CULTURAL COMPETENCE AND GOOD PRACTICE

The Epistemology of Cultural Competence

Charmaine C. Williams

ABSTRACT Cultural competence is a high priority in social work, but it is not conceptualized in a way that can effectively guide practice. The author proposes an organization of cultural competence strategies into epistemologically defined paradigms for multicultural practice. The paradigms discussed are based in postpositivism, constructivism, critical theory, and postmodernism. These paradigms are presented as potential tools for developing a better understanding of what constitutes effective multicultural practice and what contributes to cultural impasses. The author suggests that cultural competence should be defined by the capacity to work across multiple paradigms to find ways to engage with clients.

everal years ago when I was working in inpatient psychiatry, I was assigned to work with a 32-year-old woman named Akiko,1 a Japanese immigrant who had come to the United States after marrying a White American man temporarily working in Tokyo. The couple had a 4year-old son, and Akiko had not worked outside of the family home since immigrating six years earlier. Her husband brought her to the hospital because his formerly demure wife had been argumentative, accusatory, and highly agitated for several weeks. In addition, she hovered over their little boy, frantic at the possibility that he could be harmed if she left his side. When she began to stay up all night in their sons bedroom, praying loudly in Japanese, her husband decided to seek medical consultation. This precipitated her admission to the unit with a preliminary diagnosis of bipolar disorder, manic phase. When we met the husband, he was visibly shaken by his wifes transformation. He described her as a peaceful, nur1 Names and identifying details have been changed to protect the privacy of the people involved.

turing woman who had been leading a quiet, content life as a wife and mother. After her admission, his first attempt to bring their son to visit her in the hospital went poorly; Akiko was angry and refused to speak. The husband expressed concern about their sons well-being. The boy was upset by the visit and at home he was clinging to his father, crying at night, and wetting the bed. The husband and son did not visit Akiko for the next few days. After a week, we called to see how they were doing, and the husband told us he had decided it was not good to let the child see his mother that way. In the meantime, Akiko had become more settled. She had been telephoning her home to speak with her husband and son, but she would only reach the answering machine. Members of the treatment team were similarly unsuccessful in contacting the family. Almost a week later the husband finally contacted me, requesting a meeting. He arrived that day, without the child, and went directly to my office. He announced that he was separating from his wife, and she could not return to the family home. He was not interested in my attempt

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to seek further explanation or negotiate visits for the the same kind of confusion, frustration, and regret in the child. He ended the meeting, stopped in Akikos room to voices of learners attending the sessions. They tell me they inform her of his decision, and left. want to learn how to be more culturally sensitive or aware, Akiko was inconsolable. No words, no medications, and learn the right techniques, possess the correct cultural no offers of support could ameliorate her distress. She knowledge, and deal with racism and discrimination in attempted to visit her home but did not have a key to gain their workplaces. This multitude of desires speaks to the access; no one answered her knocks at the door. Her hus- dilemmas faced in contemporary workplaces in which proband did not respond to telephone calls from her or any fessionals and clients are often originating from cultural of us. I explained to Akiko that her husbands behavior backgrounds that dictate different assumptions about the was not acceptable; he could not keep her from her home world. Culture defines the norms, symbols, and behaviors and her child. She, however, believed that she was power- that aid us in making sense of this world. When there are less in the situation. She refused my suggestions of seeking cultural gaps among service systems, practitioners, and clihelp from a lawyer or the police. Some of her neighbors ents, it contributes to misunderstandings and impasses came to the hospital to offer their that prevent effective social work support. They were not surprised intervention (Bonder, Martin, & by the turn of events; they Miracle, 2001; Lee & Greene, claimed the husband treated 1999). Seeking cultural compeAkiko more like a servant than a tence is our response to that Activism and advocacy can wife. Akiko appreciated their visdilemma. its but told me that she did not Cultural competence demands look like luxury items to people feel comfortable confiding in any that we practice with skills, attiof them. I could see that Akiko tudes, and values that will make who see themselves as dealing felt terribly alone. She was an us effective and adequate in seronly child and her parents were in vice provision to clients who with issues of survival. Japan, so I arranged for her to originate from a variety of culspeak with them, hoping they tural backgrounds (Cross, 1988; would help her to feel less isolated Devore & Schlesinger, 1999). Yet and encourage her to let us help. the specific competencies that are The telephone conversation had necessary, and the appropriate the opposite effect. Akiko reported that her parents had contexts for their application, are still poorly understood told her that she now had to live with the consequences of (Carlson, Brack, Laygo, Cohen, & Kirkscey, 1998; J. W. her decision to marry this man and leave Japan. On the Green, 1995). The social work literature is laden with sugbasis of the familys response and Akikos growing shame gestions for cultural competencies, often organized into and despair, I concluded that I needed help from someone categories for self-awareness, attitudes, skills, and knowlwho could negotiate what I was beginning to understand edge that are echoed in parallel standards for counseling as a culture-based impasse. I suggested to Akiko that it psychology multicultural competence (Sue et al., 1982) . might be helpful to involve a worker from the local Social work has used these categories with additional Japanese family service organization. This person could emphasis on multilevel practice and continuums (instead discuss her situation in her first language, possibly speak of measurements) of competency (Cross, Bazron, Dennis, to her parents as well, and intervene based on an under- & Isaacs, 1989; Fong, 2001; Lum, 2003; Manoleas, 1994). standing of Japanese culture. Akiko was horrified by this Beyond those contributions, Boyle and Springer (2001) idea. She said she could never go to those people for help. claim there may be hundreds of conceptual definitions of At this point, I felt completely ineffective and unhelpful. cultural competence and related concepts like ethnic-senAkiko had come to us a wife and mother with signs of sitive, cross-cultural, and multicultural practice. This cremania. One month later, she was separated from her hus- ates a dilemma for practitioners. Presented in this form, band and child, she was homeless, and she was, apparall competencies seem equally relevant, equally useful, and ently, depressed. equally applicable to any practice situation. Perhaps more This is a very unpleasant story for me to recall both troubling, cultural competence is often presented at the because of how sad the outcome was for the client and how level of technique, overlooking the hazards associated inadequate it made me feel as a social worker. Situations with practice that is not linked to a theoretical foundation. like this made me aware that I was accumulating experi- Without this foundation we do not have a framework for ences in which I knew I was missing something important articulating why we expect a given action to be effective or that I needed to know, do, or understand so I could be expect another action to be ineffective. The lack of a more effective in working with my clients: cultural compe- coherent theory base for cultural competence also makes tence. Now when I teach about cultural competence, I hear it difficult to evaluate its effectiveness in practice.

