Getting to Know the Piece of Fluff inOur Ears: Expanding Practitioners’Cultural Self-AwarenessJulia Mirsky
Israel being a multicultural society with a variety of ethnic groups, the delivery of
culturally competent services is a crucial issue in social work practice. This paper describesthe outcomes of a training model for cultural competence applied with social work
graduate students in Israel. The model, based on work with immigrants’ narratives,increased the cultural self-awareness of the trainees. Presented are conceptual and
technical aspects of the training model as well as outcomes of an evaluation study. Fifty-one trainees submitted a short account of their personal experiences following the training.The reports indicated expansion in the trainees’ cultural self-awareness: awareness of their
own and their families’ immigration experiences as well as of other transitions in theirlives. Training elements that made this outcome possible are discussed.
Keywords: Cultural Self-Awareness; Training; Migration
If the person you are talking to doesn’t
appear to be listening, be patient.
It may simply be that he has a small piece
of fluff in his ear. (A.A. Milne, 1926)
With the growth of multicultural settings and societies, practice with culturally diverse
clients has become an everyday reality in social work and other helping professions and
growing attention is being devoted to training culturally competent practitioners
(Allen-Meares, 2008; Engstrom and Okamura, 2008; Kwong, 2009). In Israel, the home
of highly diverse populations—Jews and Arabs, and immigrants from all over the
world who speak an array of different languages—culturally competent care provision
is especially important. In the last two decades, numerous practitioners and researchers
q 2013 Taylor & Francis
Correspondence to: Professor Julia Mirsky, Department of Social Work, Ben-Gurion University of the Negev, PO Box
653, Beer Sheva, 84105 Israel. Email:
Social Work Education, 2013Vol. 32, No. 5, 626–638,

in Israel have addressed this issue (Bilu and Witztum, 1993; Ben-David, 1998; Jaffe,
1998; Arkin, 1999; Dwairy, 1999; Al-Krenawi and Graham, 2000; Roer-Strier, 2001;Lavee, 2003; Youngmann et al., 2008). However, only recently has the importance of
providing culturally sensitive care been acknowledged on the national scale with a callfor action by the Israeli Ministry of Health (Ministry of Health, 2011).
Cultural competence is the ability of professionals to function successfully withpeople from different cultural backgrounds including race, ethnicity, culture, class,
gender, sexual orientation, religion, physical or mental ability, age and national origin(CSWE, 2008). Ingredients viewed as essential for cultural competence include having
an understanding, appreciation and respect for cultural differences and similaritieswithin, among and between culturally diverse client groups (Hall, 2003). Culturally
competent care has been defined as a system that acknowledges the importance and
incorporation of culture, assessment of cross-cultural relations, vigilance toward thedynamics that result from cultural differences, expansion of cultural knowledge, and
adaptation of interventions to meet culturally unique needs (Whaley and Davis, 2007).Three components of cultural competence are consensual: cultural awareness, culture-
specific knowledge and culture-attuned skills (Lu et al., 2001; Sue, 2001; Lee andGreene, 1999). Cultural competence begins with an awareness of one’s own cultural
beliefs and practices, and the recognition that others believe in different truths/realitiesthan one’s own (Kohli et al., 2010). This involves awareness of one’s own biases or
prejudices and is rooted in respect, validation and openness toward differences amongpeople. Cultural knowledge is the knowledge of the client’s culture, worldview and
expectations. Cultural skills are the ability to intervene in a manner that is culturallysensitive and relevant (Sue, 2001).
The various cultural training programs focus on one or a number of the threecomponents of cultural competence (Betancourt, 2003). The present paper addresses
the first of them—cultural awareness.Generally, in helping professions cultural awareness refers to practitioners’
awareness of the impact of socio-cultural factors on clients’ values and behaviors(Kripalani et al., 2006). In the more psychologically oriented professions, cultural
awareness first and foremost implies self-awareness. Self-awareness by practitioners oftheir cultural heritage and of how their cultural background and experiences have
influenced their attitudes, values and biases is specified in the guidelines of theAmerican Psychological Association (APA Office of Ethnic Minority Affairs, 1993).
Among the 33 competences specified by the Association for Multicultural Counselingand Development (AMCD, 2010), nine address counselors’ cultural self-awareness.
