It is believed that a paradigm shift is occurring in social work, emphasizing respect for diversity. With globalization, it has become essential to re-evaluate social welfare from a multicultural coexistence viewpoint [1]. Internationally, the relationship between workers and clients is transitioning to one based on the client's culture. Lum [2] describes this change in the relationship as a significant paradigm shift. Japan is no exception. Due to the revision of the Immigration Control and Refugee Recognition Act in 2019, it is expected that even more foreigners will enter Japan. This is not so much to meet the strong wishes of foreigners wanting to come to Japan, but to address labor shortages in fields like caregiving. Traditional social welfare services were designed to cater to people of the same culture, but now there must be considerations for those with different cultures and religious beliefs.

In this context, wouldn't the concept of "cultural competence" be effective? Cultural competence implies that social workers respect the uniqueness of each culture and support through equal relationships. Using cultural competence to study social work with equality and diversity in mind seems highly suggestive in evolving its intrinsic meaning. Cultural Competence was proposed and popularized by Lum [3]. It appeared to be perceived as a panacea [4]. The focus in social work is to advocate for universality while emphasizing diversity. Even if the mainstream institutions offer services with full commitment, they might not reach everyone, making it evident that support in line with one's culture is essential [5]. Sue [6] mentions the benefits of respecting the religions and prayers of indigenous peoples. However, Furness et al [7]. discusses the need to address dilemmas in cultural competence. He presents this in two dimensions: first, conflicts arising from universalism in countries and differences in cultures; and second, the conflict between "doing no harm" and "respecting diversity. “While recognizing the significance of cultural competence, this paper revisits its dilemmas.

Here, a "dilemma" refers not to the frustration that arises because a social worker lacks tolerance towards different cultures, but to situations where multiple legitimate demands conflict and a choice has to be made between them [8].

Definition and Content of Cultural Competence

When discussing cultural competence, the efforts of the United States, a multicultural nation, are particularly enlightening, especially those of the National Association of Social Workers (NASW). The preamble of the NASW Code of Ethics [9] states the following points:

"The primary mission of the social work profession is to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.

Social workers are sensitive to cultural and ethnic diversity and strive to end discrimination, oppression, poverty, and other forms of social injustice."

In the ethical code for Japanese social workers revised in 2020, the following principles are outlined [10]:

Principle I (Human Dignity): Social workers respect all individuals, irrespective of their origin, race, ethnicity, nationality, gender, gender identity, sexual orientation, age, physical or mental conditions, religious or cultural background, social status, or economic situation, as invaluable beings.

Principle III (Social Justice): Social workers aim to achieve a society based on freedom, equality, and coexistence, free from discrimination, poverty, oppression, exclusion, indifference, violence, and environmental degradation.

Principle V (Respecting Diversity): Social workers strive to recognize and respect the diversity present in individuals, families, groups, and communities.

This reflects the global standard in recent social work, which teaches and practices values, knowledge, and skills that take into account differences in race, ethnicity, culture, class, gender, sexual orientation, religion, physical or mental capabilities, age, and nationality [11].

Before delving into dilemmas surrounding cultural competence, we wish to outline its definition and content.

As previously mentioned, the NASW has established " Standards and Indicators for cultural competence in Social Work Practice " [12]. In it, cultural competence is defined as "the process by which individuals and systems respond respectfully and effectively to people of all cultures, languages, classes, races, ethnic backgrounds, religions, spiritual traditions, immigration status, and other diversity factors in a manner that recognizes, affirms, and values the worth of individuals, families, and communities and protects and preserves the dignity of each."

Furthermore, Sue [13] has organized the following elements regarding the practice of cultural competence:

• Self-awareness about one's values, tendencies, and perceptions of human behavior.
• Understanding the worldviews of clients from diverse cultural backgrounds.
• Improving interventions, strategies, and techniques.
• Recognizing organizational forces that either enhance or inhibit cultural competence.

