Many minorities, when faced with systemic oppression, feel pressured to present themselves in a way that they feel is expected of them. They might avoid certain topics because they expect others will not get it. Sometimes these patterns may come up in therapy as well, particularly if clients are concerned their therapists may not understand.
Therapists who provide culturally-competent care are trained to help clients notice and overcome these patterns – they are particularly aware of different world views, including their own biases, and have the skills to tailor therapy to each client's unique needs. As a result, clients are able to more fully discuss the values, experiences, and parts of their identity that matter and, over time, make informed decisions towards restoring and protecting their mental health.
Here's what defines culturally competent care, what it looks like in treatment, and how to find a culturally competent therapist.
What is culturally competent care?
Definition of culturally competent care
Culturally competent care is provided when therapists are invested in expanding their understanding of different world views and their own biases, and in developing skills to tailor to clients' needs.
While there are many definitions of culturally competent care, the most popular understanding is derived from the works of Dr. Derald Sue, a renowned counseling psychologist and pioneer in the field of cultural competence in clinical settings.
Specifically, it highlights three critical components that providers must adhere to through consistent and active engagement:
- Build self-awareness of own worldview and biases: Therapists must invest in building their self-awareness of their own worldview, biases, limitations, and preconceived notions they bring into the therapy room
- Expand knowledge of different worldviews: Therapists must consistently strengthen their knowledge of the existence of different world views and factors that shape them, without negative judgment
- Develop skills to tailor to individual clients' needs: Therapists must develop appropriate skills and strategies, so that they can tailor appropriate and relevant interventions to the needs, worldviews, and values of their clients
Cultural competence is a process, not an outcome. As such, a therapist should constantly be working on their blindspots, awareness, skills, and knowledge.
Identities that cultural competence applies to
While cultural competence was often first discussed in the context of race, the idea has since been applied to many important identities as well, including:
- Beliefs, faiths, and religions
- Cultural values
- Linguistic needs
- Sexuality and gender identity
How culturally competent care affects treatment
The provider takes culture into context
Culturally competent care centers your definitions of what might be healthy by prioritizing the values, identities, and goals that matter to you.
If a South Asian client who comes from a community where it is often common for multiple generations to live together, it would be important for their therapist to understand their own biases of “healthy,” especially if their training and upbringing valued middle class European American norms of independence and the focus on the nuclear family.
The provider demonstrates to the client that they are worthy of care
Culturally competent care can be healing on a really deep level – it reminds you that you and people who look and/or feel like you deserve thoughtful care.
Often, discriminated individuals have assumed that “therapy is not for them” so it is really powerful when you have access to care that centers your values, needs, and experiences.
When care is not culturally competent
Examples of care that isn’t culturally competent
- When your provider minimizes or denies your culture-specific experiences
- When there is negative judgement about your communication style or coping without any understanding of how cultural factors and stressors may shape them
- If you find that you often have to explain your background in much detail, it suggests that your therapist may not be well informed at least on the knowledge, and possibly the skillset, component of cultural competence
- If statements are made that are reinforcing stereotypes, including the seemingly “positive” ones (“You’re a strong Black woman,” “You’re so smart,” “You’re so inspiring”)
- If you find that the work seems to be about getting you to fit the intervention rather than the interventions fitting you
- If your therapist struggles to discuss systemic issues such as racism, classism, heterosexism, ableism, and sizeism by avoiding, being defensive, or even overly eager, it might suggest that they may not have the capacity at this stage of their journey to offer cultural competent care that matches your needs.
What to do if your therapist doesn’t understand your background
Since, as mentioned above, cultural competence is a process (not an outcome), there may be times when your therapist doesn’t understand your background. If that happens, you do have options!
Provide open, honest feedback for your therapist
If you feel comfortable – and you think your therapist is open to feedback – you can try talking to your therapist about your concerns. You can say something like, “I find that I’m often explaining my background and that it takes time from the focus of my concerns - could we consider ways to minimize this?”
Note that this suggestion places a lot of work on your shoulders. However, if changing therapists isn’t a viable option – and if you think your therapist might be open to this feedback – it could be an important way to share the workload with your therapist.
(FYI, many therapists, including myself, are trained to “explore” these kinds of requests. If you find your therapist is exploring this request with a lot of follow up questions, but is not actually talking any responsibility for their role, it might be a sign that they are unable to take this kind of feedback.)
Not able to share feedback? Consider changing therapists
If you are concerned that your therapist may not be able to hear your honest feedback, it might be helpful to consider changing therapists:
- You can try search for therapists who may have more expertise in the identities/background that matter to you
- Sometimes – due to geographic, insurance, or financial reasons – it can be difficult to find a therapist who has expertise in your background. In this case, look for a therapist who seems open to feedback, appears nonjudgmental, and is willing to learn with you, so that way you aren’t doing all the cultural work in the room.
What to look for in a culturally-competent therapist
Desirable qualities in a culturally-competent therapist
- Comfort in discussing topics and identities that are important to you
- An ability to communicate awareness about the specific communities/groups they say they are competent in
- Experience working with clients with backgrounds that match their competency areas
- Ability to use their knowledge in a way that deepens and supports your growth, rather than using their knowledge in ways that feel like further stereotyping
- Someone who helps you feel more comfortable and at ease
Prioritize providers who strive to be adaptable, and are committed to clients’ well-being
Since our cultures are constantly evolving (due to political and societal reasons), culturally competent care requires providers to keep up-to-date and flexible. Because of this constant need to evolve, I’d recommend looking for therapists who seem flexible, invested in their clients’ welfare, and committed to their professional growth in relation to different cultural identities.
You may prefer working with a therapist with whom you strong identify
For some individuals, seeing a therapist who looks or acts like you can be very empowering because it can help you realize that therapy can really be for you, and that members of your community care about mental health.
You can receive culturally competent care from a provider who looks or acts differently from you
Since culturally competent care is really about a therapist’s ability to be self-aware, knowledgeable, skilled, and attentive to your needs, it would be important to ask them questions about these aspects of their professional identity.
Look for a therapist whose specialties match your needs
For example, if you have anxiety, and are frustrated by gender-related issues at home or the workplace, look for a therapist who is able to understand and offer expertise in those areas.
Questions to ask a therapist when seeking culturally competent care
I’d recommend asking your therapist or potential therapist (if you are searching for one):
- Where their cultural competencies lie – if they mention several different things, ask them to rank them :)
- What is their definition of cultural competency in therapy?
- What do they see as the most important impact of a culturally competent therapist in the room?
Culturally competent care is a nuanced concept, but it’s also a powerful one. Whether you’re looking to switch to a more culturally-competent provider, or just starting your search for a therapist, connecting with someone who’s able to gain and maintain cultural cognizance has the potential to make or break your therapy experience.