Meeting Clients Where They Are: Cultural Competency in Psychotherapy

In today’s world, which has been overtaken by globalization and the spread of multiculturalism, mental health professionals are serving individuals from diverse cultural backgrounds more frequently than in the past. The current situation necessitates a cultural competence framework that enables clinicians to provide sensitive, effective, and ethical care that is responsive to clients’ cultural identities, values, and lived experiences (Sue et al., 2009). In the context of psychotherapy, cultural competence goes beyond awareness; it encompasses the attitudes, knowledge, and skills that support effective cross-cultural interactions in therapeutic settings. So what does the concept of cultural competence mean? Cultural competence in therapy can be defined in several different ways (Seales, 2022):

‘’A care model that takes into account a client’s life experiences and social and cultural contexts.’’

‘’A care model that can see a client in all their dimensions and take into account the elements they value.’’

‘’A care model that involves a mental health professional understanding clients’ beliefs, histories, and values in all their dimensions (culture, race, ethnicity, socioeconomic status, sexual orientation, etc.).’’

In a therapeutic setting, cultural competence facilitates the establishment of a therapeutic alliance between the client and the therapist and also helps to overcome cultural barriers that may exist between them. A culturally competent therapist strives to understand both complex issues such as oppression and microaggressions, as well as the moments when their clients are at their most authentic. An example of this might be a client using a particular dialect that may not be considered standard English. 

In conclusion, cultural competence in the context of psychotherapy is not only about understanding different cultures but also about actively using this understanding to provide effective and ethical mental health care to all clients. Ethical practice in psychotherapy requires a commitment to cultural humility, lifelong learning, and a willingness to engage in difficult conversations. Indeed, the American Psychological Association emphasizes that professional ethical standards highlight the moral imperative of cultural sensitivity in psychotherapy (Hook et al., 2013). In the current therapy sketch, the theoretical foundations of cultural competence in psychotherapy will be defined, its key aspects will be addressed, how it functions in the therapeutic context will be examined, and its benefits will be evaluated.

What is Cultural Competency in Psychotherapy?

To begin with a definition, cultural and linguistic competence is a set of harmonious behaviors, attitudes, and policies that come together among systems, institutions, or professionals, enabling effective work in cross-cultural situations. ‘’Culture’’ refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, traditions, beliefs, values, and institutions of racial, ethnic, religious, or social groups. ‘’Competence’’ means having the capacity to function effectively as an individual and an organization in the context of cultural beliefs, behaviors, and needs presented by consumers and communities (SAMHSA, 2014). In other words, cultural competence refers to the ability of mental health professionals to understand, communicate with, and interact effectively with people from different cultures. In the context of psychotherapy, it involves integrating cultural awareness into assessment, diagnosis, treatment planning, and therapeutic intervention (American Psychological Association, 2017).

There are three key components of cultural competence that lead to strong positive effects in therapeutic context (Sue et. al., 1992; SAMHSA, 2014):

1. The clinician must be aware of their own cultural worldview, biases, limitations, and assumptions.
2. The clinician must be knowledgeable about different cultural phenomena, interventions, and practices, worldviews, and experiences.
3. The clinician must be able to effectively participate in culturally relevant therapeutic skills.

Culturally competent psychotherapy is not a fixed set of techniques; it encompasses a continuous process of development that integrates cultural awareness, knowledge, and skills into every aspect of clinical practice. According to the Substance Abuse and Mental Health Services Administration (2014), the effective delivery of culturally competent care depends on several key elements that reflect sensitivity, humility, and a commitment to contextual treatment planning:

Cultural Awareness and Self-Reflection: The fundamental element in the context of cultural competence is the therapist’s awareness of their own cultural background, values, assumptions, and biases. Clinicians should regularly engage in self-reflection to understand how their cultural identities shape their perceptions, interactions, and clinical judgments (Sue et al., 2009). The self-awareness that develops through self-reflection exercises helps prevent cultural encapsulation, which is the tendency to impose one’s own cultural values on others. Additionally, clinicians should develop a ‘’culturally sensitive attitude’’ by recognizing power imbalances, acknowledging privilege, and remaining open to different cultural narratives (SAMHSA, 2014). This also involves understanding how multiple identities (gender, race, socioeconomic status, etc.) interact to shape individual experiences (intersectionality) (Crenshaw, 1991).

