Culturally Competent Care

Culturally competent care refers to the conscious, ongoing effort that some therapists make to explore and understand cultural and subcultural values, culture-specific beliefs, and culturally-informed interventions, to ensure their clients get the best attentive care possible.

It's both an outlook, and a skill. It means the therapist is taking not only your background into context, but their own background as well. They’re checking their assumptions and biases and are striving constantly to ensure they’re tailoring the therapy experience to your unique needs.

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:

Not sure whether the care you’re receiving is culturally competent? Here are indications of a culturally-competent therapist, warning signs that your therapist may not be culturally attentive to your needs, as well as some tips for finding a therapist who is equipped to provide this level of care.

The following are qualities of culturally-competent care:

Culturally competent therapists prioritize your unique background and upbringing – rather than imposing their own values

What’s considered normal in one culture might not seem so to another – and a culturally competent therapist remains aware of this. They work hard to center your background so that your worldview isn't eclipsed by their own worldview or biases.

Say you come from a South Asian community where it is often common for multiple generations to live together. It would be important for your therapist to understand and be aware of their own biases of “healthy,” especially if their training and upbringing valued middle-class, European-American norms of independence and the nuclear family.

A therapist who offers culturally competent care also recognizes the ways in which cultural norms, personal preferences, and experiences have shaped you. For example, if you're a person of color who has had past experiences of not being heard by white people, you may find yourself holding back from speaking about a recent experience of discrimination with your therapist who is white. A culturally-competent therapist has the skills to center your experiences, create safety, and earns your trust so that you have the space and comfort level to discuss what's on your mind.

Culturally competent therapists encourage you to discuss your identity and experiences – even if it feels uncomfortable at first  

A culturally competent therapist doesn’t typically shy away from the tough topics, like if you're experiencing racial tension at work. They treat each topic that you bring up with due consideration and respect – and observe it within the current context as well relevant past personal and larger political experiences.

A culturally competent therapist may discuss stereotypes with you, to identify how you have had to navigate them in your everyday experiences. That said, they are unlikely to ever reduce you to a stereotype associated with your background, or make statements that reinforce those stereotypes. (See below for warning signs of care that isn’t culturally competent.)  

To summarize, You want to be able to open up in sessions about difficult cultural experiences, and not hold back on what you want to say, when you want to say it. This trust and openness between a therapist and client, known as the therapeutic alliance, is one of the fundamental elements of successful therapy.

Culturally competent therapists remind us that therapy isn't "just for white middle class straight people" and that your struggles matter

Often, individuals from marginalized backgrounds assume that “therapy is not for them" – given this, culturally competent therapists ensure you feel welcome in therapy, and that your struggles are worth addressing.

A good therapist, but especially a culturally competent provider, makes you feel your issues are valued, worth it, and respected, especially if they've been trivialized in the past (for example, by being seen as "not that bad").

Culturally competent care is especially powerful because it gives you access to care that is not only welcoming, but also uniquely centered around your values, needs, and experiences.

As a result, 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 respectful, quality care.

When care is not culturally-competent, you may feel misunderstood, judged, or reduced to a stereotype

Therapy is a space for you to get the care you need, not feel like you have to conform to societal expectations.

If you’re experiencing any of the following, then the care you’re getting may not be culturally-competent:

You often find yourself having to explain your background in elaborate detail

If you find yourself having to consistently walk your therapist through your background and beliefs, your parents’ cultural expectations of you, or even why you value certain attributes in a partner, then chances are, the treatment you’re receiving isn’t culturally competent.

And while yes, you may have to do some cultural explaining in sessions because of the various subtleties of how we practice our different cultures, that shouldn’t take up the majority of your time together – because a culturally-competent therapist will usually have enough background and knowledge to be able to keep up with you.

There is automatic judgement about your communication style or coping

You may feel your therapist writes off how you talk to your friends and family (or how they speak to you), without any understanding of how cultural factors and stressors may shape them.

For example, nicknames in your culture may reflect physical appearance (e.g., gordo, flaco) – and if your therapist doesn't have familiarity with this tendency, they might rush to negative judgement.

The provider minimizes or denies your culture-specific experiences

Rather than validating and offering thoughtful perspectives on your experiences, a therapist who isn't culturally-competent may shrug off your perceptions with discrimination or cultural isolation.

For example, you might feel like too much or too little is expected of you at work based on your race – but your therapist automatically denies this pattern is occurring.

Or you may be feeling misunderstood by your greater friend group due to judgements about cultural differences, but your therapist doesn't validate and try to understand this experience.

The therapist struggles to discuss systemic issues

They might avoid, or become defensive, or even overly eager to discuss issues like racism, classism, heterosexism, ableism, and sizeism.

The therapist makes statements that reinforce stereotypes

A therapist who isn't culturally competent may rely on stereotypes to do work with you. For example, they might describe you using stereotypes without understanding the history behind them. This may include the seemingly positive ones, such as “you’re a strong black woman,” “you’re so inspiring,” or “you’re so smart.”  

The above examples suggest they are not yet at the capacity at this stage of their journey to offer culturally competent care that matches your needs.

How to look for a culturally competent therapist  

If you determine that your current therapist doesn’t fit your needs, or are just starting your search, here’s how to get started.

Look for a therapist whose specialties match your unique 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.

Seek someone who has worked with other clients who are like you

If you’re just starting out with your therapist, don’t be afraid to ask about what different backgrounds they’ve worked with – and if they’ve worked with other clients who are like you!  

For example, if you're looking for therapy in Spanish and the therapist indicates they speak Spanish on their profile, ask them about their comfort with Spanish and learn more about their experiences providing therapy in Spanish.

Questions to ask a therapist when seeking culturally competent care

If you are looking for a culturally competent therapist, I'd recommend asking them:

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 provide culturally-attentive care has the potential to make or break your therapy experience.