Culturally Competent Care Quotes

Let me outline briefly as I can what seem to me the characteristics of these opposite kinds of mind. I conceive a strip-miner to be a model exploiter, and as a model nurturer I take the old-fashioned idea or ideal of a farmer. The exploiter is a specialist, an expert; the nurturer is not. The standard of the exploiter is efficiency; the standard of the nurturer is care. The exploiter's goal is money, profit; the nurturer's goal is health -- his land's health, his own, his family's, his community's, his country's. Whereas the exploiter asks of a piece of land only how much and how quickly it can be made to produce, the nurturer asks a question that is much more complex and difficult: What is its carrying capacity? (That is: How much can be taken from it without diminishing it? What can it produce dependably for an indefinite time?) The exploiter wishes to earn as much as possible by as little work as possible; the nurturer expects, certainly, to have a decent living from his work, but his characteristic wish is to work as well as possible. The competence of the exploiter is in organization; that of the nurturer is in order -- a human order, that is, that accommodates itself both to other order and to mystery. The exploiter typically serves an institution or organization; the nurturer serves land, household, community, place. The exploiter thinks in terms of numbers, quantities, "hard facts"; the nurturer in terms of character, condition, quality, kind.

A society that fails to value communality — our need to belong, to care for one another, and to feel caring energy flowing toward us — is a society facing away from the essence of what it means to be human. Pathology cannot but ensue. To say so is not a moral assertion but an objective assessment. "When people start to lose a sense of meaning and get disconnected, that's where disease comes from, that's where breakdown in our health — mental, physical, social health — occurs," the psychiatrist and neuroscientist Bruce Perry told me. If a gene or virus were found that caused the same impacts on the population's well-being as disconnection does, news of it would bellow from front-page headlines. Because it transpires on so many levels and so pervasively, we almost take it for granted; it is the water we swim in. We are steeped in the normalized myth that we are, each of us, mere individuals striving to attain private goals. The more we define ourselves that way, the more estranged we become from vital aspects of who we are and what we need to be healthy. Among psychologists there is a wide-ranging consensus about what our core needs consist of. These have been variously listed as: - belonging, relatedness, or connectedness; - autonomy: a sense of control in one's life; - mastery or competence; - genuine self-esteem, not dependent on achievement, attainment, acquisition, or valuation by others; - trust: a sense of having the personal and social resources needed to sustain one through life; - purpose, meaning, transcendence: knowing oneself as part of something larger than isolated, self-centered concerns, whether that something is overtly spiritual or simply universal/humanistic, or, given our evolutionary origins, Nature. "The statement that the physical and mental life of man, and nature, are interdependent means simply that nature is interdependent with itself, for man is a part of nature." So wrote a twenty-six-year-old Karl Marx in 1844. None of this tells you anything you don't already know or intuit. You can check your own experience: What's it like when each of the above needs is met? What happens in your mind and body when it's lacking, denied, or withdrawn?

If only we lived in a culture in which internal measures of satisfaction and success — a capacity for joy and caring, an ability to laugh, a sense of connection to others, a belief in social justice — were as highly valued as external measures. If only we lived in a culture that made ambition compatible with motherhood and family life, that presented models of women who were integrated and whole: strong, sexual, ambitious, cued into their own varied appetites and demands, and equipped with the freedom and resources to explore all of them. If only women felt less isolated in their frustration and fatigue, less torn between competing hungers, less compelled to keep nine balls in the air at once, and less prone to blame themselves when those balls come crashing to the floor. If only we exercised our own power, which is considerable but woefully underused; if only we defined desire on our own terms. And — painfully, truly — if only we didn't care so much about how we looked, how much we weighed, what we wore.

Even you, the professional helper, often mistaken for the enlightened Guru or Staretz, can become lost in your thoughts that you must be competent without fault. You may become enthralled with your identity as a professional, even the pressures of the culture of mastery that expects you to heal your clients without fail. Never mind all of the variables over which you have no control, it is up to you, according to the canons of mastery, to control the health and well-being of those for whom you provide professional care. This potentiates a furthering alienation between you and your clients. You are at risk to become, if you have not already, the one who does to your clients; to be the one the active subject acting upon the passive and receptive objects, your clients; to be the one in possession of special knowledge, technique and mastery. All of this conspires to coax or coerce you into treating your client as reduced, a mere case. Unawareness to these influences gives you little chance to consider their influence on your practice in the clinical setting, much less give attentive efforts to resist or change them.

