How Your Cultural Identities Shape Your Approach to Therapy

When was the last time you sat with the question, Who am I, culturally?

Almost twenty years in this field has taught me one thing with certainty: you need to know who you are before you invite your clients to show you who they are. When you are with your clients, every piece of you is with your clients. Your history, your family's stories, your assumptions about what “good therapy” looks like, your comfort level with silence, your unexamined beliefs about independence, about struggle, about what healing should feel like.

Culture shapes every clinical decision you make, often before you're even aware of it.

Whether your training program acknowledged the need for cultural self-understanding and cultural humility doesn’t matter. It’s never too late to take a deep-dive into the cultural being you are and how it impacts your work as a therapist.

The (uncomfortable) truth about mental health’s one-size-fits-all model

For a long time, the mental health field operated on the convenient assumption that people are essentially more similar than different. Freud's universal drives, Skinner's behavioral reinforcement… the implicit message was that the same psychological principles apply across all humans, regardless of cultural background (Hook, Davis, Owen, & DeBlaere, 2025).

Research began to dismantle this in the 1970s and 80s. Studies documented that racial and ethnic minority clients had measurably worse therapy outcomes compared to White clients, with higher dropout rates, lower symptom improvement, and less service utilization overall (Hook et al., 2025).

This was a signal that something in the therapeutic encounter itself was failing clients. And researchers began to name it: therapists were doing a poor job of addressing cultural identities in therapy, mainly because no one had taught them how, and more critically, no one had asked them to look at themselves first.

I tell every student I teach that becoming a therapist is an emotional and personal journey, for the very reason noted above; you have to be willing to name culture and how it shows up in every space. It’s not easy work, but it’s worth it when you can be certain you are bringing your authentic self into each session.

The importance of cultural humility for therapists from privileged backgrounds

Something that trips up a lot of therapists, especially those who belong to historically dominant groups, is the assumption that culture is something other people have.

Culture is often invisible to those who are members of privileged groups, because societal structures and norms have been framed around their values and interests (Hook et al., 2025).

So if you grew up in a predominantly White, middle-class, Christian, heteronormative environment, you may not have had much reason to think about your cultural background at all. That said, invisibility does not mean neutrality. It's a kind of cultural positioning that shows up in the therapy room whether you name it or not. Your assumptions about eye contact, about emotional expression, about the appropriateness of directness, about whether a client “should” prioritize family or self, all of that is cultural. All of it influences how you conceptualize cases, form alliances, and select interventions.

A note for therapists who hold marginalized identities

Most of the cultural humility literature has historically addressed therapists from dominant cultural groups (White therapists, straight therapists, able-bodied therapists) learning to show up more responsibly for clients from marginalized backgrounds. It is important to directly address the experiences of therapists who themselves hold marginalized identities.

A therapist of color working with a White client navigates a specific and layered set of dynamics. A queer therapist working in a religiously conservative community faces a different kind of cultural labor. A therapist with a disability brings embodied knowledge that is clinically rich and also sometimes othered within the profession itself.

These therapists are not simply mirroring the cultural humility framework back at themselves, they are navigating questions about disclosure, about managing clients’ assumptions, about carrying the weight of their own marginalized experiences into the room while also being present with the clients (Hook et al., 2025).

Cultural competence vs. cultural humility

The multicultural competence or cultural competence framework was initially introduced by Sue and colleagues in the early 1980s and it transformed the field. From required coursework to awareness training and cultural knowledge-building, it moved the needle in meaningful ways.

The Multicultural and Social Justice Counseling Competencies now organize counselor development around four domains (Ratts et al., 2015):

• Attitudes and beliefs - awareness of one's own assumptions, values, biases, and privileged or marginalized status
• Knowledge - understanding how power, privilege, and oppression shape clients' worldviews and lived experiences
• Skills - developing culturally responsive strategies for cross-cultural practice
• Action - actively seeking professional development, community engagement, and advocacy opportunities to translate self-awareness and knowledge into meaningful practice)

But there's a clinical problem with the core language of “competence.” It sets up an ill-defined end state that therapists anxiously strive toward, often leading them to perform multicultural awareness rather than genuinely examine their limitations (Hook et al., 2025).

Think about it. A therapist who rates themselves “very high” in multicultural competence might be accurate, or they might be demonstrating the exact lack of self-awareness that undermines growth.

