On Being a Culturally Competent and Compassionate Therapist

There's a version of therapy that assumes everyone walks into the room with the same understanding of what it means to ask for help, how to talk about emotions, and be vulnerable. That version of therapy leaves a lot of people out.

As an Asian American therapist who trained and practiced in the U.S. and now lives in the Netherland, understanding and responding to differing cultures has always been a part of my life, both personally and professionally. And of course, it influences my clientele: people of color, second-generation children, expats, and internationals, including those navigating what it means to belong to more than one world at once.

Cultural Competency vs. Cultural Humility: There's a Difference

"Cultural competency" gets used a lot in clinical spaces; it's a good starting point. It refers to a therapist's ability to understand, respect, and work effectively with people from cultural backgrounds different from their own. That includes knowledge of different cultural norms, values, communication styles, and how systemic factors like racism, immigration, and acculturation affect mental health.

But cultural competency alone can suggest that culture is something you eventually master: a checklist you complete and then you're done. And that's where cultural humility comes in.

Cultural humility is an ongoing practice. It's the willingness to sit with what you don't know, to continuously reflect on your own biases and blind spots, and to let the person in front of you be the expert on their own experience. It's asking instead of assuming and being willing to be corrected.

What This May Look Like in Session

When working with clients from differing cultures, especially those where English is not their first language, I think it's important to gauge client's comfort level with vulnerability and get clear on their expectations of therapy. I've noticed some clients expect therapy to take a certain amount of sessions to "feel better". And whether or not this is your stance on the therapeutic journey, there are ways to support your client's own desires with your own methodologies. This may be an opportunity to adopt a more Solution Focused approach and ask more direct questions and learn what the client's own ideas of feeling better mean to them. You can still introduce emotions through safe modalities, like a feelings wheel, somatic experiences, and even play.

During sessions, it might mean checking in with your own bias and teachings, regularly. Therapy is traditionally rooted in Eurocentric and Western ideologies and cultures. But as a culturally aware therapist, it's important to understand that CBT, DBT, EMDR, etc. may not land well with clients of other cultures -- and it shouldn't, at least not immediately. And I don't think this always means we need to convince clients to that these are the only ways healing is achieved. This is a great time to do you own research as a therapist to learn about their culture: how did they grow up, what's their cultural connection in present day, what therapy skills are practical and realistic for their daily life, etc.

Don't assume that a client's reluctance to "open up" is resistance. In many cultural contexts, talking about mental health -- especially to a stranger -- carries stigma, shame, or simply isn't something that was ever modeled. Meeting someone where they are means respecting that the process of building trust might look different, and take longer, than it would for someone who grew up with therapy normalized in their household.

It looks like being curious about language. For multilingual clients, the language they're speaking in session can actually change how they access emotion. Some people find it easier to talk about painful things in their second language -- there's more distance. Others find that their native tongue is the only one that really captures what they're feeling. That's worth exploring. This might be being open to finding translations of materials in the clients native language! I've been deeply touched by how excited my clients have been when I can find and share resources in their first language; it makes a difference.

Working with Expats, Internationals, and Third Culture Individuals

Moving to a new country is disorienting in ways that are hard to explain until you've done it. Even when the move is chosen, even when it's exciting -- there's a grief that comes with it. A loss of the familiar: your people, knowing how things work without having to think about it.

This is something I'm still working through myself. Relocating to the Netherlands brought its own process of cultural adaptation to learn new social norms, navigate systems in another language, and do my own identity work in a new context. It gave me a renewed appreciation for how much energy it takes to simply function in an unfamiliar place, and how invisible that exhaustion can be to the people around you.

For expats and internationals in therapy, this context matters enormously. Many are high-functioning on the outside: managing demanding jobs, raising kids in a foreign country, building a life from scratch, while quietly dealing with loneliness, identity confusion, or a sense of never quite fitting in anywhere.

Third culture individuals (people who grew up between cultures, often as children of immigrants or as expats themselves) carry a particular kind of complexity. The question "where are you from?" can be genuinely hard to answer. Therapy can be a space to explore that, not to resolve it into a neat answer, but to make peace with the in-between.

Why Representation in the Therapy Room Matters

Research consistently shows that clients from marginalized or minority backgrounds have better therapeutic outcomes when they feel understood — and that feeling understood is closely tied to whether their cultural context is acknowledged and held with care.

That doesn't mean a therapist has to share your exact background to work with you well. It means they have to be willing to show up with knowledge, curiosity, and genuine respect for your experience. It means they don't make you do the labor of explaining your culture before you can get to the actual work.

For people of color especially, the therapy room has not always been a safe or affirming space. Being seen — really seen — by a therapist who gets it, or is at least deeply committed to getting it, changes things.

A Note on My Own Practice

The communities I work need a space where they don't have to shrink or explain themselves before the real work begins.

Cultural competency, for me, isn't a credential. It's a commitment — one I return to and refine constantly.

If you're looking for a therapist who will hold your whole self — where you come from, who you're becoming, and everything in between — I'd love to connect.

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Based in the Netherlands and working with individuals navigating culture, identity, and everything that comes with it. If you'd like to learn more or connect, email hello@withlizzie.com for a free consultation