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Previous discussions that have explored cultural competence in terms of its theoretical underpinnings (Dean, 2001; Fong, 2001; Goldberg, 2000) or its emic and etic foundations 2 (Al-Krenawi, 1999; Cheung & Chan, 2002) have been important steps toward defining cultural competence in social work with a focus on its links to theory, practice, and research. I propose that these analyses can be developed further. I believe that we can explore cultural competence on the basis of its epistemological foundations and thereby better appreciate its scope, its relevance, and the implications of its application. The purpose of this article is to explore the epistemological landscape of cultural competence and demonstrate the utility of this theoretical foundation for multicultural social work practice. I suggest that an epistemology-based framework can organize the confusing array of suggestions for cultural competence into a coherent and comprehensive set of strategies. These strategies present multiple entry points for addressing service needs in multicultural contexts.

be articulated. First, I have chosen not to link specific authors to specific paradigms. Typically, authors do not identify their epistemological positions, and I do not claim the authority to identify them on their behalf. Instead, this review situates specific ideas about cultural competence within specific paradigms. In this way it acknowledges that single bodies of work can build on multiple paradigms. A second judgment made is to clearly contrast the paradigms by emphasizing their differences. An attempt has been made to foreground the unique aspects of each, but with the awareness that there can be overlap between ideas and strategies across paradigms. The definitions of the paradigms are derived from work by Guba and Lincoln (1998), F. Williams (1996), and Sim (1999).
Postpositivism and Cultural Competence The postpositivist paradigm suggests that reality is something that we can understand and capture probabilistically using the right tools. This position is postpositivist in that it revises earlier assertions that reality exists independent of the observer and can be apprehended accurately by objective processes (Guba & Lincoln, 1998). Contemporary social researchers acknowledge that objectivity is a goal that can never be attained completely because research is influenced by the theories and biases of researchers. Still, it is proposed that we can pursue knowledge that is uncontaminated and reasonably stable. Cultural competence approaches that are consistent with postpositivism similarly concede the difficulty of understanding culture without the influence of our own cultural expectations and biases (J. W. Green, 1995). However, culture is understood as part of an identity that is common to members of a group and maintained in a continuous form because of its foundation in their shared experiences. Individual differences within the group are acknowledged (Caple, Salcido, & di Cecco, 1995), but culture is made knowable by privileging the experiences that are common to everyone and asserting these experiences as the core of the cultural identity. This stable constellation of traits, behaviors, and expectations is something that can be defined, validated, and shared with others. Therefore, cultural competence can be developed through the acquisition of accurate knowledge about specific cultures (Husband, 2000; Weaver, 1999). This approach is often characterized as anthropological3 because it relies on systematic gathering of cultural information in categories that have been recognized as relevant (Bonder et al., 2001; Dean, 2001; J. W. Green, 1995). The approach is exemplified in texts that provide sections with information about the beliefs, practices, and characteristics of different ethnocultural groups (Al-Krenawi & Graham, 2003; Devore & Schlesinger, 1999; Fong &
3 This characterization of the anthropological method is applicable to 19th- and early 20th-century traditions but does not reflect more critical contemporary approaches (Marcus & Fischer, 1999).

