his question made her feel uncomfortable and felt inappropriate. She shared her experience with her field advisor, who was a white, heterosexual male, when he came for a field visit. After their conversation, the field advisor spoke with her supervisor (which was appropriate since she had already expressed her discomfort to her supervisor) and reported that “it was a cultural thing” and that she had misunderstood the cultural nature of his question. Her supervisor explained to her field advisor that he felt as though she was “part of the family” and, being the head of the family, his intent was to “get to know her on a personal level” and “look out for her as a father would a daughter.” The supervisor explained that as a Latino, this is how he sees the people with whom he works. On a clinical level, of course, this could imply countertransference or a part of a parallel process with a particular case with which the intern is working; yet, the important point is that the supervisor himself identifies it as coming from his cultural worldview. This may have been his relationship with his culture, but it was very rigid. It was as if he was using his culture as a defense, putting the topic of someone’s reaction to him off limits. The student’s feelings of discomfort (as a Latina woman) seemed inconsequential to him. This could have been about her relationship to the Latino culture, for example the paternalistic, patriarchal predilections with which she does not align; or, the homophobic and heterosexist attitudes that, similar to any culture, can be found within Latino cultures (Brooks, Etzel, Hinojos, Henry, & Perez, 2005; Diaz, Ayala, Bein, Henne, & Marin, 2001). In a sense, it could be said that what occurred was Downloaded by [University of Connecticut] at 05:32 13 June 2013 Cultural Competence Revisited 105 a consequence not only of the student’s relationship to her culture, but the culture’s relationship to the student. This experience could have resulted in a very rich dialogue among all three people involved here, but instead, the supervisor’s and field advisor’s responses stopped the conversation rather than built upon it. The supervisor’s one-dimensional understanding of his actions, which he associated only with his cultural background, lacked flexibility, a spirit of inquiry, and curiosity about what had occurred between them (Jacobs, David, & Meyer, 1995). When we have a one-dimensional view of our identity it can be used as a defense rather than as a tool to increase our understanding of ourselves and others. As Zerubavel (1993) states, “Flexibility need not entail giving up structure altogether. It does imply however, dynamic, elastic mental structures. Such structures would allow us to break away from the mental cages in which we so often lock ourselves, yet still avoid chaos. With them, we can be creative as well as secure” (p. 122). That is what our identities should make us feel: creative and secure in who we are. Identity is not static. It is living between person and environment, constantly rediscovering ourselves within the context of power, privilege, and the myriad boundaries that create the self. Example 2 A second example serves to further elucidate the ways in which our work is greatly enriched by utilizing the tenets of intersectionality. An MSW at an urban community mental health center who identifies as both AfricanAmerican and Puerto Rican consulted with the staff psychiatrist about a black adolescent she had been treating for six months. The adolescent had been struggling with complicated family dynamics largely due to the financial stress her parents were under. The parents lacked formal education and were only able to secure minimum wage jobs at best; they struggled to support the family of five and were often on the brink of eviction. The client watched her parents’ relationship grow increasingly strained, and one day came to session stating that the tension had escalated to the point of physical violence; during an argument over money, her father slapped her mother in the face. The client was shaken by this incident and worried that her depressive symptoms would return because of the added stress she felt to assume the role of peacemaker in her family. The MSW acted immediately to intervene with the family to address the violence in the home. In addition, as this client had previously met with the staff psychiatrist for a baseline assessment, the MSW decided to consult with him about her new concerns for this client. The psychiatrist, who identifies as African-American and male, was in his second year of residency in this setting. He was described by the staff as wellliked, well-respected, jovial, and thoughtful. When the MSW approached him Downloaded by [University of Connecticut] at 05:32 13 June 2013 106 A. M. Garran and L. Werkmeister Rozas to relay her concerns about her client and to tell him that the father slapped the mother, his first response was, “Well, what’d she do?” The MSW’s first thought was, “Is he asking what the client did in the face of this horrible incident, or is he asking what the mother did to provoke such an attack?” Somewhat stunned, the MSW replied, “Are you joking around? This isn’t funny . . . .” As the MSW sought clarification, the psychiatrist quipped, “Well, she must have made him mad.” He laughed and then said, “Tell me what happened and of course we can schedule the client for an appointment so I can assess her again.” He then proceeded to ask several questions about her mental status, her current level of functioning in school and at home, and about her compliance with sessions. The MSW, unsure of what to say, answered his questions, scheduled the appointment, and left his office. She was shaken by the interaction and sought counsel from her supervisor. Upon hearing about this incident, the supervisor, a white, Irish-American woman, dismissed the MSW’s complaints, stating that she believed the psychiatrist meant no harm and reminded the MSW of his fun, albeit offbeat, sense of humor. She also told the MSW that she needed to stop reading so much into things. Certainly, such an exchange could be understood through the lens of microaggressions (Sue, 2010; Dovidio & Gaertner, 1996): a white woman unknowingly invalidating a person of color’s concerns. What intersectionality offers this analysis is that regardless of whether or not the psychiatrist’s behavior was attributed to his being male, black, or perhaps his sense of humor, all of these factors need to be understood within the context of his position within the larger social structure. There are several notable elements to this troubling exchange if we are to examine the interaction with intersectionality in mind. What weight do we give to social identity as we seek to understand the conversation between the MSW and the psychiatrist? What is the function of having a shared racial identity in this exchange? How do we see the dynamic of power manifest? Do we think that the psychiatrist felt a certain level of comfort and therefore resorted to gallows humor (Maxwell, 2003) with the MSW because of their shared racial identity and the assumption of a tacit understanding of each other’s humor? How, too, do we understand the dynamics of power and privilege in these exchanges? We see their interplay on multiple levels, particularly related to gender, race, and economic and