Look for ‘Cultural Humility’ in a Good Therapist
Photo by Annie Spratt via Unsplash
July’s Minority Mental Health Awareness Month – also known as BIPOC Mental Health Awareness Month – was established to highlight the racial disparities within the American mental health system. Research shows that one of the primary barriers to BIPOC seeking mental health care is the lack of culturally competent services, and in the years since this month was recognized, there’s been a lot of discussion around what that means.
Cultural competence is the behaviors, attitudes, and skills that allow a health care provider to work effectively with different cultural groups. That can mean having a diverse team of providers, having providers with work experience that exposes them to diverse populations, or having providers who’ve received training on the needs of different communities. As a Chinese American therapist in a field that historically has been mostly white, I’m happy to hear when AAPI clients will say, “It’s nice to see a therapist who comes from a similar background.”
While these factors are important, it still doesn’t cover the uniqueness that each person brings to the therapy room. When I think about culture and how it shows up with my clients, I can’t assume that I’m the best person to work with any Chinese American client. I was born and raised in the Bay Area, a place where there’s a sizable AAPI population. That’s a really different experience from a Chinese American who may have grown up without much AAPI influence in a Midwest or Southern small town. We may share an understanding based on race or ethnicity, but not necessarily other perspectives that come from the combination of geography, family background, beliefs, and life experiences.
That’s why I like the concept of cultural humility better.
Cultural humility isn’t just acknowledging the idea that my personal and work experiences will never make me an expert on my client; instead, it’s my job as a provider to be open-minded, curious, and adaptive enough to learn from my client what aspects of their cultural identity are most important to them, and use that understanding to inform their therapy journey. Cultural humility doesn’t necessarily mean that you should only see a therapist who is from the same background – it means that your therapist should be aware of and informed about your identity and the way it shapes your experiences in the world.
What Makes Up A Cultural Identity
Our cultural identity is made up of our race, ethnicity, gender, age, religion, language, sexual orientation, socioeconomic status, education, and other characteristics – which means cultural humility looks different with each client.
When I was working at a nonprofit with clients who had Medicaid, it was important for me to keep in mind how difficult and onerous the process of accessing some needed services can be for clients. For instance, if a client’s treatment goal involved addressing their depression and isolation, one way we would work together was to find transportation resources that were available to them. Cultural humility with that client was understanding and addressing the barriers that exist for them and remaining aware and sensitive in my therapeutic approach.
Age may also be an important part of identity. Many of my clients in their 20s view therapy as more “normal,” while some of my older clients have a more stigmatized view. Cultural humility in this case is being sensitive to generational differences, rather than applying my own generational values to their situation.
In other cases, race and ethnicity do play a significant role that I can bring an added understanding. When the recent surge of hate crimes against AAPI began, I had AAPI clients who expressed relief at having me as their therapist, so they could share their fears without context. I’ve had clients who appreciated being able to speak in shorthand about the Asian cultural taboos of criticizing family members or sharing family secrets in therapy (“It feels like I’m airing dirty laundry.”) Even in those instances, it was still important for me to listen and absorb what parts of that identity were most valuable to them.
Looking For Cultural Humility
What does this mean if you’re looking for a therapist? How do you know if your prospective therapist is not only culturally competent but also practices cultural humility?
Research shows that successful outcomes in therapy are dependent on the therapeutic alliance (the relationship between the client and therapist). The therapeutic alliance is dependent on three important elements: agreement on the goals of treatment, agreement on tasks, and the development of a personal bond made up of mutual positive feelings. The third element is where cultural humility plays its biggest role.
Utilize your first few appointments to “interview” your provider to see if their approach works for you. You can ask about experience and training working with certain populations. If you want to talk about something specific, ask about the therapist’s experience or training in that area.
As the therapist answers these questions, pay attention to how you feel:
Does the therapist seem comfortable and open to this conversation, or does this seem like a completely foreign concept?
If the therapist is not familiar with what you’re bringing up, does the therapist seem curious and willing to learn from your perspective?
As you’re having this conversation, can you see yourself confiding in this person and building a trusting relationship?
There may be certain parts of your identity that are really important to you that could shape the kind of therapist you look for. Did you grow up in America with immigrant parents? Is your religion or spiritual practice a significant part of your life? Is sexual orientation something that you’re in the process of exploring and want to focus on? Talk about these priorities upfront, and see if your therapist adapts to that.
As more and more BIPOC providers enter the profession, I’m excited to see cultural humility become more of a standard in therapy, so that even if your therapist doesn’t look like you, they can still be a valuable source of support in your life.