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Cultural sensitivity—or “cultural competence,” the term that clinical professionals often use—is critical in mental healthcare. Some cultures are more vulnerable to racism and discrimination, which lead to disparities in care. Different cultural views about mental illness or about therapy and psychiatry can pose obstacles in the treatment process. 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, DBH, 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”?
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 for cultural sensitivity is “respect for diversity”:
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.”
A Safe, Judgment-Free Environment
Stigma and shame are issues in many cultures, so it should not be a 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 will therefore create “a safe and non-judgmental environment where individuals feel comfortable discussing their mental health concerns and seeking appropriate treatment.”
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 should also inform treatment considerations:
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 for some tips about how to incorporate cultural considerations into assessment and treatment. You’ve got to be “very careful in the forms and terms that you use,” Dr. Nelson said. For example, “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.”
As a further illustration of the need for inclusive language when working with patients, Dr. Nelson appealed to insights he had gained from previously running a unit for LGBTQIA+ patients: “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.”
The meaning of “transgender,” furthermore, could be highly individualized among patients. For example, one person might come in who is transgender and wears lipstick, but that is the extent of how they self-identify, and another person might come in self-identifying as transgender, and for them that entails much more.
The bottom line? “We need inclusive and supportive language and approaches.”
Multicultural Competence and Diversity in Counseling
We asked Dr. Nelson to share an example of a time when he had to show multicultural competence. He recalled an interaction from a previous job. At the time he was working for a public hospital in a neighborhood with 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.
The Need for Continuing Education
Multicultural competence is an area where clinicians hopefully are continually learning because continuing education is critical to better treatment outcomes, Dr. Nelson said. He explained that “cultural competence, in professional psychological training, is research supported to make mental health care more accessible and effective for people of various cultural backgrounds.”
A Challenge in Providing Culturally Sensitive Mental Healthcare
Was there a time when Dr. Nelson encountered a challenge in providing culturally sensitive mental healthcare? If so, how did he overcome 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.’”
Cultural competence can be a daunting prospect, even for the most seasoned clinicians. Think of it in terms of continuing education, though, and it becomes an opportunity to learn, grow, and better help patients.
