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Getting to Know the Piece of Fluff in Our Ears: Expanding Practitioners’ Cultural Self-Awareness Julia Mirsky

Israel being a multicultural society with a variety of ethnic groups, the delivery of

culturally competent services is a crucial issue in social work practice. This paper describes the outcomes of a training model for cultural competence applied with social work

graduate students in Israel. The model, based on work with immigrants’ narratives, increased the cultural self-awareness of the trainees. Presented are conceptual and

technical aspects of the training model as well as outcomes of an evaluation study. Fifty- one trainees submitted a short account of their personal experiences following the training. The reports indicated expansion in the trainees’ cultural self-awareness: awareness of their

own and their families’ immigration experiences as well as of other transitions in their lives. Training elements that made this outcome possible are discussed.

Keywords: Cultural Self-Awareness; Training; Migration

If the person you are talking to doesn’t

appear to be listening, be patient.

It may simply be that he has a small piece

of fluff in his ear. (A.A. Milne, 1926)

With the growth of multicultural settings and societies, practice with culturally diverse

clients has become an everyday reality in social work and other helping professions and

growing attention is being devoted to training culturally competent practitioners

(Allen-Meares, 2008; Engstrom and Okamura, 2008; Kwong, 2009). In Israel, the home

of highly diverse populations—Jews and Arabs, and immigrants from all over the

world who speak an array of different languages—culturally competent care provision

is especially important. In the last two decades, numerous practitioners and researchers

q 2013 Taylor & Francis

Correspondence to: Professor Julia Mirsky, Department of Social Work, Ben-Gurion University of the Negev, PO Box

653, Beer Sheva, 84105 Israel. Email: [email protected]

Social Work Education, 2013 Vol. 32, No. 5, 626–638, http://dx.doi.org/10.1080/02615479.2012.701279

in Israel have addressed this issue (Bilu and Witztum, 1993; Ben-David, 1998; Jaffe,

1998; Arkin, 1999; Dwairy, 1999; Al-Krenawi and Graham, 2000; Roer-Strier, 2001; Lavee, 2003; Youngmann et al., 2008). However, only recently has the importance of

providing culturally sensitive care been acknowledged on the national scale with a call for action by the Israeli Ministry of Health (Ministry of Health, 2011).

Cultural competence is the ability of professionals to function successfully with people from different cultural backgrounds including race, ethnicity, culture, class,

gender, sexual orientation, religion, physical or mental ability, age and national origin (CSWE, 2008). Ingredients viewed as essential for cultural competence include having

an understanding, appreciation and respect for cultural differences and similarities within, among and between culturally diverse client groups (Hall, 2003). Culturally

competent care has been defined as a system that acknowledges the importance and

incorporation of culture, assessment of cross-cultural relations, vigilance toward the dynamics that result from cultural differences, expansion of cultural knowledge, and

adaptation of interventions to meet culturally unique needs (Whaley and Davis, 2007). Three components of cultural competence are consensual: cultural awareness, culture-

specific knowledge and culture-attuned skills (Lu et al., 2001; Sue, 2001; Lee and Greene, 1999). Cultural competence begins with an awareness of one’s own cultural

beliefs and practices, and the recognition that others believe in different truths/realities than one’s own (Kohli et al., 2010). This involves awareness of one’s own biases or

prejudices and is rooted in respect, validation and openness toward differences among people. Cultural knowledge is the knowledge of the client’s culture, worldview and

expectations. Cultural skills are the ability to intervene in a manner that is culturally sensitive and relevant (Sue, 2001).

The various cultural training programs focus on one or a number of the three components of cultural competence (Betancourt, 2003). The present paper addresses

the first of them—cultural awareness. Generally, in helping professions cultural awareness refers to practitioners’

awareness of the impact of socio-cultural factors on clients’ values and behaviors (Kripalani et al., 2006). In the more psychologically oriented professions, cultural

awareness first and foremost implies self-awareness. Self-awareness by practitioners of their cultural heritage and of how their cultural background and experiences have

influenced their attitudes, values and biases is specified in the guidelines of the American Psychological Association (APA Office of Ethnic Minority Affairs, 1993).

Among the 33 competences specified by the Association for Multicultural Counseling and Development (AMCD, 2010), nine address counselors’ cultural self-awareness.

