Professional Psychology: Research and Practice

In the public domain 2018, Vol. 49, No. 2, 142–150

http://dx.doi.org/10.1037/pro0000183

Reflective Local Practice: A Pragmatic Framework for Improving

Culturally Competent Practice in Psychology

Evelyn Sandeen Kelly M. Moore

New Mexico VA Health Care System, Albuquerque, New Minneapolis VA Health Care System, Minneapolis, Minnesota
Mexico, and University of New Mexico

Rex M. Swanda
Albuquerque, New Mexico

Psychology has long been at the forefront of recognizing the importance of cultural competence in
professional endeavors. Although the literature on culture and psychology is rich, many psychologists
and psychology training programs could still benefit from a pragmatic template for integrating and
improving cultural competence throughout the professional life span. The current article presents a
framework for improving cultural competence, called reflective local practice. The term reflective relates
to the primary focus on self-understanding and insight as tools to enhance lifelong growth in cultural
competence. The term local refers to suggestions about utilizing one’s local community and its unique
history in this reflective process. Finally, the term practice reminds psychologists and psychology
trainers that applied skills training is a necessary part of developing cultural competence. The reflective
local practice framework is intended to be relevant for psychologists and training programs situated in
any cultural milieu, and to be useful for psychologists and trainees from all cultural backgrounds.

Public Significance Statement

This article presents suggestions to help professionals improve their cultural competence and ability to
effectively work with clients of varied cultural backgrounds. The suggestions include reflecting on one’s
own experiences, learning about local cultures, and practicing skills involved in cultural awareness. The
terms hot spots, blind spots, and soft spots, are presented as useful, nonblaming language to help with
self-understanding in the service of improving culturally competent professional practice.

Keywords: cultural competence, reflective practice, diversity training, psychology training, hot spots,
blind spots, soft spots

Supplemental materials: http://dx.doi.org/10.1037/pro0000183.supp

Over the past 30 years, the role of cultural competence in ican Psychological Association [APA], 2003, 2011; Fouad et al.,
professional psychology has progressed from a footnote to a foun- 2009; International Union of Psychological Science, 2008; Tracey,
dational necessity for overall competence as a psychologist (Amer- 2005). Professional interest in cultural issues is reflected in the

EVELYN SANDEEN, PHD, ABPP, received her doctorate in clinical psy-
chology from Stony Brook University (previously SUNY Stony Brook),
and is board certified in clinical psychology. She is a former training
director for doctoral internships and postdoctoral fellowships and is cur-
rently chief of the residential treatment section at the New Mexico VA
Health Care System. She is also an adjunct clinical professor at the
University of New Mexico School of Medicine and Department of Psy-
chology.
KELLY M. MOORE, PHD, received her doctorate in clinical psychology
from Marquette University. She is currently a staff psychologist in the area
of Primary Care-Mental Health Integration at the Minneapolis VA Health
Care System. Her areas of professional interest include outcomes of integrated
care services, health psychology, preprocedural psychological evaluation for med-
ical interventions, multicultural psychology, and diversity training in psychology.
REX M. SWANDA, PHD, received his doctorate in clinical psychology
from the University of Arizona, and is board certified in clinical neuro-
psychology. He has directed neuropsychological consultation services at
Bellevue Hospital and the New Mexico VA Health Care System with
emphasis on culturally sensitive practice in assessment. He currently works
in private practice, specializing in neuropsychological assessment of trau-
matic brain injury and decisional capacity.
THE AUTHORS WOULD LIKE to thank Brenna Greenfield, Jennifer Veilleux,
and Kamilla Venner for their helpful comments on the initial drafts of this
manuscript.
CORRESPONDENCE CONCERNING THIS ARTICLE should be addressed to
Kelly M. Moore, Minneapolis VA Health Care System, 116A, 1
Veterans Drive, Minneapolis, MN 55417. E-mail: kelly.moore2@
va.gov

