Cultural Humility Exploration

Introduction:

This paper explores my thoughts and experiences with culture and cultural humility as I journeyed through the book, Using Art Therapy with Diverse Populations: Crossing Cultures and Abilities by Howie et al. The book provides a comprehensive look into working with unique populations from the perspective of a wide range of art therapists, each of whom shared their knowledge and experiences via chapter contributions. Each chapter digs into working with a unique population and discusses how cultural influences can impact treatment strategies, including how to serve the client and the art-making process best. Specific cultural perspectives and populations presented in this book include prisoners, refugees, individuals with autism, the military, individuals in hospital settings, the homeless, working with clients abroad, and others.

There were specific areas of discussion that were especially helpful to me and provided exceptional insight into cultural considerations I had yet to be exposed. These included insights into Asian culture, South Indian culture, African American culture, and Muslim culture. Additionally, Madori (2013) underscored six areas of significance regarding culture and cultural differences: “environment, language, food, music, religion, and rituals” (p. 320). I felt the book did a great job of including diverse considerations. This paper aims to highlight my self-awareness, reactions, and reflections as I learned about cultural perspectives in an art therapy setting, as well as how these insights can be applied to future clinical practice.

Self-Reflexivity and Self-Awareness:

I learned a lot about my feelings, thoughts, assumptions, and attitudes while reading about different cultural considerations in art therapy. As a woman, I have experienced microaggressions throughout my life. Still, I didn’t previously have a word to describe them, nor did I realize how prevalent they are in other marginalized communities. In many ways, I have moved through life from a privileged position as a white, cisgender woman. However, intersectionality has also exposed me to microaggressions as a woman and as a person with a history of acute stress disorder, depression, and anxiety. What was eye-opening for me was the high prevalence of microaggressions across various communities and how detrimental they can be to a person’s livelihood as they accumulate.

Additionally, as I began to explore my worldview, cultural roots, and biases, I realized that I had unknowingly committed microaggressions toward others in the past. For example, as a young adult, I remember saying, “I do not see color because I believe all people should be treated equally.” I thought this was a positive statement at that time, and I did not consider that by “not seeing color,” I was denying people of color their lived experiences and histories of oppression and discrimination. Kristel (2013) states that how we perceive our client’s experience matters and that “the way each client relates to the world is shaped by cultural norms that may not be obvious to us as clinicians” (p. 86). I hope to be more cognizant of my biases and assumptions in the future and more mindful of how I communicate and interact with others.

Color, in a different context, is also essential in the art therapy setting as it is often ascribed to meaning within art. For example, Howie (2013) tells the story of working with a Latino client who used black in his artwork. His color choice was immediately associated with depression. However, a Latino doctor explained that black is associated with the concept of strength in his culture. This story underscores the importance of asking questions about a client’s culture and not assuming Western constructs or color associations are fluid across cultures. The meaning derived from color choice can profoundly impact the direction therapy takes. Therefore, we as art therapists must get it right and not misunderstand the meaning and felt experiences the client is trying to convey. Doing so could cause significant injustice and harm.

I also became more self-aware of my assumptions and gaps of consideration about art therapy directives and how they might impact the client. For example, Kristel (2013) tells the story of a visualization directive given to a group of women in a small village in Bangladesh. The women were invited to visualize walking down a garden path. The intention was to bring forward feelings of peace and relaxation in the aftermath of an accident where several children in the community died. However, it had a reverse effect as she learned too late that in this community, “the symbol for family is garden, and that children are represented as flowers” (p. 93). Had she sought to understand the symbolism inherent in the community better beforehand, the exercise could have been tailored to fit their needs better. This story made me more aware of my gaps in cultural knowledge specific to symbolism and how important it is to seek understanding first.

Lack of access due to socioeconomic status is another area that was very eye-opening for me. For example, art therapists and clients often face space access restrictions in India. Prasad (2013) described the limited space of a hospital in India and how that impacted client privacy, particularly with children and their parents, where there was no private room to conduct the therapy session. Additionally, there are communities in Africa and Asia where socioeconomic status means no physical spaces are available for art-making, including a lack of tables, so sessions and art-making must be done on the floor (Prasad, 2013). Even if I do not practice overseas, socioeconomic status and access are essential considerations in the United States. For example, many art therapists in the United States set up private practices and do not accept insurance to avoid all the headaches and red tape that working with insurance companies brings. However, many people desperately need mental health access and cannot afford to pay for art therapy out of pocket. Unfortunately, limited availability and access to mental health services is a common form of discrimination against lower socioeconomic communities. Access will be an influential factor to consider as I determine where and how to proceed as an art therapist.

Another thing I learned about access as it relates to art therapy involves material availability. Prasad (2013) described a situation involving children who had no prior exposure to art or art supplies. Compared to children with prior exposure, the children using the art materials for the first time wanted to keep the materials private from other group members. That is an important consideration when working in art therapy groups with individuals from cultural or socioeconomic backgrounds with limited material access, as it will impact how the art therapy session needs to be conducted.

Prasad (2013) eloquently underscored what all these access issues and discriminatory experiences could mean: “being flexible and making do” (p.82), sometimes on a dirt floor or the grass outside, sometimes with found materials like dirt and leaves, and sometimes without any materials at all, using song or dance. At the end of the day, the most important thing is to approach the session with an open, curious, conscientious mind and meet the client where they are, maintaining an atmosphere of respect and dignity. Being flexible, adaptable, and approaching challenges with an innovative mindset is critical to working in a multicultural setting (Prasad, 2013). In my mind, getting comfortable working a little outside my comfort zone will also be an asset when working with individuals from different cultural backgrounds.

