“That is a very American way of looking at things, Robin,” my client said to me after I gave her some feedback about her marriage.
We gave each other a knowing look and laughed, and then I acknowledged that she was absolutely correct. In her country, the thoughts that I shared would have sounded strange, as they did to her.
I had let my values, which have been shaped by American society, enter our counseling space.
The reason why my client felt so comfortable in calling me out, and why I was so comfortable hearing and accepting it, was because we had already formed a good therapeutic relationship, and it wasn’t something that happened all the time.
Still, I blew it. And it is examples like this that have caused people to not show up to their next session.
The only thing that I could do was work harder to reduce the chance of it happening again.
In America, most therapists are probably going to be white, cisgender, likely heterosexual, and Western philosophized. It is no mystery, then, why people who do not match this description are not sprinting into therapy.
There are a number of issues that may be relevant to therapy: sexual orientation, race, gender, ethnicity, religion, ability, and other factors. So how much of this should you expect your therapist to know and understand?
What should you expect from your therapist regarding multicultural counseling? Here are some examples.
1. They Explain the Process in a Culturally Sensitive Way
There are a lot of things that someone needs to consider when they begin therapy. What is the therapist’s style? Who gets access to my information? What is the fee agreement? What if I want or need a translator?
Therapists are obligated to explain to you, in a way you understand based on your culture and language, what you can expect from therapy. To do this, a therapist may need to find a translator or take an extended period of time to explain the details.
For example, the concept of confidentiality is fairly understood by people familiar with American culture, because it is talked about whenever you receive health care.
But this concept, and how it is applied in America, is not universal. It may take time to explain the legal requirements for keeping information private in therapy, and the limitations to that privacy.
Your therapist is required to do their absolute best to make sure you know what is going on and the potential risks to being in therapy.
If you are talking to a therapist and need some clarification on something, your therapist should be willing to find a way to make the information clear to you.
2. They Have Formal Training in Multicultural Counseling
Education to become more culturally competent has been integrated into the majority of therapy training programs, and states usually require that therapists have had a certain amount of education in multicultural counseling before they can get licensed in their state.
We finally had to accept that therapy is not a “one size fits all” deal and that the mental health system has severely harmed people by failing to practice culturally sensitive therapy and ethical research.
Every good therapy training program encourages students to take a long, hard look at their own culture, values, beliefs, and prejudices. Most therapists have had multiple classes that require this, have participated in numerous role-plays, written dozens of papers, and taken some honest criticism from professors and other students if there is something about their belief system that could be harmful to clients.
In addition, no therapist can even hope to be culturally competent if they have not learned about issues like oppression or privilege, and how these things have affected people in our mental health system.
If you are seeking a therapist, ask them about their training and experience in multicultural counseling, and how they manage their personal belief system and values when they are in a counseling relationship with someone.
If you like their answer, great! If not, move on.
3. They Try to Understand Your Culture
It is impossible for any counselor to be 100% culturally competent. Many therapists have not had the opportunity to work with diverse populations.
Now, that does not mean that they can’t be effective; it just means that they may not be experts on your culture. It is completely up to you to decide if this is a deal-breaker.
If not, then there are some things that you should expect from your therapist.
For one thing, your therapist shouldn’t be afraid to talk about cultural differences. If you present them with a problem that you are having, they should be interested in the cultural significance of it from your perspective.
Family relationships, sexuality, mental illness, gender roles, and many other topics can be viewed drastically different from one culture to another.
Your therapist should listen, and probably do some research. Now, it’s not your job to educate your therapist about your culture, but they may ask relevant questions to better understand your perspective.
An ethical therapist will inform you if they don’t think they can counsel you due to cultural differences, but they then have the obligation to find you culturally relevant resources to assist you.
What a therapist should never do is accept you into therapy and then disparage your culture, or try to “fix” something that is not broken – like your sexual orientation!
If you are seeking a therapist, don’t be afraid to ask them how they plan on getting to know you. Ask them if they have prejudices. If they are ethical, they will tell you. If you get into therapy and believe they are not adequately considering your culture, you are not obligated to stay.
Remember, your therapist is human and they are likely to make some mistakes. Don’t be afraid to tell your therapist if they have gone completely off base.