142
 REFLECTIVE LOCAL PRACTICE
academic literature, with a Google Scholar search of culture and
psychology yielding over 50,000 references in the first 11 months
of 2017. However, the proliferation of literature and interest
around cultural competence has not yet yielded sufficiently prac-
tical or relevant methods to promote effective professional devel-
opment and training in this area (Forrest et al., 2013).
Many have suggested (e.g., Christopher, Wendt, Marecek, &
Goodman, 2014; Fouad et al., 2009; Strom et al., 2012; S. Sue,
1998; S. Sue, Zane, Nagayama Hall, & Berger, 2009; Wendt &
Gone, 2012), that cultural competence1 is critical for successful
functioning in clinical practice. It remains a common approach for
formal trainings on diversity and cultural competence to focus
primarily on content-based, normative information about non-
dominant cultures or minority populations. However, the critical
work of D. W. Sue, Arredondo, and McDavis (1992), suggests that
more than didactic knowledge is essential in acquisition of this
form of competence.
The acquisition of didactic information and content-based
knowledge about specific cultures and identifiable subgroups cer-
tainly provides an important foundation for cultural competence.
However, the perspective of this article is that professional growth
in cultural competence is best achieved through a comprehensive
approach that integrates content-based information about specific
cultural groups with increased self-awareness about the psychol-
ogist’s own assumptions and biases. A recent article by Bardone-
Cone et al. (2016) provides one example of this integrated focus.
Namely, the authors discuss enhancing the diversity components
of training in psychology doctoral programs through weaving
experiential, self-reflective, and didactic content throughout the
graduate experience. Similarly, the overarching aim of this article
is to promote the importance of reflective self-awareness; knowl-
edge and experience of local cultures; and acquisition of effective,
culturally sensitive clinical skills as equally important components
in honing lifelong cultural competence.
The current article provides a useful framework for improving
culturally competent practice in psychology that the authors have
named reflective local practice (RLP). This approach can serve as
a resource for psychologists and other professionals by offering a
method to promote lifelong learning in competent cultural practice.
RLP can also guide the creation of culturally competent training
programs at the practicum, internship and doctoral levels. A pri-
mary goal of the RLP approach is to instill a set of skills and
processes that are key aspects of cultural competence. The authors
believe these include reflective self-awareness of one’s own as-
sumptions and potential sources of bias, acquisition of information
about local culture, and development of culturally effective clini-
cal skills in professional practice.
Assumptions Underlying Reflective Local Practice
Several assumptions regarding the influence of culture on psy-
chologists’ professional roles underlie the RLP approach, and are
reviewed below.
Universality of Culture
Everyone has a culture. Being human implies being embedded
in a cultural matrix, in which characteristics and identities interact
and inform experiences of the world. This implies, of course, that
143
each psychologist is also embedded in a cultural matrix. Despite
this fact, in our experience as trainers, many psychologists and
psychology trainees lack explicit awareness of how their own
cultural characteristics impact their professional lives, especially if
they primarily identify with dominant cultural groups.
Implicit in many diversity training approaches is the assumption
that the learner is White, or of the dominant culture, and is being
taught about minority or disempowered others. This assumption
ignores the presence of an increasingly diverse community of
psychologists (Fouad & Arredondo, 2007, p. 3). To this point, a
former trainee who self-identified as Black/Hispanic pointed out to
us that her prior cultural diversity training failed to provide rele-
vant guidance to prepare her, as a person of color, to work with
clients of the dominant culture. Other trainees of color have told us
that prior diversity training has implied that they are already
cultural experts by virtue of their lived experience, which was
disconcerting to them. This article suggests that culturally compe-
tent practice in psychology requires a shift to a more nuanced
understanding of the universality of culture on both sides of the
therapy dyad.
Individuals Exist Within a Matrix of Multiple
Cultural Identities
It is important to consider the intersectionality of identity, dif-
ference, and disadvantage in the understanding of human experi-
ence (Cole, 2009). D. W. Sue (2001) outlines a framework of the
multiple identities experienced by a person, and the importance of
recognizing identities at individual, group, and universal levels.
Some of the cultural identities carry with them greater implications
in terms of probable experiences in the broader culture than do
others. The complex and overlapping interactions of one’s char-
acteristics and group memberships is critical to consider in case
conceptualization and interactions with clients (cf. ADRESSING
model, Hays, 1996).
Culture Is Ever-Shifting
Because the social and cultural contexts in which we live and
practice are constantly changing, it is important for psychologists
to use a flexible approach when considering cultural factors in
their work. The 2010 United States Census revealed that multiple-
race populations grew faster than single-race populations, indicat-
ing that binary categories of race are even less useful than they
may have been previously (U.S. Census Bureau, 2012). A focus on
content-based knowledge about a group may not be particularly
useful when one recognizes that the composition of that group is
1
We have chosen to use the term cultural competence, while respecting
criticism of this term; for example, that it represents a set of skills that can
be learned and applied for use with clients representing a particular
characteristic (Kleinman & Benson, 2006). We want to acknowledge that
there are alternative approaches to cultural competence (Kirmayer, 2012),
such as “cultural humility” (Hook, Davis, Owen, Worthington, & Utsey,
2013; Tervalon, & Murray-García, 1998), “cultural responsiveness” (S.
Sue, Fujino, Hu, Takeuchi, & Zane, 1991), “cultural safety” (Papps &
Ramsden, 1996), and “inclusive cultural empathy” (Pedersen et al., 2008).
Our use of cultural competence reflects the history of our experience in
training and is not intended to represent a quality that can be mastered in
a discrete way by any clinician. It is a term that for us is aspirational and
reflects flexibility and change.
144 SANDEEN, MOORE, AND SWANDA
constantly evolving, and that within-group differences on many
dimensions may exceed between-groups differences.
Bias Is Universal
We are exposed to society’s use of binary groupings regularly,
and our brains are built to use schemas to enhance efficient
cognitive processing (Banaji & Greenwald, 1994; Gregg, Seibt, &
Banaji, 2006). Although this is a natural process, our implicitly
learned systems of grouping and categorizing can lead to stereo-
types and prejudicial beliefs (D. W. Sue & Sue, 2013). In the
interest of further developing professional cultural competence, it
is important to normalize the idea that implicit bias is a part of
being human. It is essential that learners in the cultural competence
arena be helped to understand this, since the uncovering of long
held beliefs, thoughts, or reactions that had previously gone un-
questioned can be very uncomfortable if one thinks it is abnormal
or unacceptable to have such implicit biases.
Understanding Group Power Structures and History
Is Crucial to Cultural Competence Training
An essential component of the RLP approach is the recognition
and appreciation of the effect of power and powerlessness on
