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A therapist must always be aware that cultural differences between the therapist and client may lead to misunderstandings. For instance, a therapist should be cautious when interpreting nonverbal behaviors because those behaviors may have different meanings in different cultures. In some cultures, direct eye contact is considered disrespectful; pointing is viewed as rude; and too much smiling may be interpreted as shallowness. Culture may also affect the nature of a client’s symptoms and his/her explanation for them. For example, individuals from some Asian and Latino cultures may express depression primarily as physical symptoms (headaches, weakness, tiredness), while individuals from some Middle Eastern and Native American cultures may describe depression as “problems of the heart” or “being heartbroken” (Warren, 2008).
Overarching themes in the field of marriage and family therapy as a whole are the importance of a therapist being racially aware; intersectionality and social location of clients and therapists; considerations of power and power imbalances due to race and therapist status; and consideration of the minority client experience from all angles, such as: acculturation and assimilation, immigration status, and the impact of colonization (McDowell & Jeris, 2004).
The consideration of cultural factors can provide useful information about a client’s functioning as well as his or her comfort with therapy. Factors that a therapist should consider when working with clients from culturally diverse backgrounds include the following:
- Acculturation: Acculturation refers to the extent to which an individual from one cultural group has adopted the beliefs, attitudes, values, and other characteristics of another cultural group. It is a complex process that may increase the risk for depression and anxiety and lead to conflicts between family members who have integrated into the mainstream culture to varying degrees. Paniagua (2014) discusses the idea of external process of acculturation versus internal process of acculturation. External process of acculturation describes a person who has physically moved from his or her country of origin to another country. The effect can be more difficult for immigrants who move to a city in another country that shares very little similarities with their home city. Internal process of acculturation describes changes in cultural patterns when an individual moves from one U.S. region to another (e.g., from the South to the Northeast), or one area within a region to another (e.g., from a city to a rural setting).
- Racial/Ethnic Identity: Racial/ethnic identity refers to a sense of group or collective identity based on a person’s perception that he or she shares a common racial or ethnic heritage with a particular group. A client’s racial/ethnic identity may have a substantial impact on assessment and treatment. (Sanchez & Atkinson, 1983).
- Cultural Mistrust: Members of an ethnic/racial minority group may have difficulty trusting a White therapist because of past experiences with prejudice and discrimination. Consequently, mistrust in therapy may reflect an adaptive psychological response to oppression and should not be automatically interpreted as a sign of paranoia or other pathology (Sue, 2010). In many situations, the best strategy is to discuss the meaning of the mistrust with the client. However, when a client has a high degree of cultural mistrust, it may be difficult to form a good therapeutic relationship and referral to another therapist may be indicated.
When a client’s cultural background appears to be relevant to his/her presenting problems, a useful strategy is to make cultural issues explicit byÂ
(a) demonstrating interest in the client’s culture;Â
(b) defining the client’s problems within the context of his/her cultural background, practices, and values and societal responses to cultural differences; andÂ
(c) modeling non oppressive attitudes and behaviors by identifying and challenging stereotypic attitudes and behaviors and discussing how cultural differences might affect therapy (Fontes & Thomas, 1996).