Cultural Safety in Therapy: Why Emotional Expression Is Never Neutral
- Dr Tiffany Leung
- Nov 18, 2025
- 9 min read
“Every conversation about emotion happens within a web of cultural values, language, and expectations — both the client’s and the therapist’s.”
Across supervision rooms, therapy trainings, and clinical discussions, we often hear the phrase “therapy should be a safe space.”
Yet as many of us who work across cultures know, safety is not a fixed state. It is not built through neutrality, but through awareness, responsiveness, and humility.
Cultural safety is not an adjunct but the ethical foundation of therapy.
Therapy Is Not a Neutral Encounter
Therapy takes place between two worlds: two sets of cultural codes, lived experiences, and emotional languages.
For some clients, self-disclosure and emotional openness fit naturally within their cultural frameworks. For others, “talking about feelings” can feel unfamiliar, even unsafe.
Traditional therapy models, especially those rooted in Euro-American contexts, tend to privilege verbal self-expression, individual autonomy, and emotional transparency as indicators of health. However, when we assume these values to be universal, we risk misreading silence, restraint, or indirect communication as resistance.
This is where the principle of cultural safety becomes essential. Originating in Aotearoa New Zealand through the work of Irihapeti Ramsden (1993), the concept reframed safety as something defined not by the clinician, but by the client. It asks us to acknowledge the power, privilege, and difference that are always present in the therapeutic relationship.
To say therapy is not neutral is to recognise that every therapeutic moment sits within cultural, historical, and relational contexts. Neutrality can inadvertently protect dominant norms; cultural safety, by contrast, creates space for dialogue, reflection, and repair.
Reflect:
When have you noticed a moment in therapy when your client’s silence carried meaning that words could not? How did you respond?
Cultural Norms and Emotional Expression: What We Are “Allowed” to Feel
Research across cultural psychology reminds us that emotion is both biologically shared and culturally learned.
Paul Ekman’s early work on universal emotions (1992) identified basic affective states across humanity, yet later cross-cultural studies showed that display rules, when, where, and how emotions are expressed are socially encoded.
Collectivist cultures (Hofstede, 1980; Markus & Kitayama, 1991) often emphasise harmony, respect, and emotional restraint. In contrast, individualist settings value self-expression and authenticity. Neither orientation is more “evolved” than the other; both serve social functions, and both carry risks of suppression or pressure.
In clinical practice, these patterns are alive. Clients from collectivist or hierarchical family systems may struggle to express anger toward elders, or feel guilt for prioritising their own needs. Conversely, clients raised in highly individualistic societies may feel pressure to be articulate, confident, and emotionally self-aware, even when they are overwhelmed.
Beyond cultural values, emotion is also shaped by what is taught across generations. Families who have lived through displacement, war, or discrimination often internalise endurance and restraint as virtues of survival. These unspoken survival scripts can be passed down through silence, shaping how later generations experience safety and vulnerability. Recognising intergenerational trauma within its cultural context allows therapists to locate distress within systems of adaptation rather than within individual pathology.
These survival patterns reflect what we might call cultural scripts — the implicit rules a society or family conveys about what feelings are acceptable to show and which should be hidden. They are not consciously chosen but absorbed through observation, correction, and imitation. Over time, they become internalised templates for what it means to be a “good child,” a “strong adult,” or a “respectful person.”
In supervision, I recall a client who struggled to express anger toward her parents. Within her collectivist upbringing, deference was equated with respect. Naming anger in therapy initially felt like betrayal; over time, reframing it as care for her own boundaries, rather than disrespect, allowed emotion to emerge safely.
For therapists, the task is not to “translate” clients into the dominant emotional language but to meet them where they are, with curiosity rather than correction. Understanding how cultural scripts operate can help us make sense of why certain emotions feel unsafe to express, and how clients may have internalised these rules from a young age.
