From Cultural Competence to Cultural Humility & Equity By Jason Linder, LMFT on 3/13/19 - 12:18 PM

What if traditional notions of “cultural differences” in clients have been misleading? The over-representation of children of color in the welfare system is more about policies and institutions that fuel disenfranchisement, and less about cultural attributes.

Despite being a cherished ideal in psychotherapy for decades, the term “cultural competence” has become increasingly flawed. It has poorly accounted for the power dynamics present not only in psychotherapy, but also in broader institutional and healthcare settings. It has also overlooked social injustice and contextual and structural influences essential to someone’s “culture.”

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“Cultural competence” was coined by anthropologist James Green in 1982, and then disseminated to the fields of social work, psychology, psychotherapy and counseling. It is based on classifying culture by race and ethnicity. It has emphasized prior assumptions of cultural difference among ethnic groups. These classifications easily stereotype people, dismiss key intragroup differences and areas where they don’t apply, and consider culture as a monolith. This overlooks the reality that there are often more within-group than between-group differences among many categorized in certain groups. For example, the classification of “Asian” can overlook differences between Cambodian, Korean, and Japanese.

Becoming “competent” in someone else’s culture is not only insufficient, but largely untenable, especially if we have never been immersed in it. “Culture” is too nuanced for psychotherapists to “master.” Essentializing culture has become a disparaging form “otherizing,” and risks colluding with the power of the dominant group. The “other” focus also implies that default is White, and “others” as non-white, non-cisgender, non-English-speaking, non-Christian, non-heterosexual, etc.
Notions of competence are most flawed because they overlook the dominant status of the White group, the status quo of power over marginalized groups, and depend on overly formulaic prescriptions about how to do therapy with “them.”

“Cultural humility” is a promising replacement. It acknowledges the fluidity of culture and pushes individuals, communities, and institutions to scrutinize social inequities. Humility acknowledges differences in power and challenges injustice and related barriers at the broader levels outside of the client’s immediate social web. The shift from competence to humility is from an expert stance of understanding “others,” to emphasizing accountability in addressing institutional barriers that impact marginalized clients. For instance, the oil fracking in Colorado in neighborhoods with low-income Latinx communities is associated with negative health outcomes. Low-income communities also tend to be more dangerous, less sanitary, and less resourced. This is not a reflection of cultural characteristics.

“Cultural equity,” like humility, examines institutions and systems of subordination across and within cultures. Equity specifically examines the relations between power, privilege, oppression, family, and communal life. While competence aims merely to learn a group’s history, values, and attributes; humility and equity strive to reduce oppression and injustice. While competence stresses sheer self-awareness, encouraging practitioners to be more comfortable with differences, humility and equity add thorough assessment to the inherent power disparities in therapist-client relationships. Competence has also focused primarily on race or ethnicity, deemphasizing other germane disparities, such as SES, disability, sexual orientation, and gender identity.

Ana, age 18, an excelling student, has a mother from Guanajuato, Mexico, and stepfather from San Diego who is currently in jail for drug-related charges. Her mother brought her here at 9-years-old to escape Ana’s violent father, a policeman who muscled his power to block her and Ana from protection. Ana and her mother have no nearby relatives. She applied for DACA status in 2013. She came to therapy feeling depressed, barely able to get out of bed or attend school for 2 weeks. Despite acceptance into UCSD, her dream university, she was unable to access financial aid due to her legal status.

We explored her situation as being privileged growing up speaking English with a native-born step-father yet subjugated as an undocumented immigrant with temporary DACA protection. We attended to her persistent fear about her status. I humbly acknowledged that it’s impossible for me to have a complete understanding of how culture and systems of injustice impact her although I have lived in Mexico and had a Mexican partner. I recognized how my privilege as a graduate-level educated and White male US citizen may blind me from certain crucial aspects of her experience. We collaboratively strived to decrease the inherent power differential between us by encouraging her feedback throughout therapy.

In response to mentioning that the term “Latinx” is gaining popularity because it emphasizes inclusion, she self-identified as Chicana to convey pride in her dual heritage. We then discussed the unjust disparity in financial access despite her academic merit. From researching in-session, we learned an empowering loophole: a co-signer may help her access aid, something her high school’s career center did not know, and reached out to nearby clergy who presented her predicament to the community to secure a co-signer.


Cultural competence is not merely a set of skills and techniques acquired through hard work. While competence emphasizes knowledge acquisition, humility and equity stress responsibility at individual and institutional levels. While competence would imply that problems come from lack of knowledge or awareness, humility and equity recognize power differentials, and call for action and changes in attitudes about diverse clients and the broader forces that subjugate them. Clients from disenfranchised communities have less access to quality services, a lack of linguistically and culturally appropriate services, financial barriers, scarce time, and limited knowledge of resources available to them.

If you want to lead and effect change for clients, a technical and knowledge-based competence focus will not suffice. Training in humility building and equity appreciation are the keys to building improved relationships between therapists and clients. We begin to make a key difference when we attend to the equitable distribution of resources and confront unjust politics, practices, and policies, and examine how they influence one's "culture."


Almeida, R., Hernandez-Wolfe, P., & Tubbs, C. (2011). Cultural equity: Bridging the complexity of social identities with therapeutic practices. International Journal of Narrative Therapy & Community Work, (3), 43.

Fisher-Borne, M., Cain, J. M., & Martin, S. L. (2015). From mastery to accountability: Cultural humility as an alternative to cultural competence. Social Work Education, 34(2), 165-181. 

File under: The Art of Psychotherapy