Description
Reflect on the following questions:Why do you think it is important for human services workers to be culturally competent?Describe a barrier to cultural competence?How can that barrier be remedied or overcome?Discussion Requirements:Fully respond to the questions being asked. Demonstrate content knowledge from our course textbook. Refrain from oversharing. Fully spell out all words (it is, does not, etc.). You must have a minimum of 250 words. Grammar, spelling, and punctuation will affect your grade, so be sure to proof your work before submitting it.You must have an in-text citation from our course textbook to support what you are saying. You will need a reference for your in-text citation. Any information taken from a source (other than your classmate or professor) must include an in-text citation and reference to avoid plagiarism. Not including a properly formatted in-text citation and reference will affect your grade.
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Book Title: eTextbook: Cultural Diversity: A Primer for the
Human Services
Demographics
Demographics
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2-1
The demographics of the United States have been changing
dramatically, and central to these changes is a significant increase in
the non-White populations. Atkinson (2004) refers to this trend that
began in the 1980s as the “diversification” of America. The statistics
speak for themselves; according to the National Center for Education
Statistics (2016), White school-age children in the United States
decreased from 62 percent in 2000 to 53 percent in 2013. In contrast,
school-age children of other racial/ethnic groups increased. For
example, children who identified as Hispanic increased from 16 to 24
percent. These percentages represent not only a sizable increase in
the actual numbers of people of color in the United States, but also a
significant decline in the relative percentage of Whites. Colby and
Ortman (2015) expressed that Hispanic, Asian, Native Hawaiian,
Black, American Indian, and Alaska Native populations are expected
to make significantly more growth by the year 2060.
By 2042, barely a generation from now, racial minorities will make up
a majority of the U.S. population. By 2050, non-Hispanic Whites, today
66 percent of the population, will reduce to 46 percent of the
population. Hispanics, the fastest-growing minority, will triple in
number from 15 percent of the U.S. population to 30 percent; Asians
will grow from 5 percent of the population to 9 percent; African
Americans from 13 percent to 15 percent; and Native Americans from
1.6 percent to 2.0 percent. The Native Hawaiian and Pacific Islander
population will double, and the number of self-identified biracial
people will triple. And the increases are even more dramatic among
the young. By 2023, minority children under 18 years of age will
become a majority, and by 2030, for example, half of all elementary
school-age children in the United States will be children of color. By
2039, the majority of working-age Americans will be of color.
Two factors—immigration and birthrates—are particularly
responsible for these dramatic changes. The last thirty years of the
twentieth century saw an unprecedented wave of immigration to the
United States, with yearly numbers rising to 1 million. Unlike earlier
immigration patterns, however, the new arrivals were primarily nonEuropean: approximately one-third from Asia and one-third from
Central and South America. Colby and Ortman (2015) expressed that
between 2014 and 2060, the U.S. population will increase from 319
million to 417 million. Furthermore, Colby and Ortman (2015)
explained that by 2044, more than half of the U.S. population will
belong to a minority group.
Book Title: eTextbook: Cultural Diversity: A Primer for the
Human Services
Defining Professional Standards
Defining Professional Standards
2-4
What currently exists vis-à-vis standards of cultural competence in
professional codes, such as that of the American Counseling
Association (2014), are general prescriptions of
“Multicultural/Diversity Considerations (Section B.1.a.). However,
without specific guidelines as to what cultural competence
specifically looks like, how is one to achieve, assess, or enforce it?
According to Sue, Arredondo, and McDavis (1992), this problem
“represents one of the major shortcomings of our profession” (p. 481).
The framework that the two groups have developed defines three
areas of characteristics of culturally skilled counselors, borrowed
from Sue and Sue (1999). First, such counselors “understand their
own worldviews, how they are the product of their cultural
conditioning, and how it may be reflected in their counseling and
work with racial and ethnic minorities” (p. 481). Second, they
“understand and share the worldviews of their culturally diverse
clients with respect and appreciation” (p. 481). Third, they “use
modalities and define goals consistent with the life experiences and
cultural values of clients” (p. 481). Next, each of these three general
characteristics—counselor awareness of his or her own assumptions,
values, and biases; understanding the worldview of the culturally
26
diverse client; and developing appropriate intervention strategies
and techniques—is broken down into three dimensions that underlie
them: attitudes and beliefs, knowledge, and skills. Nine competence
areas (three characteristics by three dimensions) are thus defined as
basic to a culturally skilled counselor or helper. The specific
characteristics of the three dimensions of professional standards are
presented in Tables 2-3, 2-4, and 2-5.
