- 5 Ways to be a Culturally Responsive Therapist
- Moving beyond cultural competence to cultural humility and responsiveness
- Developing cultural humility: the pre-work
- How to be a culturally responsive therapist
- Barriers to being a culturally responsive therapist
- What a Culturally Competent Therapist Is and How to Find One — MyWellbeing
- Because there are unique mental health struggles Black, Indigenous, and people of color (BIPOC) face in terms of stigma and access to care
- What is culturally competent care and why is it important?
- How can you find a culturally competent therapist?
- Here are some questions you can ask a potential therapist to gauge their level of cultural competence
- How will your therapist integrate your culture into your treatment plan?
- You deserve to find a therapist who understands, affirms, and supports your background and identity and integrates your individual needs into your treatment
- 4 Reasons Why We Need Culturally Competent Therapists
- 1 – People of color need mental health care
- 2 – Cultural competency creates a higher quality therapeutic relationship
- 3 – Racial and ethnic minorities face unique mental health challenges
- 4 – Culturally competent therapy empowers queer BIPOC
- Finding a Culturally Competent Therapist
- Final Thoughts
5 Ways to be a Culturally Responsive Therapist
By: Dr. Jessica Jackson
The death of George Floyd has brought discussions of racism to the forefront of America, and ultimately into the therapy room. For many clinicians, discussions of racism, discrimination, and/or the role that race plays in our daily lives has come up in therapy sessions. If it hasn’t happened yet, it will.
Our clients do not live in bubbles and are not exempt from the current social and political climate, especially people of color. Sue & Sue (2012) put it best, “…counseling and psychotherapy do not take place in a vacuum, isolated from the larger sociopolitical influences of our societal climate” (pg. 91).
I’ve received many questions and took part in many discussions with colleagues about how to help BIPOC (Black, Indigenous, People of Color) clients, specifically Black clients. My answer: practice cultural humility and culturally responsive therapy.
Moving beyond cultural competence to cultural humility and responsiveness
Cultural competence is a phrase I am sure has popped up in recent discussions you’ve had with your colleagues. For many of us, cultural competence is what was taught in graduate school. It was the standard for discussions of diversity for years in psychology.
Cultural competence was a term that came into prominence in the early 1980s thanks to Derald Wing Sue. Culture competence is model of developing skills, knowledge and self-awareness to be more effective in working with diverse populations.
While cultural competence is an important start; I encourage you to think and reflect deeper.
The American Psychological Association Race & Ethnicity guidelines and increased multicultural emphasis in training programs have helped the field of psychology evolve beyond just possession of knowledge and skills of other cultures — moving from a way of doing to a way of being.
More and more we recognize that our cultural identity and that of our client are both salient aspects of the therapy dynamic (American Psychological Association (2003).
Cultural humility and cultural responsivity are building blocks to understanding our clients and the cultural context that shapes their distress, building blocks that help us provide needed support on a deeper level.
Davis et al. (2011) breaks down humility into intrapersonal humility and interpersonal humility. To practice cultural humility, we must have both an accurate view of ourselves and respect for others without an attitude of supremacy or superiority.
Cultural humility is a continuum of:
- Inward self-awareness,
- Outward valuing of others and
- Upward growth. (Hook et al. 2013).
Culturally responsive therapy is responding to and making room for the client’s culture in the therapeutic process. This may look :
- Asking questions about their family’s cultural background and beliefs,
- Asking about their use of emotional expression, and
- Learning their perspective of their symptoms, even if it’s unrelated to the presenting problem.
As therapists, we cannot be culturally responsive if we have not first worked on developing cultural humility.
Developing cultural humility: the pre-work
Cultural humility is a mind-set shift and a career-long commitment. For those looking to get started on this journey, here are three skills you can begin working on. I call this the pre-work, the work that should happen on your own time before you enter the therapy room.:
- Self-awareness – Engage in self-reflection and self-understanding to develop an accurate view of self. Take the time to reflect on how your different social identities (e.g. religion, sexuality, generation, acculturation, socioeconomic status, education, ethnicity etc.) have influenced your worldview. Engage in reading, dialogues, workshops etc. that help you have a better understanding of your privileges, biases and values.
