Conscious Mental Health

Embracing Cultural Humility and Intersectionality in Counselling and Psychotherapy

As a Counselling Therapist, I have embarked on a deeply personal journey, navigating the rich tapestry of cultural diversity. My track record of working with clients from diverse cultural and immigrant backgrounds has not only provided me with firsthand insights into the profound impact of integrating cultural humility and intersectionality into psychotherapy sessions but also led to my personal growth and learning. Over the years, I have realized that our cultural backgrounds permeate every facet of our existence, shaping our beliefs, values, communication styles, and even our attitudes toward mental health and wellness. This realization underscores the imperative for us therapists not just to acknowledge but to wholeheartedly embrace cultural humility and intersectionality in our professional practice.

The demand for multicultural understanding within mental health professions has grown significantly in recent decades (Sehgal et al., 2011), particularly as we engage more with diverse immigrant communities, people of colour, and Indigenous clients. However, understanding these diverse cultural landscapes in counselling is not just about learning customs and practices; it is about immersing ourselves in the richness of these cultural narratives and respecting the unique perspectives they bring to our therapeutic dialogues. As mental health professionals, we play a pivotal role in this process.

As counsellors committed to supporting clients from diverse backgrounds, we often face the challenge of truly understanding their unique experiences. This can sometimes lead us to unintentionally impose our own values onto clients, which can leave them feeling misunderstood or misrepresented. It is a delicate balance that requires constant self-reflection and a commitment to cultural humility and intersectionality.

In the forthcoming paragraphs, I will delve into how cultural humility and intersectionality shape therapy sessions, prompting you to contemplate their significance for your own reflection as well.

The Evolution from Cultural Competence to Cultural Humility

The landscape of diversity and inclusivity in healthcare has seen a remarkable evolution, marked by a shift from cultural competence to the more profound ethos of cultural humility. Esteemed organizations acknowledge this transition, which reflects a deeper understanding of the complexities of cultural interactions and their impact on mental health services (Foronda et al., 2016).

Rooted in the social work domain, cultural competence emerged as a pivotal concept, emphasizing the need for professionals to navigate multicultural environments. It encapsulated attitudes, behaviours, and policies crucial for respectful and impactful cross-cultural engagements (Danso, 2016). However, as our understanding grew, so did the recognition of its limitations.

Critics pointed out that cultural competence, while essential, often fell short in addressing systemic disparities and social justice issues (Abe, 2020). This critique led to the emergence of cultural humility—a paradigm that goes beyond mastering competencies to embracing lifelong self-evaluation, dismantling power imbalances, and forging genuine partnerships with diverse communities (Abe, 2020).

From a counsellor’s lens, the journey from cultural competence to cultural humility represents a profound shift in values and practices. It demands introspection, commitment, and a transformative outlook (Fowers & Davidov, 2006). Psychotherapists are now encouraged not just to understand cultural nuances but also to question power dynamics, challenge biases, and foster inclusivity through intentional collaboration. In other words, this approach acknowledges the intersecting layers of identity, power, and privilege, shaping a more nuanced and empathetic therapeutic framework.

Why Intersectionality Matters in Counselling and Psychotherapy

Intersectionality is a foundational concept that acknowledges the interplay of multiple social identities within individuals, shaping their unique experiences and perspectives. For instance, consider a Black woman who confronts distinct challenges stemming from both racial discrimination and gender biases (McCann & Kim, 2017). Overlooking these intersecting dimensions in therapy can lead to incomplete understandings and ineffective interventions.

Recognizing intersectionality is paramount to delivering culturally sensitive and impactful therapy. It enables psychotherapists to grasp the intricate layers of clients’ experiences and the diverse systems of oppression they navigate daily. By embracing intersectionality, therapists can design tailored interventions that address clients’ holistic needs, taking into account their intersecting identities.

