Cross-Cultural Competencies

¶ … Krentzman and Townsend (2008) indicates that multicultural competence means "having the beliefs, knowledge, and skills necessary to work effectively with individuals different from one's self; that cultural competence includes all forms of difference; and that issues of social justice cannot be overlooked" (p. 7). Although improved cultural competency is widely regarded as being an important element of high quality health care services, it is not a "magic bullet" for mitigating existing inequities in the provision of such care (Larson & Ott, 2010).

Nevertheless, developing cross-cultural competencies is viewed by many health care providers as an essential first step in improving access and the quality of health care services in Australia today (Sharma & Phillion, 2011). Therefore, in this context, the term "multicultural competence" is used to describe the relationship between a counselor and a patient in cross-cultural settings (An introduction to cultural competency, 2012).

The focus of cultural competence is the ability of health care providers to provide health care services that result in positive clinical outcomes through the integration of culture into the clinical context (An introduction to cultural competency, 2012). These issues represent more than merely being aware of cultural differences.

In this regard, the Royal Australasian College of Physicians (2012) reports that, "Recognition of culture is not by itself sufficient rationale for requiring cultural competence; instead the point of the exercise is to maximize gains from a health intervention where the parties are from different cultures" (An introduction to cultural competency, 2012, para. 3).

The term "cultural competence" is defined by the Royal Australasian College of Physicians (2012) as being "a set of congruent behaviours, attitudes, and policies that come together in a system, agency, or among professionals and enables that system, agency, or those professionals to work effectively in cross -- cultural situations" (An introduction to cultural competency, 2012, para. 3).

More precisely, multicultural competence in counseling can also be defined as the successful "integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes used in appropriate cultural settings to increase the quality of health services; thereby producing better health outcomes" (An introduction to cultural competency, 2012, para. 3).

From this perspective, cultural competence represents an essential element for the provision of timely and informed health care services for patients from diverse cultural populations by customizing these services according to patients' unique cultural, social and linguistic needs (An introduction to cultural competency, 2012). In sum, given the overwhelming need to develop effective cross-cultural competence, it is not surprising that a majority of health care organisations have attempted to develop a culturally competent workforce. 4.

The importance of developing effective attending behavior skills is part of a larger skill set that typically subsumes understanding and executing attending behavior skills that are related to fundamental counseling skills (Koltz & Felt, 2012). For instance, according to Koltz and Felt, "These skills are often known as the micro-skills and include: attending behaviors, reflection of feeling, paraphrasing, summarizing, questions for clarification, open questions, focusing, theme development, immediacy, and confrontation. These skills are considered the foundation of counseling" (2012, p. 37).

Likewise, the Allen Ivey's Microcounseling Model is comprised of more than a dozen skill set components, including attending behaviors as well as (a) ethics and multicultural competence; (b) open and closed questions; (c) client observation; (d) encouraging, paraphrasing, and summarization; (e) reflection of feeling; (f) clinical interview structure; (g) confrontation; (h) focusing; (i) reflection of meaning; (j) influencing skills; (k) skill integration; and (l) determining personal style (Hawley, 2006, p. 199). 5.

The Gestalt Therapy counseling approach draws on humanistic origins to provide a process-oriented therapeutical intervention that combines field theory, dialogue, and phenomenology (Novack & Park, 2013). On the one hand, Gestalt Therapy provides a useful and efficient framework for the therapist in which individuals' unique internal and external environmental factors can be identified and evaluated for positive and negative impacts. On the other hand, though, Gestalt Therapy is constrained by some methodological issues that adversely affect generalizability of studies using this approach.

For instance, according to Novack and Park (2013), "Gestalt therapy values each client's unique context and diversity variables and strives to understand the client's experience from his or her perspective. Gestalt work is characterized by active experiments that can challenge traditional notions of counseling" (p. 484). Despite these constraints, the confrontational nature of Gestalt Therapy can help evoke meaningful responses and effect positive changes in clients (Novack & Park, 2013).

These benefits for the clients in Gestalt Therapy, though, are the direct result of counselors' cultivation of client awareness and empowering them to make better life choices (Novack & Park, 2013). Of particular interest for therapists is the empirical observation by Novack and Park (2013).