Beyond the recognition and insight this article provides, there are several elements that demand more attention and conceptual depth. None is more important than the construct of culture. Recognizing that culture is a construct that is more elaborate than simply race and ethnicity is important. However, to rely on other elements of demography such as disability, age, and sexual orientation as the explanations for expanding the defi- nition of culture is simply insufficient. Those elements of culture appear at the surface structure of understanding rather than at the level of the deep structure. In my opinion, culture helps to center and order our experiences in ways that are congruent with historic traditions. Culture, as I and others have argued previously, is a complex constellation of mores, values, customs, and traditions that provides a general design for living and a pattern for interpreting reality. Thus, exploring how the variables of culture, responsive treatment, and ethical standards intersect must rigorously question how client worldview assumptions converge and diverge with the protocols of a particular treat- ment regimen and with the ethical practices that may be in harmony with or in opposition to them. To do so, as I have mentioned earlier, requires that readers of this article commit themselves to understanding culture at the deep-structure level rather than at the surface-structure analysis typically used.
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