The synergy between cultural humility and intersectionality lies in acknowledging the multifaceted nature of human identities. It promotes therapists’ self-awareness, continuous self-reflection, and a genuine openness to learning from diverse perspectives. By integrating intersectionality into counselling and psychotherapy practices, counsellors can cultivate a more inclusive, empathetic, and effective therapeutic environment that honours the complexity of clients’ lived realities.

Effects of Cultural Humility and Intersectionality on Clients

Embracing cultural humility and intersectionality in counselling and psychotherapy can profoundly affect clients. Let us explore some of these effects based on my own experiences and insights from scholars I have engaged with over the years:

Increased Trust and Rapport: When therapists demonstrate cultural humility by acknowledging their own biases and actively seeking to understand clients’ unique experiences shaped by intersecting identities, it fosters a sense of trust and rapport. Clients feel heard, valued, and understood, leading to a more effective therapeutic alliance.

Enhanced Cultural Sensitivity: Integrating intersectionality allows therapists to address the diverse and nuanced aspects of clients’ identities and experiences. This heightened cultural sensitivity ensures that therapy is tailored to meet each client’s specific needs, values, and cultural contexts, promoting inclusivity and relevance in interventions.

Deeper Self-Exploration: Clients are encouraged to engage in deeper self-exploration and reflection about the intersection of their social identities. This exploration can lead to greater self-awareness, insight, and understanding of how societal structures and biases impact their thoughts, emotions, and behaviours.

Empowerment and Validation: Cultural humility and intersectionality empower clients by validating their lived experiences and affirming the significance of their intersecting identities. Clients feel empowered to express their perspectives, challenges, and strengths without fear of judgment or marginalization, leading to a more empowering therapeutic process.

Improved Treatment Outcomes: Clients who experience cultural humility and intersectional therapy are more likely to engage actively in the therapeutic process, leading to improved treatment outcomes. The tailored interventions and culturally sensitive approach contribute to better symptom management, increased coping skills, and enhanced overall well-being.

Social Justice Advocacy: Cultural humility and intersectionality encourage therapists and clients to explore systemic oppression, discrimination, and social justice issues. This advocacy-oriented approach can empower clients to become agents of change, advocate for their rights, and engage in community activism for broader societal impact.

For a practical example, consider Claudia (hypothetical case), a Latina woman who sought therapy after experiencing workplace discrimination. Claudia faced unique challenges at the intersection of her gender and ethnic identity. As her counsellor, I would utilize cultural humility and an intersectional approach, actively listening to her experiences and acknowledging the dual impact of sexism and racism on her mental health. Integrating culturally sensitive practices, such as respecting Claudia’s cultural norms and values, learning from her background, and tailoring interventions like assertiveness training and empowerment exercises, might help Claudia feel validated and supported. Providing reflections on how to access resources for legal advice and support networks can further empower her. This comprehensive, empathetic approach may foster a solid therapeutic alliance, leading to more effective therapeutic outcomes.

Overall, the cultural humility and intersectionality approach in counselling and psychotherapy not only benefits clients but also contributes to creating more inclusive, equitable, and socially just therapeutic environments. Regardless of where you currently stand in your therapy journey, whether you have been with a therapist for years or are just starting out, I have some reflections and tips to share with you.

Reflections and Questions for Clients

I would like to propose reflection questions for you to consider, encouraging you to reflect on your own identities, therapeutic expectations, communication preferences, and the importance of cultural sensitivity in therapy.

Have you ever felt uncomfortable or misunderstood in therapy sessions?

Have you pinpointed what made you uncomfortable in these therapy sessions?

Have you discussed this with your therapist, and if so, how did that conversation go?

It is crucial to recognize that such experiences reflect on the therapist’s approach, not on you is crucial. No therapist is flawless, just as no one is perfect. It is essential to acknowledge that psychotherapists, like all individuals, can make mistakes and misinterpret things. However, what truly matters is whether they are open to learning from these mistakes and understanding your unique needs.