27
Table 2-3 Professional Multicultural Competencies I
Counselor Awareness of Own Cultural Values and Biases
Beliefs and Attitudes
Culturally skilled counselors believe cultural awareness and
sensitivity to one’s own cultural heritage is essential.
Culturally skilled counselors are aware of how their own
cultural background and experiences, attitudes, and values
and biases influence psychological processes.
Culturally skilled counselors are able to recognize the limits
of their multicultural competency and expertise.
Culturally skilled counselors recognize their sources of
discomfort with differences that exist between themselves
and clients in terms of race, ethnicity, and culture.
Knowledge
Culturally skilled counselors have specific knowledge about
their own racial and cultural heritage and how it personally
and professionally affects their definitions and biases of
normality-abnormality and the process of counseling.
Counselor Awareness of Own Cultural Values and Biases
Culturally skilled counselors possess knowledge and
understanding about how oppression, racism,
discrimination, and stereotyping affect them personally and
in their work. This allows individuals to acknowledge their
own racist attitudes, beliefs, and feelings. Although this
standard applies to all groups, for White counselors, it may
mean they understand how they may have directly or
indirectly benefited from individual, institutional, and
cultural racism as outlined in White identity development
models.
Culturally skilled counselors possess knowledge about their
social impact upon others. They are knowledgeable about
communication style differences, how their style may clash
or foster the counseling process with persons of color or
others different from themselves, and how to anticipate the
impact that all this may have on others.
Skills
Counselor Awareness of Own Cultural Values and Biases
Culturally skilled counselors seek out educational,
consultative, and training experiences to improve their
understanding and effectiveness in working with culturally
different populations. Being able to recognize the limits of
their competencies, they
(a) seek consultation,
(b) seek further training or education,
(c) refer cases to more qualified individuals or
resources, or
(d) engage in a combination of these strategies.
Culturally skilled counselors are constantly seeking to
understand themselves as racial and cultural beings and are
actively seeking a nonracist identity.
Table 2-4 Professional Multicultural Competencies II
Counselor Awareness of Client’s Worldview
Attitudes and Beliefs
Culturally skilled counselors are aware of their negative and
positive emotional reactions toward other racial and ethnic
groups that may prove detrimental to the counseling
relationship. They are willing to contrast their own beliefs
and attitudes with those of their culturally different clients
in a nonjudgmental fashion.
Culturally skilled counselors are aware of the stereotypes
and preconceived notions that they may hold toward other
racial and ethnic minority groups.
Knowledge
Culturally skilled counselors possess specific knowledge and
information about the particular group with which they are
working. They are aware of the life experiences, cultural
heritage, and historical background of their culturally
different clients. This particular competency is strongly
linked to the minority identity development models available
in the literature.
Counselor Awareness of Client’s Worldview
Culturally skilled counselors understand how race, culture,
ethnicity, and other background elements may affect
personality formation, vocational choices, manifestation of
psychological disorders, help-seeking behavior, and the
appropriateness or inappropriateness of counseling
approaches.
Culturally skilled counselors understand and have
knowledge about sociopolitical influences that impinge upon
the life of racial and ethnic minorities.
Culturally skilled counselors understand how immigration
issues, poverty, racism, stereotyping, and powerlessness may
affect self-esteem and self-concept in the counseling process.
Skills
Culturally skilled counselors should familiarize themselves
with relevant research and the latest findings regarding
mental health and mental disorders that affect various
ethnic and racial groups. They should actively seek out
educational experiences that enrich their knowledge,
understanding, and cross-cultural skills for more effective
counseling behavior.
Counselor Awareness of Client’s Worldview
Culturally skilled counselors become actively involved with
minority individuals outside the counseling setting (e.g.,
community events, social and political functions,
celebrations, friendships, neighborhood groups) so their
perspective of minorities is more than an academic or
helping exercise.
Table 2-5 Professional Multicultural Competencies III
Culturally Appropriate Intervention Strategies
Attitudes and Beliefs
Culturally skilled counselors respect clients’ religious and/or
spiritual beliefs and values, including attributions and
taboos, because these affect worldview, psychosocial
functioning, and expressions of distress.