- Valuing of others – Be curious! Demonstrate a willingness to learn from others around you (e.g. colleagues, clients, friends etc.) and respond from a place of genuineness and authenticity. It’s okay to not know everything, in fact, admitting ignorance and asking questions is a cornerstone of humility. A caveat to this point is to be careful that you are not placing the responsibility on clients to teach you about their culture. There is a difference between asking someone to teach you about racism and asking to learn their experience of racism. Finding the balance is necessary.
- Growth – Remember, practicing cultural humility is a process. This is not a skill that we build overnight, but a continuum of continuing learning throughout our careers as clinicians. Push through discomfort and anxiety related to cultural conversations and enter conversations acknowledging that you may not feel your best throughout the conversation.
How to be a culturally responsive therapist
Once we have engaged in the pre-work, we can then focus on building on our increased self-awareness to foster empathy for clients. Culturally responsive therapy requires this empathy to truly understand and conceptualize how the client’s social identities interact and influence the client’s perception of their distress.
I have outlined five tips for doing culturally responsive work in the therapy room:
- One-size doesn’t fit all – Be mindful of how client’s social identities interact to make them unique. Appreciate individual differences and approach clients with an understanding of and respect for the client’s needs and cultural values. Be open-minded and recognize that there are multiple ways of viewing the world.
- Consider how your values, worldview, upbringing, etc. may influence your client’s perception of, rapport with, or trust in you. – Conceptualization and diagnosis often go hand in hand. Consider how your client’s behaviors and decisions may be guided by their cultural values and beliefs.
- Ask yourself, are you being tolerant, inclusive or integrative? – Consider culture at each step of the appointment, from advertising for clients to the termination session with a client. Tolerance is acknowledging there are differences between you and your client. Inclusivity is asking them their social identities and cultural background and considering it in your conceptualization. Integration is all of the above and having office décor reflective of different cultures or having intake forms/screeners in multiple languages. The goal in culturally responsive therapy is demonstrating integration. Georgetown University’s National Center for Cultural Competency has a checklist available to self-assess the inclusiveness of your practice.
- Acknowledge what is happening in the world outside of the therapy room – Even if your client does not bring it up, it’s okay to open the door for the discussion. They may be waiting to see if you’re comfortable bringing up a certain topic (e.g. racism, police brutality etc.). Asking a client how they are holding up with everything happening this week (note what’s been in the news or all-over social media etc.) is a general way to make it clear you are open to the conversation. Keep in mind, acknowledging a topic does not mean that it has to be the focus of treatment, but could be helpful in establishing rapport.
- Don’t make assumptions – Ask clients how they identify. Don’t assume, your client’s outward appearance, that they don’t want to discuss certain topics OR that they relate to specific topics. We all have fallen prey to stereotyping. Work on being intentional about not generalizing prior knowledge or prior experience with similar clients. For example, with the current COVID-19 pandemic, some Black American clients may be more focused on grief or financial concerns than racism. That’s not to say racism may not be important to them but may not be what’s most affecting them in session. In this case acknowledging the racism that is occurring may help the client feel more comfortable addressing the other concerns.
Barriers to being a culturally responsive therapist
As you practice these skills, be mindful of common barriers that may get in our way:
- Lack of preparedness for emotionally charged conversations
- Feelings of inadequacy
- Politeness protocol, and
For example, fear of saying the wrong thing often goes along with feeling incompetent, especially when addressing a topic, you don’t normally discuss.
It’s okay to name this anxiety in the therapy room, as long as the intention is to communicate, “I might get this wrong, but I’m willing to take the risk to create a necessary space for my client.
” What is not okay is not doing the self-work or preparing for the discussion and expecting the client to educate you in session.
It’s helpful to give yourself time before the session to prepare and reflect on what you want to say. Jumping into this conversation without thoughtfulness or intentionality could disrupt the rapport, the opposite of the goal.
Lastly, I challenge you to push past colorblindness and politeness protocol. Telling a client that you do not see color is essentially telling them that you do not see the totality of who they are.
It is not polite, it not good etiquette, it is not a compliment. If you feel the pull to tell a client you do not see color, I encourage you to pause and reflect on why that may feel safer for you.