Epistemology and Cultural Competence

Simply stated, epistemology is the study of the nature of knowledge. It attempts to answer questions about what should count as knowledge, what should be rejected, and what methods are appropriate for gaining the type of knowledge that is desirable. In a seminal analysis of epistemological positions underlying social science, Guba and Lincoln (1998) identified three contemporary knowledge paradigms: postpositivism, constructivism, and critical theory. They described these paradigms as encapsulating specific beliefs and worldviews that guide us in choosing methods for social research. Similarly, an epistemological understanding of cultural competence defines beliefs and worldviews that guide us in choosing methods for investigating culture and working with it in practice. This study uses Guba and Lincolns (1998) paradigm descriptions as a framework for exploring cultural competence but also adds a discussion of postmodern contributions. Postmodernism is emerging as highly influential in social work (Leonard, 1997) and in a form that distinguishes it from other inquiry paradigms that have been proposed as alternatives to positivism. Therefore, it is worthwhile to consider its unique contributions to cultural competence theory. This discussion of cultural competence will center on racial and ethnic diversity because it simplifies the analysis and because race and ethnicity are addressed most comprehensively in the social work literature. This approach is not intended to minimize the relevance of other categories of diversity to providing effective social work services. Defining a typology of cultural competence requires me to make this and other judgments that should
2 Emic refers to perspectives derived from the viewpoint of a particular cultural group, and etic refers to perspectives based on the interpretation of outsiders (Alean Al-Krenawi & Graham, 1999).

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Furuto, 2001; Lum, 2003; McCubbin, McCubbin, Thompson, & Thompson, 1995; McGoldrick, Pearce, & Giordano, 1996). Generic social work skills are highly relevant in this paradigm because they have applications to work in the context of cultural diversity. Requisite competencies include self-awareness (Kondrat, 1999; Lee & Greene, 1999); analysis of power structures (Caple et al., 1995; DeHoyos, 1989); empowerment (Abbott, 1999; West Stevens, 1998); critical thinking (Gambrill, 2000); and development of an effective working alliance (Burgest, 1989; Compton & Galaway, 1999). These are understood to be basic components of social work practice that are relevant in any context. Yet the foundational clinical skills require modification for the multicultural environment. These modifications may include application of these competencies in new contexts that are preferred or available localities of specific cultural groups (Poole, 1998). In some cases, cultural competence can also be enhanced by extracting elements from indigenous traditions that are compatible with Western models (Nwoye, 2000). More often, however, it necessitates strategic deviation from conventional social work practices. Assessments and interventions must be altered to increase their compatibility with culturally determined treatment goals and expectations for the helping relationship (Boyle & Springer, 2001; Devore & Schlesinger, 1999; Earle, 1998; Fukuyama, 1990; Mizio, 1998; ShonfeldRingel, 2001). Ultimately, good social work practice, enhanced by cultural content, is assumed to meet requirements for multicultural practice. There are at least two obvious limitations of this perspective. First, it is widely acknowledged that the cultural knowledge found in community profiles and similar sources can promote stereotypes and be based on information that is inaccurate and unrepresentative (Bonder et al., 2001; Congress & Lyons, 1992; Lee & Greene, 1999; McGoldrick, 1998). It is becoming increasingly difficult to defend any static description of culture specifics or even broader generalizations such as traditional versus modern cultures or individualistic versus collectivistic orientations (Cooper & Denner, 1998). Second, it is clear that conventional social work practice is at the center of this type of cultural competence; culture is not integrated as a core concept in any of these generic or modificationbased methods (Yan & Lam, 2000). Therefore, culturally competent practice originating in this perspective is always influenced by the Euro-American-centered origin of existing practice models and, often, consistent assumptions about the anglicized identity of the worker and the diverse properties of his or her client. Yet the postpositivist iteration of cultural competence offers a tangible method for increasing the capacity to work across cultural differences. It becomes possible for us to evaluate the development of cultural competence by testing the sophistication of our knowledge about different cultures

and our capacity to use that knowledge to serve multiple segments of the community (Garces & Rodenas, 2001; Manoleas, 1994).
Constructivism and Cultural Competence The constructivist paradigm suggests that reality is constructed through social interaction and dialogue. What we come to understand as knowledge is based on the shared experiences of groups and is inextricably connected to the participants who are involved in knowledge production (Guba & Lincoln, 1998). Social interactions shape knowledge that is local and specific to a particular context but can be known in more sophisticated forms by immersion in the dialectical process of knowledge construction. Culture, understood through a constructivist lens, is a set of group-based experiences and expectations used to make sense of the world. Therefore, cultural competence requires readiness to engage with alternative, distinctive accounts of what is significant and necessary to gain an accurate understanding of the world. There are other important characteristics of this view of culture. First, a constructivist approach recognizes that part of what makes cultural knowledge local and specific is its integration of issues emerging from the specific social context that the group experiences and the individual uses to define identity (Castex, 1994; Tran & Dhooper, 1996). Therefore, cultural competence cannot be based on the acquisition of knowledge about past ways of life or undiluted cultural experiences in other contexts. Instead, it must focus on immersion in the current lived experience of culture as it has adapted and developed to meet contemporary challenges. A second important issue is that the culture as the group defines it must be the core of a helping process that is co-constructed according to emic language, symbols, and social processes. Some examples from the social work literature include models for intervention that are based on long-established family and community practices among African Americans (Freeman, 1994; Gray & Nybell, 1990; Wilhelmus, 1998) and Native Americans (Edwards & Edwards, 1980; Weaver & Yellow Horse Brave Heart, 1999). This type of cultural competence requires carrying out social work that is congruent with the behaviors and expectations that are normative within the culture of the client (J. W. Green, 1995). The intra- and intercultural narratives embedded in the helping context affect the helping relationship. Therefore, there are opportunities for connection, estrangement, and distortions in the working alliance; these have been explored comprehensively in the literature on cultural transference and countertransference (Comas-Diaz & Jacobsen, 1991; Foster, 1998). Acknowledging these complexities, constructivist cultural competence is implemented most precisely through the strategic application of ethnocentrism to affirm particular cultural identities and create contexts within which clients can seek and receive