Here are some exercises for you to contemplate. Take your time, breathe in and out with calm and control, be kind to yourself throughout this process, and reach out for help when needed. Navigating these waters can be quite challenging.

Self-Exploration: As you reflect on your own life experiences, consider how your various social identities intersect and influence your perceptions, challenges, and strengths. How do factors such as race, gender, ethnicity, sexual orientation, socioeconomic status, and ability intersect in shaping your worldview and interactions?

Therapeutic Expectations: What are your expectations from therapy? How important is it for you that your therapist acknowledges and understands the complexities of your intersecting identities? What aspects of your identity and experiences do you hope therapy addresses or explores?

Communication Preferences: Reflect on your preferred communication style and how comfortable you are discussing topics related to your identity and lived experiences. Are there specific cultural or social factors that you believe are important for your therapist to be aware of to facilitate open and meaningful dialogue?

Cultural Sensitivity: Consider the significance of cultural humility and intersectionality in therapy. How important is it for you that your therapist demonstrates cultural humility, actively seeks to understand your unique experiences, and incorporates intersectional perspectives into your treatment plan?

Therapy is a collaborative process, and a therapist who actively listens, engages in dialogue, and seeks to understand your perspective can create a more meaningful therapeutic experience. It is about finding a therapist who is not only skilled but also compassionate, empathetic, and willing to grow alongside you.

Remember, therapy is not about finding someone who has all the answers or never makes mistakes. It is about finding someone who respects your journey, values your input, and is committed to supporting your growth and well-being.

I wish you a transformative journey abundant with self-compassion, self-love, patience, and the openness to embrace growth and new experiences.

Reference List:

Abe, J. (2020). Beyond cultural competence, toward social transformation: Liberation psychologies and the practice of cultural humility. Journal of Social Work Education, 56(4), 696–707. https://doi.org/10.1080/10437797.2019.1661911

Danso, R. (2016). Cultural competence and cultural humility: A critical reflection on key cultural diversity concepts. Journal of Social Work, 18(4), 410–430. https://doi.org/10.1177/1468017316654341

Foronda, C., Baptiste, D. L., Reinholdt, M. M., & Ousman, K. (2016). Cultural humility: A concept analysis. Journal of Transcultural Nursing, 27(3), 210-217.

McCann, C., & Kim, S.-K. (2017). Feminist theory reader: Local and Global perspectives (4th ed.). Routledge.

Sehgal, R., Saules, K., Young, A., Grey, M. J., Gillem, A. R., Nabors, N. A., Byrd, M. R., & Jefferson, S. (2011). Practicing what we know: Multicultural counseling competence among clinical psychology trainees and experienced multicultural psychologists. Cultural Diversity and Ethnic Minority Psychology, 17(1), 1–10. https://doi.org/10.1037/a0021667

What is Language Coaching? How it Works, and Who it Can Benefit.

I often receive inquiries about what language coaching is, and what I do. While I am happy to answer inquiries at any time, a blog post on the topic was long overdue! Being a developing field (that is rapidly gaining traction), it’s important to understand how it works and who it can help.

So, what exactly does language coaching entail, and how can it help you reach your specific goals with a non-native language?

The reality is that language coaching is going to be approached differently by every professional. Just like language teachers, each language coach has their own unique style.

And just like students, each of my clients has their own unique needs.

Generally, language coaching is an approach to supporting language development and acquisition that takes the needs of the learner into account, and allows flexibility on the part of the coach to adapt to those needs throughout the partnership – as opposed to being caged in by a fixed curriculum or lesson plan.

Language coaching also typically encourages a high level of independence on the part of the learner. While teaching tends to take place inside the classroom, language coaching requires a desire for continued learning on the part of the client. Long and short-term goals are discussed, which help to shape the partnership going forward.

I work as a language coach specifically with professionals in the mental health field. As I have a combined background is in psychology and mental health, as well as in education and language teaching, I work with this specific population because 1) I am passionate about the field, and 2) I am well-geared to meet their needs. As someone who has worked in both the role of a “teacher” as well as in “coaching” in more corporate environments, my own personal language coaching style has been influenced by these experiences.

