INTRODUCTION: Culture, Oppression, and Privilege in Psychological Assessment

A. Jordan Wright, PhD, ABAP, ABPP

Respecting, understanding, and ultimately integrating culture into the psychological  assessment process is nuanced, tricky, and extremely effort‐intensive. Indeed, even   the idea of what constitutes “culture” and what role it plays in clinical presentation, interaction between client and assessor, and many other aspects of psychological assessment is not well defined. With the professional and ethical goal to help people who need it, the history of psychological assessment has been one that has in fact perpetrated and perpetuated harms onto marginalized, minoritized, and oppressed groups of people (see, for example, Sayegh et al., 2023). Beyond not being racist, homophobic, and otherwise oppressive, the practice of psychological assessment should be deliberately anti‐oppressive. The ultimate goal of this book is to help assessors be much more deliberate in acknowledging the many roles and nuances that culture and cultural experiences can play in the psychological assessment process (Wright, 2022). Psychological assessors will be encouraged to think about cultural issues as they relate to clients—including both the cultural background clients bring with them and oppressive experiences they have endured; their own cultural issues—including the roles that power and privilege may play in the process; and cultural variables in the interaction with clients and the process as it unfolds. Culture and oppression should be considered and accounted for throughout the entire life cycle of a psychological assessment (see Figure I.1)—no easy feat!

Figure I.1 Life Cycle of a Psychological Assessment.

PREPARATION/TRAINING

While the American Psychological Association requires training in diversity issues (APA Commission on Accreditation, 2015), how this training actually plays out and how it is integrated into training in psychological assessment is nebulous, at best. That is, programs can technically meet APA’s accreditation standards without actually infusing cultural issues and considerations into the assessment curriculum at all. Despite this, training and preparation to be competent at psychological assessment should include deliberate discourse in cultural issues and how they play out in the process. Two models of preparation are discussed below.

Cultural Competence

The notion of cultural competence has been utilized throughout training and practice in psychology for decades. Cultural competence refers to psychologists being conscious of and responsive to the diversity of cultural perspectives and backgrounds of those they serve (e.g., Betancourt et al., 2002). Many in the field have operationalized training in cultural competence as comprising different culturally‐sensitive attitudes/values, knowledge/awareness, and skills (e.g., Health Service Psychology Education Collaborative, 2013; Sue & Torino, 2005). Courses in culture and diversity often aim themselves toward this kind of knowledge and skill‐base to be able to respect and work with individuals from diverse backgrounds (Green et al., 2009; Newell et al., 2010).

There have been two major criticisms of the cultural competence model (there have been others as well, but these are the two most prominent). First, there is an implication in the model that there is a finite amount of knowledge that is achievable by clinicians (Tervalon & Murray‐García, 1998). That is, the term competence sounds like it is somehow achievable—one can be fully culturally competent at some point. However, most psychologists and scholars know this is not the case—cultural competence is to be strived for continually, deliberately, and painstakingly. The second major criticism has to do with amassing cultural knowledge about diverse groups of individuals being riddled with potential for both error and stereotype (Johnson & Munch, 2009). That is, if we aim for going into clinical situations with pre‐knowledge of a client’s cultural background (and assumptions of their values and experiences), we risk great error.

Because of the vast literature on cultural competence (and related and infuriatingly distinct constructs like multicultural counseling competence), some have argued that the construct itself has adapted beyond these limitations and become more fluid, more focused on one’s own biases, privileges, and blind spots, and more challenging to White supremacist and other oppressive aspects of culture (Danso, 2018). However, these updates are slow to make it into preparation and training (specifically into the APA Commission on Accreditation [2015] Standards of Accreditation and consequently graduate training programs in health service psychology).

Cultural Humility

Tervalon and Murray‐García (1998) countered the traditional notion of cultural competence with a call to supplant it with the construct of cultural humility. Cultural humility entails a consistent, vigilant, and ongoing self‐reflective and self‐critical exploration; a commitment to mitigating the power imbalances inherent in the clinical dyad; and a striving to develop mutually beneficial partnerships with clients and communities to best advocate for their wellbeing (Yeager & Bauer‐Wu, 2013). The ultimate goal of cultural humility is to reflect on power differentials in the service of not replicating or reinforcing oppression in any way. It honors the fact that we as clinicians can and will never be fully knowledgeable about (and in turn skilled to work with) any client’s cultural lived experience, as well as respecting a collaborative relationship with clients in their clinical care.

While cultural humility has become more and more popular in the literature, with some calling for it to entirely supplant the construct of cultural competence (e.g., Abe, 2020; Hollinsworth, 2013; Patallo, 2019), it is not without criticism. Primarily, putting cultural humility into practice can be extremely difficult and even at times impossible, such as when either or both clinician and client adhere strongly to their own worldviews, but their values conflict (Foronda et al., 2016; Hollinsworth, 2013; Hook, 2014). Further, exactly how it plays out in clinical practice—especially with regard to clinical goal‐setting—is extremely unclear (Danso, 2018).

Utilizing Cultural Competency and Humility

Several authors in the space have called for a reconciliation in the debate between cultural competence and cultural humility (Danso, 2018; Greene‐Moton and Minkler, 2020; Stubbe, 2020), with Danso reflecting that both contribute to an overarching goal of anti‐oppressive practice. With regard to psychological assessment, preparing ourselves to be both culturally knowledgeable/skilled and culturally humble is extremely important. That is, while we want to remain open to the culturally lived experience of the client we are assessing—in their own articulation of their own experience—we also want to “do our homework” about the potential values, oppressive experiences, and interactional nuances that arise from them with us (given our power and privilege) in the clinical interaction. This is a combination of both cultural humility and cultural competence, and it is a foundation of anti‐oppressive practice (and truly respecting the role that culture and cultural experience/oppression can play in the assessment process).

REMEMBER

Cultural Competence: developing attitudes/values, knowledge/awareness, and skills to work with clients from diverse backgrounds.

Cultural Humility: maintaining ongoing self‐reflection of limitations, commitment to mitigating the power imbalances, and striving to develop mutually beneficial partnerships with clients and communities to best advocate for their wellbeing.

In Combination: dedicating oneself to anti‐oppressive practice by both “doing the homework” about potential values and experiences of the client and honoring the lived experience of the client—in their own words.

REFERRAL QUESTIONS

Referral questions come in many varieties in psychological assessments. They can range in specificity from, “Do I have this disorder?” to “What the heck is going on?” As a result, psychologists often have to either collaborate with clients or do work themselves to truly articulate the assessment question(s), the deep, underlying inquiry: What questions do you really want answered with this assessment? When determining the true question of an assessment, it is important for psychologists to remember what sets our field apart from all others. We are not in the business of only describing what is happening with a client. We are in fact in the business of articulating the underlying why (Wright, Pade et al., 2022), the marriage of clinical data (from tests and every other source of information we have learned about a client) to psychological theory. Psychologists need to use their amassed knowledge (from the empirical literature, from psychological theory, etc.) to help explain both what is going on with clients and what are the likely underlying...