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The Case for Cultural Competency in Psychotherapeutic Interventions
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Cultural competency practices have been widely adopted in the mental health field because of the disparities in the quality of services delivered to ethnic minority groups. In this review, we examine the meaning of cultural competency, positions that have been taken in favor of and against it, and the guidelines for its practice in the mental health field. Empirical research that tests the benefits of cultural competency is discussed.
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“When compared to White Americans, racial/ethnic minority populations have less access to mental health care, are less likely to receive care, and when they do, it tends to be poorer in quality (Institute of Medicine, 2001; Sue, Zane, Nagayama Hall, & Berger, 2009; U.S. Department of Health and Human Services [DHHS], 2001).”
From Guest Editors' Introduction to the Special Section: Cultural Adaptation of Mental Health Interventions for Americans of East Asian Descent (2019) · cites this paper as Sue, Zane, Nagayama Hall, & Berger, 2009
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“Importantly, the cross-cultural validity of these processes is actively debated.”
From Differential associations of Acceptance and Commitment Therapy processes with psychological distress across racial groups. (2026) · cites this paper as [19]
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Blended Care Therapy for Depression and Anxiety: Outcomes across Diverse Racial and Ethnic Groups
Owusu, J. T., Wang, P., Wickham, R. E., Cottonham, D. P., Varra, A. A., Chen, C., & Lungu, A. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01450-z · Cited by 14
“The BCT program incorporates culturally responsive practices [22, 31, 32], which include providing culturally appropriate support across diverse racial and ethnic identities.”
BackgroundKeshani, I. M., Merkouris, S., Guyett, A., Rodda, S. N., & Dowling, N. A. (2025) · Journal of Behavioral Addictions · doi:10.1556/2006.2025.00004 · Cited by 14
Ahrens, C. E., Nguyen, P., Phan, S., & Mechanic, M. B. (2021) · Journal of Family Violence · doi:10.1007/s10896-021-00261-w · Cited by 14
Elder abuse and its prevention : workshop summary
Taylor, R. M. (2014) · Cited by 14
Treatment Processes of Counseling for Children in South Sudan: A Multiple n = 1 Design
Jordans, M. J. D., Komproe, I. H., Tol, W. A., Nsereko, J., & de Jong, J. T. V. M. (2013) · Community Mental Health Journal · doi:10.1007/s10597-013-9591-9 · Cited by 14
“Advocates of such evidence-based treatment (EBT) in turn argue for the adaptation of EBT to culturally diverse populations (Lau 2006; Ngo et al. 2008) emphasizing issues of cultural adaptation and cultural competency (Bernal et al. 1995; Ivey and Ivey 1999; Sue et al. 2009).”
BackgroundOliver, D. G., Caldwell, C. H., Faison, N., Sweetman, J., Abelson, J. M., & Jackson, J. S. (2016) · American Journal of Orthopsychiatry · doi:10.1037/ort0000170 · Cited by 12
“Together, these results support the systematic exploration of ethnic group differences within the Black population, as suggested by Jackson and colleagues (2004), as well as Agyemang et al. (2005) and Sue et al. (2009).”
ResultMills, A. S., Vimalakanthan, K., Sivapalan, S., Shanmugalingam, N., & Weiss, J. A. (2020) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-020-04538-9 · Cited by 16
“It is important that mental health interventions are sensitive to cultural and linguistic diversity (Sue et al. 2009).”
Pinna, K. L. M., Lewis, L. K., Karatekin, C., Lamb-Onyiga, A., Hirilall, A., & Jones, S. D. (2015) · Journal of Public Child Welfare · doi:10.1080/15548732.2015.1060918 · Cited by 14
Álvarez, K., Marroquin, Y., Sandoval, L. R., & Carlson, C. I. (2014) · Journal of Mental Health Counseling · doi:10.17744/mehc.36.2.480168pxn63g8vkg · Cited by 14
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“They result from culturally competent processes (encompassing attitudes, knowledge, and skills) (Gone and Trimble, 2012; Sue, 2001; Sue et al., 2009).”
BackgroundKrause, M., Espinosa-Duque, D., Tomicic, A., Córdoba, A. C., & Vásquez, D. (2018) · Counselling and Psychotherapy Research · doi:10.1002/capr.12171 · Cited by 14
Evidence-based Care of the Human Trafficking Patient
Costa, C. B., McCoy, K. T., Early, G. J., & Deckers, C. M. (2019) · Nursing Clinics of North America · doi:10.1016/j.cnur.2019.08.007 · Cited by 14
Predictors of self-perceived cultural competence among children’s mental health providers.