Similarly, the second of 10 standards for cultural competence in social work approvedby the National Association of Social Workers addresses self-awareness (NASW, 2001).
The assumption is that the social worker’s cultural identity is fundamental to practiceand the basis for professional development. Cultural competence requires social
workers to examine their own cultural backgrounds and identities to increaseawareness of personal assumptions, values and biases.
To achieve this aim, experiential learning is being implemented in many culturalcompetence training programs in social work and other helping professions (Weaver,
Social Work Education 627

1998; McCreary and Walker, 2001; Lijtmaer, 2004). A multitude of experiential
techniques is applied in training, among them, structured exercises and role play(Arbour et al., 2004), narrative analysis (Kerl, 2002), cultural immersion (Lough, 2009),
multimedia and web-based learning (Korhonen, 2004) etc.This paper demonstrates a model of cultural competence training based on work
with immigrants’ narratives and on the exploration of unconscious group processes.The model has been successfully applied with social work graduate students in Israel,
as indicated by the results of an evaluation study. The present paper illustrates theapplication of the training model to the encounter of practitioners from the majoritygroup (i.e. Jewish Israeli natives) with Jewish immigrant clients. However, its
principles and techniques can be applied to educate for culturally competent practicewith clients from other minority groups in Israel and in other countries.
The Training Model
Aims and Rationale
The goals of the training are to help the trainees develop empathy towards clients fromvarious cultural backgrounds, enrich their knowledge about clients’ culture and help
them implement culture-attuned interventions. The training emphasizes the open-ended nature of this process and encourages ongoing knowledge-seeking and skills-development. In order to promote the empathic stance, the training aims at expanding
the trainees’ awareness of their own cultural roots and culturally molded attitudes andbiases. Modeling is offered for continuous reflection and self-exploration as an
inseparable part of multicultural practice in helping professions.The training combines two techniques—narrative analysis and the exploration of
group processes—each based on a conceptual rationale.Narratives have been increasingly recognized in mental health and related
disciplines as an important source of insight into the complexity of human experience(Lieblich, 1998). Narrative techniques are especially suited for the exploration of the
experiences of immigrants, refugees and members of minority populations. They areflexible and narrator-oriented and therefore can contain unique cultural as well aspersonal materials (Peterson and Van Meir, 1996; Lijtmaer, 2004). The analysis of
narratives is based on the notion that sense making is an interactive human activity(Glanz, 2003). Therefore, it investigates the meaning (not the cause) of experience.
Especially emphasized in the present model is the active role of the listener and the factthat the meaning is shaped in a collaborative creative relationship between the
narrator and the listener. When trainees are active participants in the sense-makingprocess, learning may result in greater self-awareness, which is a pre-condition for
empathy (Kerl, 2002).The conceptualization of the class setting as a group is based on psychodynamic
theories. Two fundamental notions typify this approach; one is that a ‘group mind’
exists (McLeod and Kettner-Polley, 2004) and the second is that unconscious processesshape the behavior in groups and the group mind (VanGunten and Martin, 2001).
628 J. Mirsky

When identified, verbalized and made conscious, these processes may advance the
work of the group. Following these basic notions, it is assumed that the class group
becomes a ‘resonant box’ for immigrants’ narratives. The conscious and especially
unconscious reactions of the participants come together with the narrative to create
a ‘group sound’ of the narrative (Mirsky, 2008). The group sound may become
an important source of insight into the narrator’s experience (Mirsky, 2008) as well
as into the trainees’ unconscious emotional reactions, attitudes and resistances
(Mirsky, 2011).
Setting and Techniques
This model is put into practice in a course that the author has been teaching for the
past 10 years to social work graduate students in a university in the south of Israel. The
course consists of 48–50 academic hours with weekly sessions; 20–24 students on
average participate in the course yearly. The course syllabus, accessible to students
prior to registration, clearly specifies the different components of the course, the
assignments and the method of assessment.Presentation and discussion of scientific articles on psychological aspects of
migration are combined in the course with the analysis of immigrants’ narratives.
