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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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Subhan, B. A., & Johnson, V. E. (2022) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-022-01472-7 · Cited by 6
“Perceived racism, microaggressions, and unintentional bias from clinicians can impede successful therapeutic outcomes for racial and ethnic minority clients and historically oppressed groups, such as Black women (Owen et al. 2017; Owen et al. 2014; Pieterse et al. 2012; Sue et al. 2009).”
BackgroundCultural pragmatism: In search of alternative thinking about cultural competence in mental health.
Yahalom, J., & Hamilton, A. B. (2023) · Journal of Theoretical and Philosophical Psychology · doi:10.1037/teo0000230 · Cited by 9
Counselling Asian Smokers: Key Considerations for a Telephone Intervention
Tedeschi, G. J., Zhu, S., Cummins, S. E., Shin, H. Y., & Nguyen, M. H. (2013) · The Journal of Smoking Cessation · doi:10.1017/jsc.2013.1 · Cited by 6
“Through our work with Asian clients and review of the pertinent literature (e.g., American Psychological Association, 2003; Benish et al., 2011; Sue et al., 2009), we identified six main areas that address cultural relevance and client retention: 1) capitalising on first contact; 2) managing gender…”
BackgroundWilliams, N. D., Foye, A., & Lewis, F. (2016) · Journal of Feminist Family Therapy · doi:10.1080/08952833.2015.1130547 · Cited by 6
In praise of cultural-competence training for mental health professionals.
Mirsky, J. (2012) · PubMed · Cited by 6
Rosmarin, D. H. (2016) · Clinical Psychological Science · doi:10.1177/2167702616647926 · Cited by 5
Psychotherapy and Psychosocial Support in Host Countries: State-of-the-Art and Emerging Paradigms
Drožđek, B., & Silove, D. M. (2018) · Springer eBooks · doi:10.1007/978-3-319-72914-5_11 · Cited by 6
Veronese, G., Pepe, A., Sala, G., & Vigliaroni, M. (2019) · International Journal of Migration Health and Social Care · doi:10.1108/ijmhsc-07-2018-0043 · Cited by 7
Zilberstein, K. (2021) · Critical and Radical Social Work · doi:10.1332/204986021x16177218690703 · Cited by 6
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Slobodin, O., & Ziv‐Beiman, S. (2021) · Psychoanalytic Dialogues · doi:10.1080/10481885.2021.1925284 · Cited by 6
“Cultural competency in psychotherapeutic interventions In the last decades, the importance of cultural competence and cultural sensitivity in mental health interventions has gained increased recognition (Bredström, 2019; Sue et al., 2009).”
BackgroundCounseling and Psychotherapy with Clients of Middle Eastern Descent: A Qualitative Inquiry
Boghosian, S. (2021) · Digital Commons - USU (Utah State University) · doi:10.26076/c766-e35b · Cited by 6
Paquin, J. D. (2017) · International Journal of Group Psychotherapy · doi:10.1080/00207284.2016.1218771 · Cited by 6
“Dynamic sizing, along with “scientific-mindedness,” are considered to be two important skills associated with being a multiculturally competent therapist (Sue et al., 2009).”
BackgroundThe Measurement of Mental Disorder
Wakefield, J. C., & Schmitz, M. F. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.005 · Cited by 7
Saleem, F. T., Howard, L. C., Schmidt-Temple, C. T., Langley, A. K., & Howard, T. C. (2024) · Urban Education · doi:10.1177/00420859241227961 · Cited by 5
“Sue et al. (2009) posit that when dif fi cult dialogs are not handled well by teachers it can harm the integrity of students of color and reinforce biased world views of White students.”
Alcaraz, C. G., Roesch, S. C., Aguilar, R. A. C., Gombatto, S. P., & Wells, K. J. (2023) · Journal of Pain · doi:10.1016/j.jpain.2023.03.011 · Cited by 5
Ormiston, C. K. (2023) · Journal of Asian Health · doi:10.59448/jah.v3i2.36 · Cited by 5
“…patient and culture, language concordance, understanding cultural importance of food), education, and training 51,74 • Reduces treatment disparities 75,76 • Can improve health outcomes, patient satisfaction, patient self-efficacy, and patient-provider relationships 77,78 Engage in open,…”
BackgroundSuen, Y. N., Chen, E. Y. H., Wong, Y. C., Ng, W., Patwardhan, S., Cheung, C., Hui, C. L. M., Wong, S. M. Y., Wong, M. T. H., & Mahtani, S. (2023) · BMJ Mental Health · doi:10.1136/bmjment-2023-300788 · Cited by 6
“14 Therefore, tailoring counselling interventions to fit the cultural values, beliefs and practices of the target population is needed.”