Keyser, V. E., Gamst, G. C., Meyers, L. S., Der‐Karabetian, A., & Morrow, G. (2014) · Cultural Diversity & Ethnic Minority Psychology · doi:10.1037/a0035762 · Cited by 13
“This outcome, while unexpected, is not entirely surprising, because practitioner racial attitudes and awareness have been noted as crucial constituents in the development of cultural competencies and sensitivity (Sue et al., 2009; Mollen, Ridley, & Hill, 2003).”
BackgroundTo cross or not to cross: Clinical boundary considerations with persons who are refugees
Shors, M. K., & Kroll, J. (2019) · Transcultural Psychiatry · doi:10.1177/1363461519878289 · Cited by 13
“…of a patient’s ethnicity, the professional is ignoring or insensitive to the hyper-diversity that exists within each sociocultural group, and thus is missing the unique individuality of the specific patient (Block, Riggs, & Haslam, 2013; DelVecchio Good & Hannah, 2015; S. Sue et al., 2009).”
BackgroundImplications of ideological bias in social psychology on clinical practice.
Silander, N. C., Geczy, B., Marks, O., & Mather, R. D. (2020) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12312 · Cited by 17
“, cultural, sexual orientation, and spiritual/religious), clinical psychologists cannot effectively provide services if they do not sufficiently understand the clients they serve or do not recognize limited personal understanding (Gartner et al., 1990; Lopez et al., 1989; Sue et al., 2009).”
BackgroundMata-Greve, F., WIECHMAN, S. A., McMullen, K. A., Roaten, K., Carrougher, G. J., & Gibran, N. S. (2021) · Burns · doi:10.1016/j.burns.2021.11.003 · Cited by 14
A Multistate Asian-Language Tobacco Quitline: Addressing a Disparity in Access to Care
Cummins, S. E., Wong, S., Bonnevie, E., Lee, H., Goto, C. J., Carrington, J. M., Kirby, C. A., & Zhu, S. (2015) · American Journal of Public Health · doi:10.2105/ajph.2014.302418 · Cited by 13
A Review and Critique of Multicultural Competence Measures
Gamst, G. C., & Liang, C. T. H. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-394420-7.00028-x · Cited by 13
Integrating culture, pedagogy, and humor in CBT with anxious and depressed youth.
Consoli, A. J., Blears, K., Bunge, E. L., Mandil, J., Sharma, H., & Whaling, K. M. (2018) · Practice Innovations · doi:10.1037/pri0000069 · Cited by 13
Bryl, K. L., & Goodill, S. W. (2019) · American Journal of Dance Therapy · doi:10.1007/s10465-019-09312-8 · Cited by 14
Hilliard, M. E., Ernst, M. M., Gray, W. N., Saeed, S. A., & Cortina, S. (2011) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsr084 · Cited by 13
“Specific strategies include incorporating culturally salient examples and values, directly addressing issues of racism, spirituality, and acculturation, involving family members, and delivering interventions in community settings (Kataoka et al., 2010; Sue et al., 2009).”
BackgroundCulturally adapted mental health services: An updated meta-analysis of client outcomes.
Smith, T. B., & Trimble, J. E. (2015) · American Psychological Association eBooks · doi:10.1037/14733-007 · Cited by 16
“Over time the fourth recommendation, providing alternative methods and cultural modifications to existing methods, has received more emphasis than the other three (e.g., Chen & Davenport, 2005; Smith, 2010; Sue et al., 2009).”
MethodTestimonial Psychotherapy in Immigrant Survivors of Intimate Partner Violence: A Case Series
Lakshmin, P., Slootsky, V., Polatin, P. B., & Griffith, J. L. (2018) · Transcultural Psychiatry · doi:10.1177/1363461518777146 · Cited by 12
Gotseva-Balgaranova, K., Popivanov, I. D., & Mutafchieva, M. (2020) · Zeitschrift für Psychodrama und Soziometrie · doi:10.1007/s11620-020-00568-8 · Cited by 12
“…challenges of conducting such a research, in particular, the linguistic demands, cultural barriers, the heterogeneity of the refugee population, and the cultural competence of both the experts who provide the services and the researchers who conduct the assessment (Paniagua 2005; Sue et al. 2009).”