Readings include the state of the art theoretical and research publications on individual
and family processes in migration, immigrants’ stress, coping strategies and
psychopathology as well as clinical papers on interventions with clients from diverse
cultural backgrounds and on counter-transference with such clients. Immigrants’
narratives are collected by students through in-depth, unstructured interviews. As the
MA program, in the context of which this course takes place, includes compulsory
courses on qualitative research methods, it is assumed that students are proficient in
conducting such interviews. Typically students interview their co-workers, neighbors,
acquaintances, friends or relatives. The uses of the interview material are explained to
the interviewees and written informed consent is obtained from them for each of the
uses separately: for the interview, for presentation in class and for inclusion in a
scientific publication.
Interviews are tape-recorded and transcribed. Each student writes a paper based on
the analysis of the interview material and the relevant literature.
Students may choose to present their interviews in class and typically 10–12
students opt to do so. (This is an elective assignment and is not taken into account in
the assessment.) The interviewer presents the narrative from a transcript almost
verbatim for 40–45 minutes. Then the course instructor opens the discussion by
thanking the presenter and asking the group: ‘Well, what did you hear?’. The class is
encouraged to comment and share their emotional reactions and thoughts. Once the
students seem to have exhausted their reactions, the instructor summarizes the
discussion. When relevant, information specific to the culture at hand is added by
the instructor, but typically the summary focuses on the contents and processes in the
group work, which the instructor generalizes and integrates with relevant literature.
Social Work Education 629

In order to allow the reader a glimpse into the training process, an illustration from
the class work with a narrative is presented below.Gregor, 67 years old, immigrated to Israel at the age of 12, from Europe a few years
after World War II. Soon after arrival he was sent to a boarding school, where he was the
youngest in his group and became the target of mockery and bullying. For yearshe struggled to become a ‘model Israeli’ and eventually succeeded in erasing his past:
‘I don’t remember anything from before the age of 12. My memory starts when we got toIsrael’ he said. Gregor reported his story in a very dry tone, did not admit to ever feeling
lonely or disappointed and a number of times repeated: ‘I have no hard feelings’.The interviewer was very emotional when he presented the narrative in class, had
tears in his eyes and found it difficult to speak. He was surprised by his own reactionbecause during the interview he was not that moved. In the discussion of the narrativemany students identified the covert loneliness and sadness in Gregor’s narrative.
Gradually a picture emerged: that of a little boy, feeling rejected by the new society andabandoned by his parents, who desperately tried to be brave and cope, and who
eventually denied all these feeling in order to survive and adjust. It took the group‘resonant box’ to unveil the emotions that accompanied Gregor’s adjustment as an
immigrant, emotions that he had denied for most of his life. Once this pictureemerged, the facilitator was also able to reflect to the group the difficulty in seeing
through a façade such as Gregor’s in an individual setting. A number of participantssupported this notion with examples from their own practice. In the discussion it
became clear that the trainees’ personal reactions could be causing such empathicfailures as many of them were second-generation immigrants, whose parents copedwith their immigration difficulties by erecting a similar façade.
The Evaluation Study
In the past three years an evaluation of each course was performed two months after its
completion. Students were asked to submit a short account (200–500 words) of theirpersonal experience on the course. Fifty-one students submitted the requested account(76% of all students who participated in the course over the three years). The majority
of the respondents (80%) were women. This rate reflects the over-representation ofwomen in the training program and in the social work profession in general. They
were mostly in their late twenties, about half (47%) were married, and most belongedto the middle socio-economic class.
A minority of the respondents (25%) were first generation immigrants, mostly fromthe former Soviet Union. About half were second-generation immigrants from
different countries, however most did not define themselves as such and reached thisawareness only following the training. A quarter (25%) of the respondents were thirdor fourth generation, among them six Arab and Bedouin students.
The accounts were analyzed via a holistic method common in qualitative research(Lieblich, 1998). In the first reading, general themes were discerned in the material and
630 J. Mirsky

noted. In the second reading, meaningful categories were detected within each of the
themes. Then all the accounts were analyzed again in view of the themes and categoriesfound. Repeated readings revealed additional categories and contents.
Self-Awareness Outcomes
The analysis of the students’ accounts revealed three general outcomes of the training:advanced cultural self-awareness, cognitive enrichment and improvement in practice.
