Cultural Humility in Trauma-Informed Therapy: Safety, Power-Sharing, and System-Level Change

What does it mean to feel safe in therapy, when culture shapes how pain is carried? This post explores how cultural humility makes trauma-informed care truly healing, from the therapy room to wider systems.

In many cultures, love is shown through action, not words.

‘We don’t talk about grief.’

Those were the first words my client said, and they stopped me still. She wasn’t saying her family did not care; she meant their love showed up in food, in presence, in action, just not in words.

When clients tell me their story, it is never just about the event that happened. It is also about the culture they grew up in, the identities they carry, and the messages they have been given about what it means to show pain, strength, or need. If I had assumed that “healing grief” required talking openly, I would have missed the deeper story.

This is why cultural humility matters in trauma-informed therapy. Being trauma-informed isn't enough unless we are also culturally adaptive. In fact, trauma-informed care must evolve with cultural humility.

Culture shapes what hurts, what is hidden, and what is allowed to be healed. We can only understand the person's deep experiences when we are attuned to how culture, identity, and power shape both harm and healing. Without it, we risk retraumatising the people we want to support.

Cultural humility is not an “add-on”. It is core to trauma-informed care.

If you are a trainee or early-career practitioner, you may recognise how cultural dynamics show up in supervision and client work. Part of my role as a supervisor is helping practitioners build this awareness with care and curiosity, so they can practise safely without fear of getting it wrong.

What Do We Mean by Cultural Humility in Trauma-Informed Therapy?

Cultural humility is more than “awareness of difference.” It is a posture of curiosity, context, and collaboration. It asks us to notice how trauma is filtered through culture, what emotions we are “allowed” to show, how families interpret pain, and which identities carry added burdens of discrimination or exclusion.

• Curiosity: asking, “What did your family teach about anger, grief, or asking for help?”

• Context: mapping wider stressors like racism, migration, poverty, unsafe housing, or exclusion alongside symptoms.

• Collaboration: sharing power like offering choice of format, pace, or language; checking whether metaphors land; and inviting correction.

Cultural humility is not a checklist. It is a commitment to show up as learners, to be open to correction, and to resist assuming that one size fits all in therapy. Families may pass down survival strategies: silence, hypervigilance, or shame, without ever naming them as trauma. For young people, these patterns can feel especially heavy.

A therapist once reflected with me about a client who, after his father’s death, said “In my family we don’t talk about grief.” He described how his mother cooked meals and how funeral decorations were carefully prepared. Sitting with the client, the therapist felt lost: if she named the lack of emotional expression as a barrier, she felt she risked offending his culture. If she ignored it, she risked colluding with silence.

This is the work of trauma-informed care with cultural humility — not imposing our own frame, but cultivating space where the client can lead how grief is carried. It opens a doorway without forcing disclosure, or assuming feelings must be expressed verbally.

In another article, I wrote about subtle forms of trauma that are easily missed. Seen through a cultural lens, those patterns vary widely across identities. We honour this by assuming each person’s experience is unique, and that it may take time to understand it well.

Intergenerational & Identity-Layered Trauma

Many families live with the echoes of past trauma: silence after war, hypervigilance after migration, shame tied to poverty or exclusion. These survival strategies can pass down without ever being named as trauma. For teenagers, particularly those navigating migration and identity stress, this can feel intense. I have worked with young people who say, “Sometimes I feel like I’m carrying emotions that don’t even belong to me, like they are my parents’ emotions, not mine.” 

Anxiety about achievement, guilt about rest, fear of disappointing family — these are not random. They’re the cultural and intergenerational layers of trauma.

👉If you’d like to read more, see my Teen Counselling page and in my blog on Why Gen Z Often Feel Overwhelmed and Misunderstood.

Research also helps us see patterns across services and systems, beyond the personal and family lived experiences of trauma. Healing isn’t only individual; it is also shaped by the conditions we create in care and community.

What the Research Says

Evidence suggests trauma-informed approaches can improve survivors’ sense of safety, staff confidence, and overall service culture. Some programmes report reductions in coercive practices and distress (Sweeney et al., 2016; Purtle, 2020) when trauma-informed care sits within the service.

In fact, notable researcher Judith Herman (1992/2023) reminds us that trauma recovery unfolds in safety, relationship, and justice, recognising how systems either support or silence survivors.

What tends to drive success?

• Leadership buy-in and diverse representation in leadership

• Workforce training and supervision.

• Co-production with people with lived experience.

For example, an NHS Scotland pilot of trauma-informed training across mental health wards reported a 39% reduction in use of seclusion and restraint within the first year (NHS Education for Scotland, 2018). This kind of figure highlights why leadership buy-in and staff training are not just abstract ideas, but measurable levers for reducing harm.