Culturally skilled counselors respect indigenous helping
practices and respect help-giving networks among
communities of color.
Culturally skilled counselors value bilingualism and do not
view another language as an impediment to counseling
(monolingualism may be the culprit here).
Knowledge
Culturally skilled counselors have a clear and explicit
knowledge and understanding of the generic characteristics
of counseling and therapy (culture-bound, class-bound, and
monolingual) and how they may clash with the cultural
values of various cultural groups.
Culturally Appropriate Intervention Strategies
Culturally skilled counselors are aware of institutional
barriers that prevent minorities from using mental health
services.
Culturally skilled counselors have knowledge of the potential
bias in assessment instruments and use procedures and
interpret findings in a way that recognizes the cultural and
linguistic characteristics of the clients.
Culturally skilled counselors have knowledge of family
structures, hierarchies, values, and beliefs from various
cultural perspectives. They are knowledgeable about the
community where a particular cultural group may reside
and the resources in the community.
Culturally skilled counselors should be aware of relevant
discriminatory practices at the social and community level
that may be affecting the psychological welfare of the
population being served.
Skills
Culturally Appropriate Intervention Strategies
Culturally skilled counselors are able to engage in a variety
of verbal and non-verbal helping responses. They are able to
send and receive both verbal and non-verbal messages
accurately and appropriately. They are not tied down to only
one method or approach to helping, but rather recognize
that helping styles and approaches may be culture-bound.
When they sense that their helping style is limited and
potentially inappropriate, they can anticipate and modify it.
Culturally skilled counselors are able to exercise institutional
skills on behalf of their clients. They can help clients
determine whether a “problem” stems from racism or bias in
others (the concept of healthy paranoia) so clients do not
inappropriately personalize problems.
Culturally skilled counselors are not averse to seeking
consultation with traditional healers or religious and
spiritual leaders and practitioners in the treatment of
culturally different clients when appropriate.
Culturally Appropriate Intervention Strategies
Culturally skilled counselors take responsibility for
interacting in the language requested by the client and, if not
feasible, make appropriate referrals. A serious problem
arises when the linguistic skills of the counselor do not
match the language of the client. This being the case,
counselors should
(a) seek a translator with cultural knowledge and
appropriate professional background or
(b) refer to a knowledgeable and competent bilingual
counselor.
Culturally skilled counselors have training and expertise in
the use of traditional assessment and testing instruments.
They not only understand the technical aspects of the
instruments, but also are aware of the cultural limitations.
This allows them to use test instruments for the welfare of
the culturally different clients.
Culturally skilled counselors should attend to as well as work
to eliminate biases, prejudices, and discriminatory contexts
in conducting evaluations and providing interventions and
should develop sensitivity to issues of oppression, sexism,
heterosexism, elitism, and racism.
Culturally Appropriate Intervention Strategies
Culturally skilled counselors take responsibility for
educating their clients to the processes of psychological
intervention, such as goals, expectations, legal rights, and the
counselor’s orientation.
Source: Based on from Operationalization of the Multicultural
Counseling Competencies by P. Arredondo, R. Toporek, S. P. Brown, J.
Jones, D. C. Locke, J. Sanchez, and H. Stadler, Journal of Multicultural
Counseling and Development, 3, January 1996, 42–78. Copyright 1996.
Midgett and Doumas (2016) expressed several professional standards
that may help foster cultural competence at the educational level.
They suggest that educational programs must prepare students to
adequately work with individuals of diverse backgrounds. In doing
so, programs can implement culturally focused assignments or
classroom activities, have students engage with culturally diverse
populations in the community, and also allow students to gain real
world experiences with cultural immersion/exchange programs.
Book Title: eTextbook: Cultural Diversity: A Primer for the
Human Services
Demographics
Reactions to Changing Demographics
Reactions to Changing Demographics
What has been the reaction to this growing diversification? First,
White America has clearly felt threatened by these changes. The
sheer increase in non-White numbers has stimulated a widespread
political backlash. Most prominent has been a rise in anti-immigrant
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sentiment and legislation and a strong push to repeal affirmative
action practices, which were instituted over the last several decades
to level the economic and social playing fields for people of color.