Findings on the two latter aspects were reported previously (Mirsky, 2012). Theygenerally showed that trainees acquired new understanding of the centrality ofimmigration in the lives of immigrants, the psychological processes typical to
migration and the unique nature of immigrants’ experiences. On the practical level thetrainees reported becoming more attentive to their clients’ experience of migration
and more respectful and empathic towards their cultural diversity. Outcomespertaining to cultural self-awareness are reported below and specify three aspects of
self-awareness that the students reported gaining. Of the 51 students, 25 specificallyrelated to this issue and quoted below are representative accounts.
Increased Awareness of Own Immigration Experience
Nine of the respondents had directly experienced immigration, either as children or asadults. All of them, without exception, reported that following the course they connected
to experiences and feelings with which they had not been in touch before. Some onlygenerally relate to these experiences and stressed the positive effect of the course:
Being an immigrant myself, the participation in this course helped me open toexperiences that were closed before, moved me and gave me the opportunity to workthrough events that had been bothering me. And for this I am grateful. (AA)
For others, connecting to their immigration was not altogether pleasant:
I have a feeling that I passed up on a lot. For many years I have been working withimmigrants, and I am an immigrant myself. Yet I knew nothing about the importantand significant process they and I were going through and how this process canmake a big difference in life . . . I got a glimpse not only into the interviewee’sexperience, also into my own . . . (MY)
Here are two more specific accounts:
Being an immigrant, a daughter to immigrant parents, the course helped me reacha personal closure . . . I learnt that many of the psychological processes that I and myfamily went through are cultural, and not necessarily personal. This made me moreempathic towards my family . . . (MB)
The course made me reflect back on my own immigration. I immigrated to Israel atthe age of 6 and was sure that I had “made it” and everything was behind me . . .Now I realize that this is not true. I understand that the experience of immigration
Social Work Education 631

will probably accompany me throughout my whole life . . . and this opened for methe way to go on exploring it. (SZ)
Increased Awareness of One’s Family Immigration History
Many students reported increased awareness to their being second- or third-
generation immigrants and to their families’ immigration background. This outcomecan be quite expected when the students choose to interview a family member. The
instructor initially discourages this choice, lest as a result of the interview familyrelationships become complicated. With students who insist, the instructor works
individually to prepare them for the interview and for possible ramifications. Thisapproach provides a natural screening procedure and indeed only those who have
a high interest in their family immigration history end up interviewing their closerelatives. It can be expected, therefore, that they will be personally affected as thefollowing examples demonstrate:
The interview with my father was held after the course ended . . . I thought I wasready . . . but the interview was so powerful . . . nothing could have prepared me forits content. I felt pain when he told me about the grave losses that shaped his life . . .I shared his disappointment with not being able to fulfill his dream of getting aneducation. I was furious with the immigration policy at the time, which was notbeneficial to him . . . The interview had a profound influence on me, on my father,and on my whole family. (LA)
. . . I had a vested interest in interviewing my aunt. It was an opportunity to heara detailed story, which I never heard before . . . I gained a different perspective onmy past and my roots. When I presented the interview in class, I worried whethershe will be perceived according to the stereotypes of Oriental Jews—vulgar and loud?She is somewhat loud . . . I am asking myself, whether I was ashamed of her? Well, itis possible. Although I am very proud of my roots . . . (OA)
The second example represents a small group of students for whom the courseoffered an opportunity to complete a personal search they had started long before.