BackgroundJager, M., den Boeft, A., Versteeg-Pieterse, A., Leij‐Halfwerk, S., Pelgrim, T. C., van der Sande, R., & van den Muijsenbergh, M. E. T. C. (2020) · Patient Education and Counseling · doi:10.1016/j.pec.2020.10.010 · Cited by 14
Sapkota, R. P., Valli, E., Wilhelms, A., Adlam, K., Bourgeault, L., Heron, V., Dickerson, K. C., Nugent, M., & Hadjistavropoulos, H. D. (2023) · Healthcare · doi:10.3390/healthcare11152135 · Cited by 11
Abe, J. S. (2012) · Asian American Journal of Psychology · doi:10.1037/a0029842 · Cited by 12
Moleiro, C., Freire, J., Pinto, N., & Roberto, S. (2017) · Counselling and Psychotherapy Research · doi:10.1002/capr.12157 · Cited by 21
Rivera, A. M., Zhang, Z., Kim, A., Ahuja, N., Lee, H. Y., & Hahm, H. C. (2019) · American Journal of Orthopsychiatry · doi:10.1037/ort0000391 · Cited by 12
Turhan, Z. (2019) · Aggression and Violent Behavior · doi:10.1016/j.avb.2019.101337 · Cited by 12
Barksdale, C. L., Ottley, P., Stephens, R. L., Gebreselassie, T., Fua, I., Azur, M. J., & Walrath-Greene, C. M. (2011) · American Journal of Community Psychology · doi:10.1007/s10464-011-9442-1 · Cited by 12
“et al. 2003; Pumariega et al. 2005; Smedley et al. 2003; Sue 1998; Sue et al. 2009 ).”
Cultural Context in DSM Diagnosis: An American Indian Case Illustration of Contradictory Trends
Langa, M. E., & Gone, J. P. (2019) · Transcultural Psychiatry · doi:10.1177/1363461519832473 · Cited by 15
Golker, C., & Cioffi, M. C. (2021) · The Cognitive Behaviour Therapist · doi:10.1017/s1754470x20000616 · Cited by 13
“In recent times, cultural competence has become regarded as a crucial skillset for mental health professionals, especially when working with minority cultural groups (Sue et al., 2009).”
BackgroundLeisure and trauma-informed practice
Yuen, F. C., Reilly, R. C., & Sjollema, S. D. (2023) · Leisure Studies · doi:10.1080/02614367.2023.2228508 · Cited by 11
“An intersectional awareness of trauma also requires culturally competent capacities necessary to address the disparities in the quality of human services (Sue et al., 2009).”
BackgroundSouthampton Adaptation Framework to Culturally Adapt Cognitive Behavior Therapy
Naeem, F., Phiri, P., & Husain, N. (2024) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2024.02.009 · Cited by 16
Salmani, Z., Zargham‐Boroujeni, A., Salehi, M., Killeen, T. K., & Khoei, E. M. (2015) · PubMed Central · Cited by 11
Assessment of the Hispanic Cognitively Impaired Elderly Patient
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Understanding and Addressing the Stigma in Mental Health Within the Asian and Asian-American Culture
Tran, B. (2018) · Advances in psychology, mental health, and behavioral studies (APMHBS) book series · doi:10.4018/978-1-5225-3808-0.ch004 · Cited by 11
Sifat, M. S., Tasnim, N., Hoque, N. J., Saperstein, S. L., Shin, R. Q., Feldman, R. H. L., Stoebenau, K., & Green, K. M. (2022) · Cambridge Prisms Global Mental Health · doi:10.1017/gmh.2022.24 · Cited by 12
“…define the construct of ‘mental health knowledge’ based on participants’ knowledge of the symptoms and effects of mental health illnesses that are defined by Western countries, like the United States, but these definitions are not widely established in non-Western countries (Sue et al., 2009).”
BackgroundKeklik, İ. (2022) · Journal of Multicultural Counseling and Development · doi:10.1002/jmcd.12252 · Cited by 11
Qinaʻau, J., & Masuda, A. (2020) · Springer eBooks · doi:10.1007/978-3-030-32229-8_7 · Cited by 11
Cultural Competence for Teachers and Students
Elphinstone, L. (2018) · Cambridge University Press eBooks · doi:10.1017/9781316996706.005 · Cited by 11
Improving Treatment Engagement and Psychotherapy Outcomes for Culturally Diverse Youth and Families
Huey, S. J., & Jones, E. O. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-394420-7.00022-9 · Cited by 11
Husain, N., Chaudhry, N., Durairaj, S. V., Chaudhry, I. B., Khan, S., Husain, M., Nagaraj, D., Naeem, F., & Waheed, W. (2011) · Trials · doi:10.1186/1745-6215-12-159 · Cited by 14
“There is sufficient evidence to suggest that cognitive behaviour therapy might need adaptation for use with ethnic minority clients in the west [21].”