professional status. While the MSW immediately directed her concerns to her supervisor, her attempts both to discuss and subsequently make meaning of the situation were met with disinterest. Thus, the MSW is left to process on her own a sense of marginalization that is often a parallel sentiment shared by clients when they are stonewalled by manifestations of power and privilege. Clearly, both examples include elements of poor supervision through potential boundary crossings and dismissiveness on the part of the supervisor, and there is no way of knowing how things may have progressed Downloaded by [University of Connecticut] at 05:32 13 June 2013 Cultural Competence Revisited 107 had the individuals involved had a set of different positionalities. However, intersectionality lends credence to the importance of adding the lens of power and privilege into the supervisory relationship. As Hernandez and McDowell (2010) explain, it “is an avenue to address the complexities of empowerment and accountability within groups and across groups in a particular social context” (p. 30). In these case examples, it is clear that neither the field advisor nor either of the supervisors had given much thought to intersecting identities, relational power, or the social forces that shape a person’s experience in the world. In one example, they assumed that simply attending to the understanding of cultural differences (and in this case some assumed cultural similarities) they were being culturally competent. In the second, the supervisor’s direct dismissal can be understood as the manifestation of privilege by calling a worker emotional rather than confronting an uncomfortable situation. By refusing, though, to recognize or acknowledge individual, structural, or institutional power, the supervisor in the second example remains in her place of privilege and simultaneously minimizes the worker’s claims and concerns. Had she chosen to address the psychiatrist’s messages, the supervisor would have been in the unenviable position of having to deconstruct an interaction where she, as someone from the dominant group, had to comment on the actions of a professional who “outranks” her, but who is also a member of a marginalized group. [T]his dismissal allows dominant group members to project the problem outward onto minoritized groups and their allies while simultaneously minimizing it—the problem now belongs to the minoritized group and they themselves create it by taking life too seriously . . . it isn’t really an issue at all; the minoritized group itself could easily solve oppression by simply getting over it and moving on. (Sensoy & DiAngelo, 2012, p. 139) In addition, in both cases, the supervisors were dismissive of concerns raised by workers who reported to them. This dynamic, referred to as privileged resistance by Okun (2010), is an all too common occurrence in situations where a person in a subjugated position attempts to draw attention to an area of inequity. “[D]ominant group members tend to dismiss the voices of minoritized group members as: representing ‘special’ or biased interests; angry and disruptive; emotional and illogical; and therefore, as unworthy of consideration” (Sensoy & DiAngelo, 2012, pp. 148–149). Without acknowledgment and analysis of the power and privilege inherent in this situation, knowledge, awareness, and skills remain static at best and stagnant at worst. Important opportunities were missed to have conversations about identity and the larger social structures that influence us profoundly every day in agency practice. Self-reflection and self-awareness are inhibited, and key elements of relationships on many levels remain unaddressed and unchanged. 108 A. M. Garran and L. Werkmeister Rozas Downloaded by [University of Connecticut] at 05:32 13 June 2013 CONCLUSION Proponents of culturally responsive practice call for a more intersectional way of working, but currently most of this literature is housed in the education field (Gay, 2000). With mental health in mind, Ancis (2004) writes that culturally responsive interventions require clinician awareness, knowledge, and behavioral flexibility: “. . . the clinician must have an understanding of the impact of culture and social context on world view, expression and manifestation of distress, outcome, and help seeking behavior. There exists a dynamic interplay between individuals and their environments” (p. 217). She goes on to state that in order to be an effective culturally responsive clinician, one must have an awareness of power dynamics and stigmatizing experiences of those from historically marginalized groups. Ancis notes, too, that clinicians must also be aware of their own worldview and cultural background and the impact of these sociocultural factors on clinical work, to allow for a more flexible approach to the work. The need for a more comprehensive adaptation of cultural competence that includes intersectionality is called for in schools of social work as well as in our social service organizations. Anastas (2010) contends that [s]ocial work education has not yet even taken on all the dimensions of difference that we should teach in our curricula and in interacting with our students . . . . Just as no one can be fully “competent” in knowing everything about all ethnicities and cultures, it is impossible to understand all the intersectionalities that we, our students, and our clients inhabit and enact. Remembering these complexities is an important reason to make curiosity and openness to alternative worldviews central to approaching diversity and oppression issues, for teachers and for learners alike. (p. 91) Schools of social work must challenge students and field personnel to reformulate a definition of cultural competence that acknowledges power and privilege in relationships. Organizations should consider reviewing policies that might affect marginalized clients and should also consider expanding cultural competence training, bringing the focus to the interplay of power and privilege in relationships on multiple levels (with clients as well as between staff members). Too many organizations offer trainings that lack complexity and which often essentialize populations instead of helping workers to increase their capacity for self-reflection and for reflexivity. It is critical that social workers embrace the tenets of the code of ethics but also build on them. The standards, in particular, lack a clear directive to consider the impact of power and privilege as we move toward a higher level of cultural competence. Without this acknowledgment of the importance of a power analysis (Levine-Rasky, 2011), we will miss out on myriad opportunities for our clients and for ourselves. Cultural Competence Revisited 109 Downloaded by [University of Connecticut] at 05:32 13 June 2013 REFERENCES Abrams, L. S., & Moio, J. A. (2009). Critical race theory and the cultural competence dilemma in social work education. Journal of Social Work Education, 45(2), 245–261. Almeida, R., Hernández-Wolfe, P., & Tubbs, C. (2011). Cultural equity: Bridging the complexity of social identity with therapeutic practice. The International Journal of Narrative Therapy and Community Work, 3, 43–56. Retrieved from http://www.instituteforfamilyservices.com/almeida_ phernandez-wolfe_ctubbs%202011_ Anastas, J. (2010). 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