Changes in Research Figures on the Dilemma of Cultural Competence

Having clarified the definitions and content, we now turn our attention to the changes in research figures regarding the dilemma of cultural competence. To get an overview of the discussion surrounding the dilemma of cultural competence, a search was conducted on the search engine "Scopus" without any time constraints, looking for literature that included the keywords "cultural competence" and "dilemma" in their titles or abstracts. The numbers, broken down by domain, are shown in Table 1, and by era in Table 2. From Table 1, it is evident that the medical field stands out prominently. Additionally, from Table 2, as mentions of cultural competence increase, there is also a noticeable rise within the domain of social work.

Table 1: Number of literature references on the dilemma of cultural competence by domain (%).

Literature Search Method

The focus of this study is on articles written in English. Using the search engine "Scopus", without restricting the search period, literature that included the keywords "cultural competence", "social work", and "dilemma" in their titles or abstracts were sought. Scopus is an abstract and citation database provided by Elsevier, encompassing literature from all fields (science, technology, medicine, social sciences, humanities).

Literature Selection and Exclusion Criteria

Publications not discussing dilemmas in cultural competence, conference proceedings, and reports without analysis were excluded. Furthermore, in this paper, a "dilemma" does not refer to the frustration arising from a social worker's lack of tolerance toward different cultures. Instead, it refers to situations where a social worker, in a sequence of actions, faces conflicting legitimate demands and must choose one over the other. Therefore, cases where a social worker failed to adequately address a different culture due to lack of experience were excluded.

Analysis Method

To elucidate possible discussion points regarding dilemmas in cultural competence, the following steps were taken:

1. Literature discussing "cultural competence", "social work", and "dilemma" was extracted using the search engine "Scopus".
2. From the literature extracted in ?, those that met the above criteria were further excluded.
3. The obtained studies were closely read, and the subjects of investigation and the content of the dilemmas were organized.

Throughout the extraction and selection of the literature, as well as all the stages of analysis, repeated discussions were held among the researchers to ensure reliability and validity. As an ethical consideration, the sources of the utilized literature were explicitly mentioned, and care was taken to not distort the context or core arguments of the sources when extracting content from them.

Figure1: Research Selection Process.

Using the search engine "Scopus", literature examining "cultural competence", "social work", and "dilemma" was extracted. Upon searching for literature meeting the above criteria, 10 articles matched. Additionally, a search was conducted on Academic Search Premier, ERIC, and PubMed to ensure no overlooked articles, and no additional articles were deemed necessary.

Table 3: Analysis of Relevant Literature.

In this study, while agreeing with the philosophy of cultural competence, an increase in papers addressing its dilemmas was observed. In practical settings, it is believed that the dilemmas of cultural competence in social work are being recognized. Five perspectives were identified:

(1) The discrepancy between the spread of understanding other cultures and the deep recognition of the oppressive structures of the dominant culture.

The term cultural competence has evolved to encompass differences in groups related to gender, sexuality, religion, age, ability, language, nationality, and more. While it has become widespread, there has also been a tendency to focus on cultural understanding and self-awareness, leading to disagreements. There is a need to understand cultural competence in terms of scrutinizing racial and ethnic categories carefully concerning the oppressive structures emphasizing individual and social identities.

(2) The principles of "do no harm" and "respect for diversity" can be in conflict and compete.

The commentary notes for the global definition of Social Work global definition by the International Federation of Social Workers [24] states the following:

“The overarching principles of social work are respect for the inherent worth and dignity of human beings, doing no harm, respect for diversity and upholding human rights and social justice.

In some instances, “doing no harm” and “respect for diversity” may represent conflicting and competing values, for example where in the name of culture the rights, including the right to life, of groups such as women and homosexuals, are violated. The Global Standards for Social Work Education and Training deals with this complex issue by advocating that social workers are schooled in a basic human rights approach, with an explanatory note that reads as:

Such an approach might facilitate constructive confrontation and change where certain cultural beliefs, values and traditions violate peoples’ basic human rights. As culture is socially constructed and dynamic, it is subject to deconstruction and change. Such constructive confrontation, deconstruction and change may be facilitated through a tuning into, and an understanding of particular cultural values, beliefs and traditions and via critical and reflective dialogue with members of the cultural group vis-à-vis broader human rights issues.”

