Culturally Responsive and Historically Aware Care

What this means for you

Culture shapes how you experience distress, how you relate to family and community, what safety feels like, and what healing looks like. Good therapy takes this into consideration and incorporates it. When the way we work fits the way you actually live and understand your own life, you're more likely to feel understood, more likely to stay in the work, and more likely to get better.

Research supports this approach as well. Large studies of treatment outcomes show that therapy adapted to a client's cultural context tends to work better than therapy delivered the same way to everyone.

• A meta-analysis of 78 studies and nearly 14,000 clients, most of them not of European-American background, showed that culturally adapted techniques performed better than other approaches. (Hall, Ibaraki, Huang, Marti & Stice, 2016, Behavior Therapy).

• Another review of 99 studies showed an overall benefit for culturally adapted treatment. The same work found something I take seriously: when clients rated their therapist's cultural responsiveness, that rating predicted better outcomes. When therapists rated their own competence, it didn't (Soto, Smith, Griner et al., 2018, Journal of Clinical Psychology).

• An even earlier review of 76 studies found that adaptations built for a specific cultural group were several times more effective than generic, one-size-fits-all approaches (Smith & Griner, 2006, Psychotherapy).

What is it like to work together using this approach?

I ask how you understand what you're going through, before I bring any framework to it. We start with how you understand what’s happening.

I treat the effects of injustice, displacement, discrimination, and historical harm as causes of real distress! A reasonable response to an unjust situation is not a symptom to be corrected. In the human rights trauma field, we say trauma is “a normal reaction to abnormal circumstances.”

I adapt the methods I'm trained in (EMDR, Internal Family Systems, Ego State work, and other trauma-focused approaches) to fit your context, rather than asking you to fit the method.

We recognize and celebrate the resources you already carry: family, community, faith, spiritual or cultural practice, and your own ways of coping. These belong in our work in ways you’re comfortable with.

As we go, I will check in with you to see how our process is going, and whether it feels like we are really connecting.

A note on me.

I'm a white, European-descended clinician, and I think it matters that I say so plainly. Cultural responsiveness isn't a credential I claim. It's ongoing work I'm responsible for, and part of that work is staying open to correction from you. If something I do or say doesn’t work or is even a problem, telling me won’t interrupt the work. It IS the work.

References

Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47(6), 993–1014.

Soto, A., Smith, T. B., Griner, D., Rodriguez, M. D., & Bernal, G. (2018). Cultural adaptations and therapist multicultural competence: Two meta-analytic reviews. Journal of Clinical Psychology, 74(11), 1907–1923.

Smith, T. B., & Griner, D. (2006). Culturally adapted mental health intervention: A meta-analytic review. Psychotherapy, 43(4), 531–548.

Rathod, S., Gega, L., Degnan, A., et al. (2018). The current status of culturally adapted mental health interventions: A practice-focused review of meta-analyses. Neuropsychiatric Disease and Treatment, 14, 165–178.