Rethinking cultural competence: insights from indigenous community treatment settings

Transcult Psychiatry. 2012 Apr;49(2):206-22. doi: 10.1177/1363461511425622. Epub 2011 Dec 22.


Multicultural professional psychologists routinely assert that psychotherapeutic interventions require culturally competent delivery for ethnoracial minority clients to protect the distinctive cultural orientations of these clients. Dominant disciplinary conceptualizations of cultural competence are "kind of person" models that emphasize specialized awareness, knowledge, and skills on the part of the practitioner. Even within psychology, this approach to cultural competence is controversial owing to professional misgivings concerning its culturally essentialist assumptions. Unfortunately, alternative "process-oriented" models of cultural competence emphasize such generic aspects of therapeutic interaction that they remain in danger of losing sight of culture altogether. Thus, for cultural competence to persist as a meaningful construct, an alternative approach that avoids both essentialism and generalism must be recovered. One means to capture this alternative is to shift focus away from culturally competent therapists toward culturally commensurate therapies. Indigenous communities in North America represent interesting sites for exploring this shift, owing to widespread political commitments to Aboriginal cultural reclamation in the context of postcoloniality. Two examples from indigenous communities illustrate a continuum of cultural commensurability that ranges from global psychotherapeutic approaches at one end to local healing traditions at the other. Location of culturally integrative efforts by indigenous communities along this continuum illustrates the possibility for local, agentic, and intentional deconstructions and reconstructions of mental health interventions in a culturally hybrid fashion.

MeSH terms

  • Community Mental Health Services / methods
  • Community Mental Health Services / organization & administration*
  • Cultural Competency / organization & administration*
  • Culture
  • Evidence-Based Medicine
  • Health Services, Indigenous / organization & administration*
  • Humans
  • Indians, North American / psychology*
  • North America
  • Population Groups
  • Psychotherapy / methods
  • Psychotherapy / standards*