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The Case for Cultural Competency in Psychotherapeutic Interventions
Open accessAbstract
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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Chua, K. J., Knorr, D. A., Jimenez, J., Francia, A., Rojas, V., Garcia, J. I., & Fox, M. M. (2023) · Journal of Racial and Ethnic Health Disparities · doi:10.1007/s40615-023-01684-5 · Cited by 2
“Structural barriers include lack of health insurance or cultural miscommunication in health care, while cultural barriers include mental health stigma [38–40].”
Hymenoplasty in India: A Comprehensive Review of Contemporary Trends and Impact on Young Adults
Dhaketa, M., Acharya, S., Taksande, A. B., Prasad, R., Munjewar, P. K., & Wanjari, M. B. (2023) · Cureus · doi:10.7759/cureus.41852 · Cited by 2
“By engaging in community education and awareness programs, counseling services can foster discussions on gender equality, sexual autonomy, and respecting individual choices [33].”
BackgroundDesafíos del enfoque de competencias culturales para atender la salud de personas migrantes en Chile
Lues, M. F., Jaramillo, M., Chepo, M., Muñoz-Lizana, N., Cortés, C. A., & Tijoux, M. E. (2024) · Migraciones internacionales · doi:10.33679/rmi.v1i1.2726 · Cited by 2
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Bekteshi, V., Hunter, C. D., & Bellamy, J. L. (2024) · Journal of Social Service Research · doi:10.1080/01488376.2024.2415016 · Cited by 3
“This intersectional approach to mental health advocates for social change and diversity incorporation in counseling practices (Crenshaw, 1989; Frey, 2013; Sue et al., 2009).”
InfluentialDoron, E., Tobis, S., Tuval‐Mashiach, R., & Domaradzki, J. (2025) · Journal of Religion and Health · doi:10.1007/s10943-025-02298-3 · Cited by 2
Urpis, O. (2019) · doi:10.26493/978-961-7055-43-6 · Cited by 2
Supporting Post-secondary Youth Mental Health Through Inclusive Practices Attuned to Culture
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Contemporary Quantitative Methods and “Slow” Causal Inference
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Social Justice Education: Impacts on Social Attitudes
Cross-Denny, B., & Heyman, J. C. (2011) · Cited by 2
Blampied, N. M. (2008) · New Zealand journal of psychology · Cited by 2
Understanding Acculturation and Its Use in Counseling and Psychotherapy
Ibrahim, F. A., & Heuer, J. R. (2015) · International and cultural psychology/International and cultural psychology series · doi:10.1007/978-3-319-18057-1_4 · Cited by 2
Culturally Responsive Adlerian Counseling for East Asian Clients
Yee, T. (2018) · The Journal of Individual Psychology · doi:10.1353/jip.2018.0029 · Cited by 2
“Following the suggestions by Sue et al. (2009), the article first presents some cultural values of East Asians, followed by an examination of the compatibility of Adlerian concepts with East Asian beliefs and suggestions to tailor the Adlerian approach to East Asian individuals.”
BackgroundAn Exploration of Service Providers’ Experiences With Latinos Convicted of a Sex Offense
Domínguez, S. F., Jeglic, E. L., Gonzalez, K., & Escobar, D. (2019) · Sexual Abuse · doi:10.1177/1079063219852950 · Cited by 2
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Eleuteri, S., Rossi, R., & Simonelli, C. (2019) · Sexologies · doi:10.1016/j.sexol.2019.05.010 · Cited by 2
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Gutierez, D., Revens, K. E., & DeHaven, M. J. (2019) · Collaborations A Journal of Community-Based Research and Practice · doi:10.33596/coll.26 · Cited by 2
van Herwaarden, A., Rommes, E. W. M., & Peters-Scheffer, N. C. (2019) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2019.103543 · Cited by 2
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The HIV-Mental Health Challenge
Walkup, J. T., & Crystal, S. (2017) · Cambridge University Press eBooks · doi:10.1017/9781316471289.032 · Cited by 2
Mental Health and Well-being of Refugees
Ilyas, M., Siddiqui, A. A., Alshammary, F. L., Al-Enizy, A. S., & Alam, M. K. (2021) · Springer eBooks · doi:10.1007/978-3-030-36811-1_14 · Cited by 2
Counseling Mexican American Men Struggling with Paternal Postpartum Depression
Hernandez, S., Brown, T., & Henderson, S. E. (2022) · Hispanic Journal of Behavioral Sciences · doi:10.1177/07399863231153296 · Cited by 2
“For this reason, we suggest that counselors engage in a respectful, warm, and mutual introduction with the client because they may have negative attitudes toward mental health services (Sue et al., 2009).”