BackgroundWilbur, R. E., Pham, T. V., & Gone, J. P. (2024) · The Counseling Psychologist · doi:10.1177/00110000241279120 · Cited by 9
“Within the last twenty years, there has been a move within psychological research and practice, as well as allied health fi elds, to engage in culturally competent practices as a means of bridging the gap in health outcomes between White and minoritized populations (Sue et al., 2009).”
Williams, O. J., & Jenkins, E. J. (2015) · Journal of Child Custody · doi:10.1080/15379418.2015.1060877 · Cited by 5
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What Do We Mean by Culturally Adapting Psychotherapy?
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Adaptation of the TEAM Mental Healthcare Delivery Model: A Mixed-Methods Evaluation
Nagy, G. A., Arnold, B. M. L., Gagliardi, J. P., Convoy, S. P., Molloy, M. A., Wall, P. H., Christian Mauro, P., & Rosenthal, M. Z. (2021) · Issues in Mental Health Nursing · doi:10.1080/01612840.2021.1975330 · Cited by 5
Cultural Competence of Mental Health Nurses in Israel
Segalovich, J., Dahan, S., Levi, G., & Segev, R. (2022) · Journal of Psychosocial Nursing and Mental Health Services · doi:10.3928/02793695-20220428-03 · Cited by 5
Vicarious Impacts of Working with Refugees and Asylum Seekers: An Integrative Review
Fernandes, P., Buus, N., & Rhodes, P. (2022) · Journal of Immigrant & Refugee Studies · doi:10.1080/15562948.2022.2049949 · Cited by 7
“The impact of cultural competency and cultural influences in role perception, valuing and understanding healing and recovery of diverse unfamiliar cultures, and the impact of these factors on empathic connections have not been sufficiently unpacked (Riess, 2017 ; Sue et al., 2009 ).”
Measuring Implicit Biases About Disability: A Scoping Review
Huang, Y., Kim, J., Levine, A., Park, J., & Kuo, H. J. (2023) · Rehabilitation Counseling Bulletin · doi:10.1177/00343552231199246 · Cited by 5
“Implicit biases can undermine counselor’s cultural competency and harm the counseling process and outcome (S. Sue et al., 2009).”
The work experience of male nursing teachers in Chinese universities: a phenomenological study
He, Z., Yao, J., Ala, M. B. D., & Zhang, X. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1256934 · Cited by 5
“In addition, work experience is closely related to aspects of the external environment, such as cultural concepts and social roles (Sue et al., 2009).”
BackgroundRadež, J., Causier, C., Maughan, D. L., Waite, F., & Johns, L. (2024) · Psychology and Psychotherapy Theory Research and Practice · doi:10.1111/papt.12524 · Cited by 5
Rivera, P. M., Heiden‐Rootes, K. M., Nguyen, H. N., & Iheanacho, E. C. (2021) · American Journal of Family Therapy · doi:10.1080/01926187.2021.2019142 · Cited by 5
Mental Health Service Utilization and Psychological Help-Seeking Preferences Among Canadian Muslims
Zia, B., Abdulrazaq, S., & Mackenzie, C. S. (2022) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2022-003 · Cited by 5
Ede, M. O., Okeke, C. I. O., & Onah, S. O. (2022) · Criminal Behaviour and Mental Health · doi:10.1002/cbm.2269 · Cited by 5
Ryu, S., & Lee, O. E. (2016) · Mental Health Religion & Culture · doi:10.1080/13674676.2017.1290593 · Cited by 5
Hussain, B., Khalily, M. T., Waqas, A., Rahman, A., Angelakis, I., Nisar, A., Zaman, S., & Akhtar, T. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2024.1413809 · Cited by 5
African traditional healing and mental well-being: insights from traditional healers in Gqeberha
Williams, B., & Sikrweqe, O. (2025) · South African Journal of Psychology · doi:10.1177/00812463251404676 · Cited by 4
“This aligns with cultural competence theory, which emphasizes the need for healthcare providers to respect and incorporate patients’ cultural and spiritual beliefs into treatment (Sue et al., 2009).”