There are cases where social workers, while assisting clients, face conflicts between rights and cultural beliefs. Ife [25] argues that the statement on human rights by the International Federation of Social Workers is often discussed in legal and national obligations. While many social workers might see no problem in adhering to conventional laws, deeper contributions to human rights are sought when more than mere compliance is required.

However, the literature illustrates a picture of dialogue and conflict over values and beliefs in culture. From a human rights perspective, there are practices that may be culturally accepted but recognized as abusive. This suggests that the promotion and respect for diversity should not remain superficial. Attention should also be given to the process of considering legal protections, delays in reporting to the police, and support aimed at family reintegration [26]. Some cultural elements might seem religious but are actually imposed by the group on its members.

(3) Conflict of values and beliefs in different cultures (the existence of non-negotiable standards for practitioners).

Commonly seen is the difference between Western culture and other cultures. The West values individualism, independence, autonomy, self-satisfaction, competitiveness, self-expression, assertiveness, results-oriented thinking, immediacy, technological dependence, scientism, and materialism [27]. This arises due to differences between universalistic standards and minority cultures. Certainly, the uniqueness of a culture and ethical dilemmas must not be confused [28].

(4) Shaking one's own values

In the NASW's "Standards and Indicators for Cultural Competence in Social Work Practice" [29], there's a standard on self-awareness. However, self-awareness is not easy and can greatly shake the foundation of one's values. There are times when one must fundamentally reconsider their own culture upon which cultural competence is based. Chung has mentioned that through dialogue in worker-client relationships, new relationships and meanings are reconstructed [30]. In other words, social workers should maintain cultural neutrality, not just existing within their own world but also suggesting a dynamism where they construct a world shared with their clients. Regarding this, I'd like to quote what Ozaki has said as an example of social welfare practice where creativity and innovation are exercised [31]. "The field is ? the forefront where services, care, consultation, etc. are provided to support each client's self-realization, and where practitioners and users aim to embody welfare principles. ? It's a place where people engage and interact, facing themselves and aiming for mutual growth and transformation. ? It's a place to deepen understanding of life, history, and society through practice and have an interest in social reform. ? It's not a perfect place, it inherently has imperfections. Also, there are no predefined correct answers in the field. But it's a place where creativity can be utilized, fostering new lifestyles, values, and creativity. “Through the dynamism of interaction between workers and clients, there's a possibility that the foundation of one's values and beliefs might crumble and a new shared world could be built.

(5) The dynamic aspect, including conflicts, of securing personnel who understand cultural competence within the organization and enhancing their voice to expand cultural competence as an organization.

As previously mentioned, Sue emphasizes the importance of recognizing the organizational force that either promotes or hinders cultural competenc [32]. This aligns internationally and also with Japan's ethical guidelines. Social workers must draw the attention of employers and policymakers to oppressive practices and situations where resources are unfairly distributed [33]. Cultural competence cannot be unrelated to the organizational context. Organizations have their own missions and policies regarding support. However, as indicated in Table 1, what Nybell states suggests that efforts within the organization and workplace are needed to promote an understanding of cultural competence within the organization to realistically enhance it.

When cultural considerations and human rights are at odds, there are times when support must be provided with human rights as the central consideration [34]. On the other hand, there are moments when we must fundamentally reevaluate the standards, we believed were correct within our own culture [35]. This article is a literature review of currently published papers, and it does not fully encompass practices related to dilemmas in cultural competence. Additionally, there were two points that could not be addressed. Firstly, while culture is uniformly discussed, in reality, there are those who can adapt flexibly to the dominant culture and elevate their voice, and there are those who cannot. Secondly, what is understood as 'culture' should not be perceived as a monolithic entity. There are smaller subgroups within it, each distinct from the other. The article couldn't provide ample pointers towards resolving these issues. Further research and inquiry into practical settings are desired to refine these points.

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