psychological functioning. A robust literature highlights the sig-
nificant impact on health and well-being of discrimination associ-
ated with membership in a nondominant group (e.g., Broudy et al.,
2007; Hwang & Goto, 2008; Ong, Fuller-Rowell, & Burrow,
2009). Research on discrimination has included focus on micro-
aggressions, which are conceptualized as “brief and commonplace
daily verbal, behavioral, or environmental indignities, whether
intentional or unintentional, that communicate hostile, derogatory,
or negative racial slights and insults toward people of color”
(D. W. Sue et al., 2007, p. 271). Understanding the historical
context for the degree of power or powerlessness felt by any given
individual, particularly within the unique context of the local
culture, can help the psychologist or trainee appreciate the multi-
and intergenerational experiences and challenges various groups
have encountered. Psychologists can become more attuned to
current expressions of privilege, and acknowledge the ways overt,
covert, and institutional forms of discrimination have impacted
clients’ interactions, challenges, and life course. Doing so en-
hances the professionals’ capacity for empathy, understanding, and
genuine relationships in clinical practice.
Cultural Competence Is an Ethical Necessity in
Professional Psychology
We must attend to culture within professional practice in order
to conform to the ethical principles of beneficence and nonmalefi-
cence (Tracey, 2005). When psychologists attend to cultural fac-
tors, they enhance rapport and sharpen empathy, thus improving
the therapeutic alliance and treatment outcomes (e.g., Rasoal,
Eklund, & Hansen, 2011). Rapport and empathy are basic corner-
stones of all therapeutic approaches; they are two of the common
factors that are confirmed by research as being potent agents of
change (Orlinsky, Ronnestad, & Willutski, 2004). Without aware-
ness of culture, the psychologist risks making blunders that will
limit or prevent benefit to the client. Additionally, cultural com-
petence helps the psychologist create more useful case conceptu-
alizations by considering the contribution of cultural factors and
interactions, thus limiting inappropriate pathologizing and increas-
ing awareness of client strengths.
Reflective Local Practice Approach
The term reflective local practice can serve as a mnemonic
device to help psychologists who seek to acquire a more compre-
hensive level of cultural competence in their work. The RLP
approach may provide a flexible template for designing formal
training programs or directing one’s own individual professional
development in this area. The approach presented here encourages
the use of the multitude of existing helpful multicultural training
resources, including activities for experiential learning (e.g., De
Ricco & Sciarra, 2005; Pedersen, 2004) and for enhancing comfort
with discussion and focus on self-awareness of culture (e.g.,
Metzger, Nadkarni, & Cornish, 2010). There are also meaningful
examples in the literature of training programs that facilitate cul-
turally meaningful conversations and interventions with diverse
clients (Grote, Zuckoff, Swartz, Bledsoe, & Geibel, 2007; Venner,
Feldstein, & Tafoya, 2007). Some specific language and activities
that are particularly helpful within this RLP approach are high-
lighted below, along with additional resources that can be found in
the online supplemental materials.
Reflection: Expanding Self-Awareness of One’s Own
Cultural Influences
The most important aspect of cultural competence is the psy-
chologist’s ability to reflect on the cultural contributions that enter
every clinical interaction through the professional’s own assump-
tions and implicit biases. Therefore, cultural competence training
should be grounded in a reflective process that promotes self-
awareness. As noted above, content-based knowledge about spe-
cific cultural groups, especially those in the local region, is foun-
dational. Many psychologists can expect to move around and work
in several geographic areas during the course of their careers. The
one constant they can count on is that they will carry their own
lifetime of accumulated cultural assumptions, experiences, and
biases wherever they go. Whether a psychologist will be able to
effectively practice in a culturally competent way in any specific
locale will largely depend upon whether the person has acquired a
method of reflective practice around culture during formal training
(Hansen et al., 2006) or during their lifelong development of
professional skills. Developing an understanding of oneself as a
cultural being who has reactions toward others, both similar and
different from oneself, is a critical step in becoming more sensitive
to cultural concerns. In other words, it is important to recognize
bias as a natural and universal part of being human, and to
differentiate bias from malicious intent. The following activities
support this endeavor, and others can be found in the literature, as
cited above. The reader is referred to supplemental materials for
more specific suggestions.
Hot Spots, Blind Spots, and Soft Spots
A barrier to effective communication related to self-reflection
can appear when practitioners do not have a sense of confidence in
 REFLECTIVE LOCAL PRACTICE
the language they can or should use with cultural topics. Common
terms, such as prejudice, racism, privilege, and even microaggres-
sion can arouse strong emotions, increase defensiveness, and shut
down learning in some situations. It is important for trainers and
everyone interested in promoting cultural competence to under-
stand the pedagogical necessity of attending to defensiveness in
learners (Venner & Verney, 2015) and, for example, not introduce
the concept of “White privilege” too soon in the learning sequence
(Cross & Reinhardt, 2017).
The RLP approach handles this by using novel terms hot spots,
blind spots, and soft spots, to discuss self-awareness of cultural
factors in a nonblaming way.
Hot spots may arise when persons who have experienced pow-
erlessness in certain areas of their lives have understandably strong
emotion associated with that dimension. Strong emotion is a nor-
mal reaction to having been powerless, oppressed, or harmed.
Psychologists and psychology trainees should become well ac-
quainted with the topics and actions that arouse in them strong
emotion related to their past negative experiences, as unacknowl-
edged hot spots could cause harm in clinical interactions. For
example, a gay psychologist who has experienced family rejection
or other negative events related to his sexual orientation might be
expected to have a hot spot pertaining to perceived homophobia in
a client. This psychologist’s capacity to work effectively with that
client will depend on his self-awareness of and subsequent ability
to compensate for this hot spot.
Blind spots refer to those situations in which a psychologist is
unaware of relevant cultural information regarding the client be-
cause of unexamined assumptions related to the psychologist’s
own background. Blind spots tend to occur in dimensions of
experience in which the person has held relative power. The
experience of having power or privilege associated with power is
often not readily perceptible by the person who has had this
experience (e.g., McIntosh, 1989). Not being aware of power and
privilege in a certain dimension can blind the psychologist to
certain aspects of clients’ situations and lead to overpathologizing
or ignoring important factors in clients’ lives. For example, a
psychologist who has been raised in a middle- or upper-middle
class family and has not had many interactions with persons who
struggle financially could misinterpret missed sessions as thera-
peutic resistance instead of difficulty meeting basic needs (e.g., the
client having to make hard choices regarding spending money on
gas to travel to the appointment).
Soft spots occur when the psychologist holds unexamined as-
sumptions that lead to deviations from usual practice, often in the
