‘Over and over again it has been necessary to learn the lesson that the observer influences the observed. In the field of mental health, we have not only to reckon with the natural effect of the observers’ own bias but we also have to deal with a second variable: the effect of this bias on the patient.’
(Jackson, 1960: pp. 5–6)Intercultural work has converted into a daily reality the challenges of demographic change taking place all over the world (International Organization for Migration, 2012). Professionals who work in intercultural contexts are inevitably affected by the experiences and perceptions of patients from different cultures, and this can place a strain on their professional role (Smedley et al, 2002; Qureshi & Collazos, 2005; de Leon Siantz, 2008; Engebretson et al, 2008; Clark, 2009; Blume & Lovato, 2010). Mental healthcare professionals continue to raise questions about the sort of knowledge and skills base that contribute most to effective and sensitive intercultural work (Cunningham et al, 2002; Kumagai & Lypson, 2009; Ben-Ari & Strier, 2010; Mian et al, 2010):
• What sorts of adjustments should one make to meet the needs of a patient from a different culture?
• Beyond linguistic difficulties, manageable with the participation of a medical interpreter or intercultural mediator (see Chapter 11, this volume), what should the clinician keep in mind in order to adequately attend to the patient?
• How can cultural knowledge be applied effectively rather than get in the way?
• What abilities is it most useful to develop?
• Can they be applied to all patients from the same ethnic group?
• Which attitudes facilitate the creation of a therapeutic space and effectiveness in intercultural work? Should the clinician directly raise the matter of clinician–patient differences (race, ethnicity, etc.), or is it better to wait for the patient to take the initiative?
• How can clinicians develop their cultural competence without losing their personal professional style, which is founded on their own professional and cultural background?
Many institutions have published position statements, teaching materials and literature promoting cultural competence.