Treatment Modalities: Learn It 3—Cultural Factors and Therapy

There are many factors that may feed into a person’s decision about whether or not to seek treatment. By looking at a person from a sociocultural perspective, we can start to understand a person’s barriers to seeking treatment.

sociocultural perspective

The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background.

For example, José is an 18-year-old Hispanic male from a traditional family. José comes to treatment because of depression. During the intake session, he reveals that he is gay and is nervous about telling his family. He also discloses that he is concerned because his religious background has taught him that homosexuality is wrong. How does his religious and cultural background affect him? How might his cultural background affect how his family reacts if José were to tell them he is gay?

cultural competence

Cultural competence is one’s ability to understand and address issues of race, culture, and ethnicity.

Mental health professionals must develop strategies to effectively address the needs of various populations for which Eurocentric therapies have limited application (Sue, 2004). For example, a counselor whose treatment focuses on individual decision-making may be ineffective at helping a Chinese client with a collectivist approach to problem-solving (Sue, 2004).

Multicultural counseling and therapy aims to offer both a helping role and process that uses modalities and defines goals consistent with the life experiences and cultural values of clients. It strives to recognize client identities to include individual, group, and universal dimensions, advocate the use of universal and culture-specific strategies and roles in the healing process, and balances the importance of individualism and collectivism in the assessment, diagnosis, and treatment of client and client systems (Sue, 2001).

This therapeutic perspective integrates the impact of cultural and social norms, starting at the beginning of treatment. Therapists who use this perspective work with clients to obtain and integrate information about their cultural patterns into a unique treatment approach based on their particular situation (Stewart, Simmons, & Habibpour, 2012). Sociocultural therapy can include individual, group, family, and couples treatment modalities.

A photo collage composed of eight photographs arranged in two parallel rows of four. These photos show people from many different nations. From the top-left-hand-side, the photos are as follows: a person with a bicycle standing in a rice paddy, three children, three elderly people sitting along a rock wall, four cooks standing around a table, a classroom of students, a group of people seated at a covered outdoor table, two children wearing robes, and two people being held up by other people during a wedding ceremony.
Figure 1. How do your cultural and religious beliefs affect your attitude toward mental health treatment? (credit “top-left”: modification of work by Staffan Scherz; credit “top-left-middle”: modification of work by Alejandra Quintero Sinisterra; credit “top-right-middle”: modification of work by Pedro Ribeiro Simões; credit “top-right”: modification of work by Agustin Ruiz; credit “bottom-left”: modification of work by Czech Provincial Reconstruction Team; credit “bottom-left-middle”: modification of work by Arian Zwegers; credit “bottom-right-middle”: modification of work by “Wonderlane”/Flickr; credit “bottom-right”: modification of work by Shiraz Chanawala)
Watch this short video that explains about cultural competence and sociocultural treatments.

Barriers to Treatment

Statistically, BIPOC individuals tend to utilize mental health services less frequently than White, middle-class Americans (Alegría et al., 2008; Richman, Kohn-Wood, & Williams, 2007). Why is this so? Perhaps the reason has to do with access and availability of mental health services. Ethnically marginalized groups and individuals of low socioeconomic status (SES) report that barriers to services include lack of insurance, transportation, and time (Thomas & Snowden, 2002). However, researchers have found that even when income levels and insurance variables are taken into account, BIPOC individuals are far less likely to seek out and utilize mental health services. And when access to mental health services is comparable across ethnic and racial groups, differences in service utilization remain (Richman et al., 2007).

In a study involving thousands of women, it was found that the prevalence rate of anorexia was similar across different races, but that bulimia nervosa was more prevalent among Hispanic and Black women when compared with non-Hispanic White people (Marques et al., 2011). Although they have similar or higher rates of eating disorders, Hispanic and Black women with these disorders tend to seek and engage in treatment far less than White women. These findings suggest ethnic disparities in access to care, as well as clinical and referral practices that may prevent Hispanic and Black women from receiving care, which could include lack of bilingual treatment, stigma, fear of not being understood, family privacy, and lack of education about eating disorders.

