In their 1998 article, Tervalon and Murray-Garcia defined cultural humility as a commitment to which three things?
Choose an answer, then check it.
Social Work & Human Services · Social Context
Cultural Humility
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Cultural humility An orientation to practice built on three ongoing commitments: lifelong self-evaluation and self-critique, redressing power imbalances in the practitioner-client relationship, and non-paternalistic partnership with communities. Full entry → is a stance, not a credential. Melanie Tervalon and Jann Murray-Garcia proposed it in 1998 as a training outcome: a lifelong commitment to self-evaluation and Self-critique Deliberate, repeated examination of one's own assumptions, reactions and social position, treated as an ongoing professional task rather than a private mood or a one-off exercise. Full entry →, to redressing power imbalances in the practitioner-client relationship, and to building mutually beneficial, non-paternalistic partnerships with communities. It asks you to be a learner about this person's life rather than an expert on their group. Knowing about the communities you serve still matters. Humility is what keeps that knowledge from hardening into assumption.
Why this matters
Human-service work runs on interpretation. You hear a story, decide what it means, and act - and every one of those steps passes through your own norms. When the person in front of you does not share them, the risk is that your reading gets written down as fact and follows them through a system. Cultural humility names the discipline that catches this: asking rather than assuming, checking your interpretation, noticing when your own standards are doing the judging. Social work's ethical code now names it directly, and U.S. organizations face structural expectations through the National CLAS Standards Fifteen action steps issued by the U.S. Office of Minority Health setting out what health and human-service organizations should do to make services culturally and linguistically appropriate. Full entry →. Courses use the concept to connect what happens in one conversation to the organizational and policy questions you meet again in ethics, case management and advocacy.
The college version
Where the idea came from
Melanie Tervalon and Jann Murray-Garcia published the article that named cultural humility in the Journal of Health Care for the Poor and Underserved in May 1998, volume 9, issue 2, pages 117 to 125. They were writing into a specific argument: medical schools were being told to graduate culturally competent physicians, and nobody could say what that meant or how to know when a trainee had it. Their objection was to the word competence as clinical training normally uses it: an easily demonstrable mastery of a finite body of knowledge, measured by the kind of before-and-after testing that works for pharmacology. Applied to people and their cultures, that framing puts a finish line where there is none. They proposed a different training outcome and defined it as three commitments held for the length of a career. The first is a lifelong commitment to self-evaluation and self-critique. The second is a commitment to redressing the power imbalances in the patient-physician relationship. The third is a commitment to developing mutually beneficial and non-paternalistic partnerships with communities, on behalf of individuals and of defined populations. The article was written about physician training. Social work, nursing, counseling, and human services adopted the idea later, and the 2021 revision of the NASW Code of Ethics names cultural humility directly inside its standard on Cultural competence A family of frameworks that treat knowledge about other groups' beliefs, values and behaviors, plus the skills to work across difference, as something a practitioner or organization can acquire and demonstrate. Full entry →.
Why they thought competence was the wrong finish line
The article makes its case with a case. A patient was moaning after surgery; a consulting physician remarked that she appeared to be in a great deal of pain; the nurse caring for her dismissed the observation, explaining that she had taken a course on cross-cultural medicine and knew that patients of that background overstate what they feel. Tervalon and Murray-Garcia read this as stereotyping the patient's experience and ignoring the evidence in front of the nurse, and they say plainly that equating cultural competence with having completed a past series of trainings is an inadequate and potentially harmful model of professional development. The mechanism worth learning here is that knowledge about a group, once it feels complete, stops functioning as knowledge and starts functioning as a prediction. Helen-Maria Lekas and colleagues, writing in 2020, push the argument further: they hold that a static, totalizing account of a group's beliefs simply is a stereotype, and they recommend dropping the term competence altogether. That is their position, and it is contested. Other conceptual literature treats cultural humility and the related idea of cultural safety as critiques of cultural competence, and sometimes as its foundation, rather than as a replacement for it. In most current practice writing the two vocabularies appear side by side. What is not in dispute is the direction of the correction: from an endpoint to a process.