direction of lowered expectations for client behavior and outcome.
Soft spots can arise due to overidentification with a client (because
of shared background) or sympathy for a client (usually coming
from a privileged trainee or psychologist toward a less-privileged
client). For example, a Latina psychologist working in a residential
rehabilitation setting with mostly White peers might give extra
leeway regarding unit rules to a Latino client due to unexamined
assumptions that her non-Latino peers do not understand this
particular client.
It is assumed that virtually all psychologists and psychology
trainees have a combination of hot, blind, and soft spots. For
example, a psychologist who identifies as cis-gender, White, and
from an upper-middle class family may benefit from understand-
ing that those experiences make her vulnerable to failing to ap-
145
preciate the struggles of poor or non-White clients (a blind spot,
given her history of White privilege), potentially resulting in such
clients perceiving the psychologist as dismissive or invalidating of
their problems. If the same psychologist had experienced signifi-
cant sexism on the part of her father during her youth, she may also
have a hot spot on the dimension of gender. Armed with the
self-knowledge that she is vulnerable to strong reactions toward a
male client in whom she perceives sexist attitudes (a hot spot), she
might be able to provide more effective therapeutic assistance by
being able to better separate her own issues from those of the client
or seek appropriate consultation. In a related scenario, without the
benefit of this same self-knowledge, this psychologist might be at
risk for overidentifying and being less therapeutically challenging
with a female client who is herself experiencing effects of sexism
(a soft spot).
The online supplemental materials include a form useful for
self-reflection around identification of potential hot spots, blind
spots, and soft spots (see the online supplemental materials, Table
S1). Using the concept of intersectionality, this form provides a set
of commonly identified dimensions of culture. This form can be
used to identify dimensions in which one has experienced power-
lessness, and dimensions which the individual associates with
having power or being unaware of power dynamics (which often
occurs when one does have power). We also recognize that the
experiences one has in regard to status in a given domain of
diversity may not be consistent or equal in meaning to the expe-
riences had in regard to other domains of diversity. It should be
emphasized that this process is designed for self-evaluation only,
and should not be used to “diagnose” a trainee or a client.
Implicit Association Test
The Implicit Association Test (IAT; Baron & Banaji, 2006;
Greenwald, McGhee, & Schwartz, 1998) and its many iterations is
useful for exploration and normalization of one’s own implicit
biases. The IAT examines the automatic and implicit thought
processes related to (typically unintentional) discrimination that
may impact professional work with a client. The IAT can be used
as part of a formal training program, followed by group discussion.
Also, individuals can use it for self-reflection and understanding of
their own levels of implicit bias in various domains.
Provocative Questions
Another technique helpful in the process of increasing self-
reflection around culture is to increase awareness of meaningful
events within one’s own cultural background and their potential
impact upon clinical work. The RLP approach recognizes that
culture has a very broad meaning that includes but goes beyond
ethnic, racial, religious and other well-defined categories, to in-
clude culturally shared values and perspectives that might be found
within shared social affiliations, regions, interests and acquired
experiences. Thus, it is important for the psychologist to explore
her or his own unique cultural matrix. A technique referred to as
“Provocative Questions and Discussion Points” (see the online
supplemental materials, Table S2). consists of questions that are
designed to elucidate nuanced elements of one’s cultural back-
ground. Following this exercise, reflection on how one’s back-
ground is impacting one’s clinical work is natural and helpful.
146 SANDEEN, MOORE, AND SWANDA
When this exercise is facilitated in a group, we encourage the
facilitators to lead the way by discussing aspects of their own
background before asking others to do so.
Local: Geographically Specific Knowledge
A priority for the RLP approach is to make sure that cultural
competence includes knowledge and experience with local cul-
tures that are relevant to the psychologist’s practice. This means
that it is important to gain familiarity with the history and content-
based knowledge of local cultural practices, norms, and customs
that might apply to clients one is likely to see. However, as a note
of caution, it is important for professionals to be aware of the
potential for stereotyping that can emerge from overreliance on
strategies focused on content-based knowledge about specific
groups. It is also important to consider the extent to which a
specific cultural “authority” might be broadly representative of
that culture, or the extent to which a cultural resource might reflect
implicit bias. In other words, it is important that all content
learning be used for hypothesis-testing with clients rather than
assuming that a particular bit of content knowledge applies to a
particular client due to membership in a group. Given those cave-
ats, some of the following methods might be useful ways for a
professional to seek additional knowledge about local culture,
especially if multiple resources are sought in an effort to avoid
overgeneralization.
Expanding Experiential Knowledge of Local Cultures
Many forward-thinkers in the area of diversity training have
emphasized the desirability of promoting experiences that impact
the understanding of culture at a nonintellectual level (e.g., De
Ricco & Sciarra, 2005; Pedersen, 2004). The RLP approach en-
courages psychologists to seek out activities in order to have
first-hand experiences of local cultures other than their own. Every
locale has its own unique events that reflect its cultural heritage.
Some activities that may be useful across many locales in the
United States include attending a variety of religious services,
attending a recreational activity populated by persons who differ in
age or social class from oneself, or going on a driving tour of
unfamiliar neighborhoods and shopping in stores in those areas. It
can be particularly useful to attend a cultural event with colleagues
who are seeking a similar experience of uncovering and owning
one’s unique reactions to the experience. Experiential activities
can also be undertaken within a structured group format as part of
a formal professional training program, a peer discussion group, or
other continuing education activity (see activities presented in
Fouad & Arredondo, 2007; Pedersen, 2004; Pedersen, Crethar, &
Carlson, 2008). Group exercises, including cultural immersion
experiences (De Ricco & Sciarra, 2005) or cultural plunge (Neito,
2006) can be particularly helpful in forming an appreciation for
power dynamics and increasing empathy for those with less power.
Movies, literature, poetry, visual arts, and culinary arts provide
other powerful methods for experiencing and learning about local
culture. Within formal training programs, we encourage trainers to
join trainees in such activities, and to facilitate debriefings after-
ward to examine individuals’ experiences and their relevance for
clinical work. In our experience, debriefing opportunities such as
these provide the best way of countering tendencies to stereotype
and to promote continued questioning of assumptions.
Local History
Understanding the histories of local people, especially as inter-
preted through analyses of power dynamics, is essential to under-
standing the living cultures in which one finds oneself as a psy-