These scripts are internalised through emotional socialisation and reinforced by family and community feedback, the process by which children learn when and how to express emotion through modelling and correction. As Gottman et al. (1996) describe, meta-emotional philosophies within families guide what feelings are validated, dismissed, or ignored. Understanding these socialisation pathways helps therapists distinguish between individual avoidance and culturally learned emotional regulation. In the therapy room, this awareness invites us to view emotional style as learned communication rather than pathology.
Acculturation, Identity, and the Emotional Body
For migrants, international students, and those living across cultures, emotion itself can undergo adaptation, a process known as emotional acculturation (De Leersnyder et al., 2011).
As people navigate multiple cultural worlds, they learn not only new social norms but new emotional repertoires. Over time, they may begin to feel emotions that fit their host culture, while losing access to those once familiar in their home culture.
Clinically, this may manifest as emotional confusion or disconnection: “I can no longer feel the way I used to,” or “I do not know which version of me is real.”
These experiences are often compounded by acculturation stress (Berry, 1997) and bicultural identity negotiation (Benet-Martínez, 2012), particularly when other identities such as gender, sexuality, class, or faith intersect.
While cultural adaptation influences identity, it never occurs in isolation. Intersectionality further shapes how emotions are expressed and received in therapy. Gendered expectations, for instance, men being socialised toward stoicism, or women toward self-sacrifice and relational attunement, intersect with class, sexuality, and cultural values.
When these layers meet, clients may carry conflicting emotional “rules,” producing guilt, confusion, or fear of judgment. Awareness of these intersections helps therapists contextualise emotion without collapsing it into stereotypes. Supervision spaces that invite exploration of these intersections enable more nuanced attunement and ethical responsiveness.
As therapists, we must attend to how cultural adjustment lives in the body. Suppression, tension, and chronic self-monitoring are not signs of avoidance but of adaptation. In trauma-informed work, we recognise these as survival responses, the protective strategies that may have served clients well in one context but now constrain them in another.
Trauma-informed practice, which emphasises safety, empowerment, and choice, reminds us that emotional suppression often reflects protection, not resistance. As van der Kolk (2014) observed in The Body Keeps the Score, the imprint of what could not be safely expressed is held in the nervous system. In intercultural therapy, this embodiment of survival is often intertwined with cultural trauma, collective silence, and the learned regulation of feeling.
A trauma-informed approach complements cultural safety by recognising that symptoms often arise from disrupted safety, disempowerment, or historical trauma. Integrating these lenses encourages therapists to prioritise regulation, agency, and cultural context as foundations of healing.
Trauma-informed and cultural safety frameworks intersect at the point of relational repair. Both ask not only “What happened to you?” but also “Within what world did this happen, and whose values shape how it is understood?”
Cultural Humility and the Work of Relational Repair
Cultural humility, as described by Sue & Sue (2016), is less a competence to achieve than an ongoing posture of learning. It requires us to engage reflexively with our professional, cultural, and personal identities, recognising how each shapes the relational field and our capacity for repair.
When working interculturally, rupture and repair take on a different texture. A client’s withdrawal or polite silence may represent a culturally adaptive form of respect, not avoidance. Similarly, what may appear as confrontation to one practitioner might represent trust to another. In trauma-informed practice, such humility is what transforms potential rupture into relational safety.
Cultural humility therefore asks:
How do I respond when the client’s way of relating challenges my professional norms?
Do I pathologise restraint, or do I see it as communication in another dialect?
What does safety mean from the client’s standpoint — and how do we co-create it?
This is the ethical heart of cultural responsiveness. Safety is not built by avoiding difference but by making it discussable.
Embedding this stance within supervision cultures ensures humility becomes a living practice, rather than just a personal ideal.
The Therapist as Cultural Participant
Extending this stance of humility, we remember that therapists are cultural participants as well. For trainees, this recognition marks the transition from technical proficiency to reflective maturity, the hallmark of advanced intercultural competence. Our training, theoretical orientation, and language shape what we notice and value. In intercultural work, our capacity to tolerate ambiguity, to sit with “not knowing” becomes central.
Culturally responsive supervision benefits from a trauma-informed lens: one that recognises parallel processes of safety, power, and repair. Supervisors can model cultural humility by inviting discussion of emotional resonance, micro-ruptures, and embodied reactions within cross-cultural dyads.
