General Considerations

In approaching the subject of cultural proficiency training, it is important to bear in mind that the general ethnic/racial labels used in the U.S. Census as well as in many textbooks typically include groups that share commonalities as well as diversities. The previous discussion is simply an illustration of the issues using the Asian American groups and the Hispanic American groups as examples. The same observations can be made of other ethnic/cultural groups. For instance, in mental health services for African Americans, clinicians need to be aware of the differences in values, norms, and expectations due to socioeconomic group differences, as well as the differences among new immigrants versus those who have been in the United States for generations, in addition to regional differences and other considerations. The same is true for Native Americans, which, far from being a single cultural group, is a general label referring to about 550 federally recognized nations, tribes, bands, clans, or communities, speaking a variety of tribal languages, with a number of different cultural traditions (Axelson, 1999).

The White American population is also composed of diverse ethnicities. In addition to people from Western Europe, this term also includes people from other areas, cultures, or ethnic backgrounds. Some of the White American subgroups frequently mentioned in the literature are Jewish Americans, Italian Americans, Polish Americans, and Appalachian Americans. Besides these groups, the term White Americans also includes, among others, people from other Eastern European countries, the Middle East, and the former U.S.S.R. Immigrants from these regions constitute a growing presence in some areas of the United States. As such, mental health professionals need to understand the differences among the various White American subgroups, as well as the general mainstream White population. In addition, socioeconomic issues and regional subcultures within the United States are important considerations.

In view of such diversities among the U.S. population, the integrated etic-emic approach offers a practical strategy for cultural proficiency training. This approach presents the commonalities in the cultural orientation of the groups encompassed by the general ethnic categories, while at the same time, alerting the mental health professional to the possible diversities among them, and focusing more on the specific groups with which one is most likely to work.

As applied to actual clinical practice, etic principles help mental health professionals find a common ground from which to begin a professional journey into the lives of their clients as fellow human beings and cultural beings. However, it is important for the clinician to move from a general approach to a more specific, emic approach that recognizes the client's specific cultural experiences. Similarly, in the context of professional training, starting from an etic perspective can help students and trainees develop a firm grasp of general clinical principles that they will subsequently learn to adapt to particular cultures through an emic perspective. Emphasizing an exclusive emic approach too early in a training program may simply force students and trainees to narrow their scope of competence to one or two specific groups within a general ethnic/ cultural category. This will not permit them to take full advantage of cultural commonalities that make it possible for them to generalize their knowledge to other groups sharing a similar cultural heritage. The integrated etic-emic approach starts with the general principles of counseling and therapy as well as human development; but at the same time, alerts students and trainees that each of these principles must be considered and applied within the context of the client's culture. As each principle is introduced, the trainer uses examples from one or two cultures other than mainstream White culture to illustrate its relevance or application in different sociocultural contexts. However, the more detailed discussion of applying these principles to specific ethnic/cultural groups is held off until students and trainees have a firm understanding of the general principles. In sum, the integrated etic-emic perspective is a practical approach that provides students, trainees, and clinicians a general view of human similarities and the sociocultural issues of the major ethnic/cultural groups; while helping them to understand the nuances of both between-group and within-group differences as well as similarities.

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