Cultural Knowledge and Literacy: Clinicians should acquire comprehensive knowledge about different cultural groups, including their histories, belief systems, communication styles, family structures, and experiences of systemic oppression, and keep themselves up to date in this context (APA, 2017; Sue & Sue, 2016). Similarly, SAMHSA’s (2014) guide emphasizes the importance of clinicians understanding various social and historical factors that influence clients’ worldviews, such as trauma from migration, intergenerational poverty, colonization, and racial discrimination. To this end, clinicians are encouraged to ask open-ended and culturally sensitive questions during the assessment to gain insight into the client’s cultural identity.

Culturally Adapted Clinical Skills: Culturally competent psychotherapy skills include adapting assessment tools, treatment plans, and interventions to the cultural context of the client (Hwang, 2006). Interventions may require incorporating culturally appropriate healing practices into the therapeutic process. SAMHSA (2014) recommends using client-centered participation strategies such as the following:

• Working with interpreters or bilingual clinicians when necessary.
• Bringing cultural metaphors familiar to the client into the therapy room.
• Recognizing cultural symptoms caused by distress in the individual (e.g., somatization in some cultures).
• Developing cross-cultural communication skills, including cultural empathy, active listening, and sensitivity to nonverbal communication patterns that vary across cultures (Tseng & Streltzer, 2004).

Organizational and Systemic Support: While individual clinician competence is critical, the broader organizational context in which therapy takes place must also be culturally competent. Culturally competent practice should be regularly monitored and supported by institutional policies, procedures, and educational initiatives. Culturally competent care can only be provided through effective collaboration between the clinician and the organization to which they belong.

Cultural Humility and Lifelong Learning: Cultural competence is not a static achievement; it encompasses a continuous process requiring humility, openness, and lifelong learning (Hook et al., 2013). Cultural humility in the therapeutic setting involves the clinician acknowledging the limits of their knowledge, being willing to learn from the client, and addressing power differences within the therapeutic relationship. In short, clinicians should adopt cultural humility not as a goal but as an attitude and proceed accordingly. Additionally, it should not be forgotten that in every therapeutic encounter, the goals of partnership, respect, and mutual learning should be prioritized (SAMHSA, 2014).

Understanding the fundamental elements of culturally competent psychotherapy provides a strong foundation for ethical and sensitive mental health care. To take the process one step further, it is necessary to learn how these elements are applied in therapeutic settings. The following section examines how cultural competence works in practice and focuses on how therapists incorporate these principles into client participation, assessment, and the overall therapeutic relationship.

How Does Cultural Competency Work in Therapy Setting?

In a therapeutic setting, cultural competence becomes clinically meaningful when it is incorporated into every point of contact with the client and every level of the organization providing care. The ways in which culturally competent practice is reflected in the psychotherapy room are outlined below:

Client Engagement and First Contact: From the first phone or email contact with the client, client engagement is encouraged by providing materials in multiple languages, using gender-affirming intake forms, and providing clear explanations about confidentiality processes (SAMHSA, 2014).

Therapeutic Alliance Building: Rather than focusing solely on the client’s symptoms, clinicians encourage the client to talk about their migration history, family life, spiritual values, and experiences of discrimination in the context of the client’s migration history, family life, spiritual values, and experiences of discrimination, thereby developing a comprehensive view of the client’s culture, which contributes to the therapeutic alliance between the client and the clinician (Hook et al., 2013).

Assessment and Case Formulation: The clinician strives to uncover the cultural definitions of the problem during the interview (Hwang, 2006). Identifying various social determinants such as immigration status, racism, and social pressure is also part of the assessment process (SAMHSA, 2014). In addition, the clinician pays attention to the client’s somatic symptoms and considers the cultural elements through which distress is expressed. Thus, the client’s problem is effectively assessed within a comprehensive cultural framework.

Treatment Planning and Goal Setting: As stated in SAMHSA (2014), clinicians should balance the Western concept of ‘’self-actualization’’ with the collectivist concept of ‘’social conformity’’ and set both individual and collective treatment goals. On the other hand, during evidence-based practices, while basic intervention principles (e.g., cognitive restructuring) are maintained, superficial elements (language, metaphors, etc.) should be modified. In other words, relevant adjustments should be made for the client without disrupting the general outline of the practice.

