In entering this section of the training program, we need to begin with a definition. What is culture? From there we will begin to look at what culture is made of, and how it works. This will prepare us for examining how decisions are made when working with different cultures.

Below you will find a very well respected definition of culture.

“Culture: A pattern of basic assumptions – invented, discovered, or developed by a group as it learns to cope with its problems of external adaptation and internal integration – that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to these problems.” (26)

The job of a culture is to create shared purposes and meanings, thereby reducing internal conflict and tensions so that energies may be directed towards adapting to external challenges. This allows the culture to be more adaptive, since energy is not lost through constantly needing to resolve internal conflicts within the culture.

Culture is often thought of having the following common elements:

- Perceptions
- Beliefs and assumptions
- Values and attitudes
- Myths and stories
- Heroes (and villains)
- Artifacts, symbols and rituals
- Rules and norms (4)

The different elements of the culture work in mutually supportive ways to bind people together in their shared purposes. Each of the elements requires that something be given up by the members of the culture - in exchange for what the culture provides in terms of security, affiliation, shared meaning and purpose.

For example, cultures may ask its members to have only certain perceptions and beliefs about the world (and the culture). Some ways to perceive the culture and the external world are championed, while others are attacked. Within some cultures, members may even at times be asked to hold on to perceptions and beliefs about the world or the culture in ways that do not align with reality.

If the dissonance between the cultural beliefs / perceptions and reality creates too much distress, then the culture will need to find ways to adapt – either by trying to alter the reality or by realigning the cultural perceptions and beliefs.

There are cultures that are strong and durable, and cultures that are less strong and durable. Stronger cultures tend to resist being absorbed or changed by competing cultural material. They do this in either of two ways. They find ways to provide to their members meaning, purpose, and methods of organizing that allow for successful adaptation to externally imposed challenges. Or they become disconnected from the larger world, isolated and cult-like.

Generally speaking, a strong culture is one that (a) is internally consistent, (b) is widely shared, and (c) makes it clear what appropriate behavior is. (29) A strong culture has a compelling vision that everyone understands and to which everyone responds in a generally positive way. There is security in a strong culture, because the world is explained in ways that provide comfort, meaning and purpose.

There are also open cultures and closed cultures. Closed cultures tend to resist changes in the core framework of the culture, while open cultures tend to incorporate changes in the cultural framework more easily. (10)

The shared perceptions and beliefs create cognitive frameworks through which members of the culture will be able to see the world and the culture in a commonly understood way that reduces conflict. The myths and heroes support this by presenting models of ways to behave - in accordance with those shared perceptions and beliefs.

With people working quickly and readily together, culture can act as a hidden mechanism of coordination: everybody works in a synchronized manner because they understand what the goals are and the coordinated process for getting to those goals. The culture provides reinforcement for this process through a sense of affiliation, positive feedback for compliance with the demands of the culture, and diminishment of uncertainty through a defined sense of meaning and purpose.

Strong cultures also have deeply held and widely shared values that provide powerful items of value to the people that hold them. Whereas perceptions and beliefs are largely cognitive in nature, values are deeply held cognitive and emotional constructs that 1) help people define themselves, their lives and their actions, 2) provide positive emotional support for adhering to the cultural beliefs, and 3) provide limits and sanctions for any aberrant behavior that might create conflict and the breakdown of group cohesion.

Values are perceptions and beliefs combined with powerful feelings about how the world is supposed to work and how people are supposed to behave in their relationship with the world. Any situation in which a value is involved is one in which there is a lot of information with complex practical and emotional implications.

Values are tremendously important for people in terms of making complicated decisions quickly. Without values, each person in each complicated situation would have to re-evaluate everything about the situation and its potential effects and outcomes. The amount of cognitive and emotional work in this would be paralyzing. Values organize important information in a sort of shorthand form that allows for integrated and self-consistent decision making.

Through this organizing aspect, values also become a kind of glue that holds together esteem, identity, and self-image when the values are reinforced and supported, and the dynamite that threatens the cultural cohesion of an individual or a group when those values are challenged. Values, at a very deep level, define the meaning of things - including oneself and one's life.

