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The emphasis on cultural context of diagnosis and treatment of psychiatric disorders was expanded in the DSM-5, but the commonly used term for this orientation, “cultural competence,” is potentially misleading, according to a panel of experienced clinicians participating in a workshop at the annual meeting of the American Psychiatric Association.
“I am not even sure how competent I am in my own culture,” said Richa Bhatia, MD, medical director of the Child and Adolescent OCD Institute at McLean Hospital, Belmont, Mass.. The remark was representative; like other panelists in a workshop developed by the Association of Women Psychiatrists, she de-emphasized the importance of becoming fluent in the specifics of a culture relative to simply being sensitive to variations in cultural landmarks and milestones.
However, she, like others, expressed concern about the label “competence.” “Cultural humility is really a much better term,” Dr. Olarte said. The reason is that Furthermore, it encourages clinicians to consider and manage their own prejudices, values, and biases in order to allow them to be effective in the therapeutic interaction.
In the DSM-5, a systematic outline is provided for eliciting culturally relevant information from the diagnostic interview and incorporating it into a therapeutic plan. Cultural competence is important for communication and for building patient trust, but the panelists uniformly agreed that it is not necessary to be fluent in the culture of the patient to be an effective clinician.
“Cultural identification is fluid, and patients have multiple identities,” said Lourdes M. Dominguez, MD, associate professor of psychiatry at Columbia University, New York. Recounting her work with first responders to the Sept. 11, 2001, World Trade Center attack, Dr. Dominguez offered care to police officers associated with a variety of cultures. In addition to different ethnicities and sexual orientations, this included the culture of law enforcement itself. The key for all patients was an ability to convey the message that the patient was being heard.
“The us-versus-them mentality in law enforcement limits the options when fellow officers are not providing the support they need,” Dr. Dominguez explained. “First, you need to win their trust.”
Familiarity with cultural milestones can be reassuring to patients, but Sherry P. Katz-Bearnot, MD, assistant clinical professor of psychiatry at Columbia University, cautioned that there is counterproductive underside to cultural competence. While recognizing the significance of cultural milestones, such as a bar mitvah or quinceañera, can be reassuring to patients, Dr. Katz-Bearnot emphasized that clinicians must remain sensitive to the personal responses to those events.
“If you know too much, there is a risk of glossing over the issues unique to the individual in front of you,” Dr. Katz-Bearnot said. She emphasized that those cultural landmarks do not necessarily mean the same thing to all members of a community. Sensitivity to personal issues trumps cultural familiarity.
The same statement could be made for delivering care to transgender patients, judging from a presentation by Courtney Saw, MD, a PGY3 resident in the department of psychiatry at the University of Pennsylvania, Philadelphia. Quoting a survey that found most transgender individuals consider health care professionals inadequately trained to manage their health issues, she stressed the importance of how questions are phrased.
“Every patient’s gender journey is unique,” Dr. Saw said. For example, specific questions about gender anatomy should be supplanted by open questions about gender transition, allowing patients to respond at their own level of comfort. This, according to Dr. Saw, is essential for “building a therapeutic collaboration.”
Embracing the concept of cultural humility, all of the panelists agreed that it is far less important to have cultural expertise than it is to be open, curious, and accepting. Sensitivity is more important than competence when specific cultural issues are relevant to treatment.
“We don’t have to have all the answers. We just need to be good at listening so that we can help patients work their way towards the answers,” Dr. Saw suggested. Others agreed.
Dr. Bhatia, Dr. Olarte, Dr. Dominguez, Dr. Katz-Bearnot, and Dr. Saw reported no potential conflicts of interest related to this topic.
The emphasis on cultural context of diagnosis and treatment of psychiatric disorders was expanded in the DSM-5, but the commonly used term for this orientation, “cultural competence,” is potentially misleading, according to a panel of experienced clinicians participating in a workshop at the annual meeting of the American Psychiatric Association.
“I am not even sure how competent I am in my own culture,” said Richa Bhatia, MD, medical director of the Child and Adolescent OCD Institute at McLean Hospital, Belmont, Mass.. The remark was representative; like other panelists in a workshop developed by the Association of Women Psychiatrists, she de-emphasized the importance of becoming fluent in the specifics of a culture relative to simply being sensitive to variations in cultural landmarks and milestones.
However, she, like others, expressed concern about the label “competence.” “Cultural humility is really a much better term,” Dr. Olarte said. The reason is that Furthermore, it encourages clinicians to consider and manage their own prejudices, values, and biases in order to allow them to be effective in the therapeutic interaction.
In the DSM-5, a systematic outline is provided for eliciting culturally relevant information from the diagnostic interview and incorporating it into a therapeutic plan. Cultural competence is important for communication and for building patient trust, but the panelists uniformly agreed that it is not necessary to be fluent in the culture of the patient to be an effective clinician.
“Cultural identification is fluid, and patients have multiple identities,” said Lourdes M. Dominguez, MD, associate professor of psychiatry at Columbia University, New York. Recounting her work with first responders to the Sept. 11, 2001, World Trade Center attack, Dr. Dominguez offered care to police officers associated with a variety of cultures. In addition to different ethnicities and sexual orientations, this included the culture of law enforcement itself. The key for all patients was an ability to convey the message that the patient was being heard.
“The us-versus-them mentality in law enforcement limits the options when fellow officers are not providing the support they need,” Dr. Dominguez explained. “First, you need to win their trust.”
