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Why Does Culture Matter in Mental Health and Therapy?

Apr 23, 2023
6 min read

Updated: 21 minutes ago

Originally published 23 April 2023 · Updated 20 September 2026


Culture matters in mental health and therapy because psychological experiences do not develop separately from the contexts in which we live. Culture can become part of how we understand emotion, relationships, responsibility, distress, belonging and ourselves.


Overlapping scenes of everyday life, relationships, work and community representing culture and psychological context

We Do Not Experience Mental Health Outside a Context

Two people may both describe themselves as anxious.

Both may find it difficult to say no. They may worry about disappointing other people, hold themselves to very high standards or find it hard to ask for help.


From the outside, their difficulties can look remarkably similar.

For one person, saying no may carry the possibility of conflict or rejection. For another, putting other people's

needs first may be closely connected with love, responsibility and what relationships have always required of them. Someone else may have learned through difficult experiences that needing very little from other people was the safest position to take.


A description such as anxiety, people pleasing or perfectionism can tell us something important about what a person is experiencing. It tells us less about how that experience developed, what purpose a particular way of responding may once have served, or what it has come to mean.

Culture Is More Than Where We Come From

When we hear the word culture, ethnicity, nationality and heritage often come to mind first.


These can matter greatly, but they do not contain someone's whole cultural world.


We learn about relationships and responsibility within families and communities. We develop ideas about what counts as success, when emotions can be expressed, what we owe to other people and when asking for help feels acceptable. Faith, social class, education and professional environments can become part of these understandings too.


Other parts of our lives also shape our relationship with these cultural worlds.


For some people, migration or multilingualism makes differences between cultural worlds particularly visible. Others encounter them through education, work, relationships or movement between communities.


A person can feel strongly connected to a cultural identity without agreeing with every expectation associated with it. They may value some traditions and question others. Even two people within the same family may have quite different relationships with what they have inherited.


Knowing someone's cultural identity therefore does not tell us what a particular experience means to them.

Culture Shapes Meaning, Not Just Behaviour

Consider someone who rarely shows difficult emotions.

We might understand this as avoidance, fear of vulnerability or difficulty recognising what they feel. Sometimes that may fit.


Remaining composed may also have been valued in their family. It might communicate dignity, maturity or consideration for other people. Someone may have learned that strong emotion is handled privately. Another person may have discovered that showing vulnerability brought criticism rather than care.


The behaviour alone does not tell us which of these experiences we are encountering.


Achievement can carry similarly different meanings. Someone may work extremely hard because they enjoy what they do and want to succeed. Achievement may be connected with security, family sacrifice or opportunities created through migration. For someone else, doing well may gradually have become part of how they know they are acceptable or have earned their place.


Family responsibility can also carry meanings that are easy to miss from the outside. Caring for relatives or taking family needs seriously may be experienced as love, reciprocity and an important part of who someone is. The same person may also be exhausted by what is being asked of them.


Culture does not tell us what an experience means. It reminds us to ask. l Dr Tiffany Leung

When Cultural Meanings Begin to Feel Personal

Many cultural expectations do not feel cultural from the inside.

They simply feel true.

I should be able to cope.
I shouldn't burden other people.
I need to make my family proud.
I should be more independent.
Wanting this for myself is selfish.
I should be grateful.

Sometimes people know exactly where these expectations came from. At other times, they have been present for so long that they feel like personality.


We may have learned what it means to be a good daughter or son without remembering when we learned it. We may know that certain achievements make our family proud, or that some difficulties are easier to talk about than others. We notice which parts of ourselves seem to create connection and which seem to bring tension.


Over time, these experiences can become part of how we relate to ourselves.


Moving between cultural environments can make this easier to see. Something that feels obvious in one setting may be questioned in another. A way of communicating that feels respectful at home may be interpreted differently at work. Qualities that help someone belong in one community may need to be adjusted in another.


There can be considerable skill in moving between these worlds. There may also come a point when someone begins to wonder which expectations still fit them.

Why Culture Belongs Within Psychological Formulation

In my work as a Counselling Psychologist, I use psychological formulation to make sense of difficulties with the people I work with.


Formulation allows us to move beyond describing symptoms. We begin to ask how particular difficulties developed, what someone has lived through, what they learned from those experiences, how they adapted and what may now be keeping a difficulty going.


By the time we begin asking about culture, it may already be present in what we are trying to understand.


Woman looking at her reflection while getting ready in an everyday bedroom. l Dr Tiffany Leung on Culture and Mental Health Therapy

Someone may fear conflict because of what conflict has meant in earlier relationships. Ideas about respect, hierarchy or keeping harmony may also have been part of those relationships.


Someone who rarely asks for help may have learned not to expect it. They may place importance on managing for themselves. They may also have repeatedly found that the help available did not understand them.


Trauma, neurodivergence, migration and social circumstances may become relevant in different ways as we understand more of the person's life.


Cultural formulation is also part of wider clinical thinking in mental health. The DSM-5-TR Cultural Formulation Interview, for example, provides a structured way of exploring how someone understands their difficulties and how culture may be relevant to their experience and care. It can bring areas into the conversation that might otherwise be overlooked; what those experiences mean still has to be understood with the person.


For me, formulation remains a working understanding. We test it against the person's experience, notice where it does not fit and revise it as we understand more.

Cultural Responsiveness Does Not Mean Cultural Certainty

It is understandable that some people want a psychologist who already knows something about their cultural background.


Shared language can matter. So can the relief of not having to explain every cultural reference or family expectation before talking about what it means.


But sharing a culture does not guarantee understanding.

A psychologist who shares someone's ethnicity or language can still misunderstand them. Familiarity can sometimes make it easier to assume that we already know.


Two people having an attentive conversation together in a café l Dr Tiffany Leung on Culture and Mental Health Therapy
We are both Chinese, so I understand.
I have worked with many migrants, so I know what this means.
This is common in your culture.

Each statement may contain some knowledge. None tells us enough about the person.


Cultural humility requires us to notice that limit. A psychologist can bring knowledge and experience into the room while remaining prepared for the person in front of them to be different from what they expected.


Culturally responsive therapy explores more closely what this can change within the therapeutic relationship and the way psychological difficulties are understood.

Understanding the Person in Context

No one arrives in therapy with symptoms alone.


We bring relationships, ways of understanding ourselves, expectations about other people, and experiences of the different worlds we have lived in. Culture may be part of all of these, sometimes visibly and sometimes in ways that are harder to name.


An expectation can feel supportive at one point in someone's life and restrictive at another. A person may value something they have inherited while wanting a different relationship with it.


For me, this is why culture belongs in psychological therapy. Leaving it outside our understanding can narrow what we are able to see.

Exploring Culture, Identity and Psychological Therapy (Mental Health)

If culture, identity, migration or belonging have become part of the difficulties you are trying to understand, psychological therapy can offer space to explore them without assuming that any one part of your background explains who you are.


My approach is formulation-led, relationally integrative and culturally responsive. I offer online psychological therapy in English, Cantonese and Mandarin.

References and Further Reading

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