The practitioner as learner
The practical core of the 1998 article is a role reversal. Humility, the authors write, is a prerequisite for a process in which the practitioner gives up the role of expert and becomes the student of the person in front of them, while making clear that this person is a capable and full partner in the work. The interviewing style that goes with it is less controlling and less authoritative, and it signals that the practitioner values what the person came in wanting to talk about. The authors point out the consequence that makes this practical rather than merely virtuous: if the person can actually tell their own story, the practitioner no longer needs to have mastered every group's health beliefs in advance, because the person conveys how much culture has to do with this particular encounter. Sometimes the answer is a great deal. Sometimes it is nothing at all, and the presenting problem is a landlord. Four behaviors carry this in day-to-day work. Ask instead of assuming. Say your interpretation back and let it be corrected. Notice the moment when your own norms are doing the judging, which usually announces itself as mild irritation or as the word noncompliant forming in your head. And repair when you get it wrong: name it, correct the record, and change what you do next. The repair matters more than the error, because it is what tells the person that correcting you is safe.
Why group descriptions fail: intersectionality
Even a well-researched profile of a group is the wrong shape for a person. Kimberle Crenshaw introduced the term Intersectionality The idea, introduced by Kimberle Crenshaw in 1989, that social positions such as race, class, gender, disability and sexuality shape one another at once, so a person's experience cannot be read off any single category. Full entry → in Demarginalizing the Intersection of Race and Sex, published in the University of Chicago Legal Forum in 1989, arguing that a framework which analyzes one category at a time cannot see the people who sit at the crossing of several. Health and human-service scholarship has taken the point up directly: Rajvinder Samra and Olena Hankivsky describe intersectionality as the way race, class, gender, disability and sexuality intersect to shape each other inside structures of power, and argue that experiences of marginalization cannot be dissected one social category at a time and that no group is internally uniform. Tervalon and Murray-Garcia made a version of the same observation, citing Ridley's description of a patient who is at once a Mexican American, a father, a Catholic, a mechanic, a night-school student and a resident of one neighborhood, and noting that only he can explain how those memberships intersect for him. Lekas and colleagues name the failure mode this creates: if a practitioner assumes that one status is the master status, they essentialize the person and discount what the person actually says. This is the practical argument against the culture checklist. Any list of group traits is a single-axis description, and people are not single-axis.
Power, and why it is on the list
The second commitment is the one most often dropped in summaries, and it is what makes cultural humility more than good manners. The 1998 article argues that trainees must be woken to the position of power practitioners hold over the people they serve, particularly people who are poor, and taught to identify and remedy the misuse of that imbalance when priorities are set. In human services the imbalance is concrete rather than abstract: the practitioner writes the record, controls the referral, holds the assessment that determines eligibility, and in some settings holds far more than that. A person who suspects that disagreeing will cost them something will not disagree. That is why the invitation to correct you has to be issued deliberately and repeatedly, and why it has to be followed by visible change when it is taken up. Lekas and colleagues make the sharp version of the point about training: a practitioner who leaves a workshop feeling more confident and more competent may have become harder to correct, which widens the very gap the training was meant to close. Confidence and accuracy are different quantities, and only one of them is usually measured.
The structural expression: the CLAS standards
In the United States, the organizational form of these concerns is the National Standards for Culturally and Linguistically Appropriate Services, issued by the Office of Minority Health at the Department of Health and Human Services. There are fifteen. The Principal Standard requires effective, understandable and respectful quality care and services that respond to cultural health beliefs and practices, languages, health literacy and other communication needs. The remaining fourteen fall under three themes: governance, leadership and workforce; communication and Language assistance Interpretation and translation services that let someone who does not share the provider's language take part in their own care; under the CLAS standards these are offered at no cost to the person. Full entry →; and engagement, continuous improvement and accountability. Two of them read almost as translations of the third Tervalon and Murray-Garcia commitment into administrative language: Standard 12 calls for regular assessment of community health assets and needs, and Standard 13 calls for partnering with the community to design, implement and evaluate services. The standards are addressed to organizations, not to individual conscience, which matters because the 1998 article had already argued that self-critique has to happen at the institutional level too. Its authors asked what an institution's faculty actually looks like, what institutional processes contradict what is taught, and whether an organization that instructs staff not to use children as translators in fact supplies an alternative.
Interpreters as a concrete competence question
Language access is where the pairing stops being abstract. CLAS Standard 5 calls for language assistance to be offered at no cost to the person, Standard 6 for telling people it exists, and Standard 7 for ensuring the competence of whoever provides it through training and certification where available, while recognizing that the use of untrained individuals and of minors as interpreters should be avoided and discouraged. The empirical picture points the same way: Leah Karliner and colleagues, reviewing twenty-eight studies in 2007, found that professional interpreter use was associated with better care than ad hoc interpreter use across communication errors and comprehension, service use, clinical outcomes and satisfaction. That is an association from observational studies rather than a controlled demonstration, but the direction is consistent. The National Council on Interpreting in Health Care publishes thirty-two standards of practice under nine headings, and three of them shape what you do in the room: interpreters render everything that is said and tell both parties so, they promote direct communication and may ask the parties to address each other rather than the interpreter, and they limit their work to interpreting, redirecting questions rather than answering them. So you speak to the person, not about them; you allow the extra time; and you do not ask the interpreter what people from that country usually think.