While the ability to have values is very useful in terms of forming a strong and consistent view of the world, values do have certain adaptive shortcomings. First, as we have noted, values are emotional as well as cognitive constructs.

A person's emotional need to view things in a certain way can make it difficult to re-arrange his/her values - even when it may be more adaptive to do so. When new information comes along that suggests the need to re-arrange one's values, it may be experienced as a burden or a hardship for the person who must do the re-arranging.

A great deal of resistance in treatment can come from this difficulty in re-arranging values (for clinicians, as well as for clients!). People can view the necessity to re-arrange values as very threatening. They will resist their necessary adaptive work.

On the other hand, if the values that people are resisting have to do with feeling forced to assimilate into White middle-class American ideals, the resistance may ultimately be considered to be appropriate. It is the clinician who must adapt the work of therapy in such instances, or perhaps it is the culture as a whole that must adapt.

People do not like to have their values threatened, and will therefore look for ways to reinforce and strengthen their values. They do this by encouraging others to adopt their values, by forming alliances with others who share their values, and by pressuring and challenging other people who do not share their values, sometimes resorting to force or violence.

When such groups are highly organized, they may also write laws to codify their values and thereby attempt to require or force others to honor their values. The dominant culture in our – and every other - society has been engaged in this process over the course of its history. The laws on the books at each point in time are a reflection of the values of the people in the strongest position to shape law.

This is to say that the laws may include certain ideals (the cognitive side of values) that try to balance the interests of the diverse groups of people who will live under the rule of those laws. However, the laws will also probably include elements designed to make the dominant group more emotionally comfortable - by reflecting those values that are most emotionally important to the people who have the power to shape the law.

This is at the heart of the dilemma facing the culturally competent clinician in situations where there are ethical decisions to be made with parties from non-dominant cultures. In order to protect the well-being of the client, there will be a relatively constant need to investigate and evaluate a wide variety of value elements thrust into the clinical relationship.

As he/she tries to bring the best information forward about techniques and approaches to further the well-being of the client, the expert clinician must work to keep this information free from cultural or value bias put forth - sometimes with great pressure - by parties who are threatened by interpretations of the information that do not conform to their agendas or values.

There are many areas in clinical treatment in which these complex values questions play out in difficult ways. The treatment of issues related to sexual identity and sexual orientation is an arena that cannot be discussed without generating conflict from groups with competing and conflicting value positions that generate enormous political energy.

Questions of the role of spirituality in clinical treatment are given meaning and power by values issues. The rights of clients to choose the time of their own death raises questions that test the values of the society as a whole.

Information and ideas that are involved in shaping the course of clinical treatment play out against this highly charged backdrop - in which various groups apply pressure to promote their perceptions and values.

The clinician's leadership position necessarily puts him/her at the vortex of this particular storm. He/she is placed in the position of needing to sort through all of the facts and all of the values - factoring in whatever value biases might be present - to see if he/she can find the right mission.

At the same time, the clinician must also sort out his/her own value biases, and take great care not to impose those value biases on clients who may come from a different cultural context. The clinician's job, after all, is to improve the client's well-being as much as possible within the client's own cultural context and value system. This idea is contained within the concept of client autonomy.

Yet there may also be situations in which the problems for which the client is seeking help are - to some extent - caused by the interaction between their values and the evolving cultural context in which they reside. Sometimes it may even be the cultural elements that create the problems from which the client suffers. In such instances, to ignore examination of the values means to be unable to help the client.

This aspect of ethical decision making may appear to be quite abstract or esoteric. It is, however, very real, and at the heart of some of the thorniest ethical dilemmas. The clinician, in his/her leadership role, is almost asked to play God in picking and choosing which value elements to forward and which to submerge.

There are ways to approach these complex decisions, if not to fully resolve them. Later in this course, we present some ideas of how to resolve some of the complex value conflicts that arise in ethical decision making when diverse value systems are in play.

Right now, however, we are going to turn to an examination of some of the understandings about cultural composition that have been developed in the literature. This will help us understand not only the biases of our own culture, but some of the ways that different cultures approach important value questions.

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