As a language coach, I tend to work with individuals who have an intermediate to advanced level of English. I feel language coaching tends to work well with advanced speakers, as the roadblocks they encounter are usually beyond what I could assist them with in the role of a teacher. The struggles they experience are usually related to confidence with working in an English mental health setting. They tend to work as either as psychotherapists or counselors, or work in research or higher education. Having a strong grasp of the English language and feeling equally competent in English as they do in their native language becomes important for career advancement and day-to-day career satisfaction.

When I work with my clients, I put them in the driver’s seat of their own learning. I ask them to play a key role in observing their own development, and to bring me specific questions pertaining to language struggles they encounter throughout the week. I show up to each of our sessions with a coherent theme that guides our discussions and our work for the week, based on their particular problem areas and their level. I find this really helpful in giving the client direction on what to observe in their own language experiences from week to week. While language coaching really focuses on the needs of each client, coming in with a theme or a lesson allows us to set attainable goals for improvement, and gives us direction. In this way, my style really blends teaching and coaching methodologies.

Here are a few questions I’d recommend considering if you are interested in language coaching:

Assess your level and your needs. If you are looking for the basic building blocks and are new to the language, a traditional language class may be better suited to providing you with lessons on grammar and basic conversation.
Determine your learning style. If you would benefit from a more directive approach, language coaching might not be necessary. However, if you are interested in developing a partnership with someone who can more freely help you assess your needs from week to week, and help you move forward based on those, language coaching might be right up your alley. Clients I work with tend to be very motivated and independent-minded as well. We work to refine their motivation and focus their language learning in the right places.
Ask yourself if you need an expert in your field. A lot (but not all) of language coaches work with specific populations, which allow them to be experts in helping your profession. This is one fantastic advantage of language coaching.

The beauty of language coaching lies in the flexibility of it. Working independently and 1-1 with clients within my area of expertise allows us both to feel confident that they are reaching their potential, and making progress throughout our time together. As language coaching is still a developing field, each professional will have a particular approach. If you’re considering language coaching, the first step should always be a conversation with the coach. See if their working style, approach, and personality resonate with you – these elements will all massively contribute to your experience and your success.

For any questions or to set up a chat, reach out via the “Get in Touch” page of the site. I’ll be more than happy to speak with you!

The Relevance of Language in Psychotherapy

Research, conversations with other multilinguals, and my own personal experience have all demonstrated how strongly language can impact our sense of self. Depending on the language we are speaking, and the culture we are surrounded by, we may see our own selves differently, and interact differently with others due to linguistic and cultural influence.

These findings are especially important to consider in a therapy setting. When the way an individual sees and expresses themself is so intricately tied to language, how does this impact the therapeutic relationship? There are two parties involved in the client-therapist relationship, and it’s important to consider the impact of language on both.

When the way an individual sees and expresses themself is so intricately tied to language, how does this impact the therapeutic relationship?

As we know, it is significantly easier to express ourselves in our native language, for the most part. With a wider vocabulary and lexical range, and increased fluency, we can more easily achieve accuracy when communicating our sentiments, thoughts, and struggles. However, in a multicultural, globalized world, receiving or providing therapy in our native language is not always a possibility.

How Language Impacts The Client During Therapy

As a bilingual Canadian in a French-speaking province, I grew up well acclimated to receiving health services in both French and English. And, as a die-hard therapy advocate, I have received counselling in both languages as well. What I quickly noticed, however, was how differently I felt during a French session versus an English session.

When speaking with a French counsellor, I found myself more closed off – like I was holding a part of myself back. Despite wanting to be open and vulnerable, I felt an invisible barrier. Even with my best efforts to break it down, I found myself struggling to portray my truest self.

