Why Cultural Attunement Matters in Therapy

Over the years, I have noticed that many people come to therapy with a question they do not always say out loud:

“Will this therapist really understand me?”

They are not only asking whether the therapist understands anxiety, depression, grief, or trauma. They are also wondering whether the therapist will understand the life around those struggles.

Will they understand my family?

Will they respect my faith?

Will they understand why setting a boundary feels so difficult?

Will I have to explain every cultural expectation before we can even begin?

For many people, these questions are deeply connected to whether therapy feels safe.

A person does not walk into therapy carrying only a diagnosis or a list of symptoms. They also bring their language, family history, faith, culture, traditions, relationships, and experiences of belonging or exclusion.

Good therapy needs to make room for all of these parts.

Culture Shapes How We Understand Mental Health

Culture is more than food, clothing, language, or holidays.

It shapes how we understand family, success, independence, marriage, grief, responsibility, and emotional strength. It also affects how comfortable we feel asking for help.

Some people grow up learning that private struggles should stay within the family.

Others are taught that strong people do not talk about their emotions.

Some feel a deep responsibility to care for parents, siblings, or extended family.

Others feel pressure to choose a certain career, marry within their community, or follow traditional gender roles.

These experiences affect mental health.

For example, anxiety may be connected to the fear of disappointing family. Depression may be linked to loneliness after immigration. Relationship stress may involve cultural expectations, religion, finances, caregiving, or the challenge of living between two different worlds.

When therapy only focuses on symptoms, it can miss the larger story.

A culturally attuned therapist asks more than, “What is wrong?”

They also ask, “What has shaped your experience?”

What Is Cultural Competence?

For many years, therapists were encouraged to become culturally competent.

Cultural competence means learning how culture can affect a person’s values, relationships, communication, and mental health.

This was an important step. It encouraged therapists to look beyond their own way of seeing the world.

However, the word “competence” can sound as if a therapist can fully master another person’s culture.

That is not possible.

A therapist cannot take one course about South Asian families, Muslim communities, Indigenous traditions, or immigration and suddenly understand every person from those groups.

People from the same culture can have completely different beliefs, family relationships, and life experiences.

This is why many therapists now use words such as cultural humility and cultural attunement.

Cultural humility means knowing that there will always be more to learn. It means being honest about what you do not know, looking at your own bias, and being willing to listen.

Cultural attunement means paying close attention to how culture and identity affect the person sitting in front of you.

A culturally attuned therapist does not assume they already understand.

They ask.

They listen.

They stay open.

The Importance of Intersectionality

Another important word in mental health is intersectionality.

Intersectionality means that different parts of a person’s identity come together and shape their experience.

For example, a Muslim woman may experience life through her faith, gender, race, family role, work, and immigration history.

A neurodivergent immigrant may face stress related to language, family expectations, racism, work, and differences in communication or sensory needs.

These parts of identity do not exist in separate boxes.

A person is not anxious in one part of life, Muslim in another, and an immigrant in another. They experience all of these things at the same time.

A therapist who understands intersectionality tries to see the whole person instead of reducing them to one issue.

The Stories We Carry

When people think about culture, they often think about ethnicity or race. In reality, culture is much more expansive.

Culture shapes the values we inherit, the way we communicate, our understanding of family, our beliefs about mental health, the roles we are expected to fulfill, how we experience joy and grief, and even what healing looks like.

It also intersects with many other aspects of identity, including religion, disability, neurodivergence, gender, sexual orientation, socioeconomic status, and immigration experiences.

No two people experience culture in exactly the same way.

Challenging Assumptions

As a visibly Muslim therapist from a South Asian background, I have seen how quickly people make assumptions about who will understand them.

Some South Asian and Middle Eastern clients seek me out because they hope they will not need to explain every family expectation, cultural phrase, or religious practice.

They may feel relieved that I understand why saying “no” to a parent is not always simple.

They may switch between English and another language because a certain word explains the feeling better.

Some clients have told me that it feels freeing not to explain every part of themselves.

One person shared how comforting it felt to use a word from their first language and know that I understood its meaning. That word held more than a definition. It carried memory, emotion, family, and a sense of home.

