Cultural sensitivity, sometimes called “cultural competence” in clinical settings, is critical to effective mental healthcare. Some communities are more vulnerable to racism and discrimination, which can contribute to disparities in care. Different cultural views about mental illness, therapy and psychiatry can also create obstacles in treatment. So can language and communication barriers.
For more insights into cultural competence in counseling, we reached out to Chief Clinical Officer Dr. Beau A. Nelson, Doctor of Behavioral Health (DBH), Licensed Clinical Social Worker (LCSW). Dr. Nelson has decades of clinical experience serving diverse populations. We began the conversation by inviting him to share how he understands cultural competence in the clinical context.
What Is Cultural Competence Therapy?
What is cultural competence? In a basic sense, cultural competence is sensitivity to cultural differences when providing mental health services to individuals from diverse backgrounds. We invited Dr. Nelson to elaborate more on what that entails.
Respect for Diversity
The starting point is respect for diversity. As Dr. Nelson describes it, cultural sensitivity “acknowledges and respects the diversity of individuals and their backgrounds. Mental health conditions can be influenced by cultural factors such as beliefs, values, and social norms. By understanding and appreciating these cultural differences, clinicians can provide care that is respectful and relevant to the individual’s cultural context.”
Effective Communication
Another key aspect of cultural competence is effective communication. Dr. Nelson observed that different cultures “may have unique communication styles, nonverbal cues, and language preferences.” When clinicians are “sensitive to these cultural nuances,” they “build rapport, understand patients’ experiences accurately, and facilitate a therapeutic alliance, which is vital for successful treatment outcomes.”
Creating a Safe, Judgment-Free Environment
Stigma and shame remain significant issues in many communities, so it is no surprise that people from certain backgrounds “may be more hesitant to seek help, due to concerns about social judgment or fear of being labeled.” Clinicians who seek to be culturally sensitive work to create “a safe and non-judgmental environment where individuals feel comfortable discussing their mental health concerns and seeking appropriate treatment.”
Cultural Humility vs. Cultural Competence
Many professionals now use the term “cultural humility” alongside cultural competence.
Cultural competence refers to the knowledge and skills clinicians develop while working with diverse populations. Cultural humility emphasizes ongoing learning and avoiding assumptions about patients based on their background. Both are essential for treating diverse communities.
Culturally Appropriate Assessments and Interventions
“Cultural sensitivity helps clinicians avoid biased judgments and misinterpretations when assessing and diagnosing mental health conditions,” Dr. Nelson said. “Symptoms, expressions of distress, and help-seeking behaviors can vary across cultures. Without cultural sensitivity, there is a risk of misattributing symptoms to cultural practices or misunderstanding the underlying psychological distress.”
Awareness of cultural differences can also inform treatment decisions. As Dr. Nelson explained: “Different cultures may have unique healing practices, coping strategies, and support systems. Culturally sensitive clinicians can incorporate these cultural strengths into treatment plans, tailoring interventions to align with the patient’s cultural values and preferences. Culturally appropriate interventions are more likely to resonate with patients and improve treatment outcomes.”
As a follow-up, we asked Dr. Nelson for practical tips about incorporating cultural considerations into assessment and treatment. “You’ve got to be very careful in the forms and terms that you use,” he said. “People are in lots of different relationships. They’re not just married or divorced, so the language used on forms is very important—and in assessments also.”
Supporting LGBTQ+ Patients
Inclusive language is another important part of culturally sensitive care.
Drawing on his experience running a treatment unit for LGBTQ+ patients, Dr. Nelson emphasized the importance of avoiding assumptions. “If we’re working with a transgender person, we don’t necessarily know their pronouns, so we keep it open at the beginning and let them use the pronouns.”
He also noted that the meaning of “transgender” can be highly individualized. One person might identify as transgender in a way that looks very different from another patient’s experience. Allowing people to describe themselves in their own words helps clinicians better understand patients and provide gender-affirming care.
Many LGBTQ+ individuals also face microaggressions, discrimination and rejection that can affect mental health and willingness to seek treatment. As Dr. Nelson put it, “We need inclusive and supportive language and approaches.”
Multicultural Counseling and Continuing Education
We asked Dr. Nelson to share an example of multicultural competence in practice. He recalled an interaction from a previous job at a public hospital serving many immigrant families:
“One of my patients in primary care was a woman from the Middle East. During our initial visit, I put out my hand to introduce myself (as is routine in our culture), but that was not allowed in her culture. She shook her head, and that helped remind me in the moment to be sensitive to her customs.”
Experiences like these reinforce the importance of continuing education. As Dr. Nelson explained, “cultural competence, in professional psychological training, is research supported to make mental health care more accessible and effective for people of various cultural backgrounds.”
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) recommends the Cultural Formulation Interview (CFI) to help clinicians identify cultural factors that affect patients. The CFI uses structured questions to explore a patient’s cultural background, beliefs, values, and social context, helping clinicians provide more individualized care.
Language Access in Mental Healthcare
Language barriers can significantly affect mental health treatment. According to the U.S. Census Bureau’s American Community Survey, about 8.4% of people in the U.S. age 5 and older have limited English proficiency, meaning they speak English less than “very well.” That makes clear communication essential for proper care.
When patients struggle to communicate symptoms, concerns or treatment goals, misunderstandings can occur. Some patients prefer a bilingual clinician, while others prefer an interpreter. For patients who need these services, it’s best to look for providers who also offer multilingual forms and phone support.
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How to Find a Culturally Competent Therapist
Finding a culturally competent therapist often starts with asking a few practical questions about the following:
- Training and credentials. Has the therapist received training in multicultural counseling or culturally responsive care?
- Language access. If language is a concern, are bilingual services or interpreter options available?
- Representation and experience. Does the provider have experience working with people who share similar backgrounds, identities or concerns?
- Intake conversations. Does the therapist ask about cultural factors, family influences, religious beliefs or other experiences that may affect treatment?
- Comfort level. Do you feel respected, heard and comfortable discussing personal experiences openly?
The answers won’t tell you everything, but they can provide a useful sense of whether a therapist is prepared to understand and incorporate cultural considerations into treatment.
A Challenge in Providing Culturally Sensitive Mental Healthcare
We also asked Dr. Nelson about challenges he has encountered in practice. He recalled working with a fundamentalist Christian patient who assumed he would judge her beliefs because he was a psychologist. As he described it: “One of my patients was a fundamentalist Christian who had a lot of preconceived notions about psychology and my role as her therapist. She’d say things like, ‘I know you’re not okay with my views on this,’ or ‘I know you won’t agree with me.’ I had to say, ‘Please don’t presume my beliefs or judgments. This is a space for you, and I’m here to help.'”
The experience reinforced an important lesson: cultural competence doesn’t mean agreeing with every patient’s worldview. The clinician’s job is to create a therapeutic environment where people feel respected and understood.
Compassionate Care at FHE Health
Cultural competence can be a daunting prospect, even for experienced clinicians. As Dr. Nelson’s insights illustrate, it’s also an opportunity to learn, grow and better help patients.
At FHE Health, cultural considerations are part of how we approach treatment. This perspective informs our personalized specialty programs, trauma services and co-occurring disorders care. If you or a loved one is looking for help with mental health challenges, addiction or both, contact FHE Health today to learn more about available treatment options.
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