Mental Health Across The World: Exploring Therapy In Different Cultures

Mental health is a global concern.

By understanding the nuances of mental health and therapy in various parts of the world, we may be able to gain a deeper appreciation for unique cultural attitudes and provide more effective care. We can also learn how to better support those experiencing mental health issues.

Culturally competent therapy is a form of mental health treatment that focuses on providing appropriate care for individuals from different cultural backgrounds. According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), its core elements include respecting the values and beliefs of people from different cultures, adapting therapeutic approaches to fit the needs of diverse populations, recognizing any biases or prejudices held by the therapist or client, and understanding how unique cultural dynamics may affect the therapeutic relationship. 

Culturally sensitive therapy

Culture refers to a complex system of beliefs, values, behaviors, and customs that are common among members of a particular society or group. It encompasses many of the elements that define a given society’s way of life—from language and religion to art, music, cuisine, and more. 

Culture is often passed down through generations and may serve as an important source of identity for individuals. It can significantly influence how people think, interact with others, and experience their environment. 

Mental health can be shaped by one’s culture. This influence may be related to culture’s role in defining social norms around communication styles as well as approaches to dealing with difficult emotions. Thus, understanding the cultural context of a client may be essential in a therapist providing more effective therapy services.

Culturally sensitive therapy typically involves care that considers the unique lived experiences as well as the social and personal contexts within a culture. It typically takes into account an individual’s values, even if they don’t align with those of the treatment provider. 

For example, therapists are often trained to be aware of any disparities in availability of healthcare services among different racial or socioeconomic groups. They are also normally familiar with language barriers or cultural taboos that could impede successful communication between client and therapist. This could include avoiding specific topics or using alternate phrasing when discussing sensitive issues, such as skin color, sexual orientation, socioeconomic status, and more. Culturally competent therapy may require an understanding of a wide range of cultural groups and their perspectives on mental illness and recovery. These could include the traditional spiritual practices used by some communities as well as the attitudes certain minority groups may have toward therapy. 

Additionally, culturally competent therapists are often familiar with language barriers or cultural taboos that could impede successful communication between client and therapist. Also, therapists are often trained to be aware of any disparities in healthcare services among different groups.

According to a comprehensive study conducted by the American Psychological Association, the following are some of the core considerations that factor into cultural competence: include:

Cultural differences are subjective, complex, and dynamic

Perhaps one of the key considerations in culturally sensitive therapy is that the interpretation of cultural differences is subjective, both for clients and for treatment providers. Thus, treatment providers may need to go beyond providing a specific strategy based simply on cultural background. They might need to tailor their approach to the meaning that the individual attaches to cultural differences. 

Cultural differences should be addressed gradually and gently

Cross-cultural roles can play a significant role in the therapeutic alliance. Still, this may be a sensitive topic that can affect the quality of treatment. Thus, therapists might help the client by addressing their cultural differences as assets rather than deficits to the therapeutic process. Also, therapists might allow the client to take the lead on this topic while facilitating discussions on the role of the views held by mainstream culture rather than those held by the individual. In addition, providers may encourage clients to consider how these differences may be related to their strengths rather than perceiving them as deficits. 

Societal context matters

Professional psychology programs often train therapists to understand the therapeutic relationship within a wider societal context. Thus, it may be important for providers to be aware of any current events that could affect their client’s’ attitudes toward treatment. Also, while it can be helpful to recognize a client’s cultural background, therapists may help their clients feel valued by recognizing that they are individuals whose ideas may not always align with their familial or cultural background.

Therapists might say something akin to: “​​Please let me know if there are things that I say in our work together that do not fit with your values, beliefs, or life experiences. I would like for you to challenge me on these differences because I think it will be useful in our work together”.

Why culturally competent care is important

Culturally competent care may help therapists and clients to transcend cultural boundaries and enable more individuals to feel comfortable seeking therapy. 

By understanding the unique impact that culture can have on mental health, therapists may be better equipped to develop an individualized approach to treatment. In some cases, this could enable a positive shift in perspective. This approach typically considers a client’s culture, values, beliefs, and customs in order to provide meaningful solutions tailored to their needs. It also highlights the fact that different cultures may have different understandings of mental health.

Some individuals with unique cultural backgrounds may not feel comfortable sharing the intimate details necessary to make positive progress with providers of different cultural backgrounds.  Sometimes, it may help for therapy practices to allow clients to choose a therapist from a similar cultural background. One study explored the reasons why some people feel uncomfortable with mental health providers from other cultures. Researchers found that “racial matching”, which refers to matching clients and providers based on race, may be used as a form of cultural competency in order to encourage positive outcomes. While this approach may be helpful in certain circumstances, it is important to note that it is not required for culturally competent therapy. 

The role of therapy in different cultures

Mental health challenges affect people around the world, but how they are perceived and treated can vary widely across cultures. In some cultures, seeking therapy may be seen as a sign of personal or spiritual weakness, which can lead to a stigma among those who need help. In others, individuals may be more likely to experience negative emotions but less likely to seek treatment. 