chologist. For example, the Cultural Safety approach was created
in New Zealand by nursing professionals interested in increasing
nurses’ ability to relate helpfully to the native Maori population
(Papps & Ramsden, 1996). One of the central tenets of Cultural
Safety is to promote historical learning as an effective training
method by providing information about local history and local
power inequities to trainees.
Knowledge gained from historical readings and other sources
provides accessible means for the psychologist to learn about
important aspects of local history, the effects of which might still
be felt in their client populations today. For example, knowledge
about the displacement of Navajo children through a program of
government boarding schools in the 20th century may inform
psychologists from the area about some of the struggles that may
affect their Navajo clients. Similarly, it would be important for
psychologists who work with military veterans to be familiar with
United States history regarding armed conflict. Local historical
societies and museums may be a good but often overlooked source
of information about local culture.
Literature and memoir can be a rich source of nuanced cultural
material. We suggest that psychologists search for local authors
who have specific ties to the surrounding geographic region in
order to get the most out of this experience. For example, the
memoir Hillbilly Elegy (Vance, 2016) might be helpful for psy-
chologists practicing in Appalachia or locales with many Appala-
chian people. A selection by the popular mystery and nonfiction
writer Tony Hillerman might be meaningful for psychologists
learning more about the mix of Native, Anglo, and Hispanic
cultures in the American Southwest. Again, knowledge gained
through historical or literary sources should be used in a
hypothesis-testing framework to determine if it is relevant for a
particular client.
Vocabulary Specific to Local Groups
One of the most helpful methods of gaining information about
specific cultural groups is through listening closely for unique or
region-specific use of language. Because language, like culture, is
alive and ever-changing, the language used by a client will usually
reflect embedded themes of concern and history regarding that
individual’s cultural group as well as their personal concerns.
Within formal training settings, providing trainees with lists of
unfamiliar vocabulary can be a helpful tool. Of course, the psy-
chologist’s or trainee’s use of any new vocabulary should be
intentional and appropriate, given that subtle cultural rules usually
govern the use of language and terms by in-group versus out-group
members of that culture.
Practice: Learning Specific Skill Sets and
Compensating for Hot, Blind, and Soft Spots
Within a formal training setting, the most relevant and useful
cultural competence training will involve workshop-type experiences
in which learners practice actually saying and doing things that
 REFLECTIVE LOCAL PRACTICE
facilitate culturally competent practice. Some examples of these skills
include introducing the topic of culture in therapy settings, taking a
cultural history, responding to cultural questions from clients, address-
ing racism and the effects of racism in clients, and addressing cultural
ruptures. The same is true for experienced psychologists who seek to
increase cultural competence. A variety of materials are available
from which trainees and psychologists can learn or improve specific
skill sets required to fruitfully explore cultural issues with clients
(Sanchez, Del Prado, & Davies, 2010) and to recover from uninten-
tional breaches (Pedersen et al., 2008) in the therapy relationship.
However, since these complex skills can best be learned through
iterative processes of attempts and feedback, this skills development
training can be most productively accomplished through group super-
vision experiences or seminars, where one can benefit from observing
others working on the same skills.
It is worth highlighting the importance of simply “getting words
out” in these cultural discussions. Trainees and cautious psychologists
often fear saying something that could be considered ill-informed or
disrespectful. For this reason, it is helpful for facilitators of such
trainings to show through modeling that having courage and willing-
ness to engage in these conversations is an important element of
practice in itself. Being willing to be uncomfortable at times (“comfort
with discomfort”) may be a requirement for meaningful expansion of
one’s cultural competence. For an individual psychologist seeking
self-guided acquisition of skills, structured cultural interviews such as
the “Cultural Formulation Interview” of the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition (American Psychiatric
Association, 2013) can be helpful.
Once a psychologist starts to become more familiar with a personal
set of implicit biases and hot, blind, or soft spots, the process of active
compensation can begin. The single most important strategy is for the
psychologist to explicitly identify the assumptions that are carried into
every interaction. This includes assumptions regarding perceived cul-
tural similarities as well as perceived differences between the profes-
sional and client. By questioning one’s own assumptions, the psy-
chologist will be more likely to seek clarifying information from the
client. The benefit is that the psychologist might find that some
assumptions are based on a stereotype that does not hold true for this
specific individual. The potential benefit in the therapeutic relation-
ship is that the client might be more likely to experience the therapist
as respectful and responsive. Like most clinical skills, the strategy of
routinely identifying and challenging one’s own assumptions in ther-
apy takes practice, but assumptions must be explicitly identified over
and over until the professional acquires the habit of automatically
checking with the client to confirm or disconfirm as many assump-
tions as possible. It is especially important to apply the strategy of
habitually identifying assumptions to those situations in which the
psychologist does not think there are any obvious cultural issues, since
those are precisely the situations in which the psychologist is most
likely to be “culturally blind.” Cultural issues are ever-present,
whether or not they are explicitly recognized. It is the psychologist’s
responsibility to identify them.
Notes for Trainers: Breaches and Repair in Cultural
Competence Training
Training psychologists in cultural competence is an essential
task. Because cultural issues necessitate self-reflection on one’s
own background in terms of privilege, power, powerlessness, or
147
painful experiences, training in this dimension can arouse strong
emotions. Occasionally, interpersonal ruptures and feelings of
being dismissed or emotionally hurt can occur. The following
suggestions can help to prevent and repair breaches. Of note,
breaches will also occur when culture is ignored or minimized,
even though the trainers may not be aware of it and may not be
able to effectively address the breach at the time of the concern.
Prevention
The best strategy for prevention of breaches or cultural errors
within a psychology training program is for the trainer to maintain
a nondefensive and humble stance. Reviewing the basic assump-
tions about cultural competence (culture as ever-shifting, univer-
sality of culture, universality of bias, importance of understanding
group power structures and history, and cultural competence as an
ethical necessity) is a useful starting point for meeting trainees in
a culturally competent way. The use of nonblaming language such
as hot spots, blind spots, and soft spots, and the presentation of bias
as normal and without inherent malignant intent, can be useful in
creating and maintaining a good learning atmosphere.
Repair
Research has shown that tension, hurt, and disapproval can arise
among trainees and professionals in cultural diversity training