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culturally appropriate services. Those services may be best erful. The people who are marginalized in these structures provided by practitioners who are identified cultural are led to believe that existing social arrangements are natinsiders (Weaver, 1999). ural and unassailable, but true knowledge lies in exposing The involvement of social work in culture-specific serthe relations of domination that create this virtual reality. vice provision evokes some ambivalence. As some have Looking at culture through a critical theory lens leads us noted, ethnospecific agencies have functioned outside of to view culture as the outcome of oppressive processes the social work mainstream, filling a need that was not adthat constrain cultural expression. Therefore, engagement dressed in conventional services (Iglehart & Becerra, with culture requires engagement with the historical, 1996). Many of these agencies have operated through political, and economic structures that have contributed community-based helping networks (e.g., churches, local to formulations of ethnic identity, group status, and businesses, neighborhood groups) that received no supopportunities for individuals (Husband, 2000; Latting & port or assistance from the state. Social workers current Zundel, 1986). The critical approach to cultural compeinterest in the work of ethnospecific agencies can be read tence shifts focus from the cultural creations of individuals as an effort to compensate for long-term neglect of their and groups to the problematic context in which culture service providers and their clients, but it could also be read must be negotiated. This locates the target of intervention as an attempt to appropriate community-based activities to reinforce mainstream, professionbased power. In addition, not all social workers are eager to emSocial workers are expected to have knowledge and expertise brace culture-specific service provision. Some authors have critithat can benefit their clients. On the basis of that knowledge, cized the suggestion that matching clients and clinicians expertise, and state-based authority, they have power that cannot according to particular identities is a superior path to cultural be put aside through a commitment to embracing uncertainty. competence; they identify this as cultural chauvinism (TaylorBrown, Garcia, & Kingston, 2001). Extreme endorsement of the value of insider perspectives could mean that practitioners would be confined to work- as discrimination and all types of intercultural domination ing with clients perceived to be appropriately matched to that result in the decreased opportunities and internalized them, with the assumption that they would be inferior in oppression of individuals in marginalized groups (R. J. providing service to others. This is a difficult position to Green, 1998; Greene, Jensen, & Harper Jones, 1996). support because we cannot make assumptions about the The multilayered influence of oppression demands culexpertise of assumed insiders or their capacity to use their tural competence strategies at multiple levels. Critical culcultural backgrounds effectively in practice (Headland, turally competent work with individuals, families, and Pike, & Harris, 1990). However, the constructivist apgroups requires the ability to conceptualize how pervasive proach to cultural competence creates a space within inequity affects presenting problems and the capacity to which it is possible to think about the professional contriseek help and gain access to services (Fernando, 2001; butions of expertise based on lived experience and Singleton-Bowie, 1995). It is problematic, however, to immersion in the contemporary realities of a cultural focus exclusively on deficits and disadvantages associated group. From this perspective, we can evaluate our culturwith marginalization. This must be balanced with the al competence in terms of our own cultural affiliations ability to build on a critical narrative that replaces centerand our ability to collaborate with others who, based on ing on deficits with centering on strengths associated with their cultural affiliations, can provide services that affirm membership in different racial, ethnic, gender, sexual oriculture-based expectations for health and well-being. entation, and other groups (Gutierrez & Lewis, 1999; Pinderhughes, 1989). This work is complemented by Critical Theory and Cultural Competence oppositional engagement with the structure that mainThe critical theory paradigm suggests that reality is produced tains patterns of domination that contribute to individual through historically based social and political processes problems. Therefore, practitioners must intervene in the (Guba & Lincoln, 1998). The social circumstances that institutions that effect and support processes of defamaexist now are understood to be reflections of a deeply tion, exclusion, material disadvantage, and violence across embedded structure that serves the purposes of the powmultiple categories of identity. Multicultural practice

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based in critical theory takes on several forms. For example, consciousness raising is promoted as a method for developing individuals capacities to recognize the historical, social, and political processes that shape their past and present experiences (Gutierrez & Lewis, 1999). Empowerment practices are advocated for their role in supporting clients to make positive life changes and make use of available system resources (Black, 2003; BrickerJenkins & Hooyman, 1986; West Stevens, 1998). Group processes are used to foster mutual support and to mentor individuals in linking personal experience to broad social inequalities (Dominelli, 1997; Nagda & Zuniga, 2003; Saulnier, 2001). Finally, social workers are urged to challenge institutions to increase participation and decision making by marginalized groups and respond more effectively to the needs of wider segments of the population (Ferguson, 1996; Mokuau & Fong, 1994; Pina & CantySwapp, 1999; C. C. Williams, 2001).

cal cultural competence offers a path toward extensive and long-term changes that will affect our ability to provide effective services to marginalized populations and those populations abilities to build the capacity for higher quality of life. From this perspective, our cultural competence is determined by our ability to foster positive cultural identity, empower individuals and groups to negotiate oppressive social structures, and promote social change by altering institutional processes that contribute to marginalization.

