Therapy in Marginalised Communities: Cultural Competency or Cultural Humility

The goal is to give a treatment that fit the culture with increased effectiveness. 

When we speak about providing and getting individualised therapy, it should also address the cultural differences, rather than focusing only on the psychological needs. But therapists fail to address the cultural differences. The primary treatment given to psychological disorders is Psychopharmacology and psychotherapy (McHugh, Whitton, Peckham, Welge, & Otto, 2013). 

Most of the assessment tools we use and the therapeutic techniques we follow are mostly based on the Western culture. Say, for example, most of the books we use for studying and understanding Psychology are all from foreign authors. The books of Indian psychologists are few, and their usage for academic purposes is quite limited.  Let’s break down the topic and understand:

Read More: Is it Okay to See Multiple Therapists Simultaneously? 

Marginalized community 

Marginalised communities are those who were pushed to the edges of society- socially, economically, politically and culturally. Those people are not treated equally and don’t have the same voice or access as others in society. Example: LGBTQ+, disabled people, immigrants. 

Culture 

Culture is a shared set of beliefs, values, customs and behaviours that a group of people. It is passed down from generation to generation. It can differ with religion and race. Culture can be observed in external factors like artefacts (e.g. food, music) and institutions (e.g. family). It can also be represented by internal factors such as values, beliefs and attitudes. 

Cultural Competence 

Cultural competence is defined as a group of skills and knowledge about different cultures and their beliefs that can be learned to serve people from different cultures. This cultural competence can be gained by interacting with people of various cultural backgrounds. 

Benefits of following cultural competence in therapy 

• It can help the therapist to understand the client’s culture and effectively respond to their cultural beliefs, practices and values. 
• It makes it easy to learn and understand the cultural background. 
• To adapt the therapy to the client’s culture. 
• It prevents prejudice and stereotypes in a therapeutic setting. 
• It can bring the client closer to a therapist, and rapport can be easily established. 

Example: A therapist uses a culturally relevant metaphor when working with the client may help to build the rapport. 

Read More: The Psychology of Prejudice and Stereotyping

Cultural Humility 

Cultural humility is a process of understanding their own cultural biases and showing openness to learning from the client’s lived experiences.

Benefits of following cultural humility in therapy 

• Asking about the client’s cultural identity without their own bias towards their culture.
• The therapist may acknowledge that they are not experts in understanding the client culture. 
• Building a therapeutic relationship based on mutual respect and collaboration.
• To provide a safe, inclusive and empowering space for the client. 

Example: A therapist makes a statement to understand how the culture shaped the client. The therapist may say, “I want to understand how your background shapes what healing looks like for you.” 

People in a marginalised community 

People in the marginalised community tend to experience more mental health issues compared to other populations because of some factors such as unemployment, stigma and financial issues, which are more common among this population. 

Reaching out for therapy from a marginalised community 

• The therapist should be aware of the barriers an individual from a marginalised community has. 
• The barrier can be stigma, prejudice towards their community or the quality of mental health treatment they receive. 
• Being a member of a marginalised community itself can be a precipitating factor for mental health disorders. 

Mental health disparity 

Mental health disparity means unequal access to mental health care based on race, religion, gender and sexuality. It can be witnessed among the marginalised population. 

1. Structural racism 

Limited access to quality healthcare they receive and increasing the risk of mental health issues. 

2. Provider discrimination 

It is defined as the bias or unequal treatment provided by healthcare providers to people from marginalised communities. 

Culture and Psychotherapy 

Culture determines what is abnormal behaviour, how the society reacts to people with psychological disorders, and it also determines how much care they receive from the caregiver and expressed emotion (the caregiver’s attitude towards the client). And hence, it is essential to consider the cultural background of the client who seeks therapy. There are around 400 psychotherapy models, of which we use only a few theories and that too mostly from Western culture.

Read More: Positive Psychotherapy: A Unique Approach to Mental Health

Top-down vs Bottom-up 

Culture-based intervention can be designed in two ways: 

1. Top-down approach 

In this approach, we modify the already existing evidence-based intervention according to the cultural needs and expectations of a particular culture. But some critics say that modifying an intervention developed on the basis of one group of people to the other group may fail to address the clients’ needs. What if we need to change the core concept or ideas of the adapted intervention, it may lose its connection with the evidence-based approach (Castro et al., 2004). And hence, modification of treatment may decrease the effectiveness (Elliott & Mihalic, 2004). 

2. Bottom-up approach 

In response to the critics of a top-down approach, the bottom-up approach was utilised in therapies. Where the intervention was developed for the specific culture rather than modifying the approach. Studies show that culturally adapted interventions were superior to the culturally unadapted intervention (as cited in Nagayama Hall et al., 2016). And at the same time, we do not have proof that culturally unadapted treatment is ineffective. 

Example: Research done by Spieker et al revealed that a selective obesity prevention program produced significant weight loss effects for Latin Americans and was ineffective for African Americans and Latin Americans. 

This is evidence that culture plays a significant role in the benefits of treatment. Recent studies suggest that racial/ ethnic minority clients perceive mental health problems differently than members of the majority group, which may influence their help-seeking behaviour. 

Difference between the Western approach and the Indian approach 

The western approach focuses on symptom reduction, whereas the Indian approach focuses on overall well-being and self-awareness (Ryff et al, 2014) 

Read More: Psychology Behind Racism

Conclusion 

Providing effective therapy to marginalised communities requires more than just clinical knowledge; it demands a deep understanding and integration of cultural factors. Traditional therapeutic models, heavily rooted in Western frameworks, often fail to address the diverse cultural needs of marginalised groups, leading to gaps in care and effectiveness.

Cultural competence equips therapists with the skills and knowledge to respect and integrate cultural differences, while cultural humility fosters a genuine openness to learning from clients’ lived experiences. Both are essential to create safe, respectful and effective therapeutic environments. Furthermore, moving beyond a one-size-fits-all “top-down” Adaptation model towards “bottom-up” Interventions specifically designed for particular cultural contexts can significantly improve outcomes.

Addressing systematic barriers such as structural racism and provider discrimination is also crucial to reducing mental health disparities. Ultimately, therapy that acknowledges and respects cultural identities promotes healing, empowers marginalised individuals, and moves us toward a more equitable mental health care system.