The care of babies involves education, and is entrusted only to the most fit,” she repeated. “Then you separate mother and child!” I cried in cold horror, something of Terry’s feeling creeping over me, that there must be something wrong among these many virtues. “Not usually,” she patiently explained. “You see, almost every woman values her maternity above everything else. Each girl holds it close and dear, an exquisite joy, a crowning honor, the most intimate, most personal, most precious thing. That is, the child-rearing has come to be with us a culture so profoundly studied, practiced with such subtlety and skill, that the more we love our children the less we are willing to trust that process to unskilled hands—even our own.” “But a mother’s love—” I ventured. She studied my face, trying to work out a means of clear explanation. “You told us about your dentists,” she said, at length, “those quaintly specialized persons who spend their lives filling little holes in other persons’ teeth—even in children’s teeth sometimes.” “Yes?” I said, not getting her drift. “Does mother-love urge mothers—with you—to fill their own children’s teeth? Or to wish to?” “Why no—of course not,” I protested. “But that is a highly specialized craft. Surely the care of babies is open to any woman—any mother!” “We do not think so,” she gently replied. “Those of us who are the most highly competent fulfill that office; and a majority of our girls eagerly try for it—I assure you we have the very best.” “But the poor mother—bereaved of her baby—” “Oh no!” she earnestly assured me. “Not in the least bereaved. It is her baby still—it is with her—she has not lost it. But she is not the only one to care for it. There are others whom she knows to be wiser. She knows it because she has studied as they did, practiced as they did, and honors their real superiority. For the child’s sake, she is glad to have for it this highest care.

That we never allowed," answered Somel quietly. "Allowed?" I queried. "Allowed a mother to rear her own children?" "Certainly not," said Somel, "unless she was fit for that supreme task." This was rather a blow to my previous convictions. "But I thought motherhood was for each of you--" "Motherhood--yes, that is, maternity, to bear a child. But education is our highest art, only allowed to our highest artists." "Education?" I was puzzled again. "I don't mean education. I mean by motherhood not only child-bearing, but the care of babies." "The care of babies involves education, and is entrusted only to the most fit," she repeated. "Then you separate mother and child!" I cried in cold horror, something of Terry's feeling creeping over me, that there must be something wrong among these many virtues. "Not usually," she patiently explained. "You see, almost every woman values her maternity above everything else. Each girl holds it close and dear, an exquisite joy, a crowning honor, the most intimate, most personal, most precious thing. That is, the child-rearing has come to be with us a culture so profoundly studied, practiced with such subtlety and skill, that the more we love our children the less we are willing to trust that process to unskilled hands--even our own." "But a mother's love--" I ventured. She studied my face, trying to work out a means of clear explanation. "You told us about your dentists," she said, at length, "those quaintly specialized persons who spend their lives filling little holes in other persons' teeth--even in children's teeth sometimes." "Yes?" I said, not getting her drift. "Does mother-love urge mothers--with you--to fill their own children's teeth? Or to wish to?" "Why no--of course not," I protested. "But that is a highly specialized craft. Surely the care of babies is open to any woman --any mother!" "We do not think so," she gently replied. "Those of us who are the most highly competent fulfill that office; and a majority of our girls eagerly try for it--I assure you we have the very best." "But the poor mother--bereaved of her baby--" "Oh no!" she earnestly assured me. "Not in the least bereaved. It is her baby still--it is with her--she has not lost it. But she is not the only one to care for it. There are others whom she knows to be wiser. She knows it because she has studied as they did, practiced as they did, and honors their real superiority. For the child's sake, she is glad to have for it this highest care.