One of the students expressed this very eloquently:
For me, listening to narratives of immigrants is not an assignment—it is myinnermost desire, my need . . . something that is within me, as a native born,a second-generation to immigration. I never have enough and am willing to hearmore and more immigration stories. The course was a sort of support group forme. (YK)
However, the decisive majority of students registered to the course simply to earn
credits and interviewed an immigrant simply because this was a course assignment.Only following this exposure had they connected personally to their family history.Here are some representative examples:
I gained a new personal perspective . . . My parents immigrated to Israel in theiryouth. The course and writing the final paper raised in my mind many questionsabout their experiences as immigrants . . . (DH)
632 J. Mirsky

Through the course I learnt to understand better my parents, who immigrated toIsrael forty years ago and to integrate the different pieces of their immigration story.(OB)
The course was very significant as it connected me to the effects of immigration onmy father, on me, and on my family . . . The feeling of alienation that my fatherexperienced passed on to me too . . . (TB)
Taking part in this course made some closures possible in my life . . . I had notexperienced immigration, but I come from an immigrant family. My husband is alsoa son of immigrants, from a different country . . . I never thought this wassignificant . . . As we proceeded in the course I realized that I cannot evade theimplications and opened this subject with myself and my parents. I grew tounderstand some of their characteristics, the difficulties my father had to integrateinto the native Israeli society and his desire to preserve elements from his homeculture . . . I thought of the experiences my mother went through as an adolescent,alone in a foreign country . . . (IE)
Increased Awareness of Own Life Transitions
Respondents who were removed from their family migration history or did not have
such a history in their background, were often able to apply what they had learnt toother transitions in their lives.
In the interview, I encountered a woman who was in an identical life phase that I was. . . I asked myself how would have I reacted? . . . I was relieved that my calm life wasfree of physical immigrations. Yet, I became aware of my emotional migrations: froma motherless child to a second mother, from a single woman to a married one, fromthe role of a daughter to that of a mother. The course helped me find my personalimmigration with the array of attached emotions . . . (SN)
The “immigrant” feeling is not foreign to me. Firstly, I grew up in a town that isknown for its cultural and ethnic diversity. Secondly, one of my grandmothers isfrom Iraq, the other from Morocco with French and Spanish background. Mymother grew up in a kibbutz family of Holocaust survivors . . . This “eclectic”experience made me search for my own Israeli identity. When I found nothing clear. . . I identified with critical political positions on social issues. Now I understandthat this choice too held personal psychological meanings . . . The course enrichedme . . . I started noticing what are the things I don’t hear, and what are those I amattentive to. (AA)
Following the course, this student gets to know ‘the piece of fluff ’ in her ears.The following, final quotation demonstrates how the course can offer only the
initial incentive for the process of expanding self-awareness. Whether this process goeson and reaches completion is a matter of personal choice and commitment.
. . . I have been preoccupied with the final paper for two months, almost daily. Fordays I collected materials, spent hours on the Internet, in libraries . . . The writingdid not flow . . . I was stuck. I realized that it was something personal . . . I think
Social Work Education 633

I found what it was. Three weeks from now I am getting married. Issues that cameup in the interview touched me very deeply: the painful differentiation from parents,the separation from single life. Today I woke up feeling that at last, I will finishwriting the paper. Immediately I felt my stomach ache. It was excitement.I understood that in order not to deal with the excitement and the preparations formy wedding I was busy “doing”, dealing with the interview—fleeing. Through thepaper I mourned my own losses: of my single life, my childhood, of the freedom todo whatever I want. I am saying farewell to one developmental phase and movingon. (DD)
This paper demonstrates how a training model that combines narrative analysis andpsychodynamic understanding may promote the cultural self-awareness of social
workers. The trainees reported major shifts in their cultural self-awareness: anextended awareness of their own or their families’ immigration background and of
their other life transitions. Cultural self-awareness can, therefore, be taught and learnt.With a relatively short and simple intervention, significant improvement in the
practitioners’ attitudes towards culturally diverse clients can be achieved. Moreover, itis suggested that the lack of attention to self-awareness in training models that focus
on cultural knowledge and skills, may account for their controversial effectiveness(Sue, 2001). Unconscious resistances and unresolved conflicts may block theacquisition of new knowledge and prevent its application in practice. It is therefore
imperative that cognitive training is preceded by the exploration and verbalization ofunconscious processes and the enhancement of the practitioners’ cultural self-
awareness.The fact that the evaluation study is based on participants’ self-report is a limitation
of this study. ‘Objective’ measurements need to be performed in future studies tocorroborate the subjective data. Nevertheless, the reports on improvement of cultural
self-awareness following the training are quite compelling and it is important tounderstand what components of the training could explain this.