Similarly, the second of 10 standards for cultural competence in social work approved by the National Association of Social Workers addresses self-awareness (NASW, 2001).

The assumption is that the social worker’s cultural identity is fundamental to practice and the basis for professional development. Cultural competence requires social

workers to examine their own cultural backgrounds and identities to increase awareness of personal assumptions, values and biases.

To achieve this aim, experiential learning is being implemented in many cultural competence training programs in social work and other helping professions (Weaver,

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1998; McCreary and Walker, 2001; Lijtmaer, 2004). A multitude of experiential

techniques is applied in training, among them, structured exercises and role play (Arbour et al., 2004), narrative analysis (Kerl, 2002), cultural immersion (Lough, 2009),

multimedia and web-based learning (Korhonen, 2004) etc. This paper demonstrates a model of cultural competence training based on work

with immigrants’ narratives and on the exploration of unconscious group processes. The model has been successfully applied with social work graduate students in Israel,

as indicated by the results of an evaluation study. The present paper illustrates the application of the training model to the encounter of practitioners from the majority group (i.e. Jewish Israeli natives) with Jewish immigrant clients. However, its

principles and techniques can be applied to educate for culturally competent practice with clients from other minority groups in Israel and in other countries.

The Training Model

Aims and Rationale

The goals of the training are to help the trainees develop empathy towards clients from various cultural backgrounds, enrich their knowledge about clients’ culture and help

them implement culture-attuned interventions. The training emphasizes the open- ended nature of this process and encourages ongoing knowledge-seeking and skills- development. In order to promote the empathic stance, the training aims at expanding

the trainees’ awareness of their own cultural roots and culturally molded attitudes and biases. Modeling is offered for continuous reflection and self-exploration as an

inseparable part of multicultural practice in helping professions. The training combines two techniques—narrative analysis and the exploration of

group processes—each based on a conceptual rationale. Narratives have been increasingly recognized in mental health and related

disciplines as an important source of insight into the complexity of human experience (Lieblich, 1998). Narrative techniques are especially suited for the exploration of the

experiences of immigrants, refugees and members of minority populations. They are flexible and narrator-oriented and therefore can contain unique cultural as well as personal materials (Peterson and Van Meir, 1996; Lijtmaer, 2004). The analysis of

narratives is based on the notion that sense making is an interactive human activity (Glanz, 2003). Therefore, it investigates the meaning (not the cause) of experience.

Especially emphasized in the present model is the active role of the listener and the fact that the meaning is shaped in a collaborative creative relationship between the

narrator and the listener. When trainees are active participants in the sense-making process, learning may result in greater self-awareness, which is a pre-condition for

empathy (Kerl, 2002). The conceptualization of the class setting as a group is based on psychodynamic

theories. Two fundamental notions typify this approach; one is that a ‘group mind’

exists (McLeod and Kettner-Polley, 2004) and the second is that unconscious processes shape the behavior in groups and the group mind (VanGunten and Martin, 2001).

628 J. Mirsky

When identified, verbalized and made conscious, these processes may advance the

work of the group. Following these basic notions, it is assumed that the class group

becomes a ‘resonant box’ for immigrants’ narratives. The conscious and especially

unconscious reactions of the participants come together with the narrative to create

a ‘group sound’ of the narrative (Mirsky, 2008). The group sound may become

an important source of insight into the narrator’s experience (Mirsky, 2008) as well

as into the trainees’ unconscious emotional reactions, attitudes and resistances

(Mirsky, 2011).

Setting and Techniques

This model is put into practice in a course that the author has been teaching for the

past 10 years to social work graduate students in a university in the south of Israel. The

course consists of 48–50 academic hours with weekly sessions; 20–24 students on

average participate in the course yearly. The course syllabus, accessible to students

prior to registration, clearly specifies the different components of the course, the

assignments and the method of assessment. Presentation and discussion of scientific articles on psychological aspects of

migration are combined in the course with the analysis of immigrants’ narratives.