Perceptions and attitudes toward mental health services may also contribute to this imbalance. A recent study at King’s College, London, found many complex reasons why people do not seek treatment: self-sufficiency and not seeing the need for help, not seeing therapy as effective, concerns about confidentiality, and the many effects of stigma and shame (Clement et al., 2014). And in another study, Black Americans exhibiting depression were less willing to seek treatment due to fear of possible psychiatric hospitalization as well as fear of the treatment itself (Sussman, Robins, & Earls, 1987). Instead of mental health treatment, many Black people prefer to be self-reliant or use spiritual practices (Snowden, 2001; Belgrave & Allison, 2010). For example, it has been found that the Black church plays a significant role as an alternative to mental health services by providing prevention and treatment-type programs designed to enhance the psychological and physical well-being of its members (Blank, Mahmood, Fox, & Guterbock, 2002).

Additionally, people belonging to ethnic groups that already report concerns about prejudice and discrimination are less likely to seek services for a mental illness because they view it as an additional stigma (Gary, 2005; Townes, Cunningham, & Chavez-Korell, 2009; Scott, McCoy, Munson, Snowden, & McMillen, 2011). For example, in one recent study of 462 older Korean Americans (over the age of 60) many participants reported suffering from depressive symptoms. However, 71% indicated they thought depression was a sign of personal weakness, and 14% reported that having a mentally ill family member would bring shame to the family (Jang, Chiriboga, & Okazaki, 2009).

Language differences are a further barrier to treatment. In the previous study on Korean Americans’ attitudes toward mental health services, it was found that there were no Korean-speaking mental health professionals where the study was conducted (Orlando and Tampa, Florida) (Jang et al., 2009). Because of the growing number of people from ethnically diverse backgrounds, there is a need for therapists and psychologists to develop knowledge and skills to become culturally competent (Ahmed, Wilson, Henriksen, & Jones, 2011). Those providing therapy must approach the process from the context of the unique culture of each client (Sue & Sue, 2007).

A lack of diversity in the mental health field may affect how individuals view treatment and whether they are willing to seek it. For example, a person from an underrepresented minority group may prefer to work with a therapist who is from the same cultural background or has experience working with people from their cultural group, but mental health professionals are overwhelmingly White and some have limited experience working with those from other cultural backgrounds, though there is an ever-increasing emphasis on cultural competence.

Care for Transgender and Gender Nonconforming Individuals

Transgender and gender nonconforming (TGNC) individuals may face unique mental health challenges related to their gender identity, including discrimination, harassment, and violence. Mental health professionals can play an important role in supporting the mental health and well-being of TGNC individuals through the provision of culturally-sensitive care. Here are some key considerations for therapy with TGNC individuals:

  • Use affirming language: Mental health professionals should use language that is affirming and respectful of a person’s gender identity. This may involve using a person’s preferred name and pronouns, and avoiding gendered language that may be triggering or invalidating.
  • Address minority stress: Minority stress refers to the stress experienced by individuals who belong to stigmatized or marginalized groups. TGNC individuals may experience minority stress related to their gender identity, including discrimination, harassment, and violence. Mental health professionals should be aware of the impact of minority stress on the mental health of TGNC individuals and work to address these issues in therapy.
  • Understand the diversity of the TGNC community: The TGNC community is diverse and includes individuals with a range of gender identities and experiences. Mental health professionals should be aware of the diversity within the TGNC community and work to provide culturally-sensitive care that is tailored to the individual needs of each client.
  • Address co-occurring mental health concerns: TGNC individuals may be at increased risk for co-occurring mental health concerns, including depression, anxiety, and substance use disorders. Mental health professionals should be aware of these risks and work to address any co-occurring mental health concerns in therapy.
  • Advocate for social justice: Mental health professionals can play an important role in advocating for the rights and well-being of TGNC individuals. This may involve working to reduce stigma and discrimination, supporting policy and advocacy efforts, and promoting social justice in all areas of society.

Overall, therapy with TGNC individuals should be culturally-sensitive, affirming, and tailored to the individual needs of each client. Mental health professionals can play an important role in supporting the mental health and well-being of TGNC individuals through the provision of culturally-sensitive care and advocacy efforts.[1]

What is your attitude toward mental health treatment? Would you seek treatment if you were experiencing symptoms or having trouble functioning in your life? Why or why not? In what ways do you think your cultural and/or religious beliefs influence your attitude toward psychological intervention?
  1. American Psychological Association. (2017). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 72(5), 463-483. ↵