situations when topics such as White privilege are broached
(Boatright-Horowitz & Soeung, 2009). Further, consideration of
microaggressions is important for teachers and trainers who are
responsible for leading and managing difficult cultural dialogues
(D. W. Sue, Lin, Torino, Capodilupo, & Rivera, 2009). If emo-
tional tension arises, it is important for the trainer to strive for
empathy and understanding, and to gently reiterate the assump-
tions and clarify the perspective of the training.
Optimal Level of Safety
Finally, the importance of an optimally safe atmosphere in
which to conduct cultural competence training cannot be overem-
phasized. Trainees who identify with a nondominant cultural di-
mension may be at risk for experiencing instances of microaggres-
sions from trainers or peers who are perceived as more powerful
representatives of dominant culture, or by virtue of the obvious
power difference that is inherent in the trainer-trainee relationship.
Facilitators of cultural training experiences are also responsible for
making their best attempt to create a safe atmosphere for discus-
sion and self-exploration while also helping training participants to
push themselves toward deeper self-understanding (Fouad & Arre-
dondo, 2007; Venner & Verney, 2015). Further resources for
psychology trainers can be found in the online supplemental ma-
terials, Table S3.
Notes for Psychologists in Practice
The RLP approach can be used for self-guided expansion of
cultural competence by professionals past the phase of formal
professional training. See the online supplemental materials, Table
S4, for suggestions for the types of activities that a psychologist
can engage in to promote cultural competence.
148 SANDEEN, MOORE, AND SWANDA
Enhance Discussion With Others
We especially encourage psychologists in practice to seek out
peers who are willing to engage in group activities, discussion, and
learning around cultural competence. Johnson, Barnett, Elman,
Forrest, and Kaslow (2012) discuss the importance of the commu-
nitarian approach, which emphasizes the psychologist’s responsi-
bility to enhance individual and professional community compe-
tence. This could take the form of spearheading the creation of a
Diversity Committee at your workplace if one does not exist, the
creation of a peer supervision group focused on increasing cultural
competence skills, or the creation of a journal club devoted to the
topic. We encourage psychologists of all cultural, racial, and ethnic
backgrounds to take responsibility for engaging in these types of
endeavors.
Repair
In the process of becoming more aware of cultural issues, and of
“going there” in clinical work with clients, the psychologist may
also experience breaches within the therapeutic relationship. Ped-
ersen et al. (2008) detail some specific skills for repair of such
breaches, and emphasize that they may be overcome by projecting
willingness to learn from the client, an attitude of honest self-
inquiry, and earnest intent for repair to occur. Again, the benefits
of increasing cultural competence and attention to cultural factors
in therapy are great for our clients, and far outweigh the negatives
associated with potential missteps.
Research Implications
The RLP approach focuses on the psychologist’s internal as-
sumptions and examination of self, as opposed to a primary focus
on cultural factors in the “other.” Process-oriented research meth-
odologies which attempt to measure psychologists’ internal pro-
cesses related to conceptualization, diagnosis, and treatment deci-
sions would offer an opportunity to evaluate change in therapeutic
processes when the RLP approach is applied. At a more general
level, we agree with many others (e.g., Cross & Reinhardt, 2017),
that the field of psychology needs to incorporate culture more
ubiquitously into psychological research rather than treating cul-
ture as ancillary to primary psychological knowledge.
Concluding Thoughts
The RLP approach promotes the integration of cultural compe-
tence into all aspects of practice through focusing on self-
awareness (reflection), experiential knowledge of local culture
(local), and increasing culturally relevant clinical skills (practice).
In order for cultural competence training to result in actual behav-
ior change on the part of trainees and professionals, it must not be
sequestered in a few diversity seminars or a 1-hr continuing
education opportunity. If culture is, as we believe, pervasive and
omnipresent, then attention to it must be woven throughout all
aspects of professional practice and training. Further, lifelong
expansion of cultural competence should be the goal of every
professional, knowing that culture is ever-changing and can never
be “mastered.”
The overarching goal in the RLP approach is to produce psy-
chologists who have adopted a habitual method for maintaining
and expanding cultural competence throughout their careers. As a
thought experiment, a psychologist could ask,
If I were traveling outside of my home country in the next stage of my
career, would I know how to examine myself culturally in a new
setting, and would I know how to educate myself culturally about the
clients I am likely to encounter?
An affirmative answer to that question would indicate success in
this arena, and indicate that the psychologist is indeed on a path
that will support a lifelong learning approach to cultural compe-
tence.
References
American Psychiatric Association (APA). (2013). Diagnostic and statisti-
cal manual of mental disorders (5th ed.). Washington, DC: Author.
American Psychological Association (APA). (2003). Guidelines on multi-
cultural education, training, research, practice, and organizational
change for psychologists. American Psychologist, 58, 377– 402. http://
dx.doi.org/10.1037/0003-066X.58.5.377
American Psychological Association (APA). (2011). Revised competency
benchmarks in professional psychology. Washington, DC: Author. Re-
trieved from http://www.apa.org/ed/graduate/benchmarks-evaluation-
system.aspx?tab⫽1
Banaji, M. R., & Greenwald, A. G. (1994). Implicit stereotyping and
unconscious prejudice. In M. P. Zanna & J. M. Olson (Eds.), The
psychology of prejudice: The Ontario Symposium (Vol. 7, pp. 55–76).
Hillsdale, NJ: Erlbaum.
Bardone-Cone, A. M., Calhoun, C. D., Fischer, M. S., Gaskin-Wasson,
A. L., Jones, S. C. T., Schwartz, S. L., . . . Prinstein, M. J. (2016).
Development and implementation of a diversity training sequence in a
clinical psychology doctoral program. Behavior Therapist, 39, 65–75.
Baron, A. S., & Banaji, M. R. (2006). The development of implicit
attitudes. Evidence of race evaluations from ages 6 and 10 and adult-
hood. Psychological Science, 17, 53–58. http://dx.doi.org/10.1111/j
.1467-9280.2005.01664.x
Boatright-Horowitz, S. L., & Soeung, S. (2009). Teaching White privilege
to White students can mean saying good-bye to positive student evalu-
ations. American Psychologist, 64, 574 –575. http://dx.doi.org/10.1037/
a0016593
Broudy, R., Brondolo, E., Coakley, V., Brady, N., Cassells, A., Tobin,
J. N., & Sweeney, M. (2007). Perceived ethnic discrimination in relation
to daily moods and negative social interactions. Journal of Behavioral
Medicine, 30, 31– 43. http://dx.doi.org/10.1007/s10865-006-9081-4
Christopher, J. C., Wendt, D. C., Marecek, J., & Goodman, D. M. (2014).
Critical cultural awareness: Contributions to a globalizing psychology.
American Psychologist, 69, 645– 655. http://dx.doi.org/10.1037/
a0036851
Cole, E. R. (2009). Intersectionality and research in psychology. American
Psychologist, 64, 170 –180. http://dx.doi.org/10.1037/a0014564
Cross, W. E., Jr., & Reinhardt, J. S. (2017). Whiteness and serendipity. The
Counseling Psychologist, 45, 697–705. http://dx.doi.org/10.1177/
0011000017719551
De Ricco, J. N., & Sciarra, D. T. (2005). The immersion experience in
multicultural counselor training: Confronting covert racism. Journal of
Multicultural Counseling and Development, 33, 2–16. http://dx.doi.org/
10.1002/j.2161-1912.2005.tb00001.x
Forrest, L., Elman, N. S., Huprich, S. K., Veilleux, J. C., Jacobs, S. C., &