Self-reported measures of competence have been consistently linked to social desirability; meaning that overconfidence is simply masquerading as competence. Research has also consistently shown that how you are with clients culturally matters more than what you know (Tanaka-Matsumi, 2022).

All of this points toward something more useful than competence: humility.

Cultural humility is a lifelong way of being. It involves an ongoing and honest awareness of your own biases and limitations in understanding a client's cultural background.

It's other-oriented rather than self-focused. It means recognizing that there's no correct cultural perspective, only different ones; all of them worthy of curiosity and respect. There is no arrival point. Only continued growth and learning. (Hook et al., 2025)

What cultural humility looks like in clinical context

1. Your cultural story is in the room with you

It is important for therapists to recognize the preexisting cultural distance between themselves and their clients (Tanaka-Matsumi, 2022). It begins in your family of origin, your neighborhood, your religious upbringing, your experience with power and privilege (or the lack of it).

Research on therapist use of self highlights that genograms have aided trainees in better understanding how cultural, gender, and other biases and assumptions affect the administration of therapy (Haber et al., 2022).

In simpler terms: mapping your own cultural story (not just your clients’) is a critical clinical tool.

2. Intersectionality isn't just a concept

Culture has expanded well beyond race and ethnicity in professional literature. It now includes nationality, language, gender, religion, sexual orientation, socioeconomic status, disability or ability status, and size. And these identities don't stack neatly on top of each other, they intersect and interact in complex ways that are unique to every individual client (and therapist).

Using the ADDRESSING framework, researchers recommend a four-step approach to integrating intersectionality into therapeutic practice (Hays, 2022):

1. The therapist's ongoing self-assessment and multicultural orientation development
2. Attention to structural inequities embedded in the mental health system
3. Consideration of the impact of systemic oppression on clients with intersectional identities
4. Recognition of the resilience, strengths, and support that clients derive from their cultural communities

Cultural identity can be a risk factor or complicating variable, but it is also a profound source of strength that can be clinically leveraged when you allow yourself to see it.

3. Cultural opportunities in the session

There are moments in sessions when a client says something that clearly carries cultural weight; a reference to family obligation, a comment about faith, a remark about their community. You have a choice to engage with this information or let it pass.

Current evidence suggests many mental health providers do not readily recognize they lack the understandings and skills to address the experiences of racially or culturally marginalized clients, and researchers have documented a notable training-practice gap between the multicultural training provided to clinicians and the skills they need to successfully fulfill their roles (Sadusky et al., 2024).

When you move toward a cultural moment in the session, you communicate that the client's cultural identity is a legitimate and important part of who they are.

When you avoid it (whether you are doing so consciously or not) you risk communicating the opposite. These “cultural opportunities” are shaped almost entirely by your own comfort level with cultural dialogue (Hook et al., 2025). Your comfort level… that comes from your own cultural work.

The practical work: where do you start?

Working toward and maintaining cultural humility begins with honest, ongoing self-examination.

Here are some questions to consider sitting with:

• What cultural identities do I hold that carry power or privilege in my clinical context? How might those shape what I assume is “healthy” or “functional”?
• Where have I avoided a cultural conversation with a client because it made me uncomfortable? What was underneath that discomfort?
• Which cultural groups am I most uncertain or anxious about working with? What's driving that?
• How do my beliefs about independence, family loyalty, spirituality, or gender roles show up in how I conceptualize client problems and goals?
• How does my own cultural comfort level, or discomfort, affect whether I recognize and move toward cultural opportunities in session?

Research on cultural humility and therapeutic alliance has found that multiple microaggressions are associated with poorer therapy outcomes, with cultural humility and working alliance serving as important mediating factors, especially with Black, Indigenous, and women of color clients (DeBlaere et al., 2023). In most cases, the harm isn't intentional, but intent doesn't protect clients from impact.

Cultural humility is a practice

As therapists, it’s important for us to realize that cultural humility is not simply a box to check in a CEU cycle. Cultural humility is a lifelong, ongoing clinical discipline. The therapists who do it best aren't necessarily those who know the most about various cultural groups, they're the ones who have done the most honest, courageous work on themselves.

There is no end state of competence, there is only humility and continued growth. Becoming a better therapist is a career-long practice. (Hook et al., 2025)

So… what's your cultural story? And more importantly, is it helping you move toward your clients or creating distance?