Application to Clinical Practice:

In terms of how I can apply cultural humility and self-awareness practices to clinical practice, the possibilities are endless. The more I learn, the more I realize I do not know, and this profoundly underscores for me that cultural humility and awareness is a lifelong learning process with no “end.” However, this book has specific takeaways regarding the therapeutic alliance, therapeutic approach, art techniques, and social justice competencies, which I think will be helpful in the clinical setting.

Doby-Copeland (2013) underscored the value of art therapists attending diverse cultural community-based events which provide insight into specific rituals, music, food, and art of other cultures. She underscored the relevancy of such experiences and stated that “When planning art therapy interventions, culture-specific knowledge will inform your decisions on whether to use emic perspective (culture-specific behaviors, terms, and ideas) or an etic perspective (culture-universal behaviors, terms, and ideas)” (p.117). For me, that highlights how having even just a basic knowledge about the culture of a client has the potential to deepen the therapeutic alliance and lead to a better end outcome for the client.

Such knowledge can also inform art material choices. Understanding what materials or directives are considered taboo or inappropriate within a culture can dramatically impact therapeutic rapport (Anderson, 2013). For example, drawing a body or making a doll might be considered idolizing and shameful in some cultures. In some cultures, appropriate art therapy directives may differ between male and female clients. Having a basic understanding of such nuances is critical.

From a communication perspective, I can also adapt my approach to meet the needs of diverse clients. For example, Betts (2013) underscored the importance of authority in Asian cultures and that in some cultures more than others, art directives provided might be adhered to very strictly. That is an important consideration when determining a directive. Will the client follow the directive quite literally, without any individual embellishments? Or will they follow it more loosely as a general guideline? The answer can dramatically shift the trajectory of the session.

Using culturally relevant materials can have a profound impact from a technical standpoint. For example, providing culturally relevant magazines and newspapers with languages, skin tones, and region-specific imagery for collage exercises is important (Ranganathan & Malick, 2013). Magazines containing diverse body shapes, sizes, colors, and gender spectrums can make a big difference in how a client relates to the directive, the art therapist, and the art they create.

In terms of power and privilege, the very nature of the therapeutic relationship has an inherent power imbalance where the therapist (helper) has the power, and the client (needs help) does not. Moon and Shuman (2013) highlighted collective community-building to address the power differential. They discussed a community art studio experience where they signed in and made art alongside everyone else in the group. They “functioned as leaders and enthusiastically supported the leadership of others” and approached the therapeutic setting from the standpoint of “doing with rather than for or to others” (Moon & Shuman, 2013, p. 302). Additionally, stepping away from the concept of “fixing” and objectifying through psychiatric diagnostic labeling and segregation (Moon & Shuman, 2013, p. 303) created a better environment more conducive to social justice. I think that is a beautiful way to approach therapy, whether in an individual or group setting: meeting the client where they are at, stepping away from labels, and making art alongside them where appropriate.

Conclusion:

In conclusion, approaching art therapy and counseling with diverse populations through a lens of cultural humility and with a growth mindset matters immensely. In addition, I conceptualize challenging and reducing power dynamics in the clinical setting by first starting with myself. One way I can approach that is through self-exploration and understanding by clarifying who I am culturally, what prejudices and biases I have, and understanding through intersectionality what privilege and power I hold (Kristel, 2013). Only after first understanding myself can I hope to understand others and reduce the status quo inherent in the therapeutic setting and mental health community more broadly.

Regularly immersing myself in cultural events and reading books from perspectives and cultures outside my own are ways to continue learning, growing, and expanding my awareness. When I have a client from a background or culture I am unfamiliar with, I can approach it with humility, ask respectful questions to understand, and read relevant books to educate myself. That shows cultural humility and underscores to the client that I am invested in the quality of their experience and outcome within the therapeutic space.

I plan to engage in life-long learning and self-reflection to maintain a position of cultural humility in practice in several ways. Consistently being aware and mindful of the hierarchies found within intersectionality and non-dominant culture (Garlock, 2013) and continuously seeking new knowledge and understanding is one way I can work to dismantle power dynamics, avoid unintentional microaggressions, and work with and alongside clients from a culturally humble foundation. Additionally, continuous research to better understand my history, culture, and attitudes is an essential first step toward self-reflection. Garlock (2013) states that “Regardless of terminology, we must understand our past, individually and collectively, learn about the people we work with and the cultures they come from, and continually sharpen our therapeutic skills” (p. 72). I think that is an excellent way to sum up the importance and power of lifelong learning and self-reflection to be the best version of myself for my future clients and walk alongside them.

References:

Anderson, F. (2013). Overseas Art Therapy Journeys. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Betts, D. (2013). Art Therapy Assessments with Diverse Populations. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Doby-Copeland, C. (2013). Practicing Multiculturally Competent Art Therapy. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Garlock, L. R. (2013). Walk Beside Me, Not Behind Me: Cultural Issues in Art Therapy Supervision. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Howie, P. (2013). On Being Human: Color and Culture. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Howie, P., Prasad, S., & Kristel, J. (Eds.). (2013). Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Kristel, J. (2013). The Process of Attunement Between Therapist and Client. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Madori, L. (2013). Utilizing a Thematic Approach to Art Therapy with Seniors, Enhancing Cognitive Abilities and Social Interactions. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Moon, C. H., & Shuman, V. (2013). The Community Art Studio: Creating a Space of Solidarity and Inclusion. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Prasad, S. (2013). The Impact of Culture and the Setting on the Use and Choice of Materials. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

Ranganathan, S., & Malick, R. (2013). Art-Based Therapies for Substance Users and Their Families: Recognition, Deliberation, and Recovery. In Using art therapy with diverse populations: Crossing cultures and abilities. Jessica Kingsley Publisher.

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