At the same time, gaps remain. We need more high-quality, equity-focused studies to clarify which works, for whom, in which contexts, so benefits are shared across diverse communities.

When systems lack cultural humility, even well-intentioned services can retraumatise.

When Systems Hurt

Trauma is often misread through bias. A young neurodivergent student’s panic may be labelled “behavioural,” while a white middle-class peer’s is recognised as “anxiety.” A Black woman’s anger may be called “aggressive” where another is praised as “assertive.” The harm isn’t only the trauma, it is the misinterpretation that follows. Suffering gets lost in translation, and people are further harmed by being dismissed or poorly supported.

These challenges are never limited to the therapy room. Many clients describe feeling retraumatised by the wider systems meant to support them: the schools, workplaces, healthcare that are not trauma-informed.

'I remember when my own service was given feedback that clients from non-white backgrounds had lower access to our therapy. Instead of curiosity, the first reaction my team gave was defensiveness: “That’s just a coincidence. We support everyone equally.” The chance to ask 'why' was lost. One day, I caught myself describing a client as “impossible to engage.” Then it hit me: had I ever asked why engagement was difficult, and that I was actually part of the problem? I still remember that moment - I was ashamed and uncomfortable, but it was also the doorway to practise cultural humility. I realise what it means to hold accountability in practice: it is to regularly ask ourselves whether systems, or even I as a clinician, might be contributing to silence or exclusion.'

Mind’s (2020) national trauma survey highlights this clearly: survivors often report that contact with healthcare or public services worsened their distress. This can include:

• Language barriers: no interpreters or accessible formats, causing delay and exclusion.

• Medical invalidation: physical symptoms dismissed or written off as “all in your head.”

• Biased judgment: A working-class client may be more judged as ‘non-compliant’ if they can’t afford time off work for appointments, than middle class professional in specialized roles.

• Inherited silence: families using quiet as a survival strategy across generations.

• Discrimination: racism, xenophobia, sexism, homophobia and transphobia shaping who is believed and who is punished.

This is retraumatisation: when care repeats and even reinforces patterns of silencing or coercion. Without cultural humility, trauma-informed care can become trauma-blind. This is why building trauma-informed systems matters as much as trauma-informed therapy.

Trauma-informed care must acknowledge not only the individual’s pain but also the systemic forces that reinforce it.

Everyday Practice of Cultural Humility in Trauma-Informed Therapy

Cultural humility does not require grand gestures. It often shows up in small, consistent choices:

• Names & pronouns Say: “Could you share how you’d like me to say your name?” Do: Practise and use it consistently.

• Language access Say: “Would translated materials or an interpreter help?” Do: Offer bilingual resources where possible.

• Check metaphors Say: “Does ‘window of tolerance’ fit, or is there a better phrase in your words?” Do: Adjust imagery to the client’s culture.

• Name the context Say: “This isn’t just anxiety; long-term racism and housing stress can keep a body on alert.” Do: Map stressors alongside symptoms in case notes.

• Repair Say: “Thank you for telling me, that was my miss. How did that land? What would help now?”

• Do: Name the impact, invite correction, agree a repair.

These practices communicate: I see you, not just your symptoms.

Intersectionality reminds us that identities (race, gender, class, migration, neurodiversity) interact, shaping risk, access to care, and how pain is read.

Questions Clients Might Ask a Therapist

Cultural humility also empowers clients. If you are considering therapy, you might ask:

• How do you adapt therapy to my culture or identity?

• What happens if we have a misunderstanding or rupture?

• How will we handle it if you misunderstand something important about my culture or identity?

• What does “safety” look like in this therapy space?

A good therapist will not always have perfect answers. But they will be willing to pause, reflect, and learn with you.

If you’re choosing a therapist, here is a step-by-step guide to starting therapy.

For Clinicians: Demonstrating Cultural Humility

Therapists can contribute by:

• Naming systemic barriers (racism, poverty, exclusion).

• Advocating for compassionate policies and practices, not dismissive.

• Modelling transparency and fairness in their own practice (e.g., clear fee policies, accessible communication).

Even in private practice, we are part of a wider ecosystem. Our words, attitudes, and behaviours ripple outward. Our small acts matter, whether it is clarity around fees, a teacher’s patience, or a workplace’s openness to rest. These ripple outward, creating cultures of dignity and compassion. A client once said, “I appreciate you taking time to explain, and explain about fees and scheduling so clearly. It makes me trust you more.” Even small acts of clarity can shift culture.