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Rojas‐García, A., Ruíz-Pérez, I., Gonçalves, D. C., Rodríguez‐Barranco, M., & Ricci‐Cabello, I. (2014) · Clinical Psychology Science and Practice · doi:10.1111/cpsp.12081 · Cited by 10
Globalization in art therapy education: Multicultural training in South Korean context
Park, S., & Ramirez, K. (2020) · The Arts in Psychotherapy · doi:10.1016/j.aip.2020.101742 · Cited by 10
Ezawa, I. D., & Strunk, D. R. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10254-0 · Cited by 13
The Reality of Practicing the Ten Key Components in Adult Drug Court
Lutze, F. E., & van Wormer, J. G. (2014) · Journal of Offender Rehabilitation · doi:10.1080/10509674.2014.922155 · Cited by 10
“Integrating culturally competent practices into drug court is important and may have been influential to the high graduation rates and lower recidivism rates in this drug court (Beckerman & Fontana, 2001; Dannerbeck, Harris, Sundet, & Lloyd, 2006; Lutze, Lucas, & van Wormer, 2009; Lutze & Mason, 2008; Rempel & DeStefa…”
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“As was previously mentioned, initial appeals for cultural competency grew out of concerns for the status of ethnic minority group populations in the USA (e.g. African Americans, American Indians, and Alaska Natives, Hispanics, and Asian Americans; Sue et al., 2009).”
BackgroundInfluentialEthical Considerations for Psychologists Providing Treatment to Arab Americans
Cho, E. (2018) · Ethics & Behavior · doi:10.1080/10508422.2018.1435282 · Cited by 11
Lucas, T., Lakey, B., Arnetz, J. E., & Arnetz, B. B. (2010) · Psychology Health & Medicine · doi:10.1080/13548506.2010.482141 · Cited by 10
“Health disparities have provided momentum for theory and research on healthcare provider cultural competency (Perloff, Bonder, Ray, Ray & Siminoff, 2006 ; Sue, 2006 ; Sue, Zane, Hall & Berger, 2009 ).”
BackgroundSecondary Traumatization in Psychiatric Mental Health Nurses: Validation of Five Key Concepts
HUBBARD, G. B., Beeber, L. S., & Eves, E. (2015) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12145 · Cited by 13
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McGinniss, M. A., Tahmassi, A., & Ramos, E. (2018) · Current Genetic Medicine Reports · doi:10.1007/s40142-018-0150-0 · Cited by 10
Yasui, M., Choi, Y., Chin, M. H., Samuels, G. M., Kim, K. C., & Victorson, D. E. (2021) · Journal of Ethnic & Cultural Diversity in Social Work · doi:10.1080/15313204.2021.1913777 · Cited by 9
“One salient reason for the underutilization of mental health services among Asian Americans may be the lack of evidence driven culturally competent therapeutic practices (Sue et al., 2009).”
BackgroundCognitive behavioral therapy around the globe
Kuo, C. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814932-4.00005-7 · Cited by 10
Physical activity and GPA: Results from a national sample of Black students
Weston, R. E., Zeng, H. Z., & Battle, J. J. (2020) · Journal of Human Behavior in the Social Environment · doi:10.1080/10911359.2019.1687387 · Cited by 10
Link, B. G., & Phelan, J. C. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.024 · Cited by 11
Hartmann, W. E., Arnault, D. S., & Gone, J. P. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.114899 · Cited by 9
“Today, spurred in large part by theoretical advancements and professional advocacy of multicultural psychologists in the 1990s (Sue et al., 2009), “ culture ” has become the predominant conceptual and linguistic frame with which diversity issues are engaged.”