Postmodernism and Cultural Competence The postmodern paradigm suggests that reality is a moving target that cannot be reduced to reassuring regularities. Although other paradigms try to determine the conditions under which it is possible to locate knowledge that is predictable, certain, or interpretable within some type of structure, postmodernism urges us to embrace difference, relativism, and the deconstruction of all we have come to accept as true (F. Williams, 1996). Although it shares the relativistic stance of constructivism, it is more extreme in its departure from positivism. Systems and organizations need to facilitate the Postmodernism focuses on the inherent indeterminancy of meaning, advocating availability of appropriate learning experiences, staff, skepticism of all authority, received wisdom, or claim to cultural norms (Sim, pathways for advocacy, and time and space for 1999). The postmodernist understanding of culture is that all cultural identities are culturally competent practice. constructed and, therefore, changeable in response to different internal and external contingencies. Accordingly, there is no reason to expect that individuals influenced by unique combinations of personal narratives, social narratives, ideologies, and meanings should be Critical approaches to practice have been integrated in associated with any common core of values, beliefs, or the social work literature through work on feminism, empowerment, strengths perspectives, antiracism, and so experiences totaling a cultural perspective. The individual, not the group, must be the unit of analysis. The only culon, and they have been relatively unchallenged as social ture we can know is that derived from internalized meanwork positions itself as an anti-oppressive profession. ings used to make sense of the world. Therefore, However, the ideology-centered articulation of practice postmodern cultural competence involves exploring the can be at odds with other priorities. For example, collection of identities and experiences that produce conantiracist practice has been criticized for its preoccupation tinually evolving, unique cultural experiences for clients with politicized agendas that may neglect the need to solve individual problems (C. Williams, 1999). Activism and (Dean, 2001). The relativistic foundation of postmodernism makes it advocacy can look like luxury items to people who see themselves as dealing with issues of survival. Similarly, somewhat inconsistent to present a definition of its constituents; however, the literature reveals at least three practitioners may wish to implement multilevel interveninterrelated processes relevant to this type of cultural tions, but practicing on one side of the micromacro competence. First, the practitioner must cultivate an attidivide often seems more feasible. In addition, conflict can tude of complete openness and respect for cultural expearise when a critical analysis is inconsistent with client valrience. This attitudinal stance in itself does not distinguish ues or organizational values. The analysis can inform intervention without being imposed on others, but this postmodern cultural competence, but its grounding in the recommendation to enter multicultural practice from a effectively truncates practice by excising important eleposition of not knowing is distinct (Dyche & Zayas, 2001; ments of individual and institutional development. Laird, 1998). This casting off of expectations and assumpDespite these challenges, the multilevel emphasis of criti-

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tions is a method for diminishing the power imbalance in the helping relationship, centering the clients experience and ability to educate the professional (Dean, 2001; Dewees, 2001; Tsang & Bogo, 1997). It is necessary for practitioners to explore client experience without misplaced assumptions of expertise and knowledge (Laird, 1998; Lum, 2003). This approach is the foundation for a second element of postmodern cultural competence: use of the intersubjective space. Through a process of building self and other understanding, practitioners and clients develop a common language that makes use of revealed similarities and differences between them (Dean, 2001). This common language is the foundation for developing new, more emancipatory narratives. Lyotards notion of the little narrative (Sim, 1999) is helpful here. Within the helping relationship, little narratives are developed that create new meanings that can break down the tyranny traditionally exercised by dominant narratives that repress individual creativity and initiative. This dialogical process within the helping relationship is the foundation of this third element of postmodern cultural competence: eliciting, reflecting, reframing, and contextualizing problematic narratives affecting the client (Greene et al., 1996). Perhaps the most obvious limitation of postmodern cultural competence is that it defies definition. For example, this esteemed position of knowing without knowing or listening without the need to understand (Dyche & Zayas, 2001, p. 257) is difficult to visualize in practice. Although it seems clear that the imposition of assumptions and stereotypes on client experience is problematic, it also seems that attempts to affect this stance of navet and engage our clients through our curiosity create other problems. Social workers are expected to have knowledge and expertise that can benefit their clients. On the basis of that knowledge, expertise, and state-based authority, they have power that cannot be put aside through a commitment to embracing uncertainty. Therefore, it is unclear that postmodern approaches are feasible or desirable for many practitioners and clients. Another criticism of the postmodern approach to cultural competence is that it renders all cultural values equally just within their respective cultural contexts (Heineman-Pieper, Tyson, & Pieper, 2001). It may be a misrepresentation of the postmodern position to suggest that it dismisses social work values in favor of celebrating contextual influences, but the failure to articulate a clear response to these concerns diminishes the usefulness of this framework in practice. A final consideration is that, although the postmodern position is put forward as an alternative to postpositivist approaches, the emphasis on universally applicable processes of engaging clients, building the helping relationship, and eliciting subjective accounts begins to sound very similar to postpositivist articulations of generic helping processes. However, the postmodernist approach to cultural competence makes an important contribution through its cre-

