PPRNet Clinical summary: Do Therapists Become More Culturally Humble with Experience?

Cultural humility refers to the ability to be other-oriented, curious, and open-minded about patients’ cultural worldviews and experiences. For therapists, this means an ongoing, lifelong commitment to self-reflection and critique and an attitude of non-superiority toward aspects of patients’ cultural identities. Research indicates that a therapist's cultural humility is positively related to treatment outcomes and the working alliance. Whereas microaggressions (indirect or subtle discrimination) and cultural concealment (withholding cultural information) are associated with negative relationships in therapy. One would think that as therapists gain experience, their outcomes and their cultural humility will also improve. However, this does not seem to be the case when it comes to outcomes. At best, there appears to be no relationship between the therapists' level of experience and outcomes, and at worst, patients’ outcomes worsen slightly with therapists’ experience. Therapists who become less effective may also struggle to remain open to cultural and identity shifts. In this study, Coneys and colleagues looked at whether therapists become more culturally humble with experience. The data for this study were from 1,640 patients who received individual counselling by 21 therapists at a university counselling centre. Most patients reported problems with anxiety, depression, or interpersonal dysfunction. Therapists included practicum students (20%), doctoral interns (20%), postdoctoral fellows (3%), or staff psychologists (57%). They practiced from various theoretical orientations, including CBT, ACT, IPT, EFT and others, but most (83%) also reported using a mix of approaches (integrative, eclectic) to therapy. Experience was assessed by the passage of time that a therapist was seeing patients at the centre, and by the number of cases seen by the therapist at the centre. Therapists on average had data covering a period of 1.6 years (range = 0 to 4.65), and the average number of cases they saw was 60.39 (range = 0 to 191). Clients rated the therapist's cultural humility using a standardized measure. Therapists’ initial cultural humility ratings across clients decreased over time (γ10 = −0.04, p = .012) and also decreased with the number of cases seen (γ10 = −0.001, p =.008), albeit the effect sizes for time and cases were small (both β = −0.11). The results were similar for average levels of cultural humility across time and cases, as well as the change in cultural humility pre- to post-therapy. Rather than indicating growth or change in cultural humility with experience, these results point to stability or even a slight decline in therapists’ cultural humility over time.