As economic times have worsened for White working and middle
classes, frustration has increasingly been directed at non-White
newcomers who are blamed for “taking our jobs” and told to “go back
to where you came from if you’re not willing to speak English.” In a
similar vein, White supremacists, militias, and anti-government
groups, playing on racial hatred and a return to “traditional values”
and “law and order,” have attracted growing numbers. The result has
been a society even further polarized along color lines. People of
color, in turn, have sensed their growing numbers as an ultimatum to
White America: “Soon, you won’t even have the numerical majority.
How can you possibly continue to justify the enormous injustice and
disparity against us?”
For those in the helping professions, a major implication of these new
demographics is a radically different client base. More and more,
providers will be called on to serve clients from diverse cultures. Job
announcements increasingly state: “Bilingual and bicultural
professionals preferred” and “Cross-cultural experience and
sensitivity a requirement.” At the same time, there is a growing
awareness that it is insufficient to merely channel these new clients
into the same old structures and programs or to hire a few token
professionals of color. Rather, a radical reconceptualization of
effective helping vis-à-vis those who are culturally diverse and how it
occurs is needed. At the center of such a renewed vision is the notion
of cultural competence.
Book Title: eTextbook: Cultural Diversity: A Primer for the
Human Services
Why Become Culturally Competent?
Why Become Culturally Competent?
2-2
In the past, gaining what is now called cultural competence was an
ethical decision undertaken by practitioners with a particularly
strong moral sense of what was right and fair. Usually, such
individuals sought training with the express purpose of working with
specific cultural groups, and they gravitated toward minority
agencies. Mainstream providers, with their predominantly White
client base, had little reason to pursue cultural competence. Although
today, the picture is quite different. All agencies are seeing more
culturally diverse clients walk through their doors and it may not be
long before cultural competence becomes a professional imperative.
Jones, Kawena Begay, Nakagawa, Cevasco, and Sit (2016) suggest that
clinicians integrate cultural competencies into evidence-based
treatment modalities when treating diverse populations. In time,
cultural competence may be a routine requirement for all jobs, not
just those in the helping professions.
Whether it is a matter of working under a superior who is a person of
color, supervising others from diverse backgrounds, or retaining
good relations with colleagues who are culturally diverse, being
skilled in cross-cultural communication will increasingly be an asset.
Given the dramatic diversification currently under way in the United
14
States, gaining cultural competence may someday reach a status
comparable to that of computer literacy. Twenty-five years ago,
computer skills were an isolated novelty, but today it is difficult to
compete successfully in any job market without them. The same may
eventually become true of cultural competence.
Book Title: eTextbook: Cultural Diversity: A Primer for the
Human Services
Why Become Culturally Competent?
The Fear and Pain Associated with Moving Toward Cultural
Competence
The Fear and Pain Associated with Moving
Toward Cultural Competence
It is my experience most people are apprehensive of learning about
race and ethnicity; thus they approach the topic with some
reluctance, even dread. The same may be true for you. When I start a
new class, the tension in the room is palpable; students do not know
what to expect. Race is a dangerous subject for everyone, and even
cause people to become unglued in relation to it. White students
wonder if they will be attacked, called racists, and made to feel guilty.
Students of color wonder if the class is “going to be for real” or just
another “exercise in political correctness.” Everyone wonders
whether they will really be able to speak their minds, whether things
might get out of control, and, if so, whether I will be able to handle it.
Their concerns are understandable.
What is more familiar in such discussions are accusations and
attacks, name-calling, and long, endless diatribes about racial
profiling, affirmative action, anti-immigrant legislation, and differing
perspectives on terrorism.
What one does not hear about or talk about, and what must become a
focus of attention if there is ever going to be any positive change in
this arena, is the psychological pain and suffering caused by racism
and the ways in which everyone is touched by it. I cannot help but
think of these past students and their stories:
The young White woman who was traumatized as a young child
when her mother found her innocently touching the face of their
African American maid and freaked out.
The Latina girl who was never the same after being accused of
stealing the new bike that her parents had scrimped and saved to
buy for her.
The Jewish man who discovered, at the age of 25, that his parents
had been hiding from him the fact that they were Jews.
The Asian woman, adopted at birth by White parents, who could
not talk to them about how difficult it was for her living in an a
predominantly White world.
The White woman consumed by guilt because of what she felt to
be an irrational fear of African American and Latino men.
There is clearly as much fear and nervousness about letting out such
feelings as there is about the unknowns of working with clients from
other cultures.
