Recognizing Cultural Incompetence

         As I’ve mentioned in earlier posts, something I have occasionally struggled with at my internship is the racial homogeneity of the client population (white, typically New England natives, between ages 20 and 70). There are incredible challenges at Milestone, but until last week, for the most part, I didn’t feel that my cultural competence pertaining to race had been questioned, per se.

         Last week, however, I had the chance to work with an individual from another country experiencing the complexity associated with the intersection of co-occurring disorders. For the sake of this post, this individual will remain anonymous, but some of his attributes will be described.

         This client is from Kenya, a non-practicing Muslim, an English Language Learner, presents with schizoaffective disorder, a traumatic brain injury, is homeless and has a severe alcohol and cannabis use disorder. WOW! Not only did all of this clinical jargon apply to this individual, he was also enthusiastic, kind hearted, dynamic, and excited about the potential opportunity to find housing and sobriety.

         Given that substance abuse is really a “symptom” of other, greater issues, usually tied to trauma and subsequent mental health issues, it is not uncommon for clients to present with co-occurring disorders – anxiety, depression, and PTSD most often. What was unique in my experience thus far, however, was the diagnosis of schizoaffective disorder – never mind that this individual recently arrived from another continent. Not entirely familiar with this, I was a little anxious about my own competence with this client, and whether or not I possessed the knowledge, skill set, or competence to work with this individual, respecting the multiple facets impacting their  affect.

         Ultimately, however, I think the client and I surprised each other with how well we were able to work together! Given the language barrier between us, we compensated with hand gestures, and the use of visuals sketched out on a notepad to help describe the chronology of certain life events, and number scales used to rate emotions. We found levity in the interaction; he was able to share his story, I gathered important data, and helped set up referrals with case management and housing.

         What was incredibly humbling in this experience, aside from being in the presence of someone inherently positive despite enormous challenges, was realizing that if this were my client over a long period of time (multiple sessions and/or a case manager), at this time, I would not have been fit for the job, and would have needed to lean on colleagues and an interpreter, or ultimately make a referral and assist this client’s transition to another agency. This is stemming from a number of reasons:

1.) I don’t feel that I have adequate training in the mental health field (yet!) to take on repeatedly working with a client with this nature of disorder

2.) The intersection of Islam and his understanding of his mental illness, led him to interpret the voices he occasionally hears as “demons.” For the purpose of my working with him, it was important that I document this; however, given Milestone’s lack of mental health licensure, that sort of content gets passed on to future agencies and caregivers. I realized immediately that it was important for me to learn more about the perception of mental health in Islam (as it is practiced in Kenya), but in the moment, I realized that I did not know anything about that, specifically.

3.) The language barrier between us was pretty significant – and again this could absolutely be due to a speech impediment developed after the brain injury – however, it was totally unclear to me as to whether this individual’s expressive ability would have improved given the chance to speak with someone else in his native language.

         I learned a ton from this experience – most notably that I really want to take on these sorts of cases again in the future! What I learned about myself, though, is the importance of recognizing my own limits, and areas in need of “cultural growth and development.” For example, I know that I did not speak the native language of this client, and while I cannot do anything to change that in the immediate context of working with them, I understand my own deficiencies, the necessity to reach out to others for support, and the responsibility I have to continue learning (always!) to increase my cultural competency. Given that culture is constantly morphing and changing, this work will be endless, and that is exciting.