ation of a space for indeterminacy. The postmodern iteration of cultural competence works with what can be transient understandings of culture and its influence on individual and group experience. In this framework, we evaluate our cultural competence based on our capacity to facilitate processes in which our clients can self-define within narratives that nurture their sense of themselves as individuals without fixed identity, capable of agency, creativity, and cultural change. This epistemological analysis of the cultural competence literature provides an organizational structure that enables us to reflect on cultural competence within theoretical frameworks that define relevant social work roles, methods, and connections to the broader spectrum of social work practice (Table 1). It becomes possible to link specific competencies to specific paradigms of cultural competence and their goals. The application of this conceptual framework to the case presented early in this article will demonstrate its usefulness for guiding practice.

Applications in Practice
In the case report that prefaced this article, the client had suffered multiple losses after being hospitalized with a diagnosis of mania, and the social worker did not know how to bridge cultural difference to help her more effectively. Each paradigm of cultural competence presents different ideas about how this client could have been helped and why the help that was provided was not effective.
Postpositivist Paradigm The postpositivist practitioner would engage with Akiko by gaining more knowledge about values, beliefs, and behaviors consistent with her cultural background. This information would be used to provide a broader context for her problems. Information about Japanese cultural expectations 4 could have enriched the case formulation. For example, it was important to know that Akiko had challenged several cultural norms when she married a Westerner and left Japan. Japanese culture places an expectation on children that they take care of their parents as they age. As an only child, Akiko would have borne sole responsibility for this, and her decision to leave with an outsider may have disappointed her parents. Perhaps the negative response of her parents to her phone call had been a reflection of persistent conflict, guilt, and shame. In addition, the importance of saving face in Japanese culture would make it difficult for Akiko to disclose her difficulties to anyone, particularly those in the local Japanese community. The addition of this knowledge to a conceptualization of Akikos situation introduces the possibility that the attempts to involve the police, lawyers, parents,
4 The cultural information that follows was gathered from a Canadian Citizenship and Immigration sponsored Web site: http://www.settlement.org/cp/english/japan.

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FAMILIES IN SOCIETY | Volume 87, No. 2 TABLE 1. Paradigms for Culturally Competent Social Work
VARIABLE Nature of culture POSTPOSITIVISM Relatively stable, verifiable CONSTRUCTIVISM Constructed in local and specific relationships CRITICAL THEORY Historically derived from social, political, economic arrangements Advocate, mentor Consciousness raising, activism, collective participatory action Ideological barriers to implementation, neglecting individual problems Empowerment and social change Anti-oppressive, feminist, antiracist POSTMODERNISM Unfixed, constantly evolving

Practitioner role

Expert, anthropologist

Insider, cultural promoter Immersion in cultural experience, using insider frame of reference Cultural chauvinism, mainstream appropriation

Explorer, facilitator Not knowing, eliciting, reframing, reauthoring

Methods of practice Learning cultural knowledge, including it in formulations Limitations Stereotyping, overgeneralization

Not knowing is not feasible for practice

Goals, outcomes

Technically proficient practice across populations Generic, etic

Group affirmation and well-being Culture-specific service provision

Self-definition, multiple identities Narrative, intersubjective

Compatible social work models

and Japanese social services were premature given Akikos need to work through her feelings of shame and guilt. These interventions did not incorporate an understanding of the rules and expectations that constrained her choices. Cultural information also provides a possible entry point for culturally competent practice. Japanese culture places great importance on the family, and once a couple has children, their identities as parents can supersede other roles. Akiko may have been engaged through a focus on her role as a mother and the importance of taking action to reinstate her relationship with her son. This may also have activated her parents to support her.
Constructivist Paradigm A constructivist practitioner would engage with Akiko based on his or her shared experience of the cultural identity or would seek assistance from someone with expertise based on that shared experience. This insider perspective could be used to develop a helping relationship with Akiko that did not require bridging a cultural gap and, therefore, would facilitate more culturally appropriate intervention. A helping professional who had lived the experience of her predicament as a Japanese immigrant alone in a strange context might be capable of creating a space within which Akiko felt understood and less alienated. This would diminish the cultural barriers that may have made her unable to make use of the help offered. The culturally embedded practitioner could also offer proficiency in speaking Japanese, which could enable Akiko to express her concerns more candidly and accurately. The expectation of speaking English in North American health and social services creates tremendous barriers for nonnative English speakers (Minas, Stuart, & Klimidis, 1994). Akiko was living in a foreign context and coping with a distressing situation in an unfamiliar institution. We can

