Cultural and Linguistic Competency

California State Assembly Bill 1195 (AB1195) asks instructors of courses related to patient care to include their understanding of disparities in access to health care that individual patients from a non-dominant cultural or linguistic group have had to mental health services as well as how mental health treatment is perceived in their culture. As providers of health care it is important to understand our own world view and how other people’s worldview in their culture differs from ours. A culturally competent practitioner has a set of integrated attitudes, knowledge and skills that enable them to care effectively for patients from diverse cultures, groups and communities.

“Culture is defined as the belief systems and value orientations that influence customs, norms, practices, and social institutions, including psychological processes and organizations.” (Fiske, Kitayama, Markus, & Nisbett, 1998). In addition to the factors that we as analysts normally take into account; race, ethnicity, gender, sexual orientation, and religion, it is important to know that one’s worldview is also informed by the historical, economic, ecological, and political forces on a group.

Judgments about the normality/pathology of behavior can be made incorrectly if basic premises of a culture are unknown or misunderstood. For instance, a cultural facet of mainstream culture in the United States is a preference for individuals who are independent, who determine their own goals and focus on achieving them by means of rational decision making. By contrast, individuals with origins in cultures of East Asia may prefer interdependence with others, orientation towards harmony with others, conforming to social norms, and subordination of personal goals and objectives to the will of the group (Fiske et al., 1998). A preference for an independent orientation by the analyst may unconsciously shape a negative judgment towards a patient whose orientation is different.

History has been different for major U.S. cultural groups. Past experiences in relation to the dominant culture including slavery, Asian concentration camps, the American Indian holocaust, and the colonization of the major Latino groups on their previous Southwest homelands contribute to some of the sociopolitical dynamics, influencing worldview. In addition, immigration and refugee status of either oneself or one’s family may play a heavy role in a patient’s psychology and should be considered.

As you consider your course material, we encourage you to think about whether the knowledge and/or skills you are teaching have a universal application across cultures, i.e., universal aspects of human development, or whether or not you need to consider some of the aspects found in the following questions originally composed by Forrest Hamer, Ph.D.:

1. What knowledge and which experiences facilitate one’s ability to conduct psychoanalyses with analysands of varying cultural and linguistic backgrounds?
2. How do cultural similarity and difference affect the analytic process?
3. How do the conscious and unconscious aspects of an analysts’ cultural, ethnic and racial affiliations affect the way they think about the meaning of these affiliations in their analysands?
4. What value for the analyst lies in knowing the analysand’s cultural background?
5. What value lies in the analysand’s reflecting on the cultural background of themselves and their analyst?

Below is a link to the annotated bibliography (contributed by Forrest Hamer, Ph.D.) you might find useful both as you answer questions about cultural competence on the Program Request Form and as you plan your course.

Intercultural Psychoanalysis—Selected Bibliography 1984-2009

Cultural and Linguistic Competency
California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. SFCP portal at website address contains many useful cultural and linguistic competency tools including culture guides, and pertinent state and federal laws. You are encouraged to visit the portal.

State & Federal Laws

• Federal Civil Rights Act
• Executive Order 13166
• Dymally-Alatorre Bilingual Services Act of California

Provider's Guide: Health Disparaties

SFCP Library Material Pertinent to Culture and Linguistic Competency