By Doug Greenlee MA/MS, LMFT, LADC, CGC and Joycene Maroney Ryan, LADC, ADCR-MN, MARRCH Ethics Committee Members

Practitioner competence is an ongoing process that is governed by state laws, state licensure requirements, educational program requirements, professional organizations and ethics oversight committees, as well as the historical customs that inform the mores of treatment centers’ appliedtreatment practices.

These organizations—and the new DSM V—continue to develop a clear emphasis upon enhancing the clinical practitioner’s cultural awareness and values sensitive competencies via ethical guides to improvethe quality of treatment services for clients.

Problem

In spite of the systemic changes that support the practitioners’ ongoing personal assessment and professional development of a multicultural and values sensitive ethic, there are practitioners who still demonstrate an encapsulated—or privileged—cultural perspective. This practitioner attitude when meted out in clinical treatment situations can have profound ethical implications for vulnerable clients who have differentcultural views and life experiences.

Ethical Context

The primary role of clinical ethics is to enhance and guide the practitioner’s competent provision of treatment services to meet the needs of vulnerable clients. For instance, general-clinical ethical guides support practitioner competence as s/he manages multiple clients’ treatment experiences, e.g., do no harm to the client, act in the client’s best interest, respect the client’s autonomy to make choices, be truthful with the client, be faithful to the therapeutic relationship, identify and problem-solve justice issues.

For a variety of reasons, ethical dilemmas often arise for practitioners throughout the course of treatment provision. To resolve those dilemmas, ethical principles provide a systematic and transparent process to guide the practitioner, client and consultation team in their discussion about ways in which they can equitably resolve the dilemma (e.g., MARRCH’s Synthetic Ethical Problem Solving Process).

Although it receives little direct attention, aspirational ethics is another component of clinical ethics. It is noteworthy because it embodies the practitioner’s greater understanding of and personal investment into exemplifying and maintaining the spirit of clinical ethical principles. In other words, the practitioner’s multicultural awareness and values sensitivity development becomes a lifelong process, signifying his/her ongoing commitment to personal growth that is above and beyond the minimal expectations of mandatory ethics used to protectpractitioners and clients.

Cultural Encapsulation

In light of the values-sensitive/multicultural competence ethic, the basic distinction between mandatory and aspirational ethical perspectives becomes paramount for the clinical practitioner. A review of clinical ethical practice codes (MARRCH, NAADAC, APA, ACA, AAMFT, NASW) indicates that multicultural competence is a mandatory ethical requirement to be met by the practitioner to earn and maintainhis/her licensure to practice.

Unfortunately, some practitioners’ ethical compliance with the multicultural competency ethic is not informed by an aspirational intention, i.e., a lifelong personal and professional goal to be developed and maintained to improve the therapeutic dynamics associated with relationship to self, client and effective treatment provision. For a variety of reasons, these practitioners view the ethic as an unnecessary and sometimes noxious expectation, suggesting that theirpersonal, cultural perspective is encapsulated.

So what is "cultural encapsulation”? By definition, the culturally encapsulated counselor’s perspective is characterized by the following description: "Personal reality is based on one set of assumptions; insensitivity to cultural variations among individuals; accepts unreasoned assumptions without proof or ignores proof because it might disconfirm one’s personal assumptions; unwilling to evaluate other viewpoints; demonstrates minimal attempts to accommodate the behavior of others different from him/her; trapped in one way of thinking that resists adaptation and rejectsalternatives.” (Corey, et al., 117)

White Privilege

One notable example that illustrates the encapsulated perspective is "white privilege.” Simply stated, Caucasian practitioners who exemplify a white privilege perspective tend not to see themselves as socially or historically privileged, tend to get defensive when asked to discuss their cultural roots and thepower differences historically or currently influencing their resource access/socialstatus, and also tend to avoid or disregardfurther cultural self-exploration with othersnot like themselves.

Privileging Cultural Pluralism and Practitioner Competence

A pluralistic awareness of culture is the antithesis to the encapsulated/privileged view. It acknowledges the complexity of culture and honors its embodied diversity of values, beliefs and lifestyle practices. Moreover, cultural pluralism impacts the practitioner’s clinical world because the practitioner’s and client’s therapeutic relationship is a unique microcosm of society and social interaction. From a clinical practice perspective, without the development and maintenance of the therapeutic relationship between practitioner and client, treatment is lesseffective—if effective at all.

When the practitioner’s therapeutic relationship is informed by his/her compliance with mandatory ethics and guided by an aspirational ethic to embrace and role model the spirit of a values-sensitive multicultural competence, the practitioner meets the mandate and spirit of the ethical code. This union creates an optimal environment for enhancing the practitioner’s values-sensitive/ multicultural competence and ability to provide more effective treatments for his/ her clients, creating a therapeutic relationshipworth privileging.

If you would like to discuss this topic further, feel free to contact us via the MARRCHwebsite.