BackgroundThe Significance of Language to Multiracial Individuals and to Their Identities, Part III
Brooks, D. L., & Brooks, M. A. (2015) · doi:10.20700/kitasatoclas.21.0_73 · Cited by 2
Becker, S., Quaschning, K., Luzay, L., Haller, J., & Körner, M. (2021) · Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen · doi:10.1016/j.zefq.2020.11.005 · Cited by 2
Cultural Issues in Psychological Assessment
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Turhan, Z. (2019) · Goldsmiths (University of London) · doi:10.25602/gold.00026174 · Cited by 2
“Likewise, cultural norms should be recognised by professionals in all interventions in order to achieve the men‘s active engagement (Bernal, 2006; Sue et al., 2009).”
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Kor, P. P. K., Yu, C. T. K., Triastuti, I. A., Sigilipoe, M. A., Kristiyanto, H. D., Pratiwi, J. P. D., Perdamaian, T. K., Mengli Lisa, L. I., Pang, P. C. P., & Widagdo, T. M. M. (2022) · Research Square · doi:10.21203/rs.3.rs-1187682/v1 · Cited by 2
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“…changements apparaissent autant chez l’Autre que chez les membres de la communauté d’accueil, à savoir les milieux de stage des étudiant·e·s en ergothérapie ou en travail social qui tendent à privilégier la culture dominante telle que décrite précédemment (Cohen-Emerique, 2011; Sue et al., 2009).”
Backgroundde Blakeley, M. G., Stuart, J., & Sheeran, N. (2022) · Psychotherapy Research · doi:10.1080/10503307.2022.2090300 · Cited by 1
“…people has been linked to the inadequacies and limitations of the services offered to them, the lack of linguistically competent mental health services, and the lack of skills of MHPs delivering these services (Giammusso et al., 2018; Minas et al., 1994; Minas et al., 2013; Sue et al., 2009).”
BackgroundInfluentialYoung, M. Y., Chan, K. J., Vandette, M.-P., Cherner, R., Hatchard, T., Shah, D. K., & Kogan, C. S. (2022) · Canadian Journal of Community Mental Health · doi:10.7870/cjcmh-2022-016 · Cited by 1
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Interfaces entre as psicoterapias comportamentais e a cultura
Passos, J. A. F., Weydmann, G. J., Motta, P. A. C., & Dias, A. C. G. (2023) · Perspectivas em Análise do Comportamento · doi:10.18761/vecc21112022 · Cited by 2
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Furini, L. G., Henzel, G. A., Müller, S. A. Á. S., & Passos, J. A. F. (2023) · Perspectivas em Análise do Comportamento · doi:10.18761/vecc291122 · Cited by 3
Mutafchieva, M., Flegelskamp, S., & Kauppila, R. (2023) · Zeitschrift für Psychodrama und Soziometrie · doi:10.1007/s11620-023-00751-7 · Cited by 1
“…with refugees is considerable because of the linguistic demands, the cultural barriers, the heterogeneity of the refugee population, and the cultural competences of both the experts who provide the services, and the researchers who conduct the assessment (Paniagua 2005; Sue et al. 2009).”