Readings include the state of the art theoretical and research publications on individual

and family processes in migration, immigrants’ stress, coping strategies and

psychopathology as well as clinical papers on interventions with clients from diverse

cultural backgrounds and on counter-transference with such clients. Immigrants’

narratives are collected by students through in-depth, unstructured interviews. As the

MA program, in the context of which this course takes place, includes compulsory

courses on qualitative research methods, it is assumed that students are proficient in

conducting such interviews. Typically students interview their co-workers, neighbors,

acquaintances, friends or relatives. The uses of the interview material are explained to

the interviewees and written informed consent is obtained from them for each of the

uses separately: for the interview, for presentation in class and for inclusion in a

scientific publication.

Interviews are tape-recorded and transcribed. Each student writes a paper based on

the analysis of the interview material and the relevant literature.

Students may choose to present their interviews in class and typically 10–12

students opt to do so. (This is an elective assignment and is not taken into account in

the assessment.) The interviewer presents the narrative from a transcript almost

verbatim for 40–45 minutes. Then the course instructor opens the discussion by

thanking the presenter and asking the group: ‘Well, what did you hear?’. The class is

encouraged to comment and share their emotional reactions and thoughts. Once the

students seem to have exhausted their reactions, the instructor summarizes the

discussion. When relevant, information specific to the culture at hand is added by

the instructor, but typically the summary focuses on the contents and processes in the

group work, which the instructor generalizes and integrates with relevant literature.

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Illustration

In order to allow the reader a glimpse into the training process, an illustration from

the class work with a narrative is presented below. Gregor, 67 years old, immigrated to Israel at the age of 12, from Europe a few years

after World War II. Soon after arrival he was sent to a boarding school, where he was the

youngest in his group and became the target of mockery and bullying. For years he struggled to become a ‘model Israeli’ and eventually succeeded in erasing his past:

‘I don’t remember anything from before the age of 12. My memory starts when we got to Israel’ he said. Gregor reported his story in a very dry tone, did not admit to ever feeling

lonely or disappointed and a number of times repeated: ‘I have no hard feelings’. The interviewer was very emotional when he presented the narrative in class, had

tears in his eyes and found it difficult to speak. He was surprised by his own reaction because during the interview he was not that moved. In the discussion of the narrative many students identified the covert loneliness and sadness in Gregor’s narrative.

Gradually a picture emerged: that of a little boy, feeling rejected by the new society and abandoned by his parents, who desperately tried to be brave and cope, and who

eventually denied all these feeling in order to survive and adjust. It took the group ‘resonant box’ to unveil the emotions that accompanied Gregor’s adjustment as an

immigrant, emotions that he had denied for most of his life. Once this picture emerged, the facilitator was also able to reflect to the group the difficulty in seeing

through a façade such as Gregor’s in an individual setting. A number of participants supported this notion with examples from their own practice. In the discussion it

became clear that the trainees’ personal reactions could be causing such empathic failures as many of them were second-generation immigrants, whose parents coped with their immigration difficulties by erecting a similar façade.

The Evaluation Study

In the past three years an evaluation of each course was performed two months after its

completion. Students were asked to submit a short account (200–500 words) of their personal experience on the course. Fifty-one students submitted the requested account (76% of all students who participated in the course over the three years). The majority

of the respondents (80%) were women. This rate reflects the over-representation of women in the training program and in the social work profession in general. They

were mostly in their late twenties, about half (47%) were married, and most belonged to the middle socio-economic class.

A minority of the respondents (25%) were first generation immigrants, mostly from the former Soviet Union. About half were second-generation immigrants from

different countries, however most did not define themselves as such and reached this awareness only following the training. A quarter (25%) of the respondents were third or fourth generation, among them six Arab and Bedouin students.

The accounts were analyzed via a holistic method common in qualitative research (Lieblich, 1998). In the first reading, general themes were discerned in the material and

630 J. Mirsky

noted. In the second reading, meaningful categories were detected within each of the

themes. Then all the accounts were analyzed again in view of the themes and categories found. Repeated readings revealed additional categories and contents.

Self-Awareness Outcomes

The analysis of the students’ accounts revealed three general outcomes of the training: advanced cultural self-awareness, cognitive enrichment and improvement in practice.