My experience (and the experience of many others) serves as insight into how language, culture, and one’s personal experience with each can play a role in the way one portrays themself. Generally speaking, in French culture, interactions often seem to start out slightly more surface-level; there is a certain formality to interactions with new people, particularly in a professional setting. While I say this with love for my French-Quebec culture and roots, there is a diminished level of warmth when compared to my English-speaking side.

But I realized there was also another layer: as Quebec is a province torn by language laws, a misdirected desire to preserve French, and (dare I say) discrimination towards languages other than French, I had always felt a stigma in being bilingual. Bubbling just below the surface was a lack of security in who I was – I had tried to hide my bilingualism for most of my life. And so, I carefully portrayed myself the way I believed society wanted to see me, curating my every interaction. Despite being proud of my bilingualism now, I could so deeply feel the influence of French culture (and my own experience with it) in my therapy sessions.

I could so deeply feel the influence of French culture (and my own experience with it) in my therapy sessions.

Therapists need to understand that how an individual is presenting themselves can be hugely impacted by the language they are speaking. In my own case, for example, it took me much longer to open up to my therapist. The way I presented my feelings and emotions was also a lot more tactical; like I was there to get a job done. When I spoke about my feelings regarding things that had occurred in my past, I felt slightly removed from them – like I was describing something that had happened to someone else. I also felt like I prepared for my appointments much more, and walked in to strategically tackle a list of things I had planned to address. While preparing for a therapy session is definitely a positive in many instances, in this case it felt like it took away from my ability to walk in authentically.

For an individual receiving therapy in a non-native language, the effects of language can be compounded. Aside from cultural influence, they may struggle with the feeling of being misunderstood. Struggling to explain one’s emotions, and feeling like things are being lost in translation can be frustrating. I think the therapist will play a key role here – in first being conscious that the individual may be struggling with the language, and responding in a way that facilitates a less stressful interaction for the client.

I don’t think there is a right or wrong language to receive therapy in. However, the impact of language, and the way someone learns to communicate in it – either due to cultural influence or personal experience – can greatly impact the efficacy of a therapy session. By understanding the complexity of language on a person’s presentation of themself, a therapist can work to break down that barrier with their clients.

Conducting Therapy in a Non-Native Language

Research demonstrates that therapy should be conducted in the client’s language of proficiency. This puts the onus on the therapist to adapt to the language of their client. However, it’s also so important for a therapist to feel at ease with the language they are conducting therapy in.

Is this to say that psychotherapy cannot be conducted in a therapist’s non-native language? Absolutely not. Psychotherapy is an intricate combination of art and science; to say that psychotherapy purely depends on immaculate, effective linguistic expression would be incorrect, and reduces it to one mere component. While some approaches to psychotherapy may be more scientifically-oriented than others, there is always a method to the madness, so to speak; therapy methods and techniques are cross-linguistic and cross-cultural. A great therapist can apply their knowledge and expertise, regardless of whether or not they are working in their native language.

I do think language training and cultural training become extremely important for a multilingual clinician, or a therapist working in a multicultural environment. Each language carries its own nuances, expressions, and variations in how things are expressed. The way an emotion or feeling may be expressed in one language or culture can be entirely different to another. Many therapists working in their non-native language have shared with me the anxiety they have felt in not understanding certain nuances, or being unsure of how to respond in a way that feels culturally appropriate to the client. Training in these areas can level up a therapist’s ability to understand their clients, and express themselves more effectively in order to better assist.

[…] language training and cultural training become extremely important for a multilingual clinician, or a therapist working in a multicultural environment. Each language carries its own nuances, expressions, and variations in how things are expressed.

And while it is, of course, important to ensure they feel confident communicating in the language being used during a therapy session, there even may be benefits to providing therapy in a non-native language. The multilingual clinician has the ability to work from a differing perspective, and adopt new outlooks – which is greatly beneficial for understanding and connecting with their client. And at times, when the client and therapist may both be working with their non-native language, the power dynamic that sometimes exists in a therapeutic setting is eliminated. Both the client and therapist are on common ground and must work together to understand each other. The attention and care that goes into this type of interaction has the ability to positively impact the relationship.