A Quick Cultural Humility Checklist

• Am I offering choice in pace and format?

• Do I check whether my metaphors land?

• Have I acknowledged systemic stressors alongside symptoms?

• Do I reflect on my own cultural assumptions and positionality?

• Do I have a plan for repair when I inevitably miss something?

Cultural humility is less about “getting it right”, and more about staying willing to notice when we have missed something and repair.

Co-Producing Safer Services

Best outcomes arise when survivors are involved in shaping care. Advisory groups, co-production, feedback loops all help ensure services don’t replicate harm.

How We Build Trauma-Informed Systems

The same principles that help clients feel safe in therapy: predictability, voice, choice, cultural attunement, can transform schools, workplaces and healthcare. Trauma-informed culture grows when safety is not only 1-to-1, but woven into policies and everyday routines. This means trauma-informed care requires to be system-driven.

So how do we build this beyond the therapy room?

• Leadership commitment: when managers, headteachers, or healthcare leaders prioritise psychological safety, policies begin to shift.

• Workforce support: staff need training, reflective supervision, and space to process their own stress so they don’t pass it on to those they serve.

• Co-production: listening to people with lived experience ensures services do not unintentionally replicate the very harms they are meant to heal.

Building trauma-informed culture means translating clinical insight into systemic action: not only asking “what happened to you?” but also “how do we design environments that do not repeat harm?” Another evidence-based lever is psychological safety: when people feel able to speak up without fear of punishment, they are more likely to catch errors early, support each other under stress, and model the openness we hope clients will feel in therapy (Edmondson, 1999; Edmondson & Lei, 2014).

Because silence is often a survival strategy. Edmondson’s research shows in trauma-informed systems, this silence matters because it doesn’t only harm clients, it also harms staff. A school or clinic where staff fear speaking up repeats the very dynamics of silencing that retraumatise clients. Psychological safety for staff is therefore not separate, but foundational to creating safety for clients.

Track what changes: time-to-interpreter, use-of-force/coercive incidents, complaints (expect an initial rise as people feel safer to speak), staff retention, and lived-experience feedback.

Living Trauma-Informed: Everyday Compassion and Safety

Beyond professional practice, we can ask: how might all of us live more trauma-informed lives?

• Reframe our way of seeing rest: Not as laziness, but as recovery.

• Cultivate hope: Not as a solo task, but as something sustained in community.

• Practice compassion: Meeting others’ reactions not with blame, but with curiosity.

“For the first time, I felt like my struggles weren’t a personal flaw. They were my body’s way of protecting me.”

Trauma-informed care begins in a therapy session, but its ripple effect is cultural. When clinicians care for themselves, and when communities embrace compassion, we create environments where healing is not the exception, but the norm.

Conclusion: Building Trauma-Informed Cultures Together

Safety begins with how we show up, but ripples outward into the culture we build. Whether in therapy, schools, or workplaces, cultural humility turns trauma-informed principles into lived practice.

It asks us to stay curious. To notice power. To share space.

When we practise cultural humility, we do not just reduce harm in therapy. We open new possibilities for resilience, dignity, and healing.

My practice specialises in culturally adaptive, trauma-informed care. If you would like support, you’re welcome to get in touch.

If you need support, contact your GP, 111/999 in the UK, or your local crisis line.

📚 References & Further Reading

• Hook, J. N., et al. (2013/2016) on cultural humility & therapy outcomes.

• Kirmayer, L. J. (2007/2012) on culture & mental health.

• Williams, D. R., & Mohammed, S. A. (2013) on racism & health.

• Crenshaw, K. (1989/1991) on intersectionality (foundational).

• Gone, J. P. on Indigenous mental health and critiques of cultural competence.

• Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative Science Quarterly, 44(2), 350–383.

• Edmondson, A. C., & Lei, Z. (2014). Psychological safety: The history, renaissance, and future of an interpersonal construct. Annual Review of Organizational Psychology and Organizational Behavior, 1(1), 23–43.

• Mind (2020). Understanding Trauma: National Trauma Survey.

• Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2016). A paradigm shift: Relationships in trauma-informed mental health services. BJPsych Advances.

• Purtle, J. (2020). Systematic review of evaluations of trauma-informed organisational interventions in mental health and healthcare settings. Psychiatric Services.

• SAMHSA (2014). Concept of Trauma and Guidance for a Trauma-Informed Approach.

• Herman, J. L. (1992/2023). Trauma and Recovery.

• Gilbert, P. (2010). Compassion Focused Therapy.

• Ogden, P., & Fisher, J. (2015). Sensorimotor Psychotherapy.