Cam closed the door and leaned back against it, letting his caressing gaze fall on the small, tense form of his wife. He knew little of these matters. In both Romany and gadjo cultures, pregnancy and childbirth were a strictly female domain. But he did know that his wife was uneasy in situations she had no control over. He also knew that women in her condition needed reassurance and tenderness. And he had an inexhaustible supply of both for her. “Nervous?” Cam asked softly, approaching her. “Oh no, not in the slightest; it’s an ordinary circumstance, and only to be expected after—” Amelia broke off with a little gasp as he sat beside her and pulled her into his arms. “Yes, I’m a bit nervous. I wish … I wish I could talk to my mother. I’m not exactly certain how to do this.” Of course. Amelia liked to manage everything, to be authoritative and competent no matter what she did. But the entire process of childbearing would be one of increasing dependence and helplessness, until the final stage, when nature took over entirely. Cam pressed his lips into her gleaming dark hair, which smelled like sweetbriar. He began to rub her back in the way he knew she liked best. “We’ll find some experienced women for you to talk to. Lady Westcliff, perhaps. You like her, and God knows she would be forthright. And regarding what you’re going to do … you’ll let me take care of you, and spoil you, and give you anything you want.” He felt her relax a little. “Amelia, love,” he murmured, “I’ve wanted this for so long.” “Have you?” She smiled and snuggled tightly against him. “So have I. Although I had hoped it would happen at a more convenient time, when Ramsay House was finished, and Poppy was betrothed, and the family was settled—” “Trust me, with your family there will never be a convenient time.” Cam eased her back to lie on the bed with him. “What a pretty little mother you’ll be,” he whispered, cuddling her. “With your blue eyes, and your pink cheeks, and your belly all round with my child …” “When I grow large, I hope you won’t strut and swagger, and point to me as an example of your virility.” “I do that already, monisha.” Amelia looked up into his smiling eyes. “I can’t imagine how this happened.” “Didn’t I explain that on our wedding night?” She chuckled and put her arms around his neck. “I was referring to the fact that I’ve been taking preventative measures. All those cups of nasty-tasting tea. And I still ended up conceiving.” “Rom,” he said by way of explanation, and kissed her passionately.

About 41 percent of mothers are primary breadwinners and earn the majority of their family’s income. Another 23 percent of mothers are co-breadwinners, contributing at least a quarter of the family’s earnings.30 The number of women supporting families on their own is increasing quickly; between 1973 and 2006, the proportion of families headed by a single mother grew from one in ten to one in five.31 These numbers are dramatically higher in Hispanic and African-American families. Twenty-seven percent of Latino children and 51 percent of African-American children are being raised by a single mother.32 Our country lags considerably behind others in efforts to help parents take care of their children and stay in the workforce. Of all the industrialized nations in the world, the United States is the only one without a paid maternity leave policy.33 As Ellen Bravo, director of the Family Values @ Work consortium, observed, most “women are not thinking about ‘having it all,’ they’re worried about losing it all—their jobs, their children’s health, their families’ financial stability—because of the regular conflicts that arise between being a good employee and a responsible parent.”34 For many men, the fundamental assumption is that they can have both a successful professional life and a fulfilling personal life. For many women, the assumption is that trying to do both is difficult at best and impossible at worst. Women are surrounded by headlines and stories warning them that they cannot be committed to both their families and careers. They are told over and over again that they have to choose, because if they try to do too much, they’ll be harried and unhappy. Framing the issue as “work-life balance”—as if the two were diametrically opposed—practically ensures work will lose out. Who would ever choose work over life? The good news is that not only can women have both families and careers, they can thrive while doing so. In 2009, Sharon Meers and Joanna Strober published Getting to 50/50, a comprehensive review of governmental, social science, and original research that led them to conclude that children, parents, and marriages can all flourish when both parents have full careers. The data plainly reveal that sharing financial and child-care responsibilities leads to less guilty moms, more involved dads, and thriving children.35 Professor Rosalind Chait Barnett of Brandeis University did a comprehensive review of studies on work-life balance and found that women who participate in multiple roles actually have lower levels of anxiety and higher levels of mental well-being.36 Employed women reap rewards including greater financial security, more stable marriages, better health, and, in general, increased life satisfaction.37 It may not be as dramatic or funny to make a movie about a woman who loves both her job and her family, but that would be a better reflection of reality. We need more portrayals of women as competent professionals and happy mothers—or even happy professionals and competent mothers. The current negative images may make us laugh, but they also make women unnecessarily fearful by presenting life’s challenges as insurmountable. Our culture remains baffled: I don’t know how she does it. Fear is at the root of so many of the barriers that women face. Fear of not being liked. Fear of making the wrong choice. Fear of drawing negative attention. Fear of overreaching. Fear of being judged. Fear of failure. And the holy trinity of fear: the fear of being a bad mother/wife/daughter.