It’s critical that psychotherapists are culturally informed and sensitive to the language barriers that may arise. They also should be trained in the cultural nuances of a language. Without a deep understanding of the language their client is speaking, there is a risk of misconstruing the client’s communication. However, by learning to become an effective communicator in a second or third language, and becoming culturally informed on the populations they are working with, there is an opportunity for an even stronger, more beneficial therapeutic relationship.

The Complex Multilingual: How Language Impacts our Sense of Self

A vast body of research has shown that bilingualism or multilingualism profoundly impacts multiple areas of development and functioning. It affects areas such as executive functioning and cognitive functioning, as well as a person’s interactions, life opportunities, and ability to connect on a more global scale.

Even more striking to me, though, is the ability for multilingualism to so strongly impact an individual’s self-concept. Having grown up bilingual, the influence of language and culture on my identity has proven to be positive and complex all at once. The lack of general understanding around this issue, and my own personal experience with it, tells me it warrants a discussion.

Many bilinguals can readily identify with the differing senses of self that emerge from growing up surrounded by two languages – languages that so richly infuse a person with their associated cultures, communication styles, and social customs. While the overall outcome of this upbringing, in my opinion, is one of cultural understanding, acceptance, and an ability to adopt open-minded perspectives on a variety of issues, it can also impact one’s ability to define themselves in a succinct, coherent manner. And this matters.

In my own household, I grew up speaking English most of the time. On top of this, I attended school in English, so the majority of my days were spent speaking English with friends and family, and absorbing anglophone media.

The larger environment I was surrounded by, however, was French-speaking and infused with an entirely different culture. My neighbors and friends from outside of school absorbed a totally different set of media, and expressed themselves with the idioms, colloquialisms, and attitudes of French-Canadian culture and language. I had a lot of extended family that only spoke French, and my interactions at larger family gatherings consisted of a hodge-podge of expressions, ideas, and cultural ideations that would confuse any unilingual, unicultural intruder.

As a result, my sense of self throughout childhood and young adulthood was nothing short of disorganized. While I, at times – due to the high English input in my everyday life – identified as an anglophone, other days I keenly identified as a French-Quebecer. Expressing the truest form of myself couldn’t reasonably come from acclimating to just one of these two senses of self. The reality was that I was, through and through, a byproduct of two languages and cultures.

The implications of the differing sense of self can be both positive and negative. What is important to keep in mind, however, is that a large portion of the globalized world finds themselves living amongst cultures that, at times, feel at odds with their sense of self. My own experience is not unique – based on conversations with people in Quebec and globally, I discovered that this feeling of being pulled in two directions is more common than not.

We live in a world that oftentimes feels built for the monolingual. Whether it comes to informal social interactions, or communicating in a more formal scenario (like a therapy setting, perhaps), it is easy to feel at times that we should adopt a certain language, attitude, or cultural association depending on the context. There is often a sense of “language pressure” for bilinguals living in a monolingual environment; a desire to fit in with the status quo. While the past decade or so has brought a clear shift towards a more multicultural, globalized way of functioning, the reality that many people deal with a bidirectional, confused self-concept is here to stay.

While this is simply a personal recount of my own thoughts and experiences, the ramifications of failing to consider the impact of language and culture on a person’s sense of self can be huge. The influence of language and culture on an individual is enriching and complex. However, at Conscious Mental Health, we think it’s important to be aware of the feeling of disconnect that can come along with it as well.

Language plays a massive role in how we feel, express ourselves, and identify with the world around us. The first step we can take towards having more fruitful interactions with those around us, is to be conscious – conscious of the malleable, diverse, multi-faceted individuals we are connecting with. Once we are attentive to that, we can look at ways to consciously adapt our communication with this in mind.

And that will be a topic for next time. Stay tuned!