What the evidence does and does not show
Be careful here, because this is where the literature is thinnest and the enthusiasm is highest. Cultural humility is measured mainly by instruments: practitioner self-report scales, and client-report scales in which the person receiving services rates the practitioner. The best-known of the second kind comes from Joshua Hook and colleagues in 2013, who defined cultural humility as an other-oriented rather than self-focused interpersonal stance marked by respect and an absence of superiority, built a client-rated measure across four studies, and found that clients' perceptions of their therapist's cultural humility were positively associated with a strong working alliance and with improvement in therapy, with the alliance mediating the relationship. That is a real finding and it is correlational. Beyond it, the outcome literature is young. Lekas and colleagues observe that most cultural humility work remains theoretical and call for clearer conceptualization and measurement. A 2025 scoping review by Mayio Konidaris and Melissa Petrakis reports discrepancies in how the concept is defined across the literature, notes that cultural competence itself lacks agreed definitions, did not assess the quality of the sources it mapped, and recommends that future research test these frameworks with service recipients' voices included. The honest statement is therefore narrow: cultural humility is a well-specified stance with a coherent rationale, an ethical mandate behind it in social work, and an evidence base that is not yet strong enough to carry claims about outcomes.
Three things cultural humility is not
First, it is not the absence of knowledge. Tervalon and Murray-Garcia state directly that they are in no way discounting the value of knowing as much as possible about the health care practices of the communities served, and they give an example: a Cambodian child arriving with the linear marks of coining, a Southeast Asian healing practice, should not be mistaken for a victim of abuse. A practitioner who has learned nothing about the communities they serve is not humble, only unprepared. The related failure is the claim that I treat everyone exactly the same, which sounds fair and is not: identical treatment means the person who needs an interpreter does not get one, and the standard everyone is being treated the same as is almost always the practitioner's own. Second, it is not deference to whatever a person describes. Cultural humility governs how you learn about someone's life; it does not suspend mandatory reporting law, duties regarding serious and foreseeable harm, agency policy, or professional codes, and where a practice raises a safety question the response is to ask about it carefully rather than either to assume harm or to look away. Third, it is not a personality trait. It is a practice discipline, sustained by supervision, by reflective habits, and by organizational policy - which is why federal guidance describes supervision as carrying educational and supportive functions and as promoting culturally responsive practice, and why the CLAS standards address organizations rather than individuals. This lesson is educational material about a practice concept. It is not clinical, cultural, legal, or benefits advice, and none of it should be used to make a decision about a specific person.
Eli explains
The same idea, in plain words
Explain it like I’m 10
Imagine you have just walked into someone's home for the first time. You could read a guidebook about homes in that neighborhood beforehand and then walk in acting as though you already know where everything is kept. Or you could read the guidebook, walk in, look around, and ask. Cultural humility is the second one, plus two extra parts. The first extra part is that you never stop being new to somebody, so the asking does not end. The second is that you are the one holding the clipboard. You can write things down about this person that follow them for years. That means they may not feel free to correct you, so you have to make correcting you easy, and then you have to actually change your mind out loud when they do it.
Picture it like this
Learning a language is a fair picture of it. You can study grammar and vocabulary for years, and that study genuinely helps - you will understand far more than someone who skipped it. But the first time you talk to a real speaker you discover an accent, an idiom, a joke and a whole life the textbook never mentioned. The studying was not wasted. It was simply never going to be enough by itself. And the learner who sounds fluent and stops listening is the one who misunderstands most confidently.
Where the picture stops working
The analogy breaks in two places. A language has rules that stay put; a culture does not sit still, and no individual is a reliable sample of their group, which is why a checklist of traits fails in a way a verb table does not. And a language learner and a native speaker are usually equals in the conversation, while a practitioner holds real power over records, referrals and eligibility. That imbalance is one of the three things cultural humility explicitly asks you to work on, and no amount of enthusiastic studying touches it.
