Considerations for Cultural Fit in Therapy

Finding a therapist who understands you involves more than shared interests. Culture is part of what has to fit.

Cultural fit in therapy means your therapist understands, or is at least willing to learn about, the cultural context that shapes your identity, values and worldview.

A therapist's cultural competence can affect how safe, understood and respected you feel in the work; cultural fit, or the lack of it, can affect the quality of the client-therapist relationship, and with it how therapy goes. It is an easy thing to overlook when choosing a therapist.

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What is Cultural Competence in Therapy?

Cultural competence in mental health is a therapist's ability to understand and take seriously a client's background and its bearing on their lived experience.

It involves more than an awareness of different cultural norms and practices; it asks for an understanding of how a person's culture shapes their view of mental health, the ways they cope, and what they want from therapy.

It also involves the therapist accepting that different people experience the same situation differently. Two social interactions that look identical from the outside can be rudeness, or racism, to the person on the receiving end.

Why Cultural Fit Matters

The therapeutic relationship rests on trust, understanding and respect, and cultural fit bears on all three. When a therapist has a grasp of your cultural context:

• Less has to be explained first. A therapist who already recognises the context is less likely to mistake a cultural difference for a symptom, and more time goes to what your experiences mean to you.
• Speaking openly can be easier. Not having to justify your background before you can raise the problem removes one obstacle to saying what you came to say.
• Respect is easier to establish. Having your cultural identity recognised and taken seriously supports the mutual respect the work depends on.

Identifying Your Cultural Needs

Knowing your own cultural needs comes before finding a therapist who can meet them.

Three things worth working out beforehand:

• Which parts of your identity matter most. Ethnicity, religion, language, migration history and family tradition carry different weight for different people. Naming the ones that matter to you clarifies what you need a therapist to understand.
• How your background shapes your view of therapy. Culture shapes what counts as a problem, who a difficulty is spoken to, and what help is acceptable. Setting this out for yourself makes it easier to say which aspects of cultural understanding you are not willing to do without.
• What you want from the therapist. Some people want a therapist from their own background. Others want someone experienced at working across cultural difference. Either is a reasonable starting point, and it helps to know which one you are looking for.

Finding a Culturally Competent Therapist

Once you know what you need, the search becomes more specific:

• Research and referrals. Look for therapists whose profiles set out relevant training, languages or experience. Referrals from people you trust, or from community organisations, are worth asking for.
• Questions for the first consultation. Ask about their experience with clients from your background, and how they take cultural context into account in the work. How the question is received tells you something on its own.

Evaluating Cultural Fit in Therapy

After a first consultation or the early sessions, it is worth reviewing:

• Being understood. Do your cultural references land, or does each one need explaining before the conversation can continue?
• Respect. Does the therapist treat your culture, its values and its norms as worth taking seriously?
• Willingness to adapt. Does the therapist adjust their approach where your context calls for it, or apply one method regardless?

Challenges and Considerations

• Limited options. A therapist with specific cultural expertise may not be available where you live, and for some backgrounds the choice is very small. Online therapy widens the field, though it is not available or suitable in every case.
• Speaking about it directly. A therapist who does not share your background, but is open, self-aware and willing to be corrected, can still do good work with you. That usually rests on your being able to say when something has been misread, which is easier said than done and reasonable to raise as a topic in itself.

Conclusion

Cultural fit bears on how understood and respected you feel in therapy, and those conditions matter to the work. Finding a good fit may take more searching, and it is worth treating as one of your criteria rather than something to sort out later.

Key Takeaways

• Cultural competence is part of the job. Understanding a client's cultural context, and taking it into account in the work, is a reasonable expectation of any therapist.
• Your own needs come first. Naming which parts of your identity matter to you, and what you want a therapist to understand, makes the search far more specific.
• Ask directly. A first consultation is the place to ask about experience and approach, and the answer is information you can act on.
• A shared background is not the only route. A therapist willing to learn and be corrected can work well across cultural difference.

FAQ

What is cultural competence in therapy?

It refers to a therapist's ability to understand and work within the client's cultural context, and involves awareness of the therapist's own cultural position, some knowledge of other cultural practices and worldviews, and a way of working that takes both into account.

Why is cultural fit important when choosing a therapist?

Feeling understood and respected affects how comfortable you are and how much you are willing to say. Where that is in place, less time goes to explaining context and more to the difficulty you came with.

How can I find out if a therapist has experience with my cultural background?

Start with their profile, which may set out relevant training, languages or client groups. In a first consultation, ask directly about their experience and how they approach working with clients from your background.

What should I do if I feel my cultural needs are not being addressed in therapy?

Raise it with your therapist. Say what has been missed and how it affects your experience of the sessions. A therapist should be able to hear that, adjust where they can, and discuss a referral if a different therapist would suit you better.

Can cultural fit improve therapy outcomes?

It can. Working in a way that takes your cultural context into account tends to make it easier to stay engaged and to build a working relationship, and both matter to how therapy goes. The research on cultural matching and culturally adapted therapy is genuine but modest and mixed, so it is fairer to treat cultural fit as one condition among several than as a guarantee of a better result.

Two meta-analyses published together in 2018 give a sense of the size of it. Across 99 studies of culturally adapted treatments the average effect was d = 0.50, falling to 0.35 once publication bias was allowed for. Across 15 studies of therapist cultural competence, clients' ratings of their therapist's cultural competence tracked with outcome (r = 0.38), while therapists' ratings of themselves did not (r = 0.06). That second result is the practical one when you are choosing: what counts is whether you experience the therapist as culturally responsive, not how competent they judge themselves to be.

How do I communicate my cultural needs to a potential therapist?

Be plain about which parts of your cultural identity matter to you in therapy. Name the beliefs, values or traditions that shape your life, and say how you would like them taken into account in the sessions.

What are some red flags that a therapist might not be a good cultural fit?

Warning signs include a therapist playing down the importance of your background, showing no interest in learning about it, or refusing to adjust their approach where the context calls for it. If you repeatedly feel misunderstood or dismissed because of cultural differences, and saying so changes nothing, it is reasonable to look for a different therapist.

Additional Resources

Victoria Dada, “Understanding cultural competence in mental healthcare”, UK Council for Psychotherapy

American Psychological Association, Monitor on Psychology, March 2015 issue: cultural competence

Elsevier, “Cultural Competence: an overview”, ScienceDirect Topics (Psychology)

Alberto Soto, Timothy B. Smith, Derek Griner, Melanie Domenech Rodríguez and Guillermo Bernal, “Cultural adaptations and therapist multicultural competence: Two meta-analytic reviews”, Journal of Clinical Psychology, 2018, 74(11), 1907-1923