Counseling and Therapy, Multicultural

Language and Culture

Language and culture (in the broadest sense) are often considered the central components of culturally competent mental health services. In fact, the various mental health professional associations in the United States (e.g., psychology, psychiatry, social work, counseling, marriage and family therapy) all emphasize the provision of culturally sensitive services as part of their code of ethics. For many ethnic or minority clients, having no English or limited English-speaking skills, as well as holding treatment expectations based on traditional worldviews rather than Euro-American-centric views typically held by a therapist, can contribute to poor treatment outcomes and underutilization of mental health services.

There seem to be several links between culture and the underutilization of mental health services in the United States. Statistics show that ethnic groups and minorities are underrepresented in therapeutic caseloads, and about half of them drop out of treatment after the first visit, compared to 30 percent of whites. Sociocultural factors, such as a client's lack of awareness of available services, lack of transportation, inconvenient geographic location of mental health centers, and lack of health insurance (or inadequate insurance) contribute to low utilization rates. In short, these are issues that relate to health care disparities and marginalization of minority groups in the United States.

Additionally, low acculturation or adaptation to the host culture or majority group is associated with lower rates of mental health service utilization. Many members of minority and/or ethnic groups turn to helpers who are not mental health therapists or counselors. For example, studies have demonstrated that Mexican Americans often consult with family physicians, ministers/priests, chiropractors, and traditional folk healers, such as herbalists or curanderos, rather than psychotherapists. These types of healers are often sought because they share the worldview of their clients, make diagnoses that seem appropriate to that worldview, and use treatments that coincide with the clients’ belief systems. In this population, as in many other diverse groups, mental health problems are often attributed to physical and/or supernatural/spiritual causes, rather than psychological causes. For many individuals, mental health problems and treatment are often associated with stigma and shame. Furthermore, many of the existing psychotherapeutic approaches are not culturally sensitive in that they do not take into account many of the values often associated with Latino populations, including the importance of family (familismo), hospitality or relationship building (personalismo), respect for generational hierarchies and professionals (respeto), and the maintenance of traditional gender roles.

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