One client shared that it felt freeing to switch between English and their first language without stopping to explain the meaning behind certain words or expressions.

For instance, there are close to 100 words to describe the different levels and stages of ‘love’ in Arabic. There are emotions that simply do not translate, such as ‘Hasrat’ in Urdu/Hindi that describes a longing sorrow for unfulfilled wishes.

There are family roles, traditions, and cultural expectations that can take paragraphs to explain in English but are understood immediately within another language.

Those moments remind me that language carries far more than vocabulary. It carries identity, history, humour, and belonging.

At the same time, I have also had people tell me that they almost did not book with me.

Because I am visibly Muslim, they worried that I might judge them. They assumed I might hold certain views about relationships, gender, parenting, sexuality, or faith.

Some of these clients came from backgrounds very different from mine.

Later, they shared that they were surprised by how comfortable they felt. They found that they could speak openly and explore their identity without fear of judgment.

These experiences have taught me that shared culture can help, but it does not guarantee a strong relationship.

Their experience reinforced something I have come to believe deeply.

Shared culture can be meaningful, but it is not what creates healing.

Feeling emotionally safe does.

Difference can create uncertainty, but it does not prevent trust.

The most important part is whether the client feels respected, accepted, and emotionally safe.

What Psychology Training May Miss

Psychology and counselling programs teach important skills. Therapists learn about ethics, assessment, diagnosis, trauma, communication, and different treatment methods.

However, many programs provide less training in cultural attunement, neurodiversity, intersectionality, racism, colonization, and Indigenous ways of understanding health.

Neurodiversity is the idea that human brains work in different ways. It includes experiences such as autism and attention-deficit/hyperactivity disorder.

A neurodiversity-aware therapist does not assume that every difference needs to be fixed.

They try to understand how the person thinks, communicates, learns, and experiences the world. They also look at whether the person’s environment is supporting them or creating more stress.

This matters because clients do not experience mental health concerns in isolation. A person’s anxiety, depression, trauma, or relationship difficulties may also be shaped by racism, ableism, cultural expectations, immigration experiences, financial pressure, gender roles, or the challenge of living between different identities.

Therapists often learn a great deal after graduation through further training, supervision, community work, and listening to their clients. 

Textbooks teach theories. 

Clients teach context.

No workshop can teach someone what it feels like to leave your home country, navigate racism, raise children between two cultures, question your faith, or feel caught between your family's expectations and your own values.

This is why many clinicians have begun embracing the idea of cultural humility and cultural attunement instead.

Cultural humility recognizes that learning never ends.

Healing Is Bigger Than Western Psychology

Western psychology has given us many useful ideas and treatments.

At the same time, it is not the only way people understand healing.

Long before psychology became a profession, communities around the world had their own ways of supporting mental, emotional, physical, and spiritual health.

Many Indigenous traditions understand health as a balance between the mind, body, emotions, spirit, family, community, and land.

Healing may involve ceremony, storytelling, Elders, ancestors, nature, and community relationships.

Many immigrant families also find strength through prayer, cultural gatherings, music, shared meals, movement, storytelling, and family support.

These practices should not always be seen as separate from mental health care.

For many people, they are part of healing.

Someone can benefit from therapy and prayer.

A person can process trauma while reconnecting with community.

Someone can use a clinical treatment while also finding comfort in ceremony, music, or time in nature.

A client can benefit from cognitive behavioural therapy while finding comfort in prayer.

Someone can process trauma while reconnecting with their community.

Evidence and tradition do not have to compete. Often, they complement one another and offer more a path to more holistic recovery.

Culture Can Bring Both Strength and Pressure

Therapy should make room for honest conversations about the difficult parts of culture and family life.

Some people face pressure to marry, have children, choose a certain career, care for relatives, or follow strict gender roles.

They may feel guilty when they set boundaries.

They may worry that choosing themselves means rejecting their family.

These pressures are real and should not be ignored.

At the same time, therapy should not treat every close family or community-based culture as unhealthy.

Collective cultures often offer strong family ties, shared caregiving, financial support, practical help, community connection, and wisdom from older generations.

Living with extended family can create stress. It can also provide love, safety, and support.

Both things can be true.

A good therapist does not tell a client to reject their culture.