I try to alleviate the anxiety by reviewing the ground rules and
assumptions that define how we will interact in class. My intention is
to create a safety zone where students can talk about race in ways
15
that cannot be talked about in normal daily life. The following
guidelines are clearly spelled out at the beginning of the course:
There will be no name-calling, labeling, or blaming one another.
There are no heroes or villains in this drama; no good people or
bad. Each of us harbors negative reactions toward those who are
different; it is impossible to grow up in a society and not take on
its prejudices. So, it is not a matter of whether one is a racist or
not—we all are. Rather, it is a question of what negative racial
attitudes one has learned so far and, from this moment on, what
one is willing to do about them.
Everything that is said and divulged in this classroom is
confidential, and it is not to be talked about with anyone outside
of here. Students often censure, measure their words, and are
less than honest in what they say out of fear of either looking bad
or having their personal disclosures treated insensitively or as
gossip.
As much as possible, everyone will personalize his or her
discussion and talk about personal experiences. There is much
denial around racism that serves as a mechanism for avoiding
responsibility. Only by personalizing the subject and speaking in
the first person, rather than the third, can this be avoided.
You can say whatever you believe. This may, in turn, lead to
conflict with others. That is OK. But you must be willing to look at
what you say, take responsibility for your words, and learn from
what ensues. Anything that happens during class is a learning
opportunity. It can and may be analyzed as part of the process.
The class is a microcosm of the outer racial world with all its
problems, and as such, honest interaction in class can shed
valuable light on the dynamics of intergroup conflict.
Most students have serious questions about race and ethnicity that
need to be answered, or experiences in relation to these elements
that must be processed and better understood. Significant learning
about race and ethnicity cannot proceed without this happening.
Opportunities to do so are rare, but only through such occasions can
growth and healing begin. Once a degree of safety has been
established, the floodgates open, and students become emboldened
by the frank comments of others to share what is really on their
minds. These are the kind of concerns that emerge:
Why do so many immigrants to the United States refuse to learn
English? If they want to live here and reap the benefits, the least
they should be willing to do is learn our language.
My parents came over from Italy. They were dirt poor but made
successful lives for themselves. They didn’t have all this help.
16
I really don’t understand why it should be any different for
people of color.
This is all really new to me. I grew up in a small town in rural
Oregon. There was one Black family, but they stayed to
themselves mostly. It’s confusing, and to be perfectly honest, it’s
also pretty scary. There’s just so much anger. If I had a client of
color, I’m not sure I would know what to say or do.
My biggest issues are with Black men. I try to be supportive of
them and understand the difficulties they face. But when I see
them always with White women, overlooking me and my sisters
and all we have to offer, I get really angry.
To be perfectly honest, I hate being White. I feel extremely guilty
about what we have done to people of color and don’t know how
to make up for it. I don’t feel I have any culture of my own. We
used to joke about being “Heinz 57–variety” Americans. And I
envy people of color for all their culture and togetherness. We
tried practicing some Native American ways, but that didn’t seem
exactly right, and besides, we were never made to feel very
welcome.
I’ve come to realize how much racial hatred there was in my
family while I was growing up, and this disturbs me greatly. I
find it very hard to see my parents in this negative light and don’t
know what to do with all of this.
It’s gotten pretty hard being a White male these days. You’ve
always got to watch what you say, and as far as getting a job—
forget it. There’s a whole line of women and minorities and
disabled [people] in front of you. I guess I sort of understand the
idea of affirmative action, but just because I’m White doesn’t
mean I have it made. I find it very difficult just getting by
financially. I don’t see where all this privilege is.
I just can’t buy all this cultural stuff. People are just people and I
treat everyone the same. I grew up in an integrated
neighborhood. I always had a lot of Black and Latino friends and
never saw them as different. Frankly, I think all this focus on
differences is creating the problem.
I’m Jewish but am finding it hard to discover where I fit in all of
this. I don’t feel White, but everyone treats me and classifies Jews
as White. I was very involved in the Civil Rights Movement a
number of years ago; even worked down in the South for a
summer registering voters. But that seems so far away, and now
Blacks hate Jews. What did we do?
I’m in this class because I have to be. I don’t need to take a class
on racism. I’ve lived it all my life. White people don’t get it. They
just don’t want to see, and no class is going to open their eyes.
What I’m not willing to do is be a token person of color in here.
17
Moving toward cultural competence is hard, emotional work.
