Culturally Responsive Therapy: What Changes When Therapy Fits the Person?
已更新：10月4日
Originally published 17 March 2025 · Updated 22 September 2026
A psychologist’s exploration of what culturally responsive therapy can change in the way psychological difficulties are understood, worked with and experienced in the therapy room.
People do not usually come to therapy because they want their culture analysed.
They may come because they feel anxious, exhausted or stuck. A relationship keeps becoming difficult. They find themselves agreeing when they want to say no. They understand intellectually what they “should” do, yet doing it feels much more complicated.
We cannot always know from the surface of a problem what will become important as we begin to understand it.
Someone who finds it difficult to set boundaries might be afraid of rejection. Someone else may have learned that being attentive to other people's needs is an important expression of love and responsibility. Saying no may feel relatively straightforward with friends but almost unthinkable with a parent.
If therapy begins too quickly with:
“You need stronger boundaries.”
something has already been decided about what the behaviour means, where the problem lies and what healthier functioning should look like.
What Does Culturally Responsive Therapy Actually Change?
It is tempting to think of culture as information that a therapist needs to learn about someone.
Where did they grow up? What language do they speak? What is their family's cultural background? Are religion or migration important?
These things can matter. Collecting them does not necessarily tell us how they matter.
Culturally responsive therapy is not about learning a set of facts about a particular culture and applying them to an individual. It changes how we approach the difficulty itself: what we understand as problematic, what a response may have helped the person manage or preserve, what kind of change is worth pursuing, and when our original understanding needs to be revised.
Imagine someone describing a family relationship in which they take considerable responsibility for other people. They anticipate needs, reorganise their own plans and rarely say that something is too much.
We might recognise poor boundaries or people pleasing. That understanding may eventually prove useful, but there is more to stay with first.
What does responsibility mean in this relationship? What happens when the person cannot provide it? Do they resent the responsibility itself, the lack of choice around it, or the fact that nobody seems to notice what it costs them?
We may discover that being dependable matters deeply to the person. Fear and guilt may also have become tied to what happens when they disappoint someone. As we stay with the relationship, it can become harder to separate these experiences into a simple account of what the person wants and what other people expect from them.
The person may not want to care less. They may want more room to negotiate how they care when their own needs, circumstances or relationships change.
The Same Difficulty Does Not Always Mean the Same Thing
Psychological therapies give us concepts for recognising patterns. We may notice avoidance, perfectionism, self-criticism, emotional suppression, reassurance seeking, masking, hypervigilance or difficulty setting boundaries.
Concepts can be useful. They can also organise what we see before we have fully understood it.
Consider someone who rarely expresses anger.
We might wonder whether conflict has come to feel dangerous. Perhaps disagreement in their family led to withdrawal, punishment or instability.
Perhaps the person recognises anger quite clearly but does not usually express it directly. They may value restraint, preserving relationships or choosing carefully when something needs to be said.
Then we learn something more. They lie awake replaying conversations, become increasingly resentful and eventually withdraw from relationships without explaining why.
The question changes.
There may be too little room between silence and withdrawal for their needs to become known.
A formulation of difficulty expressing anger has not yet told us enough. We still need to understand what anger means, what the person expects might happen if it becomes visible, what ways of communicating have been available to them, and whether those ways still work in the relationships they are trying to sustain.
Culture may become part of that understanding alongside childhood experience, trauma, temperament, neurodivergence, gender, power within a relationship, and the actual behaviour of the people around them.
What Are We Hearing When Someone Uses a Familiar Word?
Therapy relies heavily on words that can appear straightforward: anxious, guilty, selfish, close, independent, respectful, depressed, responsible.
A person might say:
“I would feel selfish.”
We could hear this as excessive guilt.
But what would being selfish actually mean?
The person may believe that what they want would neglect a responsibility they genuinely hold. They may believe the decision is reasonable but know that someone important to them will see it differently. They may feel guilty without yet knowing whether that guilt tells them something about their own values, the expectations within the relationship, or both.
If selfish is treated immediately as an irrational belief to challenge, these differences disappear.
This becomes particularly interesting in multilingual therapy.
Someone may describe an experience fluently in English and then use a Cantonese or Mandarin expression that shifts the emotional weight of what they have been saying. A family phrase may be difficult to translate because part of its meaning comes from who says it, when it is used and what usually happens afterwards.
Changing language does not always produce such a shift. Sometimes the thought feels much the same.
There is no reason to assume that someone's first language necessarily contains a deeper or more authentic version of their experience.
Sometimes I may understand every word a person has used and still realise that I do not yet understand what the sentence means in their life.
Therapy cannot simply ask a person to learn how to describe themselves in psychological language. The therapist also needs to remain curious about the languages, relationships and experiences through which that person already understands themselves.
What Happens When the Therapist's Understanding Is Wrong?
There are moments when I will misunderstand something.
I may place emphasis in the wrong place. A question that makes sense from my perspective may miss what mattered to the person telling the story. I may recognise a familiar psychological pattern and later realise that I understood it too quickly.
Imagine I understand someone's difficulty disagreeing with their parents primarily as fear of conflict, and they tell me that this does not quite fit. They can disagree with their parents and have done so before. What feels difficult is the sense that making this particular decision would alter the relationship they understand themselves to have with them.
My understanding needs to change.
But the person has also had to decide whether to correct me.
For some people this is unremarkable. They tell me I have misunderstood, I adjust, and we continue.
Someone who is used to adapting quickly to other people may respond differently. They might accept my interpretation even though it does not quite fit. They may keep explaining until their experience makes sense in my terms. Or they may become quieter without either of us immediately knowing what has changed.