Cultural Conversations in Therapy: How Often Clients Talk About Their Identities
Kuo, P. B., Rudecindo, B., Drinane, J. M., Tao, K. W., Epps, J. V., & Imel, Z. E. (2024) · Psychiatric Services · doi:10.1176/appi.ps.20230266 · Cited by 1
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Dixon, S., & Bell, J. (2025) · Spiritual Psychology and Counseling · doi:10.37898/spiritualpc.1610763 · Cited by 4
Zhong, C., Zhang, R., Lu, S., Zeng, H., & Gao, W. (2025) · Buildings · doi:10.3390/buildings15132163 · Cited by 1
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Woodard, S. R. (2025) · Frontiers in Developmental Psychology · doi:10.3389/fdpys.2025.1605742 · Cited by 1
Healthy minds index, Spanish version of core dimensions of wellbeing
Charles-Leija, H., Kral, T. R. A., Tatar, R. G., Davidson, R., Castro, C., Ballesteros-Valdés, R., & Okamoto, M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0328361
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Living with Grief: Changes to the Family Dynamic in a Collectivist Culture
Witanapatirana, K. (2025) · The Family Journal · doi:10.1177/10664807251378705 · Cited by 1
“It is evident that South Asian clients as well as client from other collectivistic cultures often face dif fi culty fi nding counselors who have a thorough understanding of cultural practices and norms (Sue et al., 2009).”
Owusu, J. T., Shakman, K. B., Lehavot, K., Wickham, R. E., Varra, A. A., Chen, C., Lungu, A., & Lee, J. L. (2025) · Health Equity · doi:10.1177/24731242251382353 · Cited by 1
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Alnajjar, A. A., & Alaleeli, S. (2025) · Clinical Psychologist · doi:10.1080/13284207.2025.2588192 · Cited by 1
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Davì, D., Prestano, C., & Vegni, N. (2026) · Psychiatry International · doi:10.3390/psychiatryint7010037 · Cited by 1
“The present research has focused on the figure of the therapist, exploring therapists’ different characteristics [31,32], such as their ethics [1,33], perception [34], and role [35] in different contexts, such as online [36] and transcultural [27,37,38].”
Negotiating Faith in Therapy: A Qualitative Study of Christian Clients in Secular Psychotherapy
Lloyd, C. E. M., Reid, G., & Cathcart, J. (2026) · Pastoral Psychology · doi:10.1007/s11089-025-01292-6 · Cited by 3
“Furthermore, multicultural and intersectional frameworks (e.g., Sue et al., 2009) have increasingly emphasized the importance of including religion and spirituality as dimensions of cultural identity that warrant clinical consideration.”
Brown, A. N., & Hunter, S. C. (2026) · Journal of Humanistic Psychology · doi:10.1177/00221678261435219 · Cited by 2
Cultuursensitief werken als integraal onderdeel van de hulpverlening
Edrisi, M. (2011) · Psychopraktijk · doi:10.1007/s13170-011-0006-8 · Cited by 1
Frisby, C. L., & O’Donohue, W. (2018) · Springer eBooks · doi:10.1007/978-3-319-78997-2_28 · Cited by 1
Psychosocial Treatments That “Work” for Ethnic Minority Youth
Holly, L. E., Stoll, R. D., Rapp, A. M., Piña, A., & Chavira, D. A. (2018) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780190634841.013.10 · Cited by 1
How to address clinical work with older bisexual clients and their partners?
Eleuteri, S., Rossi, R., & Simonelli, C. (2019) · Sexologies · doi:10.1016/j.sexol.2019.05.009 · Cited by 1
Cultural Factors in Behavioral Health: Training, Practice, and Future Directions
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Ilyas, M., Siddiqui, A. A., Alshammary, F. L., Al-Enizy, A. S., & Alam, M. K. (2021) · Springer eBooks · doi:10.1007/978-3-319-74365-3_14-1 · Cited by 1
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“Minority culture-specific adaptations may be less important for highly acculturated ethnic minorities (Sue et al., 2009).”
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Boeding, S., Aguilera, V., Smith, J., Handler, S. S., Snyder, J. D., & Kroll, K. H. (2023) · Ethical Human Psychology and Psychiatry · doi:10.1891/ehpp-2022-0010 · Cited by 1
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“Multiculturalism, diversity, and cultural competency are vital topics for mental health professionals (Sue et al., 2009).”
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“Hence Sue et al. (2009) called for cultural competency in counseling and mental health practices.”
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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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