In supervision, it is helpful to ask:
Which cultural narratives about emotion do I unconsciously privilege?
How do my own experiences of belonging or marginalisation inform how I attune?
Where do I notice tension in myself when a client’s values challenge mine?
In supervision, trainees often describe the relief of discovering that a client’s quietness may signify respect rather than disengagement — a reframe that transforms frustration into empathy.
Recognising that the therapeutic encounter is bidirectional does not dilute professionalism; it deepens ethical authenticity. As Rønnestad and Skovholt (2013) remind us, therapist development is lifelong, shaped through cycles of reflection, disillusionment, and renewal. Cultural work is no different: it matures through humility, discomfort, and dialogue.
These principles are explored further in my other article, Intercultural Supervision in Practice: Safety, Humility, and the Work of Repair, which discusses how supervision can model cultural humility, relational repair, and parallel processes of safety between practitioner and client.
Toward a Culturally Safe Practice
In practice, cultural safety involves three intertwined commitments:
Awareness of context: Understanding how culture, migration, and systemic factors shape client experience of safety and regulation.
Reflexivity in relationship: Examining how therapist identity and cultural assumptions influence the alliance.
Shared responsibility for safety: Inviting feedback, addressing mis-attunements, and using difference as a site of growth.
Therapy that honours culture does not aim for sameness. It aims for understanding, a meeting of worlds that allows both therapist and client to remain curious, respectful, and human. Embedding cultural safety within training curricula and supervision policy ensures that awareness does not rely on individual goodwill, but becomes a professional standard of care.
As Ramsden (1993) wrote, “Cultural safety is about acknowledging difference and addressing power; it is about accepting that we are all bearers of culture.”
Closing Reflection: From Awareness to Practice
Cultural safety is not a training module to complete, but a stance to live. It asks of us, practitioners, supervisors, educators to hold cultural complexity with tenderness, and to remain accountable to those whose worlds we enter. Perhaps cultural humility begins with the courage to stay present when we do not have the right words.
This ongoing work of reflection also aligns with broader research on intercultural communication and competence (Arasaratnam & Doerfel, 2005), which emphasises adaptability, empathy, and relational mindfulness, qualities that parallel therapeutic attunement across difference.
When therapy becomes a space where differences can be named, explored, and respected, emotion itself becomes freer to emerge. That, perhaps, is the quiet revolution of culturally responsive practice: helping people feel safe enough to feel.
As a practitioner and supervisor, I have witnessed how cultural humility deepens not only therapeutic safety but also professional growth. When we treat culture as integral to emotional life, not peripheral, we move our field closer to justice, inclusion, and genuine human understanding. If you are a therapist, trainee, or supervisor interested in deepening culturally safe and trauma-informed practice, you are welcome to explore my supervision and CPD offerings, or connect for reflective consultation.
Together, we can continue building spaces where both practitioners and clients feel safe enough to grow.
Further Reading and Acknowledgement:
This article is part of Dr Tiffany Leung’s ongoing reflections on culturally responsive and trauma-informed practice. You can read the companion client-facing article, “Can You Feel Safe Being Yourself? How Culture Shapes What We Are Allowed to Feel”, which explores these ideas from the client’s perspective.
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Berry, J. W. (1997). Immigration, acculturation, and adaptation. Applied Psychology, 46(1), 5–34.
De Leersnyder, J., Mesquita, B., & Kim, H. S. (2011). Where do my emotions belong? A study of immigrants’ emotional acculturation. Personality and Social Psychology Bulletin, 37(4), 451–463.
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Gottman, J. M., Katz, L. F., & Hooven, C. (1996). Parental meta-emotion philosophy and the emotional life of families: Theoretical models and preliminary data. Journal of Family Psychology, 10(3), 243–268.
van der Kolk, B. A. (2014). The body keeps the score. New York: Viking.
Cultural Safety in Therapy: Why Emotional Expression Is Never Neutral
Cultural Safety in Therapy: Why Emotional Expression Is Never Neutral