Worked example
A case manager meets a new client who arrives with her adult son and asks him to interpret. Following CLAS Standard 7, the agency's practice is to offer a qualified interpreter at no cost and to avoid untrained family interpreters, so the case manager explains this plainly, arranges the phone interpreter, and then speaks to the client rather than about her - the interpreter's own standards of practice say the same thing. Later the client mentions a home remedy she has been using for her child's fever. The competence-only reflex is either to file it under a group trait or to correct her. The humility move is to ask what it is, what she uses it for, and how she sees it fitting with what the clinic recommended, and then to say the interpretation back: so I have this right, you want to keep giving the medicine the clinic prescribed and you also want to keep doing this. The client corrects one detail. The case manager records the correction rather than the first guess. In supervision that week she raises something else: the flash of irritation she felt at the delay the interpreter added. That reaction is not a character flaw to confess, it is information about which of her own norms were doing the judging, and it is the kind of thing that gets worked on in supervision rather than alone.
Key takeaway
Cultural humility is not knowing less. It is holding what you know loosely enough to be corrected by the person in front of you, and building the power-sharing habits and organizational supports that make correction possible.
Quick check
3 questions here, of 5 in this lesson’s practice set. Answers stay hidden until you check.
Why did Tervalon and Murray-Garcia argue that 'competence', as clinical training normally uses the word, was the wrong outcome for multicultural education?
Choose an answer, then check it.
A client who speaks limited English arrives at an agency appointment with her fourteen-year-old daughter, who offers to interpret. Which response is most consistent with the CLAS standards and with interpreter standards of practice?
Choose an answer, then check it.
Study tools & related lessonsYou’ll learn to · Common mistakes · Easily confused · Key vocabulary · Related
You’ll learn to
- Define cultural humility using the three commitments Tervalon and Murray-Garcia set out in 1998.
- Distinguish cultural humility from cultural competence, and explain why the authors argued that competence framed as mastery was the wrong training outcome.
- Explain how intersectionality, as introduced by Crenshaw, undermines single-axis descriptions of a person's culture.
- Apply humility-consistent behaviors - asking, checking your interpretation, repairing, and working with a qualified interpreter - to a practice scenario.
- Evaluate what the current evidence for cultural humility does and does not support, including how the concept is measured.
Common mistakes
Reading humility as permission not to learn - 'I do not need to know anything about the communities I serve, I will just stay open.'
Tervalon and Murray-Garcia say the opposite in the original article: they are in no way discounting the value of knowing as much as possible about the communities served, and they give the example of coining marks being misread as abuse. Humility is what keeps knowledge from hardening into prediction; it is not a substitute for having any.
Treating 'I treat everyone exactly the same' as the humble position.
Identical treatment is not equal treatment. It means the person who needs an interpreter does not get one, which the CLAS standards specifically require organizations to prevent, and the standard everyone is being held to is usually the practitioner's own unexamined norm.
Taking humility to mean deferring to any practice a client describes, because questioning it would be imposing your values.
Cultural humility governs how you learn about a person's life. It does not suspend mandatory reporting law, obligations regarding serious and foreseeable harm, agency policy or professional codes. Where something raises a safety question, you ask about it carefully and specifically rather than either assuming harm or looking away.
Describing cultural humility as a personality trait - some practitioners are humble people and some are not.
It is a practice discipline. The 1998 article extends the same demand for self-critique to institutions, the CLAS standards address organizations rather than individuals, and supervision is where the reflective work is actually structured and sustained.
Citing cultural humility as demonstrated to improve client outcomes.
It is measured mostly by practitioner self-report and client-report instruments, the outcome literature is young and largely correlational - Hook and colleagues' 2013 finding runs through the working alliance and is an association - and reviews report inconsistent definitions across the field. Say what the evidence supports and no more.
Easily confused
Cultural competence as traditionally framed vs. Cultural humility
Competence in the traditional clinical sense names an endpoint: a demonstrable mastery of a finite body of knowledge, testable before and after. Cultural humility names a process with no endpoint, evidenced by what a practitioner keeps doing rather than by what they have finished learning. Tervalon and Murray-Garcia's argument was about which of these is the right training outcome, not about whether knowledge matters.
Knowing about a community vs. Assuming about a person
The first is preparation and the 1998 article insists on it. The second is what happens when the first is treated as complete. The dividing line is whether new information from this person can still change your mind, or whether you have already decided what their behavior means.
Cultural humility vs. Deferring to whatever a client describes
Humility is a stance toward learning: you are not the expert on this person's life. It says nothing about suspending legal duties, safety obligations, or professional standards, which are set by law, licensure and codes. Confusing the two turns a discipline about listening into an excuse for not acting.
Practitioner self-report measures vs. Client-report measures
Self-report asks the practitioner how culturally humble they are, which is a strange thing to score highly on and is closely related to the post-training self-assessed confidence that Lekas and colleagues warn may widen the power gap. Client-report asks the person receiving services, as Hook and colleagues' 2013 instrument does. Both are still self-reported perceptions rather than observed behavior or outcomes.