BackgroundFujii, D., Kaseda, E., Haneda, A., Kuroda, H., Machizawa, S., Okamura, Y., Ono, K. E., Yamada, T., & Thaler, N. S. (2023) · Clinical Neuropsychologist · doi:10.1080/13854046.2022.2156395 · Cited by 8
Fish, J. N., King‐Marshall, E., Turpin, R., Aparicio, E. M., & Boekeloo, B. O. (2023) · Prevention Science · doi:10.1007/s11121-023-01505-5 · Cited by 14
“…competent care, defined as respectful of and responsive to the health beliefs, practices, and needs of diverse clients and communities (Hays, 2001; Sue et al., 2009), is widely attributed to a lack of accessible and effective training opportunities in professional clinical programs and continuing…”
BackgroundRowe, R. (2013) · Mental Health and Substance Use · doi:10.1080/17523281.2013.782333 · Cited by 9
Rosenfield, S., Kato, K., & Smith, D. T. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.017 · Cited by 9
Disparities in Treating Culturally Diverse Children and Adolescents
Rue, D. S., & Xie, Y. (2009) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.11.001 · Cited by 9
Hahm, H. C., & Yasui, M. (2019) · American Journal of Orthopsychiatry · doi:10.1037/ort0000421 · Cited by 8
Cultural Adaptations of Acceptance and Commitment Therapy
Masuda, A., Morgan, L., Spencer, S. D., Qinaʻau, J., & Jo, D. (2022) · The Oxford Handbook of Acceptance and Commitment Therapy · doi:10.1093/oxfordhb/9780197550076.013.30 · Cited by 12
Mehra, L. M., Kallen, A. M., Potter, M. R., Udupa, N. S., Bryen, C. P., Kemper, T. S., Sachs‐Ericsson, N., & Joiner, T. E. (2025) · Psychotherapy Research · doi:10.1080/10503307.2025.2481268 · Cited by 9
“Evidence suggests that multiculturally competent treatment adaptations (S. Sue et al., 2009), in addition to greater levels of perceived therapist multicultural competence, have positive influences on treatment outcomes, although evidence regarding the uniqueness and robustness for these effects is…”
Barsalou-Verge, X., Gagnon, M. M., Séguin, R., & Dagenais, C. (2015) · American Indian Culture and Research Journal · doi:10.17953/aicrj.39.3.barsalou-verge · Cited by 8
Recruiting and retaining of Indigenous Probations Officers
Morven, F., & Cunningham, J. (2019) · Equality Diversity and Inclusion An International Journal · doi:10.1108/edi-06-2019-0183 · Cited by 8
Doron, E., Tobis, S., & Domaradzki, J. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1356242 · Cited by 8
“ICT is a complex and dynamic meeting of personal values concerning world views originating in culture, beliefs, values and emotional biases regarding different ethnic groups, as well as the identity and affiliation group of the therapists themselves (Sue et al., 2009).”
BackgroundAlcohol Treatment in Native North America: Gender in Cultural Context
Prussing, E., & Gone, J. P. (2011) · Alcoholism Treatment Quarterly · doi:10.1080/07347324.2011.608593 · Cited by 8
“Although the term resists consensual definition ( Sue, Zane, Hall, & Berger, 2009 ), cultural competence can be summarized as “attributes or characteristics of service providers (and, sometimes, service agencies and organizations) that equip them to effectively provide otherwise desirable or warranted health care inte…”
BackgroundMorán, J., Díaz, M. F., Martìnez, C., Varas, C., & Sepúlveda, R. P. (2019) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2019.346 · Cited by 12
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Antiracist Practice in Psychiatry: Principles and Recommendations
Fani, N., White, D. T., Marshall-Lee, E. D., & Hampton-Anderson, J. N. (2022) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20220045 · Cited by 8
Madore, M. R., Kaseda, E. T., Chin, L., Tan, A., Wong, C. G., Lee, J., Thaler, N. S., Gee, S., Al-Dasouqi, H., & Irani, F. (2023) · The Clinical Neuropsychologist · doi:10.1080/13854046.2023.2192416 · Cited by 8
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Metadata
- Authors
- Sue, S., Zane, N., Nagayama Hall, G. C., & Berger, L. K.
- Affiliations
- University of California, Davis (US)
- Department of Psychology, University of Oregon, Eugene, Oregon 97403;
- Venue
- Annual Review of Psychology
- Publisher
- Annual Reviews
- Published
- 2009-01-01
- Volume
- 60
- Issue
- 1
- Pages
- 525-548
- ISSN
- 0066-4308 (ISSN-L)
- 1545-2085
- PMC
- PMC2793275
- OpenAlex
- W2158121413
- Cited by
- 662
- References
- 117
- Citations by year
- 2026: 37 · 2025: 50 · 2024: 43 · 2023: 47 · 2022: 32 · 2021: 41 · 2020: 47 · 2019: 51 · 2018: 44 · 2017: 63 · 2016: 36 · 2015: 31 · 2014: 35 · 2013: 26 · 2012: 24
- FWCI
- 2.38
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annual Review of Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (P50MH073511)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Counseling Practices and Supervision
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Cultural Competency in Health Care
- Social Sciences › Sociology and Political Science › Racial and Ethnic Identity Research
- Keywords
- cultural competence, psychotherapy, ethnic minority mental health, mental health disparities
- MeSH terms
- Delivery of Health Care, Humans, Minority Groups, Prejudice, Psychotherapy, Quality Assurance, Health Care, Stereotyping, Cultural Competency, Healthcare Disparities
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