Intervention Delivery: When the client’s needs are concerned, if bilingual therapists are not available, trained professional interpreters should be consulted (SAMHSA, 2014). In such a context, the clinician must inform the interpreter of the goals and confidentiality of the session in advance (SAMHSA, 2014). On the other hand, therapists are encouraged to follow speech patterns, eye contact, and turn-taking norms during the session. For example, in some indigenous cultures, pauses indicate respect rather than disconnection. A clinician who is aware of this situation will be able to behave appropriately in the context and maintain the flow (Kirmayer, 2012).

Outcome Monitoring and Program Evaluation: Clinicians’ use of tools such as the Cultural Competence Feedback Scale enables them to assess perceived respect for clients’ cultures; scores obtained from the scale accelerate course correction (Lozano et al., 2022). Similarly, SAMHSA (2014) aims to increase accountability and cultural resonance by encouraging the inclusion of clients in the process of designing service improvements.

When all steps are completed and a smooth process is ensured, cultural competence transforms therapy from a uniform service model into a flexible and contextually embedded partnership. As SAMHSA (2014) emphasizes, cultural competence is a valuable and lengthy journey sustained by humility, organizational commitment, and rigorous evaluation. The next section will explore the benefits of cultural competence in a therapeutic context.

What are the Benefits of Culturally Competent Therapy?

Cultural factors influence how individuals perceive mental health issues, how they seek help, how they express symptoms, and how they respond to treatment (Bhui et. al., 2007). In a therapeutic environment lacking cultural sensitivity, misdiagnosis may occur, misunderstandings may arise, or the client may feel alienated or invalidated. On the other hand, culturally inadequate therapy can inadvertently perpetuate systemic inequalities and re-traumatization, particularly for historically marginalized groups (Comas-Diaz, 2012). Culturally competent therapy, on the other hand, incorporates cultural awareness, sensitivity, and responsiveness into the therapeutic process, increasing client engagement, improving treatment outcomes, and contributing to the reduction of health inequalities. Other benefits of culturally competent therapy are listed below:

Increased Client Engagement and Trust: The primary benefit of culturally competent therapy is to create a trust-based therapeutic environment and establish a strong therapeutic alliance between the client and clinician. When a client’s cultural identity (race, gender, language, ethnicity, etc.) is accepted and respected in the therapy room, the client feels seen, heard, and safe (SAMHSA, 2014). This reduces hesitation about mental health care and concerns about stigma, especially among populations that are skeptical about seeking therapy. On the other hand, it is also known that culturally competent psychotherapy significantly increases client participation and seriously reduces early dropouts (Bernal and Domenech Rodriguez, 2012). When the client realizes that their entire self is accepted in the therapy room, they are more inclined to stay in that room and continue the process.

Improved Treatment Outcomes: Culturally competent therapy enables better clinical outcomes by adapting intervention methods to clients’ cultural values, communication styles, and belief systems (SAMHSA, 2014). Culturally adapted evidence-based practices are known to be more effective than their non-adapted counterparts (Hall et al., 2016). Some of the outcomes improved by culturally competent therapy are as follows (Benish et al., 2021; Sue et al., 2009):

• Reduction in symptom severity
• Enhanced resilience and identity acceptance
• Improved coping and problem-solving skills
• Greater satisfaction with care received

Reduction of Health Disparities: Culturally competent therapy helps prevent both structural and systemic inequalities by challenging institutional biases. Additionally, culturally informed care reduces disparities in diagnosis and treatment outcomes among racially, ethnically, and linguistically diverse groups. 

Clinician Growth and Ethical Practice: Cultural competence encompasses a reciprocal process that benefits not only the client but also the clinician. Culturally competent care enhances the clinician’s capacity to make decisions of higher ethical value, form stronger therapeutic alliances with clients, and respond to clients with honesty and compassion (Hook et al., 2013).

Takeaways:

• Today’s increasing cultural diversity requires mental health professionals to work more frequently with individuals from different backgrounds, significantly increasing the need for a cultural competence framework.
• Cultural competence in therapy is defined as a care model that takes into account the client’s life experiences, values, beliefs, and both social and cultural context.
• Cultural competence does not consist of fixed techniques; it involves a process that requires continuous development in terms of knowledge, skills, and attitudes, starting with the therapist’s awareness of their own cultural biases.
• Effective cultural competence is not limited to individual therapist skills; institutions must also support this process through their policies, service structures, and training programs.
• When cultural competence is integrated into every stage of the therapeutic process (from intake sessions to termination), therapy becomes a contextually adapted and meaningful partnership rather than a standard practice.
• When clients’ cultural backgrounds, communication styles, and values are sensitively incorporated into the therapeutic process, the therapeutic alliance is strengthened and treatment outcomes become more effective.

