How Culture Affects Therapy

Cheryl Lim, LMHC-LP May 19, 2021

Culture, social-economic status, area of residence, and other aspects of our identities play into how (or even if) we seek help for our mental health. Here’s how your culture impacts your experience of therapy.

Culture, social-economic status, area of residence, and other aspects of our identities play into how (or even if) we seek help for our mental health. From a clinical perspective, cultural competency is the ability to interact effectively with others with different world views, a willingness to expand clinician knowledge of different cultural values, practices, beliefs, and world views. Therapists can develop the skills necessary to build a respectful, considerate working relationship with clients from different cultures while being aware of the effects of the clinician’s own culture on both the clinician and the client. 

A good culturally competent therapist strives for cultural humility, offering a safe space of curiosity, free from judgment, to promote learning and interaction. 

So, how does culture come into play in therapy (even before you step into a therapist’s office for the first time)? 

Area Of Residence 

Where you live can strongly influence your experience with mental health/mental health care and whether you seek services at all. In communities where mental health is stigmatized, there may be limited options for clinicians or types of therapies available to you. Lower-income communities often experience a lack of specialized medical care, not to mention mental health care. If you are in an area where mental health care is limited, there is the option for teletherapy

Stigma 

Many people are deterred from seeking help due to fear of social persecution and judgment. The fear of judgment and lack of support contributes to putting off the decision to seek help, leading people to wait until symptoms are more severe, sometimes to the point of unbearable. If mental health is a taboo topic in your family or community, therapy is a difficult option to consider. 

Misinformation around what therapy is and what it consists of, as well as the false belief that “therapy is for crazy people,” will often lead potential clients to struggle in silence rather than seek help. Culture also factors into the level of social support available for an individual, such as how much support is provided, what kind is available, and who one seeks out for this support. Unlike with a family member, church, or community elder, mental health clinicians are bound by a professional code of ethics and the law to maintain client confidentiality (with few serious exceptions), so your privacy and identity are protected.

Language/Linguistic Preference 

Language differences and word choice due to translation may be an additional boundary in therapy. Finding a clinician who can speak a common language or practice in one’s native language may be beneficial, although not always necessary. Language and culture can cause variations in the way people interpret and describe their symptoms, including intensity and which ones they report (physical, cognitive, emotional, etc.). 

For example, Asian clients often report physical and somatic symptoms first as the primary concern as opposed to some other cultures. Due to the growing number of clinicians from different backgrounds who can practice in different languages, people who speak more common languages may find clinicians who practice in their native tongue. However, many languages and groups are still underrepresented in mental health care. 

Meaning And Presentation Of Symptoms

Presentations of symptoms and meaning placed on symptoms can be culturally significant. Some symptoms that appear to be psychopathology may be culturally appropriate. Culture-bound syndromes or culture-reactive syndromes refer to sets of symptoms more commonly found in some societies and have a special relationship to the culture and setting. According to the ICD-10, culture-specific disorders are variants of disorders that are already classified.

Some examples include pa-leng and taijin Kyofusho. Pa-leng (frigophobia) is the fear of becoming too cold, which has been observed in Taiwan and Southeast Asia, specifically in Chinese culture. Taijin Kyofusho (previously known as Morita shinkeishitsu) is found in the Japanese community; it shares similar traits with social anxiety disorder and body dysmorphic disorder. However, the anxiety and fear of socialization stem from embarrassment related to functions of their bodies (odor or blushing) or their appearances. 

Many culture-bound syndromes are treated by practices and professionals within that culture or community. Understanding the context within which symptoms present and ferreting out the underlying cultural assumptions at play is key when working with a culturally competent clinician. 

Despite the fact that these previously discussed factors may discourage people from seeking out mental health care, more and more people are turning to therapy as mental health is taken more seriously; the positive results speak for themselves. Some prefer to find clinicians within their own cultural background—as this may help them feel more comfortable and understood. However, you may find that therapy is a space where you can feel heard, accepted, and understood by a clinician from a different background and experience than your own. 

If you are interested in taking the next steps in your mental health journey, feel free to reach out. We don’t want you to need us, but we are here if you do.

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