Culture is the basic foundation that makes counseling successful. Culture is the basis of multicultural understanding between counselors and clients. Culture aids successful interaction in counseling. Most authors have written widely about the significance and importance of culture in counseling and multicultural interactions. This article articulates their points further by reiterating that culture is the heart of counseling relationships and healing.

Culture; Healing; Counseling relationships; Multicultural interactions; Worldview

Adekson MO (2018) Culture: The Heart of Healing. JSM Health Educ Prim Health Care 3(1): 1039.

Culture, simply defined, is the way of life of a particular group of people. Smith and Kehe defined culture as characteristic, values, behaviors, products, and worldviews of a group of people with a distinct sociocultural context [1]. Capuzzi and Stauffer articulated in the above book that clothing, foods, customs, (beliefs) or traditions, and languages, parenting beliefs, family structure, social hierarchy, gender-role expectations, communication style, and relationship in time and space are all observable characteristics of culture [2]. Sue and Sue defined culture “in simple terms, as consisting “of all those things that people have learned to do, believe, value, and enjoy in their history. It is the ideals, beliefs, skills, tools, customs, and institutions into which each member of society is born [3]. Different entities also possess their own culture. Counselors have different but unique professional culture. Culture defines our day to day activities including who we visit to care for our physical, emotional, social, mental and spiritual needs. This last aspect is important, since culture plays a part in an individual’s view of diseases, illnesses, ailments and perspectives related to our mental health and our views of healing practices. Sodi and Bojuwoye contended that “culture influences conceptualizations about illness, health and healthcare” (and in this case, mental health care) [4]. These two authors added that, “the most significant instrument in healing or healthcare delivery is the client’s culture”. Good and Good noted that, the meaning of illness (or health) for an individual is grounded in the network of meanings of an illness (or health) within that individual’s culture [5]. These two authors further added that included in this network of cultural meanings of an illness are the metaphors associated with the illness, the care patterns that shape the experience of the illness and the social reactions of the sufferer. So, also agreed that each culture has its conceptual or explanatory model for illness and health [6].

Culture also affects the interactions that counselors have with their clients. Kirmayer posited that “the goals of psychotherapy are tied to the cultural concept of the person” [7]. Kirmayer reiterated further that, “the goal of therapeutic change is generally to make individuals more able to express emotions, wants, needs; to help them to feel more ‘in control’; and to experience a renewed sense of their value and importance as ‘unique’ individuals”. Culture therefore reveals this interaction which clearly brings out a lot about clients and counselors’ selfawareness, world view and intervention strategies. Wendt and Gone posited that culture affects “the personal attributes of the practitioner (that is), the kind of person s/he needs to be”, and the nature of the interaction that takes place in the counseling relationship [8]. These two authors added that culture helps the practitioner focus on the client in his or her cultural context, using culturally appropriate assessment tools, and having a broad repertoire of interventions. Culture also affects the professional beliefs, attitudes, knowledge and skills that are used individually, and professionally and also within the community. Wendt and Gone quoting Walls, Johnson, Whitbeck and Hoyt pointed out that “more recently [9], American Indians with a variety of psychiatric problems have been shown to prefer culturally traditional services rather than formal medical services.” This last point is an indication that counselor educators, social workers, medical doctors and psychologists who train future practitioners should alert their trainees to the important aspects of learning, paying special attention to, and understanding the culture of their clients to help them get the best treatment possible. If clients know that you are genuinely interested and conversant with their culture, they will open up to you as their helper. This interaction will only be fruitful and successful where counselors are willing to go the extra mile in understanding their clients’ culture. Counselors can only get to this level when they know and are intimately attuned to their own culture. In other words, you cannot give what you don’t have. When you are comfortable “under your own skin,” you will not be intimidated learning about your clients’ culture and ultimately working with them. This is true where clients and counselors are not from the same culture. Even where they are from the same culture, there might still be differences in outlook and perspectives. As Pedersen explained, “persons from the same ethnic or nationality group may still experience cultural differences [10]”. So, it is important that counselors pay attention to, go beyond the call of duty to intimately learn and understand the culture and the language of their clients and also ask questions when necessary. McAuliffe and Associates reiterated that culturally alert counselors must have awareness of their own cultural values and biases and also take cognizant of how their own cultures impact on their choices, values, biases, manners, and privileges and how this eventually affect their ability to be comfortable with cultural differences. These authors also pointed out further that “counselors must have knowledge of their clients’ worldview, that is “possess ‘multicultural literacy,’ which consists of a reasonable knowledge of many groups’ and clients’ worldview as seen through the lenses of race, ethnicity, class, gender, sexual orientation, and religion, as well as the counselor’s own negative reactions to and stereotypes of other groups”. “Counselors,” as these authors added, must “incorporate cultural knowledge into counseling and advocacy for all members of their populations” [11].