For someone who is used to accommodating others, avoiding conflict or worrying about being seen as difficult, correction may itself carry a cost. A therapist can be genuinely open to being corrected and it can still be difficult for the person to do the correcting.
The way we deal with not understanding one another can sometimes begin to resemble something the person already knows outside therapy.
What happens between us when understanding takes time?
Culturally responsive thera
py does not require the therapist never to misunderstand. What matters is whether there is enough room for misunderstanding to become visible, to be reconsidered, and for the therapist’s understanding to change.
When Being Understood Requires Too Much Translation
There is a subtle difference between explaining ourselves and continually reorganising ourselves so that another person can understand us.
Many people become very good at the latter.
They know which parts of a story need additional explanation. They anticipate which family expectations will sound unfamiliar. They translate a phrase before anyone asks. They soften something that might otherwise require a long conversation. Sometimes they leave part of the context out because explaining it would take too much effort.
This can become highly practised. The person may barely notice how much translating is happening.
The same process can enter therapy.
Someone may spend much of a session teaching the therapist enough about their world for the psychological conversation to begin. Over time, they may notice which explanations are understood most easily and begin organising what they say around them.
Nothing obviously difficult needs to happen between therapist and client. The conversation can feel warm and useful.
Yet some experiences may remain harder to reach because so much attention is being used to make them understandable.
The therapist may only hear the version that has already been made easier to understand. Some context may have been shortened, softened or left out before the psychological conversation appears to begin.
Sometimes there is more to notice in how much work a person is doing to help us understand than in the explanation they eventually arrive at.
What Are We Assuming Change Should Look Like?
Even after we understand a difficulty more carefully, we still have to consider what therapy is helping someone move towards.
Independence is one example.
Someone may have spent much of their life having important decisions made for them. Becoming more able to make choices, tolerate disagreement and find out what matters to them may open possibilities that previously felt unavailable.
Another person may already have a clearer sense of the decision they would prefer to make. Their difficulty is that the available choices affect people for whom they feel genuine responsibility. Becoming less connected to those relationships may not be what they are looking for.
So what would having greater choice look like in this life?
Sometimes greater choice may mean speaking a need more directly. Sometimes it may mean keeping an important relationship while no longer carrying every responsibility alone. For someone else, change may be creating more room for negotiation in a relationship where very little has previously felt negotiable.
What matters to us develops within relationships, histories and communities, and our relationship with those influences can change.
Sometimes a person's preferred way of living conflicts with what people around them expect. A relationship may allow very little room for negotiation. Discrimination, immigration circumstances, financial dependence or unequal power may restrict what is realistically possible.
If there are very few safe or viable options, that should not be mistaken for a lack of motivation to change.
Psychological understanding does not remove those conditions.
Therapy can still create room to examine what matters, what has become costly, what feels difficult to relinquish, and where there is space for something to become different.
Culture Does Not Need to Explain Everything
Once we begin paying attention to culture, it is possible to start seeing it everywhere.
A person disagrees with their parents and the conflict becomes cultural. They struggle to express emotion and the explanation becomes cultural. They are perfectionistic, private, ambitious or self-critical, and these qualities are quickly connected with cultural background.
We may then know more about a cultural narrative while understanding less about the person.
Two people who share ethnicity, language, religion or migration history can have very different relationships with those parts of their lives. Even within a family, what an expectation or tradition means can change between people and across time.
The same caution applies when therapist and client appear to share a background.
Similar language, ethnicity or migration experience may make some things easier to understand. It can also make us assume we understand more quickly than we actually do.
Cultural context can move in and out of the work. It may become important around a particular family relationship, recede for a time, and return when something changes elsewhere in the person's life.
We find out how relevant it is by doing the work.
A person who repeatedly puts their own needs aside may begin to recognise what this costs them without deciding that caring for other people was a mistake. Someone living in a relationship where disagreement is unsafe may understand why speaking has become difficult while also considering what protection or change they need now.
Leaving Room for Understanding to Change
Culturally responsive therapy does not require culture to become the subject of every session.
Sometimes it will matter a great deal. At other times it may become visible only around a particular relationship, decision or phrase.
The important thing is to leave enough room for our understanding to change. The therapist’s first explanation may not be the most useful one, and the direction of therapy needs to remain connected with the life this particular person wants to live.
In my own work, this sits within an Integrative Psychological Practice. Formulation develops through the work. Something that initially appears to be anxiety, avoidance, guilt or difficulty setting boundaries may begin to make different sense as we understand more about the person's relationships, history and present circumstances.
Psychological therapy can provide space for this kind of enquiry. Culture does not need to explain every difficulty, but when it changes what an experience means for the person in front of us, there is no reason to leave it outside the room.
Knowing something about a culture is not, by itself, what makes therapy culturally responsive. The understanding also needs to remain close enough to the person’s experience to be useful, and open enough to change when it no longer fits.
If you are considering therapy and wondering whether culture, language or living across different worlds may be relevant to what you are experiencing, a complimentary 15-minute consultation offers an opportunity to discuss what you are looking for and whether my way of working may be a suitable fit.
References
Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., Jr., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366.
Orlowski, E. W., Moeyaert, M., Monley, C., & Redden, C. (2025). The effects of cultural humility on therapeutic alliance and psychotherapy outcomes: A systematic review and meta-analysis. Counselling and Psychotherapy Research, 25(2), e12835.
Boswell, N., et al. (2025). Repairing cultural ruptures in psychotherapy: Strategies to enhance the therapeutic alliance. American Journal of Psychotherapy.
Verkerk, L., Fuller, J. M., Huiskes, M., & Schüppert, A. (2024). “My recovery is in English”: Clients' language choices in multilingual psychotherapy. Counselling and Psychotherapy Research, 24(3), 949–961.