Kaslow, N. J. (2013). Training directors’ perceptions of faculty behav-
iors when dealing with trainee competence problems: A mixed method
pilot study. Training and Education in Professional Psychology, 7,
23–32. http://dx.doi.org/10.1037/a0032068
Fouad, N. A., & Arredondo, P. (2007). Becoming culturally oriented:
Practical advice for psychologists and educators. Washington, DC:
 REFLECTIVE LOCAL PRACTICE
American Psychological Association. http://dx.doi.org/10.1037/11483-
000
Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S.,
Madson, M. B., . . . Crossman, R. E. (2009). Competency benchmarks:
A model for understanding and measuring competence in professional
psychology across training levels. Training and Education in Profes-
sional Psychology, 3, 5–26. http://dx.doi.org/10.1037/a0015832
Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring
individual differences in implicit cognition: The implicit association test.
Journal of Personality and Social Psychology, 74, 1464 –1480. http://
dx.doi.org/10.1037/0022-3514.74.6.1464
Gregg, A. P., Seibt, B., & Banaji, M. R. (2006). Easier done than undone:
Asymmetry in the malleability of implicit preferences. Journal of Per-
sonality and Social Psychology, 90, 1–20. http://dx.doi.org/10.1037/
0022-3514.90.1.1
Grote, N. K., Zuckoff, A., Swartz, H., Bledsoe, S. E., & Geibel, S. (2007).
Engaging women who are depressed and economically disadvantaged in
mental health treatment. Social Work, 52, 295–308. http://dx.doi.org/10
.1093/sw/52.4.295
Hansen, N. D., Randazzo, K. V., Schwartz, A., Marshall, M., Kalis, D.,
Frazier, R., . . . Norvig, G. (2006). Do we practice what we preach? An
exploratory survey of multicultural psychotherapy competencies. Pro-
fessional Psychology: Research and Practice, 37, 66 –74. http://dx.doi
.org/10.1037/0735-7028.37.1.66
Hays, P. A. (1996). Addressing the complexities of culture and gender in
counseling. Journal of Counseling & Development, 74, 332–338. http://
dx.doi.org/10.1002/j.1556-6676.1996.tb01876.x
Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O.
(2013). Cultural humility: Measuring openness to culturally diverse
clients. Journal of Counseling Psychology, 60, 353–366. http://dx.doi
.org/10.1037/a0032595
Hwang, W. C., & Goto, S. (2008). The impact of perceived racial discrim-
ination on the mental health of Asian American and Latino college
students. Cultural Diversity & Ethnic Minority Psychology, 14, 326 –
335. http://dx.doi.org/10.1037/1099-9809.14.4.326
International Union of Psychological Science. (2008). Universal Declara-
tion of Ethical Principles for Psychologists. Retrieved from http://www
.am.org/iupsys/resources/ethics/univdecl2008.html
Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J.
(2012). The competent community: Toward a vital reformulation of
professional ethics. American Psychologist, 67, 557–569. http://dx.doi
.org/10.1037/a0027206
Kirmayer, L. J. (2012). Rethinking cultural competence. Transcultural
Psychiatry, 49, 149 –164. http://dx.doi.org/10.1177/1363461512444673
Kleinman, A., & Benson, P. (2006). Anthropology in the clinic: The
problem of cultural competency and how to fix it. PLoS Medicine, 3,
1673–1676. http://dx.doi.org/10.1371/journal.pmed.0030294
McIntosh, P. (1989). White privilege: Unpacking the invisible knapsack.
Peace and Freedom Magazine, 49, 10 –12.
Metzger, L. L. H., Nadkarni, L. I., & Cornish, J. A. E. (2010). An overview
of multicultural counseling competencies. In J. A. E. Cornish, B. A.
Schreier, L. I. Nadkarni, L. L. H. Metzger, & E. R. Rodolfa (Eds.),
Handbook of multicultural counseling competencies (pp. 1–21). Hobo-
ken, NJ: Wiley.
Neito, J. (2006). The Cultural Plunge: Cultural immersion as a means of
promoting self-awareness and cultural sensitivity among student teach-
ers. Teacher Education Quarterly, 33, 75– 84.
Ong, A. D., Fuller-Rowell, T., & Burrow, A. L. (2009). Racial discrimi-
nation and the stress process. Journal of Personality and Social Psy-
chology, 96, 1259 –1271. http://dx.doi.org/10.1037/a0015335
Orlinsky, D. E., Ronnestad, M. H., & Willutski, U. (2004). Fifty years of
psychotherapy process-outcome research: Continuity and change. In
M. J. Lambert (Ed.), Handbook of psychotherapy and behaviour change
(5th ed., pp. 308 –389). New York, NY: Wiley.
149
Papps, E., & Ramsden, I. (1996). Cultural safety in nursing: The New
Zealand experience. International Journal for Quality in Health Care, 8,
491– 497. http://dx.doi.org/10.1093/intqhc/8.5.491
Pedersen, P. B. (2004). 110 Experiences for multicultural learning. Wash-
ington, DC: American Psychological Association.
Pedersen, P. B., Crethar, H., & Carlson, J. (2008). Inclusive cultural
empathy: Making relationships central in counseling and psychother-
apy. Washington, DC: American Psychological Association. http://dx
.doi.org/10.1037/11707-000
Rasoal, C., Eklund, J., & Hansen, E. M. (2011). Toward a conceptualiza-
tion of ethnocultural empathy. Journal of Social, Evolutionary, and
Cultural Psychology, 5, 1–13. http://dx.doi.org/10.1037/h0099278
Sanchez, D., Del Prado, A., & Davis, C., III. (2010). Broaching ethnicity
competency in therapy. In J. A. E. Cornish, B. A. Schreier, L. I.
Nadkarni, L. L. H. Metzger, & E. R. Rodolfa (Eds.), Handbook of
multicultural counseling competencies (pp. 93–116). Hoboken, NJ: Wi-
ley.
Strom, T. Q., Gavian, M. E., Possis, E., Loughlin, J., Bui, T., Linardatos,
E., . . . Siegel, W. (2012). Cultural and ethical considerations when
working with military personnel and Veterans: A primer for VA training
programs. Training and Education in Professional Psychology, 6, 67–
75. http://dx.doi.org/10.1037/a0028275
Sue, D. W. (2001). Multidimensional facets of cultural competence. The
Counseling Psychologist, 29, 790 – 821. http://dx.doi.org/10.1177/
0011000001296002
Sue, D. W., Arredondo, P., & McDavis, R. J. (1992). Multicultural com-
petencies/standards: A call to the profession. Journal of Counseling &
Development, 70, 477– 486. http://dx.doi.org/10.1002/j.1556-6676.1992
.tb01642.x
Sue, D. W., Capodilupo, C. M., Torino, G. C., Bucceri, J. M., Holder,
A. M. B., Nadal, K. L., & Esquilin, M. (2007). Racial microaggressions
in everyday life: Implications for clinical practice. American Psycholo-
gist, 62, 271–286. http://dx.doi.org/10.1037/0003-066X.62.4.271
Sue, D. W., Lin, A. I., Torino, G. C., Capodilupo, C. M., & Rivera, D. P.
(2009). Racial microaggressions and difficult dialogues on race in the
classroom. Cultural Diversity & Ethnic Minority Psychology, 15, 183–
190. http://dx.doi.org/10.1037/a0014191
Sue, D. W., & Sue, D. (2013). Counseling the culturally diverse: Theory
and practice (6th ed.). Hoboken, NJ: Wiley.
Sue, S. (1998). In search of cultural competence in psychotherapy and
counseling. American Psychologist, 53, 440 – 448. http://dx.doi.org/10
.1037/0003-066X.53.4.440
Sue, S., Fujino, D. C., Hu, L. T., Takeuchi, D. T., & Zane, N. W. (1991).
Community mental health services for ethnic minority groups: A test of
the cultural responsiveness hypothesis. Journal of Consulting and Clin-
ical Psychology, 59, 533–540. http://dx.doi.org/10.1037/0022-006X.59
.4.533
Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K. (2009). The case
for cultural competency in psychotherapeutic interventions. Annual Re-
view of Psychology, 60, 525–548. http://dx.doi.org/10.1146/annurev
.psych.60.110707.163651
Tervalon, M., & Murray-García, J. (1998). Cultural humility versus cul-
tural competence: A critical distinction in defining physician training
outcomes in multicultural education. Journal of Health Care for the
Poor and Underserved, 9, 117–125. http://dx.doi.org/10.1353/hpu.2010
.0233
Tracey, M. D. (2005). Cultural competence: An ethical must in teaching
and research. Monitor on Psychology, 36, 47.
U.S. Census Bureau. (2012). 2010 Census shows multiple-race population
grew faster than single-race population. Retrieved from https://www
.census.gov/newsroom/releases/archives/race/cb12-182.html
Vance, J. D. (2016). Hillbilly elegy: A memoir of a family and culture in
crisis. New York, NY: Harper.
150 SANDEEN, MOORE, AND SWANDA

