Cultural Humility in ABA

Once, on a late Halloween night more than ten years ago, I was doing intake for a homeless veteran woman into a transitional housing program. We were processing paperwork, going through the food pantry to get her something to eat for the night, and trying to find clothes in the Boutique (a cute name for a modest closet of donated clothes) for her to wear until we could get her more. I apologized for not having any costumes for her, as the other residents were busy enjoying their Halloween shenanigans.

“Don’t worry about that,” she said easily. “I’m a Jehovah’s Witness.”

My face must have betrayed my panic. I had no experience with the religion and was completely unfamiliar with its customs. Was my apology offensive? Were the other clients, parading around the house as cowgirls and vampires, an affront to her? I stumbled over an apology, certain I had embarrassed myself and mortally wounded our relationship before it had even started. “Oh no, I am just…I’m so sorry, I didn’t know-”

She stopped my nervous tirade with a loud burst of laughter. It cut the tension like a knife, and I found myself laughing too. As we collected ourselves, she pulled a pack of cotton underwear from a shelf and turned back to me. “If you don’t know, you could always just ask.”

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If you’ve been around the field of human services for any length of time, you have probably come into contact with the phrase “cultural competency.” You may have had a cultural competency training, discussed it with a supervisor, or noticed when its practice was woefully absent in an interaction between a coworker and a client. The concept of cultural competency as integral to the practicing clinician’s toolbox is fairly common and encouraged as a practice across multiple disciplines.

However, in 1998, in a push to incorporate intersectionality into their practice, Melanie Tervalon and Jann Murray-Garcia proposed a different concept: cultural humility. At its core, cultural humility is the “ability to maintain an interpersonal stance that is other-oriented (or open to the other) in relation to aspect of cultural identity that are most important to the person.”(1)

The focus is on service to the client, and honoring the concept that the person knows what is best for them and is their own best advocate. Cultural humility encourages perspective-taking on the part of the clinician, and taking into account their personal histories and culture as the context within which therapy can be successful for them.

The goal of cultural humility in practice is to encourage growth in the clinician in terms of accepting the unfamiliar, to center introspection and empathy, and to position the client as the teacher. We, as clinicians, have a responsibility to educate ourselves on the client’s experience, and to prioritize the goals and practices that the client prioritizes.

“Cultural competence” implies that there is a possible mastery that can be attained in pursuit of human services, which is not a realistic (or even possible) goal. In our quest to serve others and help them reach clinically significant goals, it behooves us to adopt the attitude of the perpetual student: to sit beside what we don’t know, bask in the discomfort, and, if we don’t know, just ask.

1, Hook, J.N. (2013). “Cultural Humility: Measuring openness to culturally diverse clients”. Journal of Counseling Psychology. 60 (3): 353–366.