We all make mistakes. Even when we have the best of intentions to support our client’s and meet them where they are, we can still get in our own way. There is simply no way to know it all, but we can communicate to our clients that we’re ready to listen and meet them where they are to support them.
Remember, cultural humility is being comfortable admitting what we don’t know. Leaning into this uncomfortableness has the potential to lead to deeper, richer connections with clients; making it well worth the effort.
Dr. Jessica Jackson is a counseling psychologist with a private practice in Houston, TX. She has provided mental health services in correctional facilities, university counseling centers, high schools and healthcare settings.
Jessica is a 2019 recipient of Society of Counseling Psychology, Section for Ethnic & Racial Diversity Outstanding Service to Diverse/Underserved Communities Award. Jessica is an alumna of the APA Council of National Psychological Associations for the Advancement of Ethnic Minority Interests (CNPAAEMI) Leadership Development Institute Fellow.
As a practitioner-scientist -advocate, her research focus has primarily centered around barriers to outpatient treatment, culturally competent clinical practice, race-related stress and racial trauma.
Connect with Dr. Jackson on , Instagram, or her website: www.drjlauren.com.
What a Culturally Competent Therapist Is and How to Find One — MyWellbeing
July is National Minority Mental Health Awareness Month, a time to raise awareness about the unique struggles that underrepresented groups face regarding mental health care.
Its official name is Bebe Moore Campbell National Minority Mental Health Awareness Month, named after Bebe Moore Campbell, founder of the National Alliance on Mental Illness (NAMI) Urban Los Angeles chapter, champion for mental health education and support for individuals of diverse communities, journalist and New York Times bestselling author, and recipient of NAMI’s 2003 Outstanding Media Award for Literature. Bebe passed away in 2006, but her legacy lives on in her work.
“We need a national campaign to destigmatize mental illness, especially one targeted toward African-Americans,” she said on NPR’s Morning Edition in 2005. “The message must go on billboards and in radio and TV public service announcements. It must be preached from pulpits and discussed in community forums.”
Because there are unique mental health struggles Black, Indigenous, and people of color (BIPOC) face in terms of stigma and access to care
While mental health affects everyone regardless of culture, race, ethnicity, gender and sexual orientation, people from racial and ethnic minority groups are less ly to receive mental health care and American Indians and Alaska Natives have the highest rate of mental health conditions among all communities.
According to NAMI, multicultural communities:
- have less access to treatment
- are less ly to receive treatment
- have poorer quality of care and higher levels of stigma
- have to deal with a culturally insensitive health care system and face racism, bias, homophobia or discrimination in treatment settings
- could have language barriers
- have lower rates of health insurance.
Because of racial inequalities in the mental health field itself, it can be an additional hurdle to find a therapist with a similar background or identity to you, especially when you consider all of the intersectionalities of your own identity. While 13.4% of the U.S. population identify themselves as Black or African American, less than 2% of American Psychological Association members are Black or African American.
While your needs come first and your decision to work with someone who shares your background or aspects of your identity is valid, it is also possible to work with a therapist who does not share your background or identity, as long as they are culturally competent and a good fit for you.
What is culturally competent care and why is it important?
NAMI defines cultural competency as “the behaviors, attitudes and skills that allow a health care provider to work effectively with different cultural groups.”
Your culture can play a huge part in your mental and physical health, your views of mental health treatment, the way you communicate your needs to your healthcare providers, the way you interpret communication from your healthcare providers, and the way you might be treated by healthcare providers. When you work with someone who lacks cultural competency, it can have an impact on the quality of your care.
According to Mental Health America, “a culturally and linguistically competent mental health system incorporates skills, attitudes, and policies to ensure that it is effectively addressing the needs of consumers and families with diverse values, beliefs, and sexual orientations, in addition to backgrounds that vary by race, ethnicity, religion, and language.”
“As clinicians, it is our ethical duty to provide care that is culturally competent to individuals seeking our services,” says Ernesto Lira de la Rosa, a New York City therapist and MyWellbeing community member. “This will look differently depending on the clinician and the client as we need to be aware of not only the client's identities, but also our own identities as cultural beings.”