Findings on the two latter aspects were reported previously (Mirsky, 2012). They generally showed that trainees acquired new understanding of the centrality of immigration in the lives of immigrants, the psychological processes typical to

migration and the unique nature of immigrants’ experiences. On the practical level the trainees reported becoming more attentive to their clients’ experience of migration

and more respectful and empathic towards their cultural diversity. Outcomes pertaining to cultural self-awareness are reported below and specify three aspects of

self-awareness that the students reported gaining. Of the 51 students, 25 specifically related to this issue and quoted below are representative accounts.

Increased Awareness of Own Immigration Experience

Nine of the respondents had directly experienced immigration, either as children or as adults. All of them, without exception, reported that following the course they connected

to experiences and feelings with which they had not been in touch before. Some only generally relate to these experiences and stressed the positive effect of the course:

Being an immigrant myself, the participation in this course helped me open to experiences that were closed before, moved me and gave me the opportunity to work through events that had been bothering me. And for this I am grateful. (AA)

For others, connecting to their immigration was not altogether pleasant:

I have a feeling that I passed up on a lot. For many years I have been working with immigrants, and I am an immigrant myself. Yet I knew nothing about the important and significant process they and I were going through and how this process can make a big difference in life . . . I got a glimpse not only into the interviewee’s experience, also into my own . . . (MY)

Here are two more specific accounts:

Being an immigrant, a daughter to immigrant parents, the course helped me reach a personal closure . . . I learnt that many of the psychological processes that I and my family went through are cultural, and not necessarily personal. This made me more empathic towards my family . . . (MB)

The course made me reflect back on my own immigration. I immigrated to Israel at the age of 6 and was sure that I had “made it” and everything was behind me . . . Now I realize that this is not true. I understand that the experience of immigration

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will probably accompany me throughout my whole life . . . and this opened for me the way to go on exploring it. (SZ)

Increased Awareness of One’s Family Immigration History

Many students reported increased awareness to their being second- or third-

generation immigrants and to their families’ immigration background. This outcome can be quite expected when the students choose to interview a family member. The

instructor initially discourages this choice, lest as a result of the interview family relationships become complicated. With students who insist, the instructor works

individually to prepare them for the interview and for possible ramifications. This approach provides a natural screening procedure and indeed only those who have

a high interest in their family immigration history end up interviewing their close relatives. It can be expected, therefore, that they will be personally affected as the following examples demonstrate:

The interview with my father was held after the course ended . . . I thought I was ready . . . but the interview was so powerful . . . nothing could have prepared me for its content. I felt pain when he told me about the grave losses that shaped his life . . . I shared his disappointment with not being able to fulfill his dream of getting an education. I was furious with the immigration policy at the time, which was not beneficial to him . . . The interview had a profound influence on me, on my father, and on my whole family. (LA)

. . . I had a vested interest in interviewing my aunt. It was an opportunity to hear a detailed story, which I never heard before . . . I gained a different perspective on my past and my roots. When I presented the interview in class, I worried whether she will be perceived according to the stereotypes of Oriental Jews—vulgar and loud? She is somewhat loud . . . I am asking myself, whether I was ashamed of her? Well, it is possible. Although I am very proud of my roots . . . (OA)

The second example represents a small group of students for whom the course offered an opportunity to complete a personal search they had started long before.

One of the students expressed this very eloquently:

For me, listening to narratives of immigrants is not an assignment—it is my innermost desire, my need . . . something that is within me, as a native born, a second-generation to immigration. I never have enough and am willing to hear more and more immigration stories. The course was a sort of support group for me. (YK)

However, the decisive majority of students registered to the course simply to earn

credits and interviewed an immigrant simply because this was a course assignment. Only following this exposure had they connected personally to their family history. Here are some representative examples:

I gained a new personal perspective . . . My parents immigrated to Israel in their youth. The course and writing the final paper raised in my mind many questions about their experiences as immigrants . . . (DH)

632 J. Mirsky

Through the course I learnt to understand better my parents, who immigrated to Israel forty years ago and to integrate the different pieces of their immigration story. (OB)

The course was very significant as it connected me to the effects of immigration on my father, on me, and on my family . . . The feeling of alienation that my father experienced passed on to me too . . . (TB)

Taking part in this course made some closures possible in my life . . . I had not experienced immigration, but I come from an immigrant family. My husband is also a son of immigrants, from a different country . . . I never thought this was significant . . . As we proceeded in the course I realized that I cannot evade the implications and opened this subject with myself and my parents. I grew to understand some of their characteristics, the difficulties my father had to integrate into the native Israeli society and his desire to preserve elements from his home culture . . . I thought of the experiences my mother went through as an adolescent, alone in a foreign country . . . (IE)

Increased Awareness of Own Life Transitions

Respondents who were removed from their family migration history or did not have

such a history in their background, were often able to apply what they had learnt to other transitions in their lives.

