As most mental health professionals experienced in working with ethnic minorities would know, methods based on the extreme position that the Western mainstream model of psychotherapy is universal are simply too general to be practical. In addition, when translated into practice, the etic approach runs the risk of underestimating the overarching effect cultural frameworks have on every aspect of mental health services (Hong & Ham, 1994). These include conceptualization of mental health and illness, perception and expectation of mental health agencies and professionals, symptom manifestation, help-seeking behavior, therapist-client relationship, therapeutic goals, strategies, and process, among others. By treating culture simply as one among many other factors to consider, mental health professionals utilizing the etic approach could overlook the salience of culture in many of these critical areas. Indeed, as reflected in the curricula of some training programs, this approach may result in minimum attention being given to cultural competence. For example, cultural issues in mental health services are covered in a single "multicultural" course, and the content is seldom, if ever, emphasized or given further elaboration in other clinical courses. This, in actuality, perpetuates the status quo, and proves to be inadequate in preparing mental health professionals to meet the needs reflected in the new demographics of the United States in the coming years.
In contrast, emphasizing that all therapeutic transactions, and in fact all human perceptions and social interactions, occur within the context of culture, the emic approach alerts the clinician to the impact of culture in all aspects of mental health services. In particular, it highlights the importance for the clinician to be aware of his or her own culture and worldview, and to take the client's culture and worldview into objective consideration, in defining the presenting problem as well as the intervention strategies. This is especially crucial when clinicians are providing service to clients from cultural backgrounds different from themselves. For example, clinicians must make every effort to "see" how the client might behave and reason in certain ways as related to the identified problem. Unless the clinician tries to "walk" in the client's shoes and perceive the situation through the client's lenses, the emic perspective would indicate that one is not professionally able to really understand the client's problems or come up with the best or most appropriate interventions. The emic approach challenges one to think ethnic in order to fully appreciate a client's frame of reference.
Yet, when taken to the extreme, the emic position also raises practical concerns. The generic labels Hispanic Americans, Asian Pacific Americans, Native Americans, African Americans, as well as White Americans actually cover many different ethnic groups from numerous cultures and subcultures all over the world. For example, in Los Angeles county, there are 90 major languages, or 240 languages and dialects, spoken by the students in the public schools (Los Angeles County Office of Education, 1994). This is reflective of the cultural and ethnic diversity of the region. If the emic approach is taken to mean culture-specific mental health services for each ethnic group, it will basically be impossible to provide culturally responsive services for such diverse populations. The potential list of cultures to study will also become an insurmountable hurdle for professionals and students. It may even lead to the erroneous belief that because in-depth understanding of specific cultures is essential for cultural proficiency, then one might be better off by solely focusing on serving clients from one's own cultural heritage, as there are too many cultures to learn and too much complexity within each culture to master. Instead of promoting cultural competence, this position can actually result in a form of ethnic segregation in the profession, with clinicians from each ethnic group working primarily within their own group. For example, only Asian Americans might feel confident enough to study mental health services for the Asian American groups, only Hispanic Americans might feel confident enough to study Hispanic groups, and the same for African Americans, Native Americans, White Americans, and so on. In fact, we have already noticed this tendency in the field from some students and professionals of both ethnic minority and majority backgrounds. They feel too intimidated by the challenges of multiculturalism, and prefer to retreat to their own ethnic communities. Indeed, overemphasizing cultural diversity and uniqueness can become an insurmountable barrier and a disservice to the cause of multiculturalism in mental health services. It may discourage professionals and students from truly developing the cultural proficiency required for effective practice in a multicultural society, where they will be expected to serve clients from diverse ethnic backgrounds, rather than treating clients exclusively from their own ethnic communities.
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