Participatory Medicine is a model of cooperative health care that seeks to achieve active involvement by patients, professionals, caregivers, and others across the continuum of care on all issues related to an individual's health. It is possible to develop a 3 (Characteristics) x 3 (Dimensions) matrix in which most of the cross-cultural skills can either be organized or developed. Culturally skilled counselors have moved from being culturally unaware to being aware and sensitive to their own cultural heritage and to valuing and respecting differences. Culturally skilled counselors are aware of how their own cultural background and experiences, attitudes, and values and biases influence psychological processes. Culturally skilled counselors are able to recognize the limits of their competencies and expertise.
Culturally skilled counselors are comfortable with differences that exist between themselves and clients in terms of race, ethnicity, culture, and beliefs. Culturally skilled counselors have specific knowledge about their own racial and cultural heritage and how it personally and professionally affects their definitions and biases of normality-abnormality and the process of counseling. Culturally skilled counselors possess knowledge and understanding about how oppression, racism, discrimination, and stereotyping affect them personally and in their work. Culturally skilled counselors possess knowledge about their social impact upon others. Culturally skilled counselors seek out educational, consultative, and training experiences to enrich their understanding and effectiveness in working with culturally different populations. Culturally skilled counselors are constantly seeking to understand themselves as racial and cultural beings and are actively seeking a nonracist identity.
Culturally skilled counselors are aware of their negative emotional reactions toward other racial and ethnic groups that may prove detrimental to their clients in counseling.
Culturally skilled counselors are aware of their stereotypes and preconceived notions that they may hold toward other racial and ethnic minority groups.
Culturally skilled counselors possess specific knowledge and information about the particular group that they are working with. Culturally skilled counselors understand how race, culture, ethnicity, and so forth may affect personality formation, vocational choices. Culturally skilled counselors understand and have knowledge about sociopolitical influences that impinge upon the life of racial and ethnic minorities.
Culturally skilled counselors should familiarize themselves with relevant research and the latest findings regarding mental health and mental disorders of various ethnic and racial groups. Culturally skilled counselors become actively involved with minority individuals outside the counseling setting (community events, social and political functions, celebrations, friendships, neighborhood groups, and so forth) so that their perspective of minorities is more than an academic or helping exercise.
Culturally skilled counselors respect indigenous helping practices and respect minority community intrinsic help-giving networks.

Culturally skilled counselors value bilingualism and do not view another language as an impediment to counseling (monolingualism may be the culprit). Culturally skilled counselors have a clear and explicit knowledge and understanding of the generic characteristics of counseling and therapy (culture bound, class bound, and monolingual) and how they may clash with the cultural values of various minority groups.
Culturally skilled counselors are aware of institutional barriers that prevent minorities from using mental health services. Culturally skilled counselors have knowledge of the potential bias in assessment instruments and use procedures and interpret findings keeping in mind the cultural and linguistic characteristics of the clients. Culturally skilled counselors have knowledge of minority family structures, hierarchies, values, and beliefs. Culturally skilled counselors should be aware of relevant discriminatory practices at the social and community level that may be affecting the psychological welfare of the population being served.
Culturally skilled counselors are able to engage in a variety of verbal and nonverbal helping responses.
Culturally skilled counselors are able to exercise institutional intervention skills on behalf of their clients. Culturally skilled counselors are not averse to seeking consultation with traditional healers or religious and spiritual leaders and practitioners in the treatment of culturally different clients when appropriate. Culturally skilled counselors take responsibility for interacting in the language requested by the client; this may mean appropriate referral to outside resources. Culturally skilled counselors have training and expertise in the use of traditional assessment and testing instruments. Culturally skilled counselors should attend to as well as work to eliminate biases, prejudices, and discriminatory practices.
Culturally skilled counselors take responsibility in educating their clients to the processes of psychological intervention, such as goals, expectations, legal rights, and the counselor's orientation. We believe that these cross-cultural competencies represent AMCD's first formal attempt to define the attributes of a culturally skilled counselor. According to Kocet, what is the first attitude and belief a counselor should have in order to develop appropriate cross-cultural intervention strategies and techniques? Now that I am at the end of my career it is often difficult to walk away with any new information. Participatory medicine is an ethical approach to care that also holds promise to improve outcomes, reduce medical errors, increase patient satisfaction and improve the cost of care. They are knowledgeable about communication style differences, how their style may clash or facilitate the counseling process with minority clients, and how to anticipate the impact it may have on others. Being able to recognize the limits of their competencies, they (a) seek consultation, 03) seek further training or education, (c) refer out to more qualified individuals or resources, or (d) engage in a combination of these.

They are willing to contrast their own beliefs and attitudes with those of their culturally different clients in a nonjudgmental fashion.
They are aware of the life experiences, cultural heritage, and historical background of their culturally different clients. They should actively seek out educational experiences that enrich their knowledge, understanding, and cross-cultural skills. They are knowledgeable about the community characteristics and the resources in the community as well as the family. They are able to send and receive both verbal and nonverbal messages accurately and appropriately. A serious problem arises when the linguistic skills of the counselor do not match the language of the client. They not only understand the technical aspects of the instruments but are also aware of the cultural limitations.
They should be cognizant of sociopolitical contexts in conducting evaluations and providing interventions, and should develop sensitivity to issues of oppression, sexism, and racism.
This course made me think about cross cultural and same culture issues in therapy and supervision. Although this standard applies to all groups, for White counselors it may mean that they understand how they may have directly or indirectly benefitted from individual, institutional, and cultural racism (White identity development models). They are not tied down to only one method or approach to helping but recognize that helping styles and approaches may be culture bound.
This being the case, counselors should (a) seek a translator with cultural knowledge and appropriate professional background or (b) refer to a knowledgeable and competent bilingual counselor. When they sense that their helping style is limited and potentially inappropriate, they can anticipate and ameliorate its negative impact.
We propose these competencies in the spirit of open inquiry and hope they eventually will be adopted into the counseling standards of the profession. Jessie was a founding editor of JoPM and continues to have a positive impact on the field of participatory medicine and the cause of patient empowerment.

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