In the interview, I encountered a woman who was in an identical life phase that I was . . . I asked myself how would have I reacted? . . . I was relieved that my calm life was free of physical immigrations. Yet, I became aware of my emotional migrations: from a motherless child to a second mother, from a single woman to a married one, from the role of a daughter to that of a mother. The course helped me find my personal immigration with the array of attached emotions . . . (SN)

The “immigrant” feeling is not foreign to me. Firstly, I grew up in a town that is known for its cultural and ethnic diversity. Secondly, one of my grandmothers is from Iraq, the other from Morocco with French and Spanish background. My mother grew up in a kibbutz family of Holocaust survivors . . . This “eclectic” experience made me search for my own Israeli identity. When I found nothing clear . . . I identified with critical political positions on social issues. Now I understand that this choice too held personal psychological meanings . . . The course enriched me . . . I started noticing what are the things I don’t hear, and what are those I am attentive to. (AA)

Following the course, this student gets to know ‘the piece of fluff ’ in her ears. The following, final quotation demonstrates how the course can offer only the

initial incentive for the process of expanding self-awareness. Whether this process goes on and reaches completion is a matter of personal choice and commitment.

. . . I have been preoccupied with the final paper for two months, almost daily. For days I collected materials, spent hours on the Internet, in libraries . . . The writing did not flow . . . I was stuck. I realized that it was something personal . . . I think

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I found what it was. Three weeks from now I am getting married. Issues that came up in the interview touched me very deeply: the painful differentiation from parents, the separation from single life. Today I woke up feeling that at last, I will finish writing the paper. Immediately I felt my stomach ache. It was excitement. I understood that in order not to deal with the excitement and the preparations for my wedding I was busy “doing”, dealing with the interview—fleeing. Through the paper I mourned my own losses: of my single life, my childhood, of the freedom to do whatever I want. I am saying farewell to one developmental phase and moving on. (DD)

Discussion

This paper demonstrates how a training model that combines narrative analysis and psychodynamic understanding may promote the cultural self-awareness of social

workers. The trainees reported major shifts in their cultural self-awareness: an extended awareness of their own or their families’ immigration background and of

their other life transitions. Cultural self-awareness can, therefore, be taught and learnt. With a relatively short and simple intervention, significant improvement in the

practitioners’ attitudes towards culturally diverse clients can be achieved. Moreover, it is suggested that the lack of attention to self-awareness in training models that focus

on cultural knowledge and skills, may account for their controversial effectiveness (Sue, 2001). Unconscious resistances and unresolved conflicts may block the acquisition of new knowledge and prevent its application in practice. It is therefore

imperative that cognitive training is preceded by the exploration and verbalization of unconscious processes and the enhancement of the practitioners’ cultural self-

awareness. The fact that the evaluation study is based on participants’ self-report is a limitation

of this study. ‘Objective’ measurements need to be performed in future studies to corroborate the subjective data. Nevertheless, the reports on improvement of cultural

self-awareness following the training are quite compelling and it is important to understand what components of the training could explain this.

It is suggested that the active involvement of the trainees, on the cognitive, emotional and personal levels in the listening and sense-making process is one of the factors that may render the model effective. The active stance, which makes the

students more deeply affected by the narratives, needs to be fostered and kept up. Therefore, one of the roles of the facilitator is to sustain the students’ availability and

motivation to lend themselves to the exploration of the narratives. In order to achieve this, the facilitator must create a secure and accepting environment in the group and

provide modeling for the attitude of attentiveness, acceptance and respect towards students and interviewees.

The active role of the students is also sustained by the fact the narrators are not present in class. This is an additional reason why students are discouraged from interviewing people very close to them, and when they do so, they seldom present the

interview in class. In contrast to the clinical setting, in the present context