Integrating Cultural Humility into the Motivational Interviewing Trainer’s Toolkit

Cultural Humility and Motivational Interviewing
The concept of cultural humility refers to the practice of respecting folks from other backgrounds and identities on their own terms. A culturally humble approach seeks to understand others “in relation to aspects of cultural identity that are most important to the [person]” (Hook, 2013, p. 2). These most important aspects of one’s identity(ies) may not be obvious to others, thus the process of being culturally humble requires of the practitioner a non-judgmental curiosity, deep listening and self awareness among other qualities (Chavez, 2012; Tervalon & Murray-Garcia, 1998).

Understanding and communicating with folks from other cultures, backgrounds and experiences sounds simple, just as the basic OARS skills in motivational interviewing can seem deceptively simple. In fact, many of the qualities needed to practice cultural humility seem to overlap with the skills and methods taught in motivational interviewing (MI). Hofmann notes that an open minded and collaborative approach is at the foundation of cultural humility, and offers the following excerpt that highlights some of the communication skills that cultural humility and MI share:

“[Those who practice cultural humility] use their best communication skills—open-ended questions and reflective listening—to explore their concerns, thoughts, and ideas. They keep ourselves from providing advice or direction as though we were the experts in their lives” (Hohman, 2013).

​Cultural humility and motivational interviewing seem to fit naturally. MI offers skills as a way to “do cultural humility,” and cultural humility offers a context from which to teach and practice these skills (Hohman, 2016). In this article, I will attempt to convey a few ways that I have sought to provide more culturally humble trainings to diverse groups of MI learners (participants).

Cultural Humility in Motivational Interviewing Trainings
 In practice, cultural humility can be challenging to implement and counter intuitive for a trainer. MI trainings often include diverse groups of people from many backgrounds and identities, and many education levels and roles. In order to be effective as an MI trainer or facilitator, I believe cultural humility is one of the most important qualities needed by an MI facilitator, without practicing cultural humility I believe many participants are left out of the training and not given the opportunity to learn the important lessons offered through MI.
 
Cultural humility seems simple but it doesn’t “just happen” through good intentions or through an enlightened perspective. It is my experience that one must intentionally design, plan and implement trainings that are explicitly intended to approach the teaching of MI in a manner consistent with cultural humility.
 
It can often be challenging to tie down lofty theories and broad ideals into the grounded practice. The OARS communication skills and MI Spirit are important practices as we strive to provide trainings in a culturally humble way. In this article I will discus three methods I have used in attempts to facilitate MI trainings in a way that is more culturally humble and inclusive: developing community norms, allowing for individual interpretation, and using group voices in trainings.

Community Norms
Community norms are guiding principles or flexible rules that a group agrees to follow. In the MI training context community norms are important for building group cohesion, trust, and ensuring that the training environment feels safe, inclusive, and is conducive to sharing. I have found that it is helpful for community norms to be easy to understand, simple and concise. By the end of the process of setting community norms, the group is left with a list that represents a shared agreement about how participants will try to communicate and behave during training time.
 
In order to remain consistent with MI, it is important to follow a collaborative and evocative process when establishing these norms. There could be many ways of evoking norms from the group, and it is important that the processes is empowering and encourages the participation of all voices. I typically start by explaining the concept of community norms and providing some examples of norms developed by past groups. I then elicit ideas from the group in a group brainstorm using a white board. If as the facilitator I feel that there are any important norms missing, I will ask permission to add them to the brainstorm. Once the list is completed, I typically offer affirmations to the group for their ideas and participation. I then review the list and ask the participants for any final thoughts or concerns before moving on.
 
Some essential norms that I typically ask the group to consider are:

• Respect differences

• Invite all voices to be heard

• Step out to use a cell phone

• Respect others’ views and perspectives

Allow for Individual Interpretation
 During one of my MI skills groups composed of participants who represented several nationalities, I used an “ice breaker” activity that included the prompt “describe your favorite animal.” I had used this icebreaker many times successfully and I love talking about my cuddly pit bull. When I led the activity with this group I noticed some participants making some quizzical facial expressions showing confusion and discomfort. It was then that I realized that some of the participants might not have relationships with any animals. In fact, this whole icebreaker seemed to come across as a US-centric scheme to indoctrinate participants into loving rescue dogs!
 