imagine that she felt the burden of not feeling understood, needing to educate us about her cultural context, and dealing with the additional stress of communicating in her second language. The offer to connect Akiko with a service that could have intervened without the culturallanguage barriers was not welcomed. It is possible that this was not an acceptable strategy for Akiko because she was not connected to the local Japanese community and had low expectations for experiencing a sense of belonging within their specific context. Alternatively, existing connections may have made her fear judgment by people associated with the agency. It may have been more successful to introduce a cultural insider who was also an insider to the institution. Akiko was accepting some help from us, and a staff person embedded in Japanese culture could have eliminated the language and cultural gap but without necessitating the introduction of a new, unknown institutional context.
Critical Theory Paradigm The critical theory practitioner would engage with Akiko by drawing connections between the presenting problem and the oppressive social, political, and economic arrangements that created and sustained it. This would have been achieved by linking Akiko to others in the same situation who had an awareness of its social context. Many women who work exclusively inside the home are uninformed of their rights as wives and mothers. This confers significant disadvantages in child custody and divorce negotiations that are multiplied if the woman is an immigrant (C. C. Williams, 2004). In an advocacyfocused environment, Akiko may have recognized that her situation was not an outcome of individual transgressions, but instead the outcome of power imbalances in her marriage that were associated with systemic gender

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and racial inequity. In such a setting, she could obtain vital information about the legal and social resources available to cope with her family situation. She could also, through a process of consciousness raising and moving toward activism, come to understand her despair and guilt as an unjust consequence of systemically reinforced self-blame for processes that were orchestrated beyond her. The proposal to seek legal intervention for the family situation could have been part of a critical culturally competent intervention, but it fell short by not including the important elements of consciousness raising and collective action. The consultation with a lawyer was presented as an isolated act that was potentially understood by Akiko as a wider environment in which to expose her personal shame. The involvement of lawyers and police would also represent an assertion of power that Akiko did not feel ready to claim. A critical culturally competent intervention could have nurtured that empowerment by helping her to recognize her personal strengths and the resources available to her by working together with groups of women, people of color, immigrants, or others.
Postmodernist Paradigm The postmodernist practitioner would engage with Akiko by initiating a process within which she could share her unique narrative of recent events and the contingencies that contributed to them. The work together would involve negotiating the meanings attached to their cultural and other differences and how they would be woven into the process of shaping a less problematic narrative. Akiko had a multitude of identities in addition to those that were salient to us (psychiatric patient, mother, wife, daughter, immigrant, woman of color). For example, her spirituality featured highly in our conceptualization of her original presenting problem, but it made no reappearance in our thinking about solutions and pathways to healing. This spiritual identity and others contributed to her unique understanding of what was happening. The practitioner could facilitate the revelation of a more contextualized version of reality that helped her activate areas of ability and agency. Akiko had little opportunity for exploration and self-definition in the hospital because we imposed medical, legal, criminal, and cultural definitions based on our assumptions about the nature of her problems. Akiko could understandably have been overwhelmed by the onslaught of our theories about her situation. The problem-solving approach may have been better replaced by an attitude of mutual collaboration and openness to learning from her.

Potential Applications
The potential applications of these paradigms to my work with Akiko are summarized in Table 2. This process of integrating cultural competence strategies contributes a

great deal to our understanding of Akikos situation, although it also leaves out some important components. For example, this description of practice strategies foregrounds distinctive aspects of each paradigm to emphasize their distinctive contributions to understanding and intervening in Akikos situation. However, it is useful to remember that there are strategies that could be used in more than one cultural competence paradigm. For example, approaching Akikos situation from any of the cultural competence paradigms may have raised questions about the diagnosis of mania. The diagnosis reflected a medical explanation for her behavior that may have been quite different from an explanation based in cultural knowledge derived from any of the paradigms. Another important omission from the analysis is that the description of applications only addresses Akikos cultural context. Her cultural context may be more salient because it is marked by her gender, immigrant status, and racial categorization, but the multiple cultural influences affecting her husband, the health professionals, and others involved are equally relevant. In addition, the case presentation has been written to emphasize the potential failures that may have played out in my work with Akiko, but I can recognize retrospectively that there was a positive connection between Akiko and myself that facilitated providing some support for her. Yet reviewing the situation through multiple cultural competence paradigms reveals that more could have been done to help her. Despite their limitations, each paradigm offered other viable strategies for intervention and plausible hypotheses about errors made in the case. Each paradigm-based strategy bears the limitations that were described earlier here, but an understanding of their underlying premises, purposes, and goals may have aided me in understanding how and why each strategy could have contributed to more culturally competent practice. However, it is still not clear which approach would have been adequate and, therefore, competent. Adequacy is defined by sufficiency for a particular purpose, and I propose that the purpose that is of concern to social work practitioners is engaging clients sufficiently to begin work that will result in effective helping. This position is supported by research indicating that cultural clashes contribute to individuals from minority groups disconnecting from services after initial contacts (Carrillo, Green, & Betancourt, 1999). Accordingly, it is useful for us to understand cultural competence based on epistemological foundations that elucidate the conditions for effective engagement and the conditions that thwart it. Specific choices about which strategy to use will be determined by factors at the professional, organizational, and system levels. Practitioners need to be able to work within various paradigms of cultural competence. Systems and organizations need to facilitate the availability of appropriate learning experiences, staff, pathways for advocacy, and time and space for culturally competent practice. Deficits in either of these areas create significant barri-