They help the client explore questions such as:

What parts of my culture give me strength?

What expectations are causing pain?

What do I want to keep?

What do I want to change?

How can I care for my family without losing myself?

There is rarely one simple answer.

Should You Choose a Therapist From Your Own Culture?

Some people feel safest with a therapist who shares their culture, language, race, or faith.

They may feel understood more quickly.

They may not need to explain certain family roles, traditions, or community expectations.

This can be a great source of comfort.

Other people prefer a therapist from outside their culture.

They may worry about being judged by someone from their own community.

They may want more privacy or distance while they explore difficult topics.

They may also feel safer speaking to someone who does not share the same cultural expectations.

Neither choice is right or wrong.

A therapist does not need to share your identity to understand you.

However, they do need to respect your identity and remain open to learning.

How to Choose a Culturally Attuned Therapist

The first meeting with a therapist is not only for them to learn about you.

It is also your chance to notice how you feel with them.

You do not need to decide right away whether they are the perfect fit.

Start by asking whether you feel safe enough to be honest.

You can ask questions such as:

“How do you include culture and identity in your work?”

“Are you comfortable talking about faith, racism, immigration, family expectations, or cultural conflict?”

“How do you work with clients whose values are different from your own?”

“What does culturally responsive therapy mean to you?”

Pay attention to how they answer.

Do they sound curious?

Do they admit what they do not know?

Do they ask respectful questions?

Do they seem open to feedback?

Be careful with a therapist who claims to understand every culture. No one does.

You can also notice how your body feels during the conversation.

Are you tense?

Are you carefully choosing every word?

Do you feel dismissed or rushed?

Or do you feel a little more relaxed?

Do you feel invited to speak?

Do you feel heard?

Being nervous during a first session is normal. Feeling judged, ignored, or reduced to a stereotype is different.

Signs of a Culturally Attuned Therapist

A culturally attuned therapist:

• Asks what your culture means to you.
• Does not make quick assumptions.
• Respects your faith, language, family, and traditions.
• Understands that family can bring both support and stress.
• Does not treat independence as the only healthy way to live.
• Is willing to admit mistakes and repair misunderstandings.
• Adapts therapy to your needs.
• Understands that racism, poverty, disability, and discrimination can affect mental health.
• Continues learning throughout their career.

You do not need a therapist who knows everything.

You need someone who is willing to listen, reflect, and learn.

A Reflection for Your Own Healing

Before choosing a therapist, think about the places where you feel most like yourself.

Maybe it is with a close friend.

Maybe it is with family.

Maybe it is in nature, at a place of worship, or while speaking your first language.

Ask yourself what makes that space feel safe.

Perhaps you are not judged.

Perhaps you do not need to explain yourself.

Perhaps you are allowed to have mixed feelings.

Perhaps you can change your mind.

These answers can help you understand what you need in therapy.

You may also want to ask yourself:

What parts of my identity do I hide?

What parts of my culture bring me comfort?

What expectations leave me feeling heavy?

What would help me speak more freely?

What do I need a therapist to understand about my life?

Healing should not require you to leave your culture, language, faith, family, or identity outside the room.

You deserve a space where your full story is welcome.

Sometimes healing begins with a simple feeling:

I do not have to explain every part of myself here.

I am allowed to be fully seen.

Because when we feel deeply seen, without needing to translate our identity or explain our existence, something remarkable happens. We stop surviving through adaptation. And we begin healing through authenticity. 

Dr. Shereen Khan is an internationally trained and experienced Licensed Psychologist in BC. She has refined her practice with over twenty years of expertise in relationships, organizational development, family dynamics, mental health, and trauma. Shereen has worked within school, university, healthcare, non-profit and EAP organizations providing counselling, clinical supervision, facilitating workshops and crisis response debriefings. She is informed by intersectionality and uses anti-oppressive culturally competent, trauma-informed lens in her work as a therapist, consultant and educator in her private practice Noorify. In addition to her expertise in a university counselling setting, she also teaches critical thinking, counselling and psychology at local universities and regularly attends conferences and workshops to stay abreast in her professional development. Shereen is also a consultant and Approved Clinical Supervisor with BCACC.