What is Multiculturally Responsive Therapy?
By Peggy Loo, PhD
One of the things we say on our website is that we are psychologists committed to the ongoing practice of multiculturally responsive therapy. What exactly does that mean? In a world of jargon we wanted to take the time to explain.
The importance of multicultural therapy
Until the last few decades it was commonly accepted that theories about ideal psychological functioning are universal. After all, aren’t we all humans? Isn’t an anxiety disorder the same regardless of who the person is? Yes and no.
As the field of psychology grows and diversifies in representation, more psychologists are pointing out that while there are universally shared experiences - our various identities (i.e., age, generation, ability, diagnosis, religion, race, ethnicity, class, sexuality, indigenous heritage, nationality, gender, etc) shape how we will go through those moments.
There is no one size fits all experience, even if there are aspects of an experience that resonate with many. Our social identities determine all aspects of our lives. There are identities that may change over a lifetime (e.g., immigration status, class, religion), ones that remain stable, others that may be invisible (e.g., neurodivergence) or assumed, sometimes inaccurately (as can be the case for Multiracial people). Everyone has multiple identities and the overlap and interaction of these identities creates a unique lens for your life experiences (e.g., a middle class, queer, Multiracial older adult).
Decolonizing therapy and mental health care
There’s also increasing awareness that no one psychological theory can speak to all and no therapy approach works for everyone. The canon of psychology theorists referenced in every Psychology 101 textbook (often cisgender, heterosexist White men in an American or European context) had to do what all theorists do: develop ideas from personal experience, value systems, and observations. Some came up with valuable theories that are taught in psychology graduate programs today. But of course they (and their theories) have biases and blindspots when it comes to defining what’s most important to focus on in mental health and therapy.
Some biases come from being from a specific place and generation, some blindspots come from areas of gender and racial privilege. Other limitations come from not fully considering how their theories land when you cross international borders, or when globalization and immigration changes the makeup and mental health needs of our neighbors and communities. Mental health care must be adapted to the social context, needs, and identities of each person - which highlights the importance of multicultural psychology.
Multiculturally affirming training & training
In the last few decades, the need for multicultural psychology has grown where it’s now a mandatory part of training programs. A watershed moment, APA’s Committee of Accreditation declared cultural diversity to be a key component in graduate training in 1986 (APA, 2002), fundamentally changing the way that graduate programs taught emerging mental health professionals that now make up the psychology workforce. As a result, newer generations of trainees accept that the identity differences between us profoundly matter in terms of how we define and practice quality mental health care.
When therapists don’t tailor the way they listen, respond, and work, the transformative and healing potential of therapy becomes a space of invalidation and even colonialism. While there’s been progress in the mental health field, we have a lot of work to do. To this day, psychology training programs vary widely on how much multicultural training they provide graduate trainees, with some programs offering a single course while other programs have all courses grounded in a multicultural orientation.
Multicultural competency in therapy
Definition of multicultural competency
The American Psychological Association provides a starting definition of multicultural competency as “the ability to understand, appreciate and interact with people from cultures or belief systems different from one's own” (DeAngelis, 2015). A common understanding is that multicultural competent therapists have a combination of self-awareness, broad cultural knowledge, and a skill set that allows them to provide interventions in a sensitive manner (Sue, 1992).
This definition has been expanded to discussing domains of privilege and marginalization in one’s identities. It also includes the introduction of a socioecological paradigm encouraging reflection on diversity through multiple levels, from the intrapersonal, interpersonal, institutional, community, public policy, and global (Ratts et al, 2016).
Yet researchers are recognizing that multicultural competency is a difficult thing to measure (Jones et al, 2013). There is inconsistent connection between multicultural competency training and what happens in sessions and even discrepancies between therapist and patient perceptions of multicultural competency (Davis et al, 2018). Psychologist Pamela Hays points out, “This may be because competence implies an end goal that can be definitively measured and met, whereas in reality, measuring such a construct is quite difficult, due in large part to the complexity of identity. How does one assess [multicultural competency] given the enormous range of cultural influences and identities?” (2022, p.7.)
Hays wonders is there such a thing as partial multicultural competency or population-specific competency? Is anyone ever fully competent and does it really matter if a therapist rates themselves as multiculturally competent, but their patient doesn’t?
Multicultural competency is a starting point
Great questions - and I don’t have the answers. What I do know is that all licensed mental health professionals are required every few years to enroll in continuing education and training. There is a mandate in nearly every professional field to be a lifelong learner. You are deemed competent enough upon completing a standard of education, training, and supervised clinical practice - and then you are required to further professional competency your entire career. Similarly, I think there should be a baseline of multicultural competency - but it only serves as a starting point, not an ending point.
Why “multiculturally responsive” therapy?
I’ve started to think of multicultural competency like literacy. You can learn to read and write, and you need some fundamental knowledge and skills to be considered literate.
But being literate doesn’t automatically mean that you’re well read. It doesn’t mean that you comprehend what you’re reading or that your writing is clear and effective. Or just because you read very capably in one genre doesn’t mean you are automatically “competent” in other genres. An academic peer reviewed journal article couldn’t be more different than poetry. Technically, I can read both - but I know next to nothing about poetry and wouldn't pretend otherwise.
The truth is, even if you’re an avid reader and a good writer - there’s always more ways to grow. That’s why I deeply appreciate the concept of multicultural responsiveness.
