Clinical support

What therapists should consider about cultural competence in counseling

Build cultural awareness in your therapy sessions with strategies that improve understanding, reduce unintentional harm, and strengthen therapeutic trust.

January 9, 2026

By Dr. Juli Fraga, Psy.D

8 min read

By Dr. Juli Fraga, Psy.D

Cultural competence is a crucial part of therapy for both clients and mental health care providers. According to the American Psychological Association, cultural competence is the ability to understand, appreciate, and work with clients from diverse cultural, racial, and ethnic backgrounds. Not only does this mean empathizing with your client’s differences, but it also involves reflecting on your own cultural background.

Culturally competent therapists bring awareness of their own values, assumptions, and biases to their sessions. Some examples of cultural differences can include race, sexual orientation, gender, socioeconomic status, and religious affiliation.

Read on to learn more about cultural competence, as well as how to incorporate this competency into your work as a therapist.

Understanding the foundations of cultural competence

Similar to active listening and empathy, cultural competency is one of counseling’s “core competencies.” In 1992, psychologists and researchers Derald Wing Sue and Stanley Sue introduced the term “multicultural counseling competencies” to the field. According to their extensive research, these competencies include awareness, skills, and knowledge.

Culturally sensitive therapists are aware of their own beliefs, attitudes, blind spots, and worldviews. They also understand how their own biases and backgrounds may affect their clients. For example, I have worked with clients whose political views differ from my own. Maintaining a stance of nonjudgment allows me to prioritize the therapeutic relationship and gain a clearer understanding of the client’s perspective and values.

Being sensitive to a client’s background helps establish trust, which is a cornerstone of effective therapy. Awareness also helps therapists understand why trust may be more challenging for clients who have experienced marginalization, especially when working with a therapist who has not.

Understanding your client’s intersectional background, preferences, and values can also aid in treatment planning. While symptoms of depression, trauma, and anxiety can stem from experiences with racism and discrimination, cultural differences and diverse backgrounds are also sources of strength for clients. We can use those strengths to help inform treatment as well. Exploring and understanding how these experiences impact your client’s life sets the stage for culturally sensitive support.

Culturally competent therapists use self-reflection to examine their own blind spots and personal biases. Our own backgrounds and upbringings often inform our blind spots. They include automatic assumptions, beliefs, and stereotypes that we hold (even unknowingly) about a specific individual or group. For example, a therapist who grew up in a family with very traditional gender roles may unknowingly assume that a new mother should choose to be a stay-at-home mom. Unconscious bias can affect the client-therapist relationship, and in some cases, erode trust in the therapist.

Self-assessment tools like the “Implicit Association Test” can help therapists identify their own cultural assumptions and blind spots. There are many different versions of the IAT, which allows therapists to examine their blind spots as they relate to specific racial minorities and marginalized groups, such as gender identity, disabilities, and race. Self-reflection can feel vulnerable, and this exercise helps therapists strengthen their cultural competence.

Practice in-network with confidence

Simplify insurance and save time on your entire workflow — from compliance and billing to credentialing and admin.

Talk to a practice consultant

Building bridges through culturally responsive communication

Empathy and understanding for clients from diverse backgrounds are cornerstones of culturally competent therapeutic care. At times, it’s important to adjust your communication style to align with your client’s values and background. Culturally competent therapists build bridges through responsive communication, including the following:

Non-verbal awareness: The meaning of non-verbal communication varies by culture. For example, in American culture, eye contact is often a sign of respect, but in Asian cultures, this type of communication is often seen as aggressive or confrontational. Culturally sensitive therapists learn about the client’s cultural norms and adjust their communication accordingly.
Active listening: Listening to the client as they share their story without challenging their thoughts and feelings helps build a strong therapeutic alliance. Active listening also helps destigmatize therapy by letting the client know that their experience matters.
Adapting therapeutic language: When it comes to culturally responsive communication, language choice makes a difference. For example, instead of asking a client to “challenge” their automatic thoughts, which may come across as critical and uncaring, clinicians can invite the client to share the “pros” and “cons” of their thoughts.
Validate the client’s experience: Validating the client’s experiences, especially regarding racism, discrimination, and oppression, conveys respect and builds trust. Research shows that affirming and empathizing with your client’s experience can help them feel more comfortable opening up and engaging in the therapeutic process.

Adapting therapeutic approaches for cultural relevance

Adapting your therapeutic approach to align with your client’s values and culture helps create a more culturally sensitive and responsive approach. Here are some adaptations to consider.

