Kristin Miserocchi, Ph.D. (Pronouns: She/Her)
Licensed Staff Psychologist and Groups Coordinator
Mental Health Services at Washington University in St. Louis
One of the most important initial tasks in group therapy is the creation of group norms, which serves multiple functions. First, the norming process is a part of informed consent, laying out the expectations and rules necessary to participate in group. The norming process is the first step toward creating the group ulture, by identifying and clarifying the values to which all members and facilitators aspire. Finally, the development of norms is ideally collaborative between group facilitators and members, empowering members to take ownership of the group space and experience. While some group norms are open to collaboration, others are universal and non-negotiable, based on ethical guidelines – confidentiality for instance. Cultural humility should also be a universal group norm guiding both facilitators’ and members’ group interactions.
Owen et al. (2011) describes cultural humility as a “way of being” with clients, in contrast to “doing” multicultural work in therapy with clients (i.e. multicultural competence). Cultural humility consists of intrapersonal (ongoing, in-depth self-reflection and self-critique) and interpersonal components (being other-person focused), both of which are relevant to group therapy (Davis, et al., 2018; Mosher et al., 2017). Much of the literature on cultural humility has focused on the individual therapy setting and, specifically, on the client’s judgment of the therapist’s level of cultural humility (high or low). Cultural humility is an extension of humility, which is “…an accurate view of self, the ability to restrain self-focused emotions and behaviors in socially acceptable ways, and the ability to cultivate other-oriented emotions and behaviors” (Davis et al., 2013, p. 60). Humility is associated with building relationships, increasing trust and safety while in the relationship, and forgiveness when conflict arises, all of which are crucial group therapy experiences and goals. Thus, orienting oneself toward humility seems to be important to form and maintain strong relationships; and given we are all complex, cultural beings, humility and cultural awareness naturally go hand-in-hand.
A useful framework exists describing various ways cultural humility can show up in therapy. While developed with individual therapist-client relationships in mind, this framework can be adapted to better understand how cultural humility may present in group therapy spaces. One aspect of this cultural humility framework is self-examination and self-awareness (Mosher et al., 2017). Group members and facilitators oriented toward cultural humility will be tuned in to the ways their own cultural identities are intersecting with the cultural identities of the other members, beyond simply recognizing differences and similarities. This may look like self-reflection on how they show up in relationships with people who are similar and different to them, a pattern that will potentially emerge in the here-and-now space of group therapy (e.g. cultural differences/similarities in communication or emotional expression). In addition, cultural humility requires both an awareness of one’s own limitations in knowledge, as well as an acknowledgement of another person’s expertise in their lived experiences. This requires active listening skills, curiosity, openness, and a desire to more deeply understanding someone else – all important to build group cohesiveness and intimacy amongst members. Based on this, it is clear how cultural humility can enhance relationship building, though all of the research supporting this has focused on the therapeutic alliance (Mosher et al., 2017). Extrapolating to group therapy relationships, expressions of cultural humility can facilitate a sense of connection and trust amongst group members. This could manifest as a group member expressing their desire and intentions to more deeply understand other group members. These intentions can be enacted by communicating awareness of what one knows and does not know, and, further, expressing curiosity to know or learn more about someone’s cultural experiences. These behaviors are also useful when navigating differences in values or beliefs amongst members, something that can also be an important source of interpersonal learning. Another aspect of cultural humility is a willingness to repair relationship ruptures (caused by cultural mistakes) and to navigate differences in values. If a rupture occurs, a culturally humble group member would remain open to feedback from the injured group member, to better understand what happened. This might look like validating the other person’s pain, expressing remorse or apologizing for the pain caused, communicating one’s own limits in knowledge, and expressing appreciation for the opportunity to learn and repair the rupture (Mosher et al., 2017).
In addition to its relevance to group dynamics, cultural humility is also relevant when considering group therapy ethics. Brabender and MacNair-Semands (2022) describe a number of group therapy ethical paradigms that group facilitators can adopt to guide their behavior. Both components of humility are featured in all of these paradigms: adopting another-orientation (prioritizing group members’ well-being, their rights, equitable treatment) and an accurate view of self (competence and knowledge of one’s limitations, awareness of power dynamics). Culturally-relevant group therapy ethics should be universal for all group therapy experiences, regardless of the type of group or the population being served. Whether or not a group therapy space is intended to serve marginalized communities or not, these spaces will inevitably be rich with cultural diversity. Because of this reality, adopting cultural humility as a group norm and value can serve as an important guide for ethical behavior on the part of group facilitators.
Cultural humility, as an orientation in therapy relationships, has not only been found to enhance the alliance building process, but positively impact therapy outcomes as well (Mosher et al., 2017; Owen et al., 2011). As I have dug into the literature on cultural humility, and humility more generally, it has become clear to me that the benefits transcend the individual therapist-client relationship. Cultural humility, as a group norm, increases the chances of group members obtaining what they are hoping for out of a group therapy experience, such as community, connection, and interpersonal learning opportunities. Additionally, an intentional attunement to cultural humility lays the foundation for group facilitators to engage with group members in ethical and principled ways.
References
Brabender, V., & MacNair-Semands, R. (2022). The ethics of group psychotherapy: Principles and practical strategies. Routledge.
Davis, D. E., DeBlaere, C., Owen, J., Hook, J. N., Rivera, D. P., Choe, E., Van Tongeren, D. R., Worthington, E. L., Jr., & Placeres, V. (2018). The multicultural orientation framework: A narrative review. Psychotherapy, 55(1), 89–100. https://doi.org/10.1037/pst0000160
Davis, D. E., Worthington, E. L., Hook, J. N., Emmons, R. A., Hill, P. C., Bollinger, R. A., & Van Tongeren, D. R. (2013). Humility and the development and repair of social bonds: Two longitudinal studies. Self and Identity, 12(1), 58-77. http://dx.doi.org/10.1080/15298868.2011.636509
Mosher, D. K., Hook, J. N., Captari, L. E., Davis, D. E., DeBlaere, C., & Owen, J. (2017). Cultural humility: A therapeutic framework for engaging diverse clients. Practice Innovations, 2(4), 221–233. https://doi.org/10.1037/pri0000055
Owen, J. J., Tao, K., Leach, M. M., & Rodolfa, E. (2011). Clients’ perceptions of their psychotherapists’ multicultural orientation. Psychotherapy, 48(3), 274–282. https://doi.org/10.1037/a0022065