The story I shared at the beginning of this article provides a great example of a client who had no problem telling me that I was not considering her culture in my counseling. I am so glad she did, and your therapist should be glad, too.
Now, there may be times when your therapist says something that you don’t like to hear, and it may not be because they are not being culturally sensitive. It is their job to challenge some of your beliefs and help you look at things from a different perspective.
But if you are not sure what the therapist’s motivations are by bringing up things that you find uncomfortable, it is perfectly acceptable to ask.
4. They Consider Culture When Selecting Assessment Tools
There are times when therapists may use some kind of assessment tool, such as a questionnaire to screen for depression or anxiety, while working with clients. These tools can be very helpful, but history has taught us that they can be misapplied and not appropriate for multicultural use.
For example, many of the earlier intelligence tests (IQ) have been modified and improved due to complaints of cultural bias. Some argued that the questions in the tests would consist of information more commonly found in White culture, and would not actually measure the intelligence in people of color. It is argued that it is because of this bias that earlier IQ tests resulted in scores that were higher for White children compared to Black children. Such errors in testing could lead to people being mistakenly placed in special education.
Using an assessment tool with someone from a culture where the tool has not been proven effective may completely skew the results.
This is very serious because these tools can be used to help determine something like a diagnosis, which can actually change someone’s life because of the stigma that may come with it.
It is absolutely acceptable to ask a therapist if an assessment tool was validated in your culture. If it hasn’t, that doesn’t mean that the tool may not be useful, but your therapist should tell you that they will consider cultural differences when reading the results.
5. They Consider Culture When Diagnosing
Therapists should be cautious when diagnosing anyone, but special considerations must be made when counseling diverse populations. Over the years, many changes have been made in diagnostic criteria and therapists are receiving more training on how to apply these criteria to people of different cultures.
If we only considered our own cultural norms, then what may land you a diagnosis in America might be completely normal in a different culture.
If you are seeking a counselor, it is appropriate to ask if they consider culture when diagnosing.
6. They Are Willing to Adjust Their Approach
I recall a story about a black female therapist who was also a nutritionist. She would go to barber shops with a nurse and provide free blood pressure checks and advice about nutrition to the black male customers.
Counseling is usually taboo among Black men, and she knew that she would never get them to talk to her as a therapist if she went in there in that capacity, and there was no chance that they would come to her office.
In the men’s eyes, getting their blood pressure checked was a respectable thing, and while they were waiting to see the nurse they would talk to the therapist about all kinds of things and accepted her feedback because they didn’t see it as “therapy.”
While this kind of dynamic change in environment may not be possible with your therapist, it is an excellent example of how a therapist was willing to make an adjustment to her approach to meet her clients where they were.
Therapeutic interventions that may work for one culture may be completely inappropriate to try with another.
Your therapist should be willing to adjust their approach and select interventions that are appropriate for you.
7. They Are Part of a Collective That Supports You
Therapist training programs and professional organizations are becoming more involved with social justice issues.
For example, some professional therapy organizations have divisions within them devoted to addressing issues such as racism, homophobia, and disparities in mental health.
Therapists should be aware of the cultural issues facing their clients. Ideally, they support social justice movements that emphasize respecting the autonomy of clients and educating the public about issues impacting our society.
If you want to know how your therapist feels about this, just ask.
These are just a few things that you should expect from your therapist regarding multicultural counseling, but there are certainly other things to consider when selecting a therapist. Everyday Feminism has an excellent article about that here.
It is very possible to have a successful counseling relationship with a therapist who has a different cultural background from yours. But you get to decide if you are comfortable with those differences.
If you don’t feel safe, respected, and engaged, keep looking until you find a therapist who is helpful.
Dr. Robin J. Landwehr is a Contributing Writer for Everyday Feminism, mental health counselor, and an unapologetic feminist. She holds a Doctor of Behavioral Health degree from Arizona State University, a MS degree in Mental Health Counseling from Capella University, and is a licensed counselor in North Dakota and Florida. She is a National Certified Counselor through the National Board for Certified Counselors. Robin has worked in several areas, including domestic and sexual violence, substance abuse, homelessness, child abuse and neglect, mental health disorders, and health concerns that are affected by our behaviors. Follow her on Twitter @RobinLandwehr1. Read her articles.