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FAMILIES IN SOCIETY | Volume 87, No. 2 TABLE 2. Applications of the Paradigms to Practice With Akiko
VARIABLE Impasse POSTPOSITIVISM Intervention without relevant cultural information Seek information sources (e.g., cultural profiles) CONSTRUCTIVISM Outsiders addressing issues that require insider expertise Transfer case to cultural insider and/or seek expert consultation CRITICAL THEORY Reinforcing isolation and personal definition of problem Facilitate empowerment, group support, political action POSTMODERNISM Reductionistic view of client problems and client situation; imposed definitions Seek unique narrative, establish client as expert

Practitioner role

Revised intervention

Integrate cultural constructs (e.g., saving face)

Language and culture specific service

Advocacy-based service linked to collective action

Reveal/reshape a narrative with opportunities for agency

Goals

Improved sensitivity of service, modified intervention by practitioner

Improved therapeutic alliance, improved ease of client participation

Personal empowerment through collective action

New, improved self-narrative that provides script for moving forward positively

ers to providing effective service in multicultural settings. In turn, clients contribute to the choices made for culturally competent practice. Over the course of our work they will tell us that culture is irrelevant to their problems, culture is the basis of the problem, racism and discrimination are the real problems, or no one can understand their particular perspectives on the problem. These claims are often interpreted as barriers to the helping process. Yet they can be reinterpreted as expressions of epistemological positions: respectively, postpositivist, constructivist, critical, and postmodern entry points for practice. The ultimate definition of cultural competence may be the capacity to collaborate with our clients by recognizing and engaging with these potential entry points and to shift epistemologies to address different needs and different environmental contexts. It is important to understand that cultural competence is not developed by choosing more correct than incorrect responses but instead by making thoughtful practice decisions with the best information available and learning through a process of reflection and evaluation how to do better in the future (C. C. Williams, 2002). If we are able to engage with our clients effectively, we will have the opportunities we need to explore and traverse cultural competence paradigms in our work with them. Moreover, our development as culturally competent practitioners will result not from rigid adherence to specific paradigms of practice but instead a capacity to make use of many of them. This is somewhat facilitated by the awareness that no paradigm has exclusive claim on cultural competence strategies. What each paradigm contributes is different understandings of why the strategies are relevant and are proposed to be effective. Having this lens through which to understand culturally competent practice also lays down the foundation for raising questions about the effectiveness of cultural competence so that we can integrate it into the evidence base for social work.

Conclusions
Very few of us can say anymore that we are not engaging in multicultural practice. Addressing racial, ethnic, gender, sexual, religious and other diversities in practice is one of the most pressing dilemmas of contemporary social work. We find ourselves at a point where we have an impressive armamentarium of strategies for multicultural practice but we need coherent ways of describing the rationale underlying their use. The proliferation of paradigms to provide leadership in the area probably represents the type of revolution (Kuhn, 1970) that is necessary for the development of a discipline-specific knowledge base. However, I believe the process is more complex than an orderly progression from ideas once useful to ideas now proven more useful (Fong, 2001). Although there is some indication of evolution of ideas surrounding cultural competence in social work, the vast time period covered in this review of the literature demonstrates that we revisit the past and bring valuable concepts forward to inform new developments. The epistemological organization of cultural competence strategies provides a way for us to understand the theoretical foundations of these ideas and their relevance to multicultural practice. In addition, the paradigm-based organization presented here can lead to clearly defined models of cultural competence that are suitable for hypothesisdriven tests of effectiveness. Developing research evidence in this area is crucial to the ongoing development of multicultural practice and its merger with evidence-based social work. The abundance of available cultural competence paradigms is consistent with the abundance of knowledge paradigms available to social work theory as a whole. This is an opportunity, not a threat. Social work finds itself at a moment when there is no master theory but, instead, the

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space to entertain and experiment with many. The site for experimentation is social work settings across the nation in which practitioners are compelled to develop cultural competency through an arduous process of trial, error, and reevaluation. It is hoped that the development of clearer models for multicultural practice will aid them in realizing more successes than failures.
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International Social Work, 43, 481493. Charmaine C. Williams, PhD, is assistant professor, University of Toronto Faculty of Social Work. In addition, Dr. Williams recently served as the Anti-Racism Officer for the University of Toronto. Correspondence regarding this article may be addressed to the author at charmaine.williams@utoronto.ca or Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto, Ontario M5S 1A1, Canada. Authors note. Many people have listened to earlier iterations of these ideas and helped me develop them through their questions and comments. These people include members of my doctoral dissertation committee, chaired by A. K. Tat Tsang, and Izumi Sakamoto and Susan Stern of the University of Toronto, Faculty of Social Work. Manuscript received: June 25, 2004 Revised: June 13, 2005 Accepted: June 17, 2005

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