Familiarity with cultural milestones can be reassuring to patients, but Sherry P. Katz-Bearnot, MD, assistant clinical professor of psychiatry at Columbia University, cautioned that there is counterproductive underside to cultural competence. While recognizing the significance of cultural milestones, such as a bar mitvah or quinceañera, can be reassuring to patients, Dr. Katz-Bearnot emphasized that clinicians must remain sensitive to the personal responses to those events.
“If you know too much, there is a risk of glossing over the issues unique to the individual in front of you,” Dr. Katz-Bearnot said. She emphasized that those cultural landmarks do not necessarily mean the same thing to all members of a community. Sensitivity to personal issues trumps cultural familiarity.
The same statement could be made for delivering care to transgender patients, judging from a presentation by Courtney Saw, MD, a PGY3 resident in the department of psychiatry at the University of Pennsylvania, Philadelphia. Quoting a survey that found most transgender individuals consider health care professionals inadequately trained to manage their health issues, she stressed the importance of how questions are phrased.
“Every patient’s gender journey is unique,” Dr. Saw said. For example, specific questions about gender anatomy should be supplanted by open questions about gender transition, allowing patients to respond at their own level of comfort. This, according to Dr. Saw, is essential for “building a therapeutic collaboration.”
Embracing the concept of cultural humility, all of the panelists agreed that it is far less important to have cultural expertise than it is to be open, curious, and accepting. Sensitivity is more important than competence when specific cultural issues are relevant to treatment.
“We don’t have to have all the answers. We just need to be good at listening so that we can help patients work their way towards the answers,” Dr. Saw suggested. Others agreed.
Dr. Bhatia, Dr. Olarte, Dr. Dominguez, Dr. Katz-Bearnot, and Dr. Saw reported no potential conflicts of interest related to this topic.
The emphasis on cultural context of diagnosis and treatment of psychiatric disorders was expanded in the DSM-5, but the commonly used term for this orientation, “cultural competence,” is potentially misleading, according to a panel of experienced clinicians participating in a workshop at the annual meeting of the American Psychiatric Association.
“I am not even sure how competent I am in my own culture,” said Richa Bhatia, MD, medical director of the Child and Adolescent OCD Institute at McLean Hospital, Belmont, Mass.. The remark was representative; like other panelists in a workshop developed by the Association of Women Psychiatrists, she de-emphasized the importance of becoming fluent in the specifics of a culture relative to simply being sensitive to variations in cultural landmarks and milestones.
However, she, like others, expressed concern about the label “competence.” “Cultural humility is really a much better term,” Dr. Olarte said. The reason is that Furthermore, it encourages clinicians to consider and manage their own prejudices, values, and biases in order to allow them to be effective in the therapeutic interaction.
In the DSM-5, a systematic outline is provided for eliciting culturally relevant information from the diagnostic interview and incorporating it into a therapeutic plan. Cultural competence is important for communication and for building patient trust, but the panelists uniformly agreed that it is not necessary to be fluent in the culture of the patient to be an effective clinician.
“Cultural identification is fluid, and patients have multiple identities,” said Lourdes M. Dominguez, MD, associate professor of psychiatry at Columbia University, New York. Recounting her work with first responders to the Sept. 11, 2001, World Trade Center attack, Dr. Dominguez offered care to police officers associated with a variety of cultures. In addition to different ethnicities and sexual orientations, this included the culture of law enforcement itself. The key for all patients was an ability to convey the message that the patient was being heard.
“The us-versus-them mentality in law enforcement limits the options when fellow officers are not providing the support they need,” Dr. Dominguez explained. “First, you need to win their trust.”
Familiarity with cultural milestones can be reassuring to patients, but Sherry P. Katz-Bearnot, MD, assistant clinical professor of psychiatry at Columbia University, cautioned that there is counterproductive underside to cultural competence. While recognizing the significance of cultural milestones, such as a bar mitvah or quinceañera, can be reassuring to patients, Dr. Katz-Bearnot emphasized that clinicians must remain sensitive to the personal responses to those events.
“If you know too much, there is a risk of glossing over the issues unique to the individual in front of you,” Dr. Katz-Bearnot said. She emphasized that those cultural landmarks do not necessarily mean the same thing to all members of a community. Sensitivity to personal issues trumps cultural familiarity.
The same statement could be made for delivering care to transgender patients, judging from a presentation by Courtney Saw, MD, a PGY3 resident in the department of psychiatry at the University of Pennsylvania, Philadelphia. Quoting a survey that found most transgender individuals consider health care professionals inadequately trained to manage their health issues, she stressed the importance of how questions are phrased.
“Every patient’s gender journey is unique,” Dr. Saw said. For example, specific questions about gender anatomy should be supplanted by open questions about gender transition, allowing patients to respond at their own level of comfort. This, according to Dr. Saw, is essential for “building a therapeutic collaboration.”
Embracing the concept of cultural humility, all of the panelists agreed that it is far less important to have cultural expertise than it is to be open, curious, and accepting. Sensitivity is more important than competence when specific cultural issues are relevant to treatment.
“We don’t have to have all the answers. We just need to be good at listening so that we can help patients work their way towards the answers,” Dr. Saw suggested. Others agreed.
Dr. Bhatia, Dr. Olarte, Dr. Dominguez, Dr. Katz-Bearnot, and Dr. Saw reported no potential conflicts of interest related to this topic.
EXPERT ANALYSIS FROM APA