On the other hand, in the world that we care about, endlessly preparing for social change work without actually doing it produces the exact same results as endless procrastination. As a matter of simple priority-setting and time management, the dilemma is that by the time I properly ready myself by (a) apprenticing myself in one or more field placements; (b) becoming proficient in a foreign language; (c) getting up to speed about my identity and my privilege; (d) studying the structural causes of social and economic injustice; (e) figuring out the complex drivers holding back a marginalized population; (f) mapping institutional racism and sexism; (g) upping my cultural competency; (h) fine-tuning my emotional IQ; and, (i) sorting through the hurdles of political correctness—I could be dead.

Louis's reign was one of largely unrealized potential. The king of France was born with every advantage. He was diligently educated and admired.The first three decades of his life were spent in the protective care of an extremely competent mother, who bequeathed him the largest, strongest, most stable kingdom in Europe. The depth of anguish that resulted from his first crusade, and his obvious desire to redeem himself through good works, was so poignant that his subjects generously forgave him the disaster and shame. The world respected his suffering and looked to him as a moral compass. For a brief, exalted period he made good on the principles he so piously espoused. He made peace with his neighbors, fed the poor, dispensed justice to the best of his ability. He built the exquisite Sainte-Chapelle. But in the end he used all of that trust, goodwill, and deference not to improve his subjects' well-being about which he professed to care so much, but as an excuse to lead them to a ghastly, fetid plain in Tunisia with the intent of annihilating an alien culture for the greater glory of God.

The revolution is about relationships. Whether it is betrayal by seduction, terror, power, intimacy, or spirit, exploitation is simply no longer acceptable. We’ve surveyed centuries of damage, and we know better. We need to move toward a culture of mutuality and respect. We can build our relationships on the basis of our competencies, needs, and care. Men and women need to share power and privilege. All of us must commit to the nurturing of children.

For all of us, there are also likely times when therapy simply doesn't seem to move forward as we imagined it would. At this crossroads, we often question ourselves or blame our patients. Between what our culture requires and what we have experienced in childhood, we might go either direction. We have a particular challenge to feeling competent right now. Our left-centric society has done its best to codify the healing process, leaving us with a set of procedures and expected outcomes that don't welcome the individuality of our people of the fluidity of each person's unpredictable and unique process of recovery. This is doubly difficult, because when we follow the course culture provides, safety is already undermined to a greater or lesser extent. I believe it wounds us when we feel we aren't helping a person because we set out with such good hearts to relieve suffering. A well-practiced practitioner might try to guard our hearts by blaming our people's resistance. When a wounded part of us is afraid we are inadequate, this often generates a critical protective voice to try to urge us toward a better performance. In both instances, our ability to be present for our people gets lost in the need to protect. How can we hold these experiences kindly, recognizing that they are part of the human experience? Right now, we might be able to open the arms of inclusion to these parts of us.

Working at this elevated level of professional engagement entails managing lofty expectations and hypercritical judgments. The power dynamics involved with elite clientele are intense and draining, and the risk of being rejected by this group as an outsider, not worthy of entry into the inner sanctity of their power, is great. In spite of these challenges and potential obstacles, I’m drawn to the challenge of working with any population that is underserved and in desperate need of culturally competent and excellent clinical care. Doing so with success, however, demands I center myself in an artful calibration of confidence and humility.

And you’re right. The self-care culture has gotten out of control. Now people are told they need to buy certain things or look a certain way, live a certain way, to be happy, to be healthy.” I pause. “And it’s totally backfired, spiraled into something totally antithetical to self-care, actually. Now women are just competing with other women on social media. We present this bullshit, fake image of perfection to the world, but it’s totally unattainable. And it’s dangerous

In a victim-centered approach, the victim’s wishes, safety, and well-being take priority. Victim-centered feminism would bring to bear specialized services, resources, cultural competence, and, ideally, trauma-informed perspectives toward caring for the needs of those who go through the trauma of testifying or pressing charges or filing lawsuits. We would provide a conduit to the professionals best able to assess survivor needs, and we’d provide critical support to survivors in the aftermath even if they were not eligible for traditional victim-support services that may exist in their area. These skills are imperative to building rapport and trust with survivors, meeting their needs, and assisting them in creating a sense of safety and security in their lives.