An individual practitioner's stance vs. An organizational requirement
Cultural humility describes what one worker does in one relationship. The CLAS standards set expectations for organizations - language assistance at no cost, workforce training, community partnership, public reporting of progress - which is why an agency cannot meet them by sending staff to a workshop.
Key vocabulary
- Cultural humility
- An orientation to practice built on three ongoing commitments: lifelong self-evaluation and self-critique, redressing power imbalances in the practitioner-client relationship, and non-paternalistic partnership with communities.
- Cultural competence
- A family of frameworks that treat knowledge about other groups' beliefs, values and behaviors, plus the skills to work across difference, as something a practitioner or organization can acquire and demonstrate.
- Self-critique
- Deliberate, repeated examination of one's own assumptions, reactions and social position, treated as an ongoing professional task rather than a private mood or a one-off exercise.
- Intersectionality
- The idea, introduced by Kimberle Crenshaw in 1989, that social positions such as race, class, gender, disability and sexuality shape one another at once, so a person's experience cannot be read off any single category.
- Essentializing
- Treating a group as though all its members share a fixed set of beliefs, so that an individual's behavior is predicted from group membership rather than learned from the individual.
- Power imbalance in the helping relationship
- The unequal control over records, decisions, referrals and resources that the professional role gives a practitioner relative to the person receiving services.
- National CLAS Standards
- Fifteen action steps issued by the U.S. Office of Minority Health setting out what health and human-service organizations should do to make services culturally and linguistically appropriate.
- Language assistance
- Interpretation and translation services that let someone who does not share the provider's language take part in their own care; under the CLAS standards these are offered at no cost to the person.
- Client-report measure
- An instrument on which the person receiving services rates the practitioner, rather than the practitioner rating themselves - a design used to reduce the bias in professional self-assessment.
Sources & references
- Cultural Humility Versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education (Journal of Health Care for the Poor and Underserved, 9(2), 117-125) — Melanie Tervalon and Jann Murray-Garcia; Johns Hopkins University Press. Full text read from the scanned copy of the published article posted by the first author on her professional site; bibliographic record and abstract independently confirmed against the MEDLINE record served by Europe PMC (PMID 10073197, DOI 10.1353/hpu.2010.0233).
- National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care — U.S. Department of Health and Human Services, Office of Minority Health (Think Cultural Health)
- NASW Code of Ethics (2021 revision), including Ethical Responsibilities to Clients — National Association of Social Workers
- National Standards of Practice for Interpreters in Health Care — National Council on Interpreting in Health Care
- Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature (Health Services Research, 42(2), 727-754) — Leah S. Karliner, Elizabeth A. Jacobs, Alice Hm Chen and Sunita Mutha; Health Research and Educational Trust / Wiley. Record and full abstract read via the Europe PMC REST API (PMID 17362215, PMC1955368).
- Rethinking Cultural Competence: Shifting to Cultural Humility (Health Services Insights, 13, 1178632920970580) — Helen-Maria Lekas, Kerstin Pahl and Crystal Fuller Lewis; SAGE Publications. Full text read via the Europe PMC REST API (PMC7756036).
- Cultural Humility Training in Mental Health Service Provision: A Scoping Review of the Foundational and Conceptual Literature (Healthcare, 13(11), 1342) — Mayio Konidaris (Victoria University) and Melissa Petrakis (Monash University); MDPI. Full text read via the Europe PMC REST API (PMC12155312).
- Cultural Humility: Measuring Openness to Culturally Diverse Clients (Journal of Counseling Psychology, 60(3), 353-366) — Joshua N. Hook, Don E. Davis, Jesse Owen, Everett L. Worthington Jr. and Shawn O. Utsey; American Psychological Association. Bibliographic record and abstract read via the Europe PMC REST API (PMID 23647387).
- Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics (University of Chicago Legal Forum, Vol. 1989, Article 8) — Kimberle Crenshaw; University of Chicago Law School, via the Chicago Unbound institutional repository
- Adopting an Intersectionality Framework to Address Power and Equity in Medicine (The Lancet, 397(10277), 857-859) — Rajvinder Samra (The Open University) and Olena Hankivsky (University of Melbourne); Elsevier. Full text read via the Europe PMC REST API (PMC9752210).
- Supervision — Child Welfare Information Gateway, Children's Bureau, Administration for Children and Families, U.S. Department of Health and Human Services
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Researched 2026-08-18
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