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Massage Today
June, 2012, Vol. 12, Issue 06

Become a Culturally Competent Practitioner

By Ann Catlin, LMT, NCTMB, OTR

Decades ago I was an occupational therapy intern at a hospital in Iowa. One day, my supervisor called a meeting where she told her staff about a new patient — not something that typically triggered a meeting.

But, this was not a typical patient! He was the elder of a gypsy family. The hospital was making preparations to accommodate what tradition dictated in gypsy culture.

The entire extended family would stay on the premises during the elder's hospitalization. I'm no expert in gypsy culture but that's not the point here. Looking back, I admire the way the hospital handled the situation. For days this family stayed in campers in the parking lot and there were several family members in the hospital room night and day. I remember being fascinated by all this even though I didn't understand it. I'm glad the hospital set such a good example and honored the needs of this patient while demonstrating cultural sensitivity.

As the population of the United States becomes increasingly ethnically blended, health care practitioners are being called upon to care for people from diverse cultures. This is especially true in hospitals and medical clinics but also in long term care, rehabilitation hospitals, hospice and home care. Since more massage therapists are working in these settings, it's important to explore how to approach a multicultural clientele with sensitivity while respecting cultural differences of individuals, families and groups.

Culturally Competent Practitioner - Copyright – Stock Photo / Register Mark Developing Cultural Competence

In the context of health care, cultural competence is simply the ability to relate to and provide services for people from cultures and traditions other than one's own. Lots of things make up a person's culture and world view. Ethnicity, family heritage, spiritual tradition, beliefs about illness and wellbeing, views of death and dying, food beliefs, family structure, language and non-verbal communication, and attitudes about touch are a few such influences. What follows are tactics to become a more culturally competent and sensitive healthcare practitioner in our diverse society.

  1. Experts in the fields of transcultural nursing, as well as professional chaplains, suggest exploring your personal cultural identity. The idea here is that your own cultural influences determine how you think and behave towards others socially and in the workplace. Identifying your social roles, spiritual self-knowledge, cultural heritage, personal habits and attitudes, and how you relate to various groups of people in society expands perspective and self-awareness.

  2. Identify the cultural mix in your own community. The cultural tapestry of Miami is different than in San Francisco or Des Moines or the Appalachian mountains. What shapes the tapestry where you live?

  3. Generalize, rather than stereotype. Stereotyping is applying a belief or attitude to everyone in a cultural group. For example, saying that, "all Hispanics do this" or, "all Chinese think that." We are all individuals. To generalize is to have a basic understanding about a culture and use that knowledge as a starting point to learn more about a person, family or group. You don't have to be an expert about cultures to become more culturally sensitive and competent but gathering accurate basic information is a good start.

  4. Be curious and ask questions. Suppose you have a client in a hospital or elder care facility and you don't know if there are cultural considerations that would impact your plan of care or relationship with this client. I suggest first asking the client's social worker to share any information they may have. The client's chaplain may be a good resource as well. In hospice settings, the interdisciplinary team is your best resource. You can also respectfully ask your client or their family to share relevant information with you. If there is something you don't understand, ask!

  5. Practice authentic listening. Listen to your client with your ears, eyes, heart and mind. Authentic listening is paying attention in the moment while gathering information that can guide right action.

  6. Be sensitive to cultural rules regarding touch. While researching information for this article, I found the following examples in a booklet called Cultural and Spiritual Sensitivity: A Quick Guide to Cultures and Spiritual Traditions by certified chaplains Sue Wintz and Earl P. Cooper. I present them here only as examples to raise awareness. Remember, everyone is unique:
    • Americans often feel uncomfortable when someone stands less than three feet away from them, while most people from the Middle East need to stand almost nose to nose with the person to whom they are speaking.
    • Traditional Koreans believe that the soul rests in the head and may become uncomfortable, even fearful if a provider or staff member pats their child on the head or ruffles his or her hair.
    • In Chinese cultures, use of first name could be considered disrespectful. He or she may not complain about pain so be aware of non-verbal clues.
    • Address Hispanic individuals formally, especially elders. Handshaking is considered a polite greeting. Hispanics have a holistic understanding of emotional, spiritual, social and physical factors that affect an illness. Illness is seen as a crisis for the entire family because Hispanic culture is very family oriented.

Since massage therapy fosters a holistic approach, factoring in the needs of people from a range of cultures seems logical. With greater opportunities to serve clients in medical settings, you can be an example of cultural competence to other healthcare practitioners while at the same time providing excellent service for your client.


  1. Leninger, M. (2005) Culture Care Diversity and Universality, Jones and Bartlett Publishers, Sudbury, MA
  2. Wintz, S. and Cooper, E., Cultural and Spiritual Sensitivity: A Quick Guide to Cultures and Spiritual Traditions, Association of Professional Chaplains, Schaumburg, IL.
  3. Galanti, G., An introduction to cultural differences. Western Journal of Medicine, 2000 May; 172(5).

Click here for previous articles by Ann Catlin, LMT, NCTMB, OTR.


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