Cognitive-behavioral therapy: Incorporating metaphors that align with the client’s values can help communicate how CBT can help clients alter their thoughts, feelings, and beliefs, without appearing judgmental or pathologizing. For example, research shows that with Asian clients, culturally adapted CBT uses a metaphor that explains that “no matter how hard things get, there’s always a solution.”
Mindfulness-based practices: With its focus on self- and other-awareness, mindfulness can be culturally sensitive for clients from more collectivistic backgrounds. With certain clients, it may not be culturally sensitive to focus on “acceptance,” which is a key tenet of mindfulness. Instead, you can use mindfulness techniques to help your client problem-solve. For example, instead of asking your client to “accept” things just as they are, you may invite them to identify one thing they can do in the moment to help themselves or their community.
Integrative therapy: Research shows that culturally adapted treatments may be more effective when working with clients from diverse backgrounds. For example, a therapist may combine CBT with mindfulness-based practices. In this model, focusing on the client’s strengths and inviting a more collaborative approach to treatment can help destigmatize therapy. Explore more integrative therapy techniques.
Self-disclosure: As a therapeutic intervention, clients from diverse backgrounds may benefit from a therapist’s self-disclosure, especially when the disclosure helps the client feel less alone. Examples include sharing aspects or stories of your own cultural, racial, and ethnic background, as well as your sexual orientation or gender identity.

Navigating cultural differences in the therapeutic relationship

When working with diverse clients, cultural differences come into play. Without realizing it, you may make an assumption or bump into a misunderstanding. When ruptures occur, it’s important to make a culturally appropriate repair with your client. Here’s what to do.

Regulate your own emotions: When ruptures occur, regulating your own emotions with some deep breathing can help you avoid a defensive response.
Exercise cultural humility: Acknowledge that you don't know everything about your client’s experiences and cultural background, and emphasize that you’re open to learning and growing together. Cultural humility is a person-centered approach that encourages therapists to reflect on their own beliefs, values, and biases. When ruptures occur, therapists can use cultural humility to facilitate a discussion and repair. For example, a therapist might say, “I’m sorry I misunderstood and made an assumption. Can we talk about this together?”
Use open communication: Invite the client to share how they experienced the impasse or misunderstanding. Ask your client for honest feedback, and broach cultural topics they've shared in the past to help them feel comfortable.
Practice self-awareness: Continue to examine your own assumptions and biases and how they may have contributed to the cultural impasse. Educating yourself is one way to take responsibility, and may include consulting with another therapist, seeking supervision, or attending a training.

Resources for ongoing cultural competence development

As therapists, it’s important to continue learning about cultural differences and their role in therapy. Learning can take many different forms. Here are some examples.

Think Cultural Health: A free cultural competency online course for behavioral health providers. This course provides several modules: an introduction to cultural competency and increasing self-awareness; increasing awareness of your client’s background; and culturally appropriate intervention and services.
APAGS multicultural training database: An online database of readings and videos that help clinicians increase their multicultural counseling competencies.
American Psychological Association multicultural training resources: Complementary readings on race, diversity, and culture, especially related to the practice of psychology.
Multicultural training videos: A library of training videos on a wide variety of diverse topics, such as working with Black clients and inviting racial conversations into therapy. Videos are for purchase only, and some offer CEU credits.
The DSM-5-TR: Providers should consult the DSM-5-TR when diagnosing a client, as each disorder in the DSM has a "Culture-related diagnostic issues" section that can be referenced.

Headway recognizes the importance of supporting providers in this journey through our partnership with Violet, a platform dedicated to advancing mental health equity. Violet provides evidence-based resources, training modules, and consultation services specifically designed to help providers deliver more culturally responsive care. Through this collaboration, Headway providers gain access to specialized resources for working with LGBTQ+ individuals, immigrants and refugees, communities of color, and other underserved populations.

Headway helps you build a stronger practice

Whether it’s race, culture, identity, orientation, or any other difference, it’s important for therapists to exercise cultural sensitivity with their clients. At Headway, we provide resources to help increase your knowledge and awareness. Our tools help you approach your diverse clients with compassion and sensitivity‌ — ‌two mainstays of strong therapeutic care.

Headway helps you help others

Join a network of thousands of mental health providers who have already chosen Headway to streamline their practice and expand their network — for free.

Talk to a practice consultant

This content is for general informational and educational purposes only and does not constitute clinical, legal, financial, or professional advice. All decisions should be made at the discretion of the individual or organization, in consultation with qualified clinical, legal, or other appropriate professionals.