If you ever need a demonstration of the importance of cultural competence, just imagine yourself in psychotherapy in a country that doesn’t celebrate Groundhog Day. You are spending your first winter in a tropical country in Asia and, in the waning days of January, your thoughts turn to friends and family back home. You think of your snowbound grandmother and how important it is for her to get to Savannah for the country’s biggest Saint Patrick’s Day parade on March 17. With an early spring, she will have just enough time to crank up her Model A Ford and make the long drive from Pennsylvania to Georgia. If winter hangs on much longer, the roads will be impassable and she will be stuck at home long after the last leprechaun stumbles back to his hotel through the confetti in Forsyth Park. Grandma’s fate depends on one thing and one thing alone. Punxutawney Phil must not under any circumstances see his shadow on Feb. 2.
If the very thought of this scenario sends chills of anxiety down your spine, you can easily imagine why you would run to the nearest therapist for help. As a psychologist yourself, you would expect to find someone with impeccable professional qualifications and a kind, compassionate, reassuring manner. But remember, you are not in New England or even the United States. You are in a tropical Asian country where the chances are slim that the typical resident, including your therapist, would have the slightest idea of who Punxatawney Phil might be. In the domain of cultural competence, we must remember that the therapist from a culture different from our own cannot be expected to know all of the customs and traditions that we hold dear. So don’t be surprised at the quizzical arch of your therapist’s eyebrows and the questioning tone of his voice when he responds with just two words, “Punxutawney Phil?”
Patiently you explain that Phil is a groundhog who lives in Punxutawney, Penn. Every year on Feb. 2, tuxedo-clad men extract Phil from his burrow and hold him up in front of a crowd of onlookers who drive hundreds of miles to see what happens next. Phil lifts his head, sniffs the air, and looks around from his lofty perch on a stage high above the audience. One of Phil’s handlers inclines his ear to Phil’s snout and then straightens up to relay the groundhog’s message. If Phil reports that he saw his shadow, which he does about ninety-eight percent of the time, then everyone knows he is back to some serious hibernating and we are in for an extended winter. Grandma might as well forget about driving to Savannah for St. Patrick’s Day. However, if Phil says that he did not see his shadow, then we can expect an early spring and Grandma can start making her travel plans.
Having explained yourself as clearly as possible to your culturally competent therapist, you are ready for a heartfelt expression of empathy, but you get only one word, “groundhog?” There are no groundhogs in Asia. So you explain further using phrases like “big furry rodent.” You notice a dollhouse in the corner of the office together with box of Legos, a few hand puppets and some toy cars. Your finely honed powers of observation and deduction tell you that your therapist sees children as well as adults, so you ask for a sheet of paper and a crayon. You begin to draw a groundhog and soon wonder if you have taken on more than you can handle. Your groundhog looks like a cartoon version of a mongoose but it’s the best you can do and your therapist finally nods in recognition. There are plenty of mongooses in Asia.
Finally you have laid the groundwork to explain the source of your anxiety. With only a few days left until Feb. 2, you are consumed with worry that your grandmother might not get the news she is hoping for from Phil. You know how important the St. Patrick’s Day parade in Savannah is to her and cannot bear to see her disappointed. You look expectantly into the compassionate face of your therapist and notice the beginning of the increasingly familiar eyebrow arch. This time he replies with three words in the same questioning tone, “St. Patrick’s Day?” St. Patrick, you hasten to explain, chased the snakes out of Ireland.
Now there is only silence. You are sure that you have failed to make yourself understood. Suddenly you remember that time when you tried to explain Groundhog Day to a colleague back home who had recently immigrated from Asia. What kind of country is this, she asked, that has a holiday to honor a rodent? Her question made you laugh. Years later you were sitting with a depressed man who felt a bit better when one of his own traditional holidays came around. Because you aspire to cultural competence, you asked about the customs associated with this special day. That year it coincided with Groundhog Day. Because you know what a silly holiday it is and how much he needed a lift, you told him about it and he smiled.
You lift your eyes to meet your therapist’s warm gaze and notice that you are both laughing.
By Alan Bodnar Ph.D.