Derald Wing Sue et al., pointed out that “traditionally, counseling and clinical psychology have emphasized the importance of self- understanding as an important component in the development of therapists”. These authors reiterated further, quoting Espin (Note 1) that “little attention has been given to the importance of the trainee’s own ethnicity, cultural biases and prejudices” [12]. It is important to note that the first assignment that the author of this article gave to her students in the introduction to counseling and multicultural counseling classes was to find out about their heritage and discover details about who they are. This author gave them the article “counselor know thyself,” written by Hulnick to read. Reactions to this article and search for self-understanding always leave trainees astounded and full of enthusiasm to learn more about themselves and their future clients [13]. Understanding self, aids in grasping the knowledge of those who are different. This is important for the success of the counseling interaction and also important in raising counselor’s consciousness and increasing multicultural understanding and awareness.

Multicultural training should be offered to students in medical schools, counseling, social work, human services, psychology and other training institutes preparing practitioners in helping clients and patients. This training should discuss issues related to cultural worldviews that will enable practitioners to gain effective basic cultural tools that will enhance cross-cultural interactions with patients and clients. This training will go a long way to sensitize trainees to cultural understanding and develop sensitivity to their clients’ cultures, even when they have different worldviews, customs, and view of diseases and illness. Ultimately, counselors will be more comfortable in choosing appropriate techniques and theories that fit their clients’ problems. Bennett contended that “techniques that increase cultural self-esteem could include discussions of what is ‘good’ about one’s one culture, accompanied by discussions of ‘good’ things about other cultures” [14]. Bennett added that activities related to real-life communication situations will help develop empathy for someone different from the trainee. This author suggested including dyads with other-culture partners where possible or involves trainees in taking part in interviewing people from other unfamiliar cultures. If cultural communication is easy and understandable between practitioners and clients, diagnosing the problems that clients bring to counseling will not be painstaking. More minority clients who shy away from counseling because of lack of cultural understanding from counselors will encouragingly be drawn to counseling.

Vontress (in the foreword to Adekson’s book) reiterated that, “it is evident that “helping cannot be divorced from the culture in which individuals and their problems in life develop and reside” [15]. Vontress reiterated further that, “A culturally-symbiotic relationship exists between counselors and their clients” Saleh’s point [15,16] that, there is a triadic or three- pronged counseling relationship between the counselor, the client, and a third party: culture [16], can be adequately applied to all practitioners who interact with patients and clients. Culture is an integral part of the counseling process. Culture is therefore the heart of each counseling or healing relationship. As Kathyrn Douthit succinctly pointed out, “counseling practice that is not culturally appropriate threatens to re-victimize clients or in some other way add to their stress burden” [17]. Adekson discovered through research into the lives of indigenous healers from two continents that clients are comfortable consulting indigenous healers from the same culture as their own and that culture is an important reason why clients consult these healers [15,18]. Effective counseling and healing occur because indigenous healers and their clients share the same culture, experience, understanding, worldview and views of illness and disease [15,18]. Counselors should therefore realize that clients’ culture play predominant role in clients’ beliefs, counselors’ diagnoses, and in techniques of counseling and curing diseases, illnesses, and problems as pointed out earlier.

Kiev articulated that, different societies will always tend to shape the interpretation of problems according to their own inherent socio cultural characteristics [19,20]. In Western societies, individuals view healing practices from an individualistic perspective, while in farming and indigenous societies, individuals view healing in terms of communal perspectives. Tseng & McDermott reiterated to add to this last point that, “furthermore, cultural factors strongly influence the section of (diagnosis and) treatment methods” that patients and clients receive [18]. In other words, culture plays a role in what healers (both Western trained and indigenous) do with their patients and clients.

For example, individuals who are originally from Western oriented societies have different cultural views from those individuals raised in community cum traditional societies. “The cultural concept of the person that underwrites most forms of psychotherapy is based on Euro-American values of individualism. This individualistic and egocentric concept of the person can be contrasted with more socio-centric, eco-centric or cosmo-centric views, which understand the person in relation to the social world, the environment, and the cosmos [7]”. Kirmayer rightly concluded that, “intercultural psychotherapy must consider the cultural concept of the person implicit in the therapeutic discourse and practice to determine how well it fits or conflicts with the concepts, values and way of life of the patient” [7]. It is therefore important for practitioners to ask questions, identify and gain an understanding of where their patients or clients come from and what their culture is.