Baumbach, L., Barth, L., König, H., & Hajek, A. (2023) · Psychogeriatrics · doi:10.1111/psyg.12970 · Cited by 4
A Narrative Review of Culturally Informed Breastfeeding Interventions for African American Women
ADERIBIGBE, T. B., Adeleye, K. K., Simonsen, S. E., & Latendresse, G. (2025) · The Journal of Perinatal & Neonatal Nursing · doi:10.1097/jpn.0000000000000912 · Cited by 3
Yan, Y., Muenks, K. M., Mata, R. A., & Yang, Y. (2023) · Social Psychology of Education · doi:10.1007/s11218-023-09840-9 · Cited by 4
“Cultural competence encapsulates skills, knowledge, and attitudes that are required to adequately work with people of diverse cultural backgrounds (Bor-oughs et al., 2015; Sue et al., 2009).”
Ford, K., Denend, J. V., DeViva, J. C., Cooke, J. D., & Klee, A. S. (2024) · Journal of Religion and Health · doi:10.1007/s10943-024-02065-w · Cited by 4
“Existing data suggests that modification of interventions to the patient’s culture can be helpful (Sue et al., 2009).”
Gooldin, S. (2011) · Diversity & Equality in Health and Care · Cited by 4
Venkataraman, S., Jordan, G., Pope, M. A., & Iyer, S. N. (2017) · Early Intervention in Psychiatry · doi:10.1111/eip.12422 · Cited by 4
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Mensah, E. K. (2019) · Journal of Education and e-Learning Research · doi:10.20448/journal.509.2019.63.142.148 · Cited by 4
“This impacted the counselling services, instruction, teaching and inquiry (APA as cited in Sue et al. (2009)).”
BackgroundBehavioral Health Service Delivery with Asian Americans
Hall, G. C. N., & Huang, E. R. (2020) · Springer eBooks · doi:10.1007/978-3-030-32229-8_10 · Cited by 4
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Sarr, R. (2023) · Clinical Child Psychology and Psychiatry · doi:10.1177/13591045231208571 · Cited by 3
“According to Sue et al. (2009), this can include delivering treatment in the language of the service user or ensuring the therapist and service user match ethnically and culturally.”
BackgroundChou, F., Black, T., Huang, C., Tran, A., Yan, M., & Boothroyd, S. (2024) · Journal of Marital and Family Therapy · doi:10.1111/jmft.12750 · Cited by 3
Calia, C., Bhriain, U. N., Grant, L., Guerra, C., Gritti, A., & Reid, C. L. (2025) · Ethics & Behavior · doi:10.1080/10508422.2025.2500356 · Cited by 5
“While culture competence is the most referenced framework of practice when working with culturally diverse populations (Gopalkrishnan, 2018), critiques point to ambiguous definitions, mixed empirical evidence, and implications for practice (Sue et al., 2009).”
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“In addition, the programme is delivered by course leaders with cultural competence making components of SAP easily accessible to parents (Sue et al., 2009).”
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“Cultural Barriers [57] Cultural differences may impact the acceptance and effectiveness of certain therapies.”
BackgroundWorking Together to Advance Indigenous Interests with Community Psychology
O’Keefe, V. M., & Hartmann, W. E. (2019) · American Journal of Community Psychology · doi:10.1002/ajcp.12381 · Cited by 3
Yassin, S., & Evans, C. (2021) · Counselling and Psychotherapy Research · doi:10.1002/capr.12431 · Cited by 3
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Ngobe, A. J. (2015) · Cited by 3
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“Also, there is a growing movement to make mental health services more culturally competent to appreciate the importance of cultural mechanisms and relatedness of fi ndings to speci fi c cultural settings (Sue et al., 2009).”
AbuDujain, N. M., AlDhuwaihy, A. A., Alshuwaier, F. A., Alsulaim, Y. B., Aldahash, N., Aljarallah, S., Almigbal, T. H., Alrasheed, A. A., Batais, M. A., & Martin, M. M. (2024) · Healthcare · doi:10.3390/healthcare12212163 · Cited by 3
“In the field of psychological assessment, it is crucial to ensure that the tools used to measure cognitive and behavioral attributes are culturally and linguistically appropriate for the populations under study [1,2].”
BackgroundIntersectional Praxis for Addressing Health Inequalities and Promoting Population Health
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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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