Cultural Humility

How many triangles do you see?

When in mid-March I began social distancing--a practice that has involved not seeing my kid clients face-to-face--my supervisor suggested that I catch up with my training hours by participating in some on-line training modules. Because I am a paraprofessional and not a licensed therapist, my yearly quota of trainings is mostly achieved by just attending monthly staff meetings and peer reviews. This past year, however, I missed several of those due to both personal travel and Master Gardener lab classes that conflicted with meeting times; I was legitimately excused by my supervisor for not attending, but I also did not accrue the training hours. (In addition, we ended up not holding staff meetings or peer reviews in March and April--social distancing protocols--but we do have a staff meeting scheduled for May via Zoom.) Hence, for the first time since my employment with Hale Kipa,  I explored the permitted-for-credit online trainings offered. Laudably, I have learned relevant concepts and practices that make a difference for me, and, happily, I have found these endeavors to be both engaging and motivating.

During a nine-module course entitled Early Childhood Mental Health, I first encountered the term "cultural humility" in the final lesson, one which presented strategies to incorporate into your actual practice with clients, like being cognizant of cultural considerations--your own and those of the children/families with whom you work. And not only to be cognizant of culture but also to understand how culture can impact/influence relationship-building, interactions, and even perceptions. That module concluded with an assignment for self-reflection focused on these questions: Who am I? How does my cultural background influence my values, beliefs, attitudes, and assumptions? What is blocking me from hearing, understanding, and learning from the person/family I work with? What is blocking me from fully caring about someone else?

About two weeks later, I took a course titled Implicit Bias: the Influence of the Unconscious Mind (from CDC Train website)and was immediately struck with how the idea of cultural humility dovetails with the concept of implicit bias and the influence of our unconscious minds.

In this course I learned that at any given moment, our unconscious mind is processing 11,000,000 bits of information; it then passes along 40 of those bits to our conscious mind in that same moment. Even still we make around 35,000 conscious decisions per day. Crunching the data, our unconscious mind analyzes 99.999996% of all the information our minds apprehend and also determines which bits--as in 40 of every 11,000,000--to pass along to the conscious. It is the gatekeeper of information: founded on its own accumulating collection of memories, social/behavioral experiences,  and, yes, biases, it sorts through the bits of perceived information, "finding patterns" and "filling in blanks," ultimately deciding what to delete or ignore, what to emphasize or de-emphasize, when to distort, and when to generalize.

Here are terms and explanations of common biases:

confirmation bias - interpreting new evidence as confirmation of one's existing expectations and beliefs (Think guns, gun control, and mass shootings and how the same evidence is used to confirm various perspectives of the controversy.)

halo/horn effect - a first impression colors or influences one's perception of a person throughout (Here use common perceptions of men and women:  the woman is bossy and the man is assertive; the woman is shrill/strident and the man is authoritative.)

beauty bias - physically attractive people possess other desirable traits (Consider that 60% of CEO's are over six feet tall although only 14.5% of the population is over six feet tall.)

affinity bias - preference/appreciation for people with whom we have something in common

conformity bias - a strong tendency to go along with the group (as in peer pressure)

So back to that lead-in question of how many triangles you can see in the diagram. There are no triangles in the diagram--only three V's and three Pac-Man-esque blots. But we see what we expect to see.

Our unconscious mind is susceptible to all of the biases listed above, and although it works out fine at times, what about all the times when it does not?

Our unconscious biases are also not necessarily related to our conscious beliefs and desires--hence, implicit bias. The Boston Symphony--predominantly comprised of males for a long time--made the conscious decision that it wanted to diversify and have more female members. For auditions they actively encouraged more women to try out. When they still ended up predominantly male in number, they moved to having blind auditions. Yet the number of males continued to dominate. It wasn't until they decided to have those participating in blind auditions remove their shoes before entering the audition area that the number of women accepted as members of the symphony substantially increased. The sound that high heels made as someone, presumably a woman, walked across the floor triggered a response in the unconscious minds of the judges.

So certainly there are strategies to combat the biases that lurk in our unconscious minds and break the connection between bias and behavior. First of all, we must become more aware of the potential for bias to exist in any situation. We have to be willing to doubt the extent of our own objectivity and increase our motivation to be fair. And maybe most importantly, we must improve the conditions for solid decision-making: "Think slow." It's true--those admonitions to breathe or count or do some other little thing to expand the time between impulse and action have real purpose and powerful impact.

And now let's return to the idea of cultural humility. A mental health professional--an African-American woman--described her experience of working with a client, a mother with a four-year-old son who was still drinking from a bottle. The mother wanted to know how she could best end her son's continued insistence on drinking from a bottle. The therapist confessed that at first she was dumbfounded with the inquiry and thought, you're the mother and he is four--just take away his option of having a bottle. Instead, though, the therapist decided to continue the conversation: What concerned the mother about making an end to this behavior? What were the hopes and goals she had for her interactions with her son? The therapist then learned that this mother wanted her son to know that he did not have to just submit to a power figure, that he could negotiate with regard to his own wants and desires even with people in power positions. The mother felt it was important that the son learn some negotiating skills. The therapist then recounted her own thought processes as she considered how to best serve this mother: The mother and son were caucasian, and within the culture in which this boy would grow up, there could actually be a safe space for him to negotiate with people in power positions. Although such a scenario was not necessarily true in the same way for the young boys in her own culture and was not consistent with her own upbringing, for this mother and son, the option could quite possibly exist. The son would lose access to a bottle but maybe gain the power to choose what socks to wear or what flavor of yogurt to consume for breakfast. There were choices this child could learn to negotiate for and remain safe in his environment.

Universal truths exist and are commonly shared throughout many cultures. Yet, other cultural practices and circumstances vary in all kinds of ways. We, however, continue to feel more comfortable inside the design of the culture that shaped us and often judge others and the world through the lenses that culture developed for us. Cultural humility, though, allows us to acknowledge that our comfort and those lenses are not really validation that our culture is better than another or that it provides a complete understanding of our world and the human condition at large. Humility indicates one is teachable, open to learning and knowing beyond one's current state. Cultural humility is critical to building effective relationships between client and therapist in the realm of mental health, but I think it carries vast potential for the world at large. Call me idealistic, but I like to think that if we would strive to practice more cultural humility in our interactions with human beings in general, we would be more open to accepting other peoples' stories and experiences as being as valid and as important as our own, and together we could build a better world.