Careful thought here will serve the Church for years to come. Churches often find themselves disconnecting their strategic plans from their grievances with church culture. Leaders see a particular problem, but we want to move past repentance right into obedience. Leadership like this only glorifies our own wisdom and righteousness. Appropriate corporate repentance magnifies the Lord of mercy in the church. Not only this, but members of our churches see what we see. When major unbiblical deviations go unaddressed, it only serves to undermine the membership’s view of the care, courage, or competency of the leadership. If we want to see something in culture change, we need to get specific. Exposition. This next stage of managing change will begin a circular process. In this stage, new identified elements of needed cultural change will be added to the existing healthy elements of culture being maintained and reinforced. The leadership team will find itself running around the process circle from exposition to illustration to incorporation to evaluation and a back again to exposition. It may take more laps than a NASCAR race, but culture will change over time. And the process must never end because the culture must be continually cultivated. Exposition is the step in the process that gives Christ-followers a tremendous confidence in the possible future for any church. While formation is always challenging, who better to understand than those the Lord is sanctifying daily? Every single day, we must come to our Bible expecting God to change us, renew us, and cause us to repent. It should be no different for the Church of God. And the means that God uses to shape individuals is the same means He will use to change a church’s culture. The teaching and preaching of God’s Word is our hope and God’s power for change. This step in culture change is so important. The Word of God is powerful to renew hearts and produce fruit among God’s people.

Just about the only serious argument anyone tries to make in favor of diversity echoes Jonathan Alger, a lawyer who has argued before the Supreme Court in favor of racial preferences: “Corporations have to compete internationally,” he says, and “cross-cultural competency is a key skill in the work force.” This argument assumes that people get along best with people like themselves, that Koreans, for example, can do business most effectively with other Koreans. Presumably, if the United States has a large population of Koreans they will be a bridge between Korea and the United States. For that to work, however, Korean-Americans should not fully assimilate because if they do, they will lose the qualities that make them an asset. America should give up the ideal of Americanization that, in a few generations, made Englishmen, Dutchmen, Germans, Swedes, the Irish, and all other Europeans essentially indistinguishable. Do we really want to give up the idea of assimilation? Or should only racial minorities give up on assimilation? More to the point, is a diverse population really an advantage in trade or international affairs? Japan is one of the most racially homogeneous nations. It would be hard to find a country that so clearly practices the opposite of American-style diversity, but it is one of the most successful trading nations on earth. If diversity were a key advantage, Brazil, Indonesia, Sudan, Malaysia, and Lebanon would be world leaders in trade. Other great trading nations—Taiwan, Korea and China—are, if anything, even more closed and exclusionist than Japan. Germany is likewise a successful trading nation, but its trade surpluses cannot be attributed to cultural or racial diversity. Only since the 1960s has it had a large non-German minority of Turks who came as guest workers, and there is no evidence that Turks have helped Germany become more of a world presence or even a better trade partner with Turkey. The world’s consumers care about price and quality, not the race or nationality of the factory worker. American corporations boast about workforces that “look like America,” but they are often beaten in their own market by companies whose workforces look like Yokohama or Shanghai. If we really took seriously the idea that “cross-cultural competence” was crucially important, we would adjust the mix of immigrants accordingly. We might question the wisdom of Haitian immigration, for example, since Haiti is a small, poor country that is never likely to be an important trade partner. And do 32 million Mexican-Americans help our trade relations with the world—or even with Mexico? Canada is our number-one trading partner. Should we therefore encourage immigration from Canada? No one ever talks about immigration in these terms because at some level everyone understands that diversity has nothing to do with trade or influence in the world. The “cross-cultural competence” argument is artificial.

It is widely recognized that Indigenous peoples are often not well served by Western treatment styles and those seeking help are often confronted with more alienation and traumatization. Sones et al. point out that data regarding the mental health and wellness of Indigenous peoples is lacking "partly because of the challenges in the identification of indigenous clients, mistrust of mainstream health, frequent absence of culturally competent care, and lack of access to indigenous healing options and care. Furthermore, culturally influenced Indigenous behaviour is often misinterpreted by Western-oriented clinicians as evidence of psychopathy.