Three characteristics of multiculturally responsive therapy
Multicultural therapy at its core is relational
Being responsive to someone as a whole person isn’t simply knowing a lot of facts about them - it’s reflecting on that knowledge in the service of creating a connected relationship. Being responsive is an attentive reply to the unique person in front of you. It only makes sense in an interpersonal context, and it centers the goal of attunement. Strong responsiveness only occurs after many back and forth interactions resulting in a fuller and fine-tuned sense of understanding each other.
Being multiculturally responsive is fluid
While it’s important for therapists to have a body of knowledge of diverse cultures, identities, and groups (ranging from their own to others), how this information is made useful in a therapy session can’t be prescriptive. This knowledge is also ever evolving. Being responsive means appropriate adaptation across situations. It is always malleable and unique to a specific therapy relationship.
Multicultural therapy is dynamic
There is room for growth and movement as a therapy relationship moves forward - we become more responsive with time and interaction. Maybe more importantly, there’s room for some of the inevitable questions, fumbles, or challenges inherent to developing any close relationship. Spoiler alert- therapists aren’t perfect. We are also multicultural beings, with our own identities, worldviews, and blindspots - which is why I think overemphasizing the word competency can unrealistically imply therapist mastery or perfection. Being responsive means we are committed to growing personally and growing with you - whether that is checking in, clarifying, taking ownership, and changing.
What does multiculturally responsive therapy look like?
When you experience feeling seen and heard by someone, there’s often a lot that go into that, right? It’s big and small things. It could be the words said, the way they were said, a feeling of warmth and care, undivided attention, gentle eye contact, follow up question that demonstrates understanding, the sense that sometimes there are no words but there’s comfort or solidarity in being together, etc.
Similarly, there’s no one thing that determines multicultural responsiveness. Instead of giving a singular definition and being reductionistic, here are three signs to look out for.
1. Ongoing openness about multicultural topics
Are there opportunities to explore and discuss the identities that matter to you? Are there questions asked or are you expected to take the lead?
Is this an ongoing conversation across your therapy sessions?
Do you feel comfortable sharing about all parts of who you are? If not, is there exploration of how to encourage greater sharing? When you do share something about your identities, are you met with validation and openness or a change in subject?
Is there space for you to reflect on the effect of your identities on your experiences or how it may shape your mental health?
2. Discussing multicultural dynamics in the therapy relationship
Is there space for your therapist to acknowledge shared or different identities with you? Even if you and your therapist share many similar identities, is there affirmation of what you share and appreciation for what may be different?
Have you ever silenced a part of yourself to avoid rocking the boat?
Are there opportunities for feedback about this part of your therapy relationship and have you ever tried giving any?
Part of developing a trusting relationship with anyone is navigating what happens when you’re not on the same page. If there is an area that you’re not sure your therapist understands you - don’t bypass the moment for feedback if you can. Doing so may become a chance for dialogue. Or it’s clarification that you may need to reevaluate whether this therapist is right for you. Either way, it’s helpful to know. (Caveat: it’s not on you to clarify moments that are prejudicial and disrespectful.)
Does your therapist understand your cultural display rules, or cultural norms for how you express your feelings?
How do you prefer to relate to your therapist? As an authority figure, coach, teacher, ally, healer, or something else?
3. Adapting therapy to intersectional identities
Does it feel like therapy becomes increasingly tailored to you as a whole person (e.g., being BIPOC and queer)?
Does it feel as though someone else’s values are being imposed onto you and your life?
Is there space for your cultural values to be discussed and incorporated into therapy (e.g., how sessions are structured, what’s a comfortable way to relate, who takes the lead, how do you want tears handled if they come up)?
Multiculturally responsive therapy is essential in today's diverse world. By being mindful of and respecting a diverse range of backgrounds, values, and beliefs, therapists can create a safe and supportive environment for all. This approach not only fosters greater trust and rapport between therapists and patients, but also ensures that therapy is effective and relevant to each person’s unique experiences and needs. Our team of skilled therapists are trained in multicultural psychology and our goal is to promote inclusivity and mental health equity for all. Book a free consult today.
About the Author: Dr. Peggy Loo is a licensed psychologist and director of Manhattan Therapy Collective. She is passionate about growing a team of psychologists dedicated to the lifelong work and journey of multicultural responsiveness in therapy. She herself is a lifelong learner of all things multicultural, botanic, canine, and spicy.
References:
American Psychological Association. (2002). Guidelines and principles for accreditation. Washington, DC: Author.
Davis, D. E., DeBlaere, C., Owen, J., Hook, J. N., Rivera, D. P., Choe, E., ... & Placeres, V. (2018). The multicultural orientation framework: A narrative review. Psychotherapy, 55(1), 89.
DeAngelis, T (2015, March). In search of cultural competence. https://www.apa.org/monitor/2015/03/cultural-competence
Hays, P. A. (2022). Addressing cultural complexities in counseling and clinical practice: An intersectional approach. American Psychological Association.
Jones, J. M., Sander, J. B., & Booker, K. W. (2013). Multicultural competency building: Practical solutions for training and evaluating student progress. Training and Education in Professional Psychology, 7(1), 12.
Ratts, M. J., Singh, A. A., Nassar‐McMillan, S., Butler, S. K., & McCullough, J. R. (2016). Multicultural and social justice counseling competencies: Guidelines for the counseling profession. Journal of Multicultural Counseling and Development, 44(1), 28-48.
Sue DW, Arredondo P, McDavis R. (1992). Multicultural counseling competencies and standards: a call to the profession. J. Couns. Dev. 70:477–486