Does Culture Matter in Therapy (and why)?

Feb 14, 2021

Does Culture Matter in Therapy (and why)?

‘The concept of culture is more than just an individual’s race/ethnicity. Our cultural backgrounds, from psychological understanding, include a collection of external influences in a person. Even in the same ethno-cultural group, individuals are culturally different in regards to other influences such as religion, social class, education, gender, sexuality, age, career position, professional discipline, etc.’

In the past, I have seen many psychologists, psychistrists or therapists who expressed their views that culture is a secondary element to the primary and ‘bigger’ mental health problem. I remember a psychologist who once told me that learning about cultures is an individual preference – ‘I guess this is just not for me. I am more interested in studying mental disorders.’ That psychologist is of white, middle class background.

I have provided therapy for individuals from different ethno-cultural backgrounds. From these experiences, I learn how culture emerges in different ways within clients’ presenting problems in therapy. In fact, the more we work, the more clients (and myself) gain insight into how culture has been and is an integral part of their wellbeing.

Culture does Matter for an individual’s wellbeing.
It ought to be addressed and explored in therapy.’

Culture affects an individual’s sense of identity, self-worth and self esteem, confidence, interpersonal effectiveness, security, values and beliefs, lingustic ability, etc. It is certainly not an overstatement that all of us are working or dealing with culture in the everyday life without realizing.

The concept of culture is more than just an individual’s race/ethnicity. Our cultural backgrounds, from psychological understanding, include a collection of external influences in a person. Even in the same ethno-cultural group, individuals are culturally different in regards to other influences such as religion, social class, education, gender, sexuality, age, career position, professional discipline, etc.

When is the time when we need support? Let me name some examples about problems related to culture I have worked with or come across with. (And there are a lot of other relevant examples too!)

Considering Factor 1: Difficulty to advance in life
“I really struggle to be here (geographical place, work condition, relationship). My mental health is suffering because I cannot cope anymore. Everything seems to be too much.”

Considering Factor 2: Cultural clashes:
“This has to do with my family… I see my British friends get along with their parents. I don’t. I am never good enough to them. I wish I had parents who really support me.”

Many individuals experience first hand explicit or implicit challenges brought from the own bicultural/biracial upbringing. Our global era brings together individuals, families and communities and nations from all walks of life. Immigrants or second generation immigrants often have feelings ‘they can never fully be themselves’, or even wonder ‘who they are’.

“My last therapy did not work out. It is not that the therapist had a problem; I just felt he/she did not understand my experiencing cultural complications.”

Considering Factor 3: Difficulties in Relationships
“My partner is from another cultural background. We did consider therapy but hesitated. My partner felt he/she would not be able to fully express himself/herself in English which is not his/her mother language…”

“Our relationship really suffers because of his/her parents.”

“We really tried. I know he/she’s from ‘this cultural background’, and so I did this to help her. I was perfectly fine…but now I feel exhausted and frustrated…”

Considering Factor 4: Racial discrimination, bullying and oppression
“I am bullied because of where I am from”.

“I cannot put a finger at what is happening…I am definitely having issues with my line manager. He/she is always trying to find fault in me. I don’t feel supported. It is almost as if he/she is waiting for a reason to kick me away…”

What is the problem with culture?
The problem is not the fact that we carry a particular problematic social identity, but the fact “that who we” is the reason that we become vulnerbale to struggles and oppression. The longer we suffer, the easier we become prone to developing mental health problems.

That is to say, Culture is not a problem.
Who we are and who we belong is not the problem.
The problem is the problem.

Problems caused by difficulties and challenges with culture can cause stress, uncertainity in performance, affected judgment and decision making, misunderstanding and misinterpretation in reading social cues or interactions, disruption in relationships. Mental health is the result when these problems do not get resolved.

How can you find better support? How are a few suggestions for your consideration.

  1. Find a therapist who understands your cultural backgrounds or is culturally sensitive. In many occasions many clients have benefited from having a therapist who comes from the similar cultural backgrounds. The main point is not just the fact that you two are similar, but more importantly the therapist could relate to you.
  2. Find a therapist who speaks your first language. Language is a cruical factor for a person to accurately and clearly express the own thoughts and feelings. This is particularly useful when you want to express in a way which cannot be translated into English.
  3. Find a therapist who has experiences of helping individual unpack the complexity of cultures. It is more than ‘just understanding that culture is important’. The therapist should have skills and competence in helping clients reflect and unpack, even things on the ‘subconscious’ or ‘unknown’ level.
  4. Don’t be afraid to ask and get advice on how the therapist could work with you. Working with culture is not a straight forward path. It is important that the therapist walks along with you, including times as you find it difficult to express yourself or work through the obstacles.
  5. There is no absolute right/wrong knowledge about culture. There are common cultural traits as well as individually based cultural display. Find a therapist who is open to challenges and criticsms. The therapist could be learning as much as you do on understanding about culture and the complexity of it. Aside having a good level of knowledge, I personally suggest that it is more important that the therapist holds an opened, honest and approahable attitude.
  6. Aside therapy which helps you overcome problems and challenges related to culture, you can also look for education which allows you to equip yourself with intercultural knowledge and skills. Check out training titled ‘intercultural competence’, or cultural awareness training.

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