Actually, the etic and emic approaches are not necessarily mutually exclusive, especially from an applied perspective. One can combine the most practical elements of each approach to formulate a training model that includes general, universal techniques as well as specific skills relevant to specific cultural groups that the particular mental health professionals are likely to encounter. This integrated approach includes skills for communicating across cultures and efforts to sensitize clinicians to be aware of differences in worldviews, values, norms, styles of communication and social interaction, and group experiences, among others. Furthermore, while acknowledging the diversity of the many ethnic groups constituting the population of the United States, we also need to recognize that there are commonalities that justify discussing certain groups under a more general framework. This makes the task of cultural proficiency development more manageable for both trainers and trainees. We will elaborate on this issue at a later point.
Integration of the etic and emic approaches involves learning about the general clinical principles but, at the same time, viewing the clinical method as fundamentally personal. Any relevant information is applied with regard to the uniqueness of the cultural context and the personal situation of the client. There are at least two aspects of the clinical issue that need to be considered. First, the issues presented by a client are fundamentally personal to the client, irrespective of whomever else may share the problem. For example, an adolescent girl suffering from anorexia nervosa will grapple with issues surrounding weight gain and body image. Despite the fact that many other young women may be facing these same issues, the problem is unique within this adolescent's own personal experiences. The second aspect concerns the client's specific life context or situation. How does the clinician define the context or gain understanding of the situation from the client's perspective? In the example of the anorexic adolescent, the clinician will need to have an understanding of her sociocultural context, investigate her support system, obstacles, assets, and skills. Yet, recognizing a support system across cultures is challenging. A naive clinician may fail to acknowledge the opportunities for support within a particular culture, and may unintentionally misdirect the adolescent in coping with her own self-image, her physical health, and her family's values and norms regarding eating habits and thin-body ideals. Mental health professionals require skills in the applications of science to the cultural context, and a thorough understanding of science and scientific values (Trierweiler & Strieker, 1998). Thus, in working with this adolescent, a mental health professional needs to understand the general psychological and health issues concering anorexia nervosa, a subject matter on the etic level. At the same time, on the emic level, the clinician also needs to understand the adolescent's problem in her own cultural context, and from her own personal perspective. The effective mental health professional will develop situation- and context-specific hypotheses, collect data based on observations and interactions with the client in the client's social environmental context, and employ techniques derived from general clinical principles and adapted to the client's specific cultural context. This, in essence, is what we advocate as the integrated approach utilizing both the etic and emic perspectives. This balanced approach presents the subject matter of multicultural mental health services in a more attainable and practical format. It serves as a viable method for cultural proficiency training, which both trainers and trainees find effective.
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