Cultural competence in therapy involves - but is not limited to - an awareness of someone’s country of birth, ancestry, their parent’s country(ies) of birth, languages spoken, Indigeneity, sexuality, gender expression, religion or spirituality, social behaviour and customs, physical and neurological differences, age and socio-economic status (Brooks et al., 2019). But such information is only useful if used to discover how an individual uniquely experiences these aspects of their identity (Dyche & Zayas, 2001).
Feminist and multicultural theorists indicate the importance of awareness and integration of the various intersections of a client’s identity to the development of an effective therapeutic relationship (Knox et al., 2003; Collins et al., 2010; Ecklund, 2012). Culturally competent therapy also requires a practitioner’s self-examination of their own reactions, a humility and openness to learning, the ability to use culture appropriately (and to ascertain when it is not related to the presenting issue), patience, empathy, and an awareness of the differential power status which, in cross-cultural therapy, can be significant (Dyche & Zayas, 2001; Yeung et al., 2018; Brooks et al., 2019; Lee & Neese, 2020).
Awareness and incorporation of cultural differences in values, attitudes and behaviors (Interian & Díaz-Martínez, 2007) has been linked to better rapport, intimacy, disclosure, risk-taking, involvement, and therapy outcomes in marginalized clients (Henderson-Daniel et al., 2004; La Roche & Lustig, 2013; Graham-LoPresti et al., 2017). Treatment that fails to address contributing sociocultural factors in their lives may prove insufficient (Abrams, Hill & Maxwell, 2019). An exploration of intersecting aspects of a marginalized client’s identity, where relevant, and an awareness of the barrier to therapy different folks face, for example, may instead facilitate greater engagement among groups who often don’t get the support they most need (Abrams, Hill & Maxwell, 2019). As a member of such a group, and as someone for whom the idea of going to therapy was for the longest time simply unthinkable, I am determined to bring the healing power of this work to those so often failed by the mental health industry.
Abrams, J. A., Hill, A. & Maxwell, M. (2019). Underneath the Mask of the Strong Black Woman Schema: Disentangling Influences of Strength and Self-Silencing on Depressive Symptoms among U.S. Black Women. Sex Roles, 80, pp. 517–526. https://doi.org/10.1007/s11199-018-0956-y
Brooks, L. A., Manias, E. & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26, pp. 383–391. https://doi.org/10.1016/j.colegn.2018.09.007
Collins, S., Arthur, N. & Wong-Wylie, G. (2010). Enhancing Reflective Practice in Multicultural Counseling Through Cultural Auditing. Journal of Counseling & Development, 88, pp. 340-347. https://doi.org/10.1002/j.1556-6678.2010.tb00031.x
Dyche, L. & Zayas, L. H. (2001). Cross-cultural empathy and training the contemporary psychotherapist. Clinical Social Work Journal, 29 (3), pp. 245–258. https://doi.org/10.1023/A:1010407728614
Ecklund, K. (2012). Intersectionality of Identity in Children: A Case Study. Professional Psychology: Research and Practice, 43 (3), pp. 256–264. doi: 10.1037/a0028654
Graham-LoPresti, J. R., Gautier, S. W., Sorenson, S. & Hayes-Skelton, S. A. (2017). Culturally Sensitive Adaptations to Evidence-Based Cognitive Behavioral Treatment for Social Anxiety Disorder: A Case Paper. Cognitive and Behavioral Practice, 24, pp. 459-471. https://doi.org/10.1016/j.cbpra.2016.12.003
Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. doi:10.1002/jclp.20014
Interian, A. & Díaz-Martínez, A. M. (2007). Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients. Cognitive and Behavioral Practice, 14, pp. 84—97. https://doi.org/10.1016/j.cbpra.2006.01.006
Knox, S. Burkard, A. W., Johnson, A. J., Suzuki, L. A. & Ponterotto, J. G. (2003). African American and European American Therapists’ Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads. Journal of Counseling Psychology, 50 (4), pp. 466–481. doi:10.1037/0022-0220.127.116.116
La Roche, M. & Lustig, K. (2013). Being Mindful About the Assessment of Culture: A Cultural Analysis of Culturally Adapted Acceptance-Based Behavior Therapy Approaches. Cognitive and Behavioral Practice, 20, pp. 60-63. doi:10.1016/j.cbpra.2012.04.002
Lee , H. Y. & Neese, J. A. (2020). Mental and Behavioral Health of Immigrants in the United States. Academic Press, pp. 157-178. https://doi.org/10.1016/B978-0-12-816117-3.00008-7
Yeung, A. S., Trinh, N-H. T., Chen, J. A., Chang, T. E. & Stern, T. A. (2018). Cultural Humility for Consultation-Liaison Psychiatrists. Psychosomatics, 59 (6), pp. 554-560. doi:10.1016/j.psym.2018.06.004
Thoughts on Therapy and Mental Health