How can you find a culturally competent therapist?
Word of mouth and recommendations from friends and loved ones can be valuable, but this entails moving past the stigma of talking about mental health and sharing our journey with others. How much you share with another person is up to you, but through being open about your mental health needs with others, you might be connected with a culturally competent therapist.
You can also contact agencies or organizations who build communities for and serve people with your identity or cultural background. They might have directories or could put you in direct contact with therapists who could be a good fit for you.
When you do your own research, look at the websites and social media profiles of your potential therapist.
Are they using culturally competent language and images? Do they have a statement or testimonies on their site about their success with people who have different backgrounds and identities? Just you might research a potential employer, research the public profile of your potential therapist.
Matching services MyWellbeing will ask about topics you’d to explore with your therapist, such as race-related stress, immigration, cultural competence, spiritual crisis and transition, social justice, and trauma.
We also ask about the preferred identity of your therapist, including their gender and whether or not they identify as a person of color or LGBTQIA+, and we ask you to rank the importance of these factors in their search.
Your topics and style preferences are used to connect you with matches who are ly to be strong fits for you, but you are able to use your free phone consultations to gauge your chemistry together and ask specific questions.
Here are some questions you can ask a potential therapist to gauge their level of cultural competence
- Do you have experience treating people with my identity or cultural background?
- What training have you had in cultural competency?
- Do you have familiarity with my culture’s attitudes toward mental health treatment?
- Are you willing to learn about aspects of my culture and identity that you aren’t familiar with?
- How would you include my identity, race, age, religion, gender identity, etc. in my care and treatment plan?
It’s not your responsibility to teach your therapist. They should be doing the work to become culturally competent and knowledgeable about different cultures and intersectional identities themselves. You can, however, gauge their willingness and openness to learn and decide if their current level of knowledge is enough to support you.
How will your therapist integrate your culture into your treatment plan?
Many people have had less-than-positive experiences with the healthcare system. There is often pressure to defer to doctors and expectations that it’s rude to ask questions or challenge decisions and diagnoses. My own experiences with the healthcare system have been mostly neutral and often negative, and I was surprised by the level of individualized care a good therapist can provide.
“Therapists that provide culturally competent care will have an ongoing process of developing awareness and knowledge of client's racial and ethnic identity development, cultural strengths and values, and experiences with stigma, prejudice, and discrimination,” says Ernesto. “It is through this process that we are able to modify and adapt our clinical interventions so they are culturally sensitive for our clients.”
You deserve to find a therapist who understands, affirms, and supports your background and identity and integrates your individual needs into your treatment
“We are always working towards cultural competence and this is a life-long process that can be both difficult and rewarding, but ultimately will benefit all the clients we see in our practices,” says Ernesto.
A culturally competent provider should include cultural beliefs, values, practices, and attitudes in your care to meet your unique needs and they should also treat you the intersectional individual you are.
By asking the right questions, understanding the importance of culturally competent care, and finding a therapist who is a good match for your unique identity, you’ll be able to get the mental health support you deserve.
4 Reasons Why We Need Culturally Competent Therapists
For mental health professionals, cultural competency is the ability to provide mental health services that can acknowledge cultural differences between the patient and therapist. In other words, the more a therapist knows about a person’s culture, ethnicity, or background, the more ly that person will feel comfortable in therapy.
Culturally competent therapists prioritize their understanding of a client’s background, ethnicity, and belief system.
Incorporating cultural competency and cultural sensitivity into mental health services enables therapists to accommodate and respect differences in opinions, values, and attitudes of minoritized people, such as communities of color and LGBTQ communities. So, why is cultural competence in mental health care so important?
1 – People of color need mental health care
Many people of color don’t seek mental health care due to cultural stigma or the inaccessibility of POC therapists. In Black communities and many other communities of color, stigma surrounding mental health issues—whether it’s depression, substance abuse, or traumatic stress disorder— leads many to believe that mental illness is a sign of weakness.
Because of socioeconomic challenges, many communities of color face a higher risk for poor mental health—and, consequently, poor physical health, according to the National Institute of Mental Health.