Personal issues such as those just described have to be given voice
and worked through. Students need good answers to their questions
and support in finding solutions to personal conflicts with the
material. It is as if a whole new dimension of reality—that of culture
—has been introduced into a student’s phenomenological world. Old
beliefs about oneself, others, and what one does and does not have in
common must be examined and adjusted where necessary. There are,
in addition, vast amounts of information to learn and new cultural
worlds to explore. Perhaps most exciting, however, are the ways in
which one’s mind has to stretch and grow to incorporate the
implications of culture. Students who have progressed in their
learning about cultural matters often speak of a transformation that
occurs in the ways they think about themselves and the world.
Bennett (1993) has tried to describe these cognitive changes. Of
particular interest is the qualitative shift that occurs in a person’s
frame of reference—what Bennett describes as movement from
ethnocentrism to ethnorelativism. In typical ethnocentric thinking,
culturally diverse behavior is assessed in relation to one’s own
cultural standards; it is good or bad in terms of its similarity to how
things are done in one’s own culture. In ethnorelative thinking,
“cultures can only be understood relative to one another and …
particular behavior can only be understood within a cultural context,
… cultural difference is neither good nor bad, it is just different …” (p.
26). Mayer (2012) added that individuals who are ethnocentric deny
the existence of other frames of reference and those whom are
ethnorelative accept the existence of other frames of reference.
People who make this shift increase their empathic ability and
experience greater ease in adopting a process orientation toward
living. When the actions of others are not assessed or judged but are
just allowed to exist, it is far easier to enter into their felt experience
and thereby empathize with them. Similarly, realizing that behavior,
values, and identity itself are not absolute, but rather are constructed
by culture, frees one to appreciate more fully the ongoing process of
living life as opposed to focusing entirely on its content or where one
is going or has been. These skills not only transform how people
think, but also prepare them for working more effectively with
culturally diverse clients.
Book Title: eTextbook: Cultural Diversity: A Primer for the
Human Services
Why Become Culturally Competent?
Speaking Personally about Cultural Competence
Speaking Personally about Cultural
Competence
An old adage states: “You get as much out of something as you put
into it.” The same is true for pursuing cultural competence and using
this book as a beginning. There is much useful information in the
pages that follow that cannot help but contribute to your growth as a
provider of cross-cultural services, which is certainly worth the
“price of admission.” Furthermore, it can be the start of a journey
that can change you in deep and unpredictable ways. As suggested
earlier, engaging in the serious pursuit of cultural competence can be
transformational, not so much in a religious sense as a perceptual
one.
18
Black-and-white thinking will eventually be replaced by relational
and process thinking. In time, you will think very differently than you
do now. I can also guarantee that if you pursue a deeper
understanding of culture, you will at times find yourself disturbed
and disoriented, feeling very lost and alone. I can remember the first
time I experienced cultural relativity and realized that what I had
taken for my entire life as absolute reality—the underpinnings of my
world—was actually relative. It came from reading the books of Alan
Watts on Zen Buddhism and beginning to explore meditation. What I
found so disturbing and unsettling was the realization that there was
more than one way to understand reality. I was never quite the same
again, as if the center of my consciousness had shifted somewhat and
everything looked a little different. It is an unhinging aspect of the
journey that will often be repeated in miniature as one continues to
delve into cultural material.
Two qualities will make a difference in how you relate to this book,
and ultimately in your pursuit of cultural competence. The first is
self-honesty. There is an aspect of ethnocentrism that is selfdelusional; it seeks to hide the fact that human experience can be
relative and that there might be “another show in town.” As will
become evident in Chapter 3, we all have a strong tendency to deny
and hide from consciousness the negative feelings that we hold about
race, ethnicity, and cultural differences. Together, these tendencies
conspire to keep us in the dark. Only by pushing oneself to engage the
concepts and material of this book critically and to discover precisely
how they have played themselves out in the confines of one’s life can
the power of cultural competence be truly appreciated.
The second quality is a sustained commitment. The kind of learning
that leads to cultural competence takes place over the long term. It
consists as much of process as content, tends to be cumulative in
nature, and is highly developmental. This means that you may go
through various predictable stages of growth, emotion, and change.
This book is only a beginning. What happens next—what additional
cultural learning experiences you seek and the extent to which you
seriously engage in providing services cross-culturally—is up to you.
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