Venner, K. L., Feldstein, S. W., & Tafoya, N. (2007). Helping clients
feel welcome: Principles of adapting treatment cross-culturally. Al-
coholism Treatment Quarterly, 25, 11–30. http://dx.doi.org/10.1300/
J020v25n04_02
Venner, K. L., & Verney, S. P. (2015). Motivational interviewing: Reduce
student reluctance and increase engagement in learning multicultural
concepts. Professional Psychology: Research and Practice, 46, 116 –
123. http://dx.doi.org/10.1037/a0038856
Wendt, D. C., & Gone, J. P. (2012). Rethinking cultural competence:
Insights from indigenous community treatment settings. Transcultural
Psychiatry, 49, 206 –222. http://dx.doi.org/10.1177/1363461511425622
Received May 12, 2017
Revision received November 27, 2017
Accepted January 26, 2018 䡲

Members of Underrepresented Groups:

Reviewers for Journal Manuscripts Wanted
If you are interested in reviewing manuscripts for APA journals, the APA Publications and
Communications Board would like to invite your participation. Manuscript reviewers are vital to the
publications process. As a reviewer, you would gain valuable experience in publishing. The P&C
Board is particularly interested in encouraging members of underrepresented groups to participate
more in this process.

If you are interested in reviewing manuscripts, please write APA Journals at Reviewers@apa.org.
Please note the following important points:

• To be selected as a reviewer, you must have published articles in peer-reviewed journals. The
experience of publishing provides a reviewer with the basis for preparing a thorough, objective
review.

• To be selected, it is critical to be a regular reader of the five to six empirical journals that are most
central to the area or journal for which you would like to review. Current knowledge of recently
published research provides a reviewer with the knowledge base to evaluate a new submission
within the context of existing research.

• To select the appropriate reviewers for each manuscript, the editor needs detailed information.
Please include with your letter your vita. In the letter, please identify which APA journal(s) you
are interested in, and describe your area of expertise. Be as specific as possible. For example,
“social psychology” is not sufficient—you would need to specify “social cognition” or “attitude
change” as well.

• Reviewing a manuscript takes time (1– 4 hours per manuscript reviewed). If you are selected to
review a manuscript, be prepared to invest the necessary time to evaluate the manuscript
thoroughly.

APA now has an online video course that provides guidance in reviewing manuscripts. To learn
more about the course and to access the video, visit http://www.apa.org/pubs/authors/review-
manuscript-ce-video.aspx.