Psychotherapy tends to be a common form of treatment for mental health concerns in some Western societies, but the same cannot be said for all cultures. In some cultures, psychotherapy may not be considered an appropriate choice due to tradition or a lack of understanding. This can lead to limited care or even complete avoidance of treatment. 

Cultural differences in India

An example of a culture where therapy may be seen differently than in the United States is south Indian culture. According to research, mental illness is often still stigmatized and seen as something to be ashamed of in some areas of southern India, which may lead many who experience mental health conditions to remain silent and avoid treatment. 

This may be due to a long-standing stigma around mental illness as well as traditional values that place an emphasis spiritual healing over modern psychological and medical treatments. In addition, some Indian cultures may lack awareness of certain mental health challenge and have limited professional resources for support. 

For both the therapist and the client, this can present a unique challenge. Specifically, they must somehow bridge the gap between certain Western and Eastern views on mental health for therapy to be effective.  

Mental health in China

Mental health care in some areas of China tends to be shaped by many cultural values and beliefs that have been around for centuries. Traditional Chinese practices are sometimes rooted in the perspective that mental health conditions as the result of imbalances in the body. Thus, practitioners often emphasize preventative methods, such as diet, exercise, and other healthy lifestyle habits to address and avoid mental illnesses. In this part of the world, mental health treatment is also strongly impacted by Confucianism, which promotes harmony between individuals and society.

These cultural differences may have contributed to a stigma surrounding mental illness in China, which can make it difficult for those affected to seek out medical help. Although the Chinese government has enacted laws to safeguard the rights of citizens with mental illnesses, there are still gaps between policy goals and implementation. Availability of quality healthcare services remains inadequate in some places, with one study finding that 91.8% of people with a mental health disorder never sought help.

Still, traditional remedies remain a popular form of therapy in China today. Traditional Chinese Medicine (TCM) is recognized as an official system of medicine by the Chinese government. It includes techniques such as:

• Acupuncture 
• Herbal therapy
• Massage therapy
• Qigong (a type of breathing exercise)

TCM practitioners often combine elements from both Eastern philosophy (such as Taoism) and Western medicine when treating patients with mental illnesses. 

Aside from cultures around the world, there are also various sub-cultures in the U.S. that may require a culturally competent therapist:

African Americans

According to a survey conducted by the U.S. Department of Health and Human Services Office of Minority Health, African Black Americans are more likely to report negative emotional symptoms than White individuals but are less likely to seek treatment than white individuals with depression. They are also less likely to seek professional care due to the stigma associated with those in their culture who seek therapy. 

Thus, therapists of all backgrounds might serve this community better by taking time to learn about cultural differences and ways to bridge the gap in mental health care. It may be important for Black Americans to seek care from therapists who are able to meet these unique needs, including destigmatizing therapy. In this case, racial matching may enable therapists to better relate to the nuances of what it means to be a black individual in the U.S. Also, therapy practices may be able to help individuals more by allowing them to choose a therapist from a similar background to theirs.  

LGBTQIA+ community

LGBTQIA+ Americans represent a diverse array of identities. Thus, these individuals may require a personally tailored approach based on their unique needs. 

In order for therapists to provide culturally sensitive care for the LGBTQIA+ community, it is important for them to provide targeted care that takes into account unique issues that include:

• Embracing their unique identity
• Rejection by family and society
• Traumatic experiences related to bullying, abuse, and homophobia
• Homophobia at work

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As awareness around mental health increases, so does the understanding of how to provide culturally responsive care within different contexts. Through an increased understanding and sensitivity towards different cultural perspectives, mental health professionals can ensure that those experiencing mental illnesses receive proper treatment regardless of cultural differences.

Online therapy and culturally relevant care

If you’re experiencing a mental health challenge and wondering if there are therapists who understand your concerns from your cultural perspective, you may benefit from online therapy. Given the potential for stigma and language barriers associated with in-person appointments, online therapy has become increasingly popular as a means of providing mental health services to individuals from different cultures. Online therapy may also provide a safe space where individuals can receive effective treatment from the comfort of their own homes. This may be especially helpful for individuals who experience symptoms of anxiety and depression that can make leaving the house difficult. 

Many online platforms cater to people from different cultures by offering culturally aware therapists or those who speak multiple languages. This can ensure that individuals seeking treatment feel comfortable and have someone who understands their culture and specific needs. 

Numerous studies show that online therapy is effective for a variety of mental health conditions, including depression and anxiety. Also, online therapy services often serve individuals from culturally diverse backgrounds. One study of culturally diverse populations found that 61% of participants were satisfied with electronic mental health services. They specifically cited the convenience and cost-effectiveness of such services. 

In a study from the Journal of Psychiatric Practice, researchers looked at the effectiveness of online cognitive-behavioral therapy (CBT) for individuals from different cultures. Results of the study suggest that online CBT is an effective means of therapy and is able to overcome cultural and language barriers for individuals experiencing depression.