Culture and language are within us, and affect everything we do—how we dress, think, and even how we form attachments. —Lisette Rivas-Hermina, MA, LMFT, in Spotlight on Culture: Linguistic Competency, The National Child Traumatic Stress Network (NCTSN)

Culture influences how all of us perceive and interact with the world—and even the way we understand mental illness. Cultural values often dictate “appropriate” ways to express and cope with distress. For instance, some cultural groups tend to suppress strong emotions, while others value the expression of intense pain and sadness.

When seeking support for mental illness, some cultural groups may value assistance from a primary care provider to address physical manifestations of mental illness, while others may strongly prefer to seek aid from a religious leader, or perhaps even to deal with mental illness privately.

Because the U.S. population consists of countless racial, ethnic, religious, socioeconomic, and other cultural groups—with large variation within each group—it is crucial that mental health care providers understand the importance of culture and how it influences their work with clients. Building the requisite skills to interact effectively with different cultural groups—also known as cultural competence—must be an ongoing and dynamic process, based on respect for others and a willingness to learn.

The following recommendations may help mental health care providers increase their cultural competence in order to better meet the diverse needs of the children, families, and communities they serve. 

Consider Your Own Culture

[C]ulture is always present in the therapy room, regardless of the client’s and therapist’s ethnicity, race, nationality, and other cultural characteristics. —Marta I. Casas, MA, in Spotlight on Culture: Implementing Cultural Competence, NCTSN

Mental health care providers live within a cultural context that is shaped by factors such as their family values, race, and community. Although it is important to understand the culture of those seeking treatment, it is equally important for providers to consider their own culture and how it influences their interactions with others.

A group of professionals may establish and perpetuate a professional culture, sharing a common set of beliefs, values, and language when discussing their work. In the United States, health professionals tend to be deeply rooted in the culture of “Western” medicine, which draws from European roots. (For more on this topic, please refer to Mental Health: Culture, Race, and Ethnicity from the Office of the Surgeon General.)

While “Western medicine” is typically accepted as the norm in the United States, its tenets may conflict with the ways in which those seeking treatment understand their mental and physical health. For example, in Culture, Ethnicity, and Mental Illness author Albert Gaw explains that Mexican American immigrants may attribute symptoms that “Western medicine” classifies as a mental disorder, such as depression, to causes outside the framework of “Western medicine.” For instance, the authors explain that Mexican American immigrants may believe being frightened can cause “susto” (fright sickness), a condition with symptoms that tend to correlate with a host of both physical and mental conditions. If a client believes “susto” to be the source of illness, health care providers working within the framework of “Western medicine” may struggle to communicate with this client due to a disconnect in their understandings of health and illness.

Disconnect between the professional culture of the mental health care provider and the beliefs and values of the client can lead to differing assumptions, for example, regarding the role of the provider, the causes of mental illness, or viable treatment options. In order to engage with clients in a culturally competent way, providers should consider the factors that influence their own culture, both personally and professionally, and how those cultural values and beliefs are in play in all their daily interactions.

Find Common Language

Although providers and clients may speak the same language, a person’s cultural context may influence the meaning that he or she ascribes to certain words, phrases, or concepts associated with mental health. Some providers work to find creative ways to bridge cultural barriers in mental health treatment.

Marta I. Casas, a therapist from the Latin American Health Institute, uses Latin American folk tales to talk about mental health with her clients. One example is that of “La Llorena” (The Crying Woman), a folkloric figure recognized in several Central and South American countries. In the tale, La Llorena’s children drown, and ever after she cries at the sound of water because it always reminds her of her loss. Ms. Casas uses this story in therapy to discuss the notion of triggers serving as reminders of traumatic experiences, and she says it has helped her build positive relationships with her clients.

Include Families in Treatment

Children’s emotional development is strongly influenced by the culture of the adults in their lives, shaping the way they recognize and express emotions. Culture shapes which emotional behaviors are seen as “appropriate” and which behaviors indicate signs of an underlying problem. Mental health care providers must show respect for a family’s culture in order to build strong, trusting relationships with children and their families and to better understand the context in which the child’s world view has formed.

Lisette Rivas-Hermina, MA, LMFT, stresses the importance of incorporating families into children’s treatment. Although this can present challenges, she warns that excluding parents altogether disrupts the family structure and runs the risk of appearing to dismiss cultural values. Communicating regularly with families and inviting them to participate in their child’s therapy in a way that is safe and supportive of the child are good strategies for beginning to integrate families into a child’s care.

Additional Resources for Mental Health Care Providers

The resources below may help to further stimulate your thinking on this topic and provide some useful tools to support your work.

Cultural and Linguistic Competence in Early Childhood Mental Health Consultation (Early Childhood Mental Health Consultation)

Cultural Influences on Emotional Development of Infants and Toddlers (Association for Childhood Education International)

Multicultural Action Center (National Alliance on Mental Illness (NAMI)

An Overview of Multicultural Issues in Children’s Mental Health (NAMI)

Your Turn

Have you observed how your own cultural perspective influences your work with children and families? What are your strengths in terms of cultural competence? In what ways could you improve cultural competence in your work with children and families? Please leave your comments below.*

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