It is suggested that the active involvement of the trainees, on the cognitive,emotional and personal levels in the listening and sense-making process is one of thefactors that may render the model effective. The active stance, which makes the
students more deeply affected by the narratives, needs to be fostered and kept up.Therefore, one of the roles of the facilitator is to sustain the students’ availability and
motivation to lend themselves to the exploration of the narratives. In order to achievethis, the facilitator must create a secure and accepting environment in the group and
provide modeling for the attitude of attentiveness, acceptance and respect towardsstudents and interviewees.
The active role of the students is also sustained by the fact the narrators are notpresent in class. This is an additional reason why students are discouraged frominterviewing people very close to them, and when they do so, they seldom present the
interview in class. In contrast to the clinical setting, in the present context orientingthe sense-making process on the narrators’ needs and feelings may constrain the
634 J. Mirsky

learning process. When the narrator is not present, the students can freely project onto
the narrative their subjective feelings, reactions and associations and the processes canbe used as a learning experience.
In the first phase of work students are encouraged to verbalize their projectionsfreely and with a temporary suspension of judgment. This helps uncover emotions and
reactions that are evoked in the encounter with the narrative, reactions that ineveryday circumstances often remain unconscious or unnoticed. Once voiced, these
reactions may be explored and may expand the students’ self-awareness. In the nextphase of work, students are encouraged to examine and re-evaluate their reactions and
interpretations against the narrative. Now a rational process of hypotheses testing ismobilized and the group work consists of searching for validation for the various
interpretations. Interpretations that have not been substantiated are rejected and those
that seem to be better grounded in the narrative are accepted and further developed.This part of the group work allows the students to learn and experience the difference
between rough projections that block communication and between subjectiveperceptions of the other, which when systematically validated may become a source of
insight. Here too the fact that no commitment exists towards the narrators creates thefreedom to explore all interpretations relatively impartially.
Under such ‘laboratory’ conditions, the group may serve as a resonant box and anamplifier not only to the narrative, but also to unconscious resistances that
practitioners experience towards clients from diverse cultural backgrounds. In theireveryday practice, the trainees usually lack the time and skills to become aware of these
resistances. In the safe and accepting environment of the study group they areencouraged to notice their own reactions and verbalize them. Once verbalized,
unconscious defenses can be recognized and interpreted. Then they may become asource of insight about limitations and biases that hamper the work with culturally
diverse clients and about personal and cultural sources of such biases. This uniquefunction of the group also facilitates and expands cultural self-awareness.
Although in helping professions self-awareness is generally considered to be the keyto multicultural competence, research into the relationships between these two
competencies is only in its initial stages (Bender et al., 2010). In the evaluation of thepresent model, the trainees also reported, along with the raise in their self-awareness,
an improvement in their understanding and empathy with their culturally diverseclients (Mirsky, 2012 ). However, the design of this study does not permit one to draw
conclusions about causal relationships between the trainees’ self-awareness and thisimprovement. Similarly, the modest size of the sample makes it impossible to explore
the effects of personal and socio-demographic variables on the outcomes of thetraining. Further empirical research is called for in order to substantiate the intuitive
and clinical contention that cultural self-awareness is a prerequisite for multiculturalcompetence and explore the various factors that may affect it.
The model presented here is unique in the methods it applies in order to createa personal involvement of trainees, amplify their reactions so that they can be identified,
owned and transformed from obstacles into professional assets. Although thepaper presents its application with a specific group of practitioners, it is transferable to
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other ethnic groups and other settings. For example, four Arab students participate in the
current course. One of them presented an interview with a Bedouin respondent and issues
in the Arab–Israeli cultural encounter could be addressed. The course was also very
successfully taught in an academic setting in the USA where interviews with immigrants
from the Hispanic and other communities were presented and discussed.
Cultural self-awareness can be developed in many ways. Paul Elovitz,
a psychohistorian, collected in his book the narratives of immigrant practitioners
who share the results of their personal self-reflections that sometimes took years to
crystallize (Elovitz, 1997). About his own immigration background Elovitz writes:
As I reflect back on my life I am struck by two things: first, how much I was shapedby my Eastern European parents, and second how these normally honest peopletried to hide things from their three children. Some examples will reveal the specificimpact of my parents’ immigrant experience and of their multicultural identity . . .
(Elovitz, 1997, p. 95)
The present model gives insight to a different path to cultural self-awareness, that may
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