Culturally competent care can change the way patients and health professionals perceive mental disorders and attitudes toward health professionals, according to the United States Centers for Disease Control.
According to the National Alliance on Mental Illness, approximately one in five adults in the United States experience mental health problems in a given year, irrespective of ethnicity, gender identity, sexual orientation, or color.
According to the United States Department of Health and Human Services, African Americans are 20% more ly to report serious psychological distress than White people.
However, African Americans, Native Americans, and Asian Americans are less ly to seek treatment than White Americans due to long-held beliefs about stigma, lack of cultural awareness, and language barriers.
2 – Cultural competency creates a higher quality therapeutic relationship
The therapeutic relationship is the working relationship between the mental health professional and the client. Cultural competency can help therapists foster a higher quality relationship by assisting clients to feel more comfortable and understood. In turn, high-quality therapeutic relationships can boost the success of treatment, leading to positive outcomes.
Research has confirmed the positive effects of cultural competency practices in forming therapeutic relationships with new patients.
For therapists and clients from different cultures, cultural competency can encourage a closeness that would not be present otherwise.
In this way, cultural differences allow therapists to offer a new perspective that is different from potential judgments about behavior, wants, and needs that may conflict with clients’ cultural beliefs or social norms.
3 – Racial and ethnic minorities face unique mental health challenges
any other community, communities of color want to live healthy lives—physically, mentally, spiritually, and emotionally.
The challenge for communities of color and health professionals lies in defining what a healthy community looks through the lens of stigma and historical adversity, including racial disparities in health care and educational, social, economic, and mental health resources. By working together, therapists and clients can collaboratively overcome these challenges.
4 – Culturally competent therapy empowers queer BIPOC
Culturally competent therapists, social workers, and mental health counselors can empower queer Black, Indigenous, and People of Color (BIPOC) by providing safe spaces to express thoughts, feelings, and behaviors. Many LGBTQ BIPOC find it challenging to open up to close friends or family members due to stigma, with approximately 50% of LGBTQ people experiencing rejection from family members.
According to the American Psychological Association, the LGBTQ population also faces a significantly increased risk of mental health issues, including self-harm, suicidal ideation, and substance use disorder.
With more and more BIPOC openly identifying as queer and transgender, culturally competent therapy is becoming an important sense of empowerment. Culturally competent treatment can help queer people of color navigate gender identity, sexual orientation, and body dysmorphia in a space they feel comfortable.
In addition to psychodynamic or cognitive-behavioral therapy, therapists can provide safe spaces for support groups, which allow BIPOC to connect with others in their community.
Finding a Culturally Competent Therapist
Many patients who pursue therapy prefer a psychotherapist of the same racial and ethnic background. However, it’s important to keep in mind that not every therapist of color is culturally component.
When starting your search for a culturally competent therapist, the first step is to schedule an initial phone call.
During your initial consultation, it can be helpful to ask yourself the following questions:
- Is your therapist genuinely invested in your diverse and unique challenges?
- Does your therapist seek or market themselves to BIPOC?
- Does your therapist simply state that they are culturally sensitive without any evidence?
- Does your therapist reflect and actively listen to your culturally diverse experiences?
- Is your therapist able to provide insightful responses that are culturally in-tune?
If you’re unable to find a culturally competent psychotherapist of the same race and ethnicity who also has experience in your area of concern, consider expanding your search to include online therapy.
According to recent studies, online psychotherapy—also known as teletherapy—is as effective as face-to-face therapy for a wide range of mental health conditions and concerns.
If you live in a small town or city, it may be easier to find a culturally competent therapist in a neighboring city or county through online mental health services.
To find a culturally competent therapist, psychologist, or mental health counselor, consider reaching out to a mental health professional through WithTherapy.
WithTherapy’s unique matching service will connect you to a mental health professional you feel comfortable with, regardless of your race, ethnicity, gender identity, and sexual orientation.
One of the licensed therapists on the WithTherapy platform can help you find strength, control your mental health, and ensure your emotional needs are met.
No matter where you are in your search for culturally sensitive mental health care, don’t give up. Finding a good fit is hard work, and the first therapist you find won’t always be the right fit. The right therapist will help you make positive strides in your mental health, leading to a better outcome.