References

1. Substance Abuse and Mental Health Services Administration. (2014). Improving cultural competence.. In TIP 59. https://store.samhsa.gov/sites/default/files/sma16-4931.pdf 
2. Sue, S., Arredondo, P., & McDavis, R. J. (1992). Multicultural counseling competencies and standards: A call to the profession. Journal of Counseling & Development, 70, 477–486.
3. Seales, J. L. (2022b, June 14). Cultural competence in therapy: What it is and how to find it. Psych Central. https://psychcentral.com/pro/working-towards-cultural-competence-in-therapy#defining-it 
4. Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366.
5. American Psychological Association (APA). (2017). Multicultural Guidelines: An Ecological Approach to Context, Identity, and Intersectionality.
6. https://www.apa.org/about/policy/multicultural-guidelines 
7. Sue, D. W., Capodilupo, C. M., Torino, G. C., et al. (2009). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286. https://doi.org/10.1037/a0015671  
8. Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241–1299.
9. Sue, D. W., & Sue, D. (2016). Counseling the Culturally Diverse: Theory and Practice (7th ed.). Wiley.
10. Hwang, W. C. (2006). The psychotherapy adaptation and modification framework: Application to Asian Americans. American Psychologist, 61(7), 702–715.
11. Tseng, W., & Streltzer, J. (2004). Culture and psychotherapy: A guide to clinical practice. American Psychiatric Publishing.
12. Kirmayer, L. J. (2012). Rethinking cultural competence. Transcultural Psychiatry, 49(2), 149–164.
13. Lozano, A., Estrada, Y., Tapia, M. I., Dave, D. J., Marquez, N., Baudin, S., & Prado, G. (2022). Development of a family-based preventive intervention for Latinx sexual minority youth and their parents. Cultural Diversity & Ethnic Minority Psychology, 28(2), 227–239. https://doi.org/10.1037/cdp0000506  
14. Bhui, K., Warfa, N., Edonya, P., McKenzie, K., & Bhugra, D. (2007). Cultural competence in mental health care: A review of model evaluations. BMC Health Services Research, 7(15). https://doi.org/10.1186/1472-6963-7-15  
15. Comas-Díaz, L. (2012). Multicultural care: A clinician’s guide to cultural competence. American Psychologist, 67(5), 452–464. https://doi.org/10.1037/a0028692  
16. Bernal, G., & Domenech Rodríguez, M. M. (2012). Cultural adaptations: Tools for evidence-based practice with diverse populations. American Psychological Association.
17. Benish, S. G., Quintana, S., & Wampold, B. E. (2021). Culturally adapted psychotherapy and the legitimacy of myth: A critical review of meta-analyses. Journal of Counseling Psychology, 68(2), 245–260. https://doi.org/10.1037/cou0000422  
18. Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47(6), 993–1014. https://doi.org/10.1016/j.beth.2016.09.005 

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While our physical offices are located in South Loop and Lakeview neighborhoods in Chicago, Illinois for in-person sessions, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more.  

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At Roamers Therapy, our psychotherapists are here to support you through anxiety, depression, trauma and relationship issues, race-ethnicity issues, LGBTQIA+ issues, ADHD, Autism, or any challenges you encounter. Our psychotherapists are trained in Cognitive Behavioral Therapy, Dialectical Behavioral Therapy, Psychodynamic Therapy, Acceptance, and Commitment Therapy, Person-Centered Therapy, and Gottman Therapy. 

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This page is also part of the Roamers Therapy Glossary; a collection of mental-health related definitions that are written by our therapists.

While our offices are currently located at the South Loop neighborhood of Downtown Chicago, Illinois, we also welcome and serve clients for online therapy from anywhere in Illinois and Washington, D.C. Clients from the Chicagoland area may choose in-office or online therapy and usually commute from surrounding areas such as River North, West Loop, Gold Coast, Old Town, Lincoln Park, Lake View, Rogers Park, Logan Square, Pilsen, Bridgeport, Little Village, Bronzeville, South Shore, Hyde Park, Back of the Yards, Wicker Park, Bucktown and many more. You can visit our contact page to access detailed information on our office location.