Kirmayer, Brass and Valaskakis pointed out that, systems of healing are important expressions of traditional forms of spirituality, social organization and worldview of clients and patients [21]. According to Kirmayer, traditional systems of healing were grounded in a specific cultural ontology of spirits, animal powers, or non-human persons animating the world and served to demonstrate the reality of these powers through healing efficacy” [22]. This same author added therefore that, “revitalizing culture and community then can be achieved in part by reinstating, strengthening and investing in culturally grounded healing practices”. Culture, family and community should be factored in as prerequisites for working with different clients and patients for successful outcomes. Kirmayer reiterated further that “culture provide their own interpretive frameworks, notions of authority and standards of truth [22]”. Counselors, who work with minority clients from community-oriented cultures, should involve family members, pastors, spiritual leaders, healers, mentors and even friends in the counseling relationships when applicable. There is also a need to be vigilant about what entails within their clients’ culture.

Counselors need to incorporate cultural knowledge into counseling for successful outcomes. Both counselors and clients have similar or different cultures. Counselors and clients are products of their cultural conditioning and they are also both affected by the prejudices, biases, discriminatory tendencies that prevail within the larger society. It is therefore important for counselors to constantly reassess their values and worldview vis a vis the culture and values of their clients; and develop cultural appropriate techniques and strategies that will help promote their clients’ positive wellness. Culture is embedded in an individual’s worldview. Worldview is the way clients and counselors perceive their world. Worldview stems from an individual’s upbringing and interactions with the world. Counselors need to familiarize themselves with their clients’ culture and ask questions to avoid generalizations or coming to the wrong conclusions.

Lakes, Lopez and Garro rightly pointed out, quoting United States Department of Health and Human Services, that, “mental health services have historically not been responsive to the mental health needs of racial and ethnic minority groups in the United States [23]”. From the author of this article’s research ventures and professionals on the field experience, the main reason are the limitation and lack of cultural understanding from counselors. “Culture is seen as much as a part of the social world as it is part of the individual [24]”. For counselors to work successfully with clients, they need to fully understand their clients’ culture. To perceive and get into the heart of clients’ culture is an imperative way of identifying “what is at stake for others (in their personal, family and community lives) given their particular local worlds”. Lopez proposed a process model referred to as “Shifting Cultural Lenses [25]”. In this model, Lopez argued that the “essence of cultural competence ….is moving between two cultural perspectives, that of the therapist and that of the client”. “The clinician accesses the client’s cultural perspective and then integrates it within the clinician’s cultural perspective [23]”. This is an important back and forth integration that helps the counselor understand where the client is coming from and helps her/him look at and understand the problem. As pointed out earlier, counselors’ ability to learn the culture of their clients assists them to look beyond just classroom knowledge of treatment dynamics and models. What counselors learn in the classroom has to be applied in the field with empathy with the knowledge of their clients’ culture. For example, a mother from a minority group who says she is depressed might have other things going on in her life simultaneously. Counselors, who have this client in therapy, should not hastily diagnose the client with clinical depression. Looking into all the cultural aspects of the client’s life will be helpful before diagnosis. Counselors should strive to understand their clients’ personal, social, cultural, environmental, family, what entails within the community and integrate all these basic understandings into their clinical conclusions and therapy. Visiting the clients’ community and homes might not be a bad idea in order to enhance this basic understanding. This aspect is important because most of the time, like the author of this article told her students; clients focus more on the problems in living than on what counselors perceive as rudimentary mental health problems and issues. This is not to say that some problems are not mental-health related, but most of the time, the basic problems of living when looked at the onset help in alleviating or pointing to these mental health issues. Looking at all the picture, that the client brings to therapy, including factoring in the client’s culture, can help lead to successful integration of solving the client’s problems. “Culture-specific counseling begins with an understanding of the culture and then moves to the definition of concrete skills and techniques for implementing the theory [26]”. One important aspect that can aid the counselor is to acknowledge the fact that minority clients are human beings first and minority second. Therefore, treating clients as individuals regardless of where they come from as individuals is of paramount importance because to treat everyone the same is discrimination. In other words, counselors should treat their clients as unique human beings who possess unique cultures. Two clients can come from the same overt culture and not be alike. Counselors should therefore show empathy, maturity and humanness in the understanding their clients. It is also important to understand the non-verbal messages that clients convey in therapy. This presupposes asking questions where necessary most of the time because some nonverbal messages might be part of the client’s culture.

It might be necessary to bring in a professional translator who is versed in counseling dynamics and professional orientation where counselor and client’s languages are different.

People differences including, age, gender, sexual orientation, biracial status, religion, physical ability or disability, ethnicity, internationalism and other characteristics by which someone prefer to be defined as, should also be identified as counselors look at the client’s culture. This is because as we said earlier, different entities possess their unique cultures. Trainers need to pay attention to all these details in educating future counselors to work with clients from minority cultures.

As we can see from the above arguments, culture is important to clients as an invigoration of counseling practices. How then does culture invigorate counseling practices? Simply put: in how counselors treat their clients. It is therefore important for counselors to first of all gain an understanding of their clients’ culture for effective treatment outcomes when they are grounded in the understanding of their own culture.

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