Using this feedback from the participants, I made a slight shift in the prompt so that it read “please tell your partner about an experience you had with an animal. It could be a good experience, a bad experience or maybe you have never had an experience at all and that is OK too. Share this with your partner.” After that prompt, I could see looks of comfort and ease. The icebreaker went well and I heard conversations about dangerous snakes, animals as food and feral dogs running the streets of neighborhoods.
 
My suggestion here is that a facilitator be prepared to be flexible with activities and trainings to allow for individual interpretation based on their experiences and culture. Facilitators and trainers put a lot of time into planning and rehearsing trainings and in our passion for the activity we sometimes forget the importance of what we are doing; we sometimes mistake the pointing finger for the actual thing the finger is pointing at. In my case, I risked excluding a subsection of my training group based on their non-US interpretation of relationships with dogs. By seeking and recognizing participant responses, I was able to adjust the activity to be inclusive of every person in the group.

Use Group Voices
 There are many ways in which it can be challenging for a training facilitator to get their desired material across to an audience. The pace, tone of voice or language used by the facilitator may impede participant learning. The visual presentation or body language of the facilitator could distract the participants. The metaphors and references used by the facilitator can sometimes act as barriers to learning. Sometimes, even the facilitator’s social identify, role or other attributes can create challenges in engaging the participants.
 
One technique that I have employed when I am having a hard time communicating with a few members of the group is to rely on others in the group to help. Often participants have shared identities. Participants may feel very different from the facilitator but more similar to other learners.  Participants can help by translating concepts for other group members, this translation may be a literal translation of a language or cultural intricacy. Or the translation could be a fellow participant sharing a personal story of how a concept fits into their lives.
 
In my experience I have noticed that meta communication or “talking about talking” can sometimes be challenging for participants who have not engaged in this type of talk before. It can quickly get confusing as the facilitator switches between talking about content, talking about talking and then maybe even talking as a client (role/real playing). Depending on the experiences and background of participants this can throw a participate into a confusing daze, especially if the facilitator does not speak their 1st language. 

There are many ways to rely on group voices. A facilitator my explicitly request that group members share stories, examples or thoughts on a certain topic in full group. The facilitator could form smaller discussion groups to educate each other on the concepts. Sometimes it can help for the facilitator to ask the group to teach the facilitator about their culture, background or experiences.

One recent example that comes to mind in this area occurred with a participant who was not grasping the concept of a reflection. When asked to give a reflection, this participant continually gave commanding or educational statements. For example if I said “I am not sure that I want to do my homework tonight, I have better things to do,” the participants response would be, “do your homework.” At first I attempted to explain the concept of reflections, then I modeled how to do a reflection and then I became frustrated. It was only after I asked for help from the group.  Other group members were able to explain the concept of a reflection in a different way from a place of compassion and humor and the participant learned the concept in less than 5 minutes (after I had spent much longer in my attempts).

​There are many more methods or practices that MI trainers can use to become more culturally humble during a training, and I hope to address some of my other ideas regarding this in future articles. 

Works Cited

Chavez, V. [Vivian Chavez]. (2012, August). Cultural Humility: People, Principles and Practices [Video File]. Retrieved From: https://www.youtube.com/watch?v=SaSHLbS1V4w
 
Hohman, M. (2013). Cultural Humility: A Lifelong Practice. SDSU School of Social Work Blog. Retrieved on 1/16/16 from: http://socialwork.sdsu.edu/insitu/diversity/cultural-humility-a-lifelong-practice/
 
Hohman, M. (2016, January 3rd). Phone Interview.
 
Hook, J.N., Davis, D.E., Owen, J., Worthington, E.L. & Utsey, S.O. (2013). Cultural Humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology. Vol 60(3), Jul 2013, 353-366.
 
Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: a critical distinction in defining physician training outcomes in multicultural education. Journal of Healthcare for the Poor and Underserved,9(2), pp. 177-129.