What Cultural Competence Means and How It Shows Up in Mental Health Care

Key takeaways

• Cultural competence combines self-awareness, knowledge, and skills to communicate effectively across cultures outside your own.
• In mental health care, cultural competence improves trust and treatment outcomes and helps prevent misdiagnosis and harm.
• Cultural humility is now considered the modern standard and involves viewing cross-cultural understanding as an ongoing process rather than a skill to master.

A young woman sits in her therapist's office describing symptoms her family calls "nerves." She's careful not to mention the traditional healer she's been seeing or the prayers her grandmother insists will help. She worries her therapist won't understand, or worse, will dismiss what matters most to her family.

This disconnect happens more often than it should in mental health care. Cultural background shapes how people understand distress, express symptoms, interpret mental challenges, and seek help.

Cultural competence bridges that gap. It's the difference between care that feels alienating and care that is meaningful. When therapists understand how culture influences mental health, they can provide treatment that respects who their clients are and where they come from.

What is Cultural Competence?

According to the Centers for Disease Control and Prevention (CDC), cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals and enable that system, agency, or those professions to work effectively in cross-cultural situations.

When people ask what cultural competence is, they're usually asking what they can do differently. Cultural competence can be understood through three interconnected elements:

• Attitude: Awareness of your own assumptions and biases
• Knowledge: Understanding of diverse cultural practices and worldviews
• Skills: Practical behaviors that demonstrate respect and adaptability

Why Cultural Competence Matters Today

Cultural competence matters because it can have a direct impact on clinical outcomes. According to Cultural competence: a systematic review of health care provider educational interventions (Medical Care), cultural competence training has a positive impact on patient satisfaction.

In mental health care, it can improve trust between care providers and members, enhancing engagement and therapeutic relationships. Culturally competent therapists can also help reduce health disparities within marginalized racial and ethnic groups while enhancing the safety and efficacy of services.

On the other hand, when cultural competence is absent, harm can occur. When someone feels dismissed or stereotyped, they may share less with their therapist, disengage, or even completely stop seeking mental health care.

Misdiagnosis can become more common when mental health care providers don't understand how different cultures express distress or describe symptoms. Subtle, indirect, or unintentional discrimination, called microaggressions, can erode trust, causing members to drop out of treatment. Even in the workspace, a lack of cultural competence can contribute to communication breakdowns and retention problems.

Care providers who practice cultural competence skills create environments where individuals feel safe sharing their experiences. When members feel understood and respected, they're more likely to follow through with treatment recommendations.

"Understanding how culture plays a role in how a client presents with symptoms is incredibly important. Often times, diverse populations struggle to convey what they are feeling as it was not common place for them to express it. It is helpful to clinicians to consider how to ask specific questions or be transparent about not knowing enough. Most clients from minority populations seeking treatment already start off with the knowledge that their culture may not be considered. Being transparent and asking questions about their cultural background helps ease and support clients. Cultural competency is not about knowing about all cultures but knowing enough to ask the pertinent questions and being vulnerable as therapists too."

- Talkspace Therapist, Minkyung Chung, MS, LMHC

Core Components of Cultural Competence

Cultural competence develops through an ongoing process rather than a one-time achievement. Building cultural competence means working on three essential areas, each reinforcing the others.

1. Self-awareness of biases (The starting point)

Cultural competence begins with looking inward. Everyone carries implicit biases that have been shaped by their own cultural backgrounds, experiences, and personal values. However, the starting point isn't eliminating these biases, which is likely impossible. Instead, you must simply become aware of them.

Awareness requires honest introspection about your assumptions, stereotypes, and comfort levels when interacting with people from different backgrounds. Self-reflection helps you notice when your biases might be influencing your judgments or actions.

2. Cultural knowledge and worldviews (Beyond stereotypes)

Cultural knowledge involves more than memorizing facts about specific groups. You must understand broader frameworks like how different cultures approach family structures, view mental health, communicate indirectly rather than directly, or integrate spiritual beliefs into wellness.

The goal isn't to become an expert on every culture, which, again, is likely impossible. Instead, you must develop a general awareness of how cultural worldviews shape people's experiences and expectations. This knowledge helps you avoid assumptions and stereotypes and remain open to learning from each person.

3. Skill development (Application in practice)

Knowledge alone doesn't create competence. You need practical communication skills to apply what you've learned.

Active listening, where you truly focus on understanding someone's perspective without jumping to conclusions, is an essential cultural competence skill. Validation, which acknowledges that a person's experiences are real and meaningful, builds trust.

Asking respectful, clarifying questions shows a genuine interest in understanding someone's unique cultural background. These skills take practice, but they become more natural over time.

Cultural Competence vs. Cultural Humility (The Modern Distinction)

While the meaning of cultural competence has shifted over the years, it's often perceived as something you can learn and be done with. Cultural humility offers a different approach that's becoming the preferred modern standard.

Let's understand how these concepts differ in practice:

Leading Model and Frameworks

Several academic models provide the structure for developing cultural competence.

According to The Process of Cultural Competence in the Delivery of Healthcare Services: A Model of Care , cultural competence develops through the following interconnected components:

• Cultural awareness: Self-examination of biases
• Cultural knowledge: Learning about different worldviews
• Cultural skill: The ability to conduct culturally sensitive assessments
• Cultural encounters: Direct cross-cultural interactions
• Cultural desire: The genuine motivation to engage in this process

These frameworks offer a system for structured skill development.

Real-World Examples Across Sectors

Cultural competence looks different depending on the setting, but the core principles remain the same.

These examples illustrate how professionals apply it in their work:

Workplace collaboration case

 Kathleen manages international teams and remote workers from different cultural backgrounds as a content manager, making cultural competence essential to her role. A culturally competent manager recognizes that direct criticism is welcomed in some cultures but feels harsh in others, so she adapts her feedback style accordingly.

She understands that team members may view hierarchy differently based on their backgrounds—some expect clear directives while others prefer collaborative decision-making.

She also notices when silence in meetings might indicate disagreement rather than agreement, depending on cultural norms around speaking up to authority. By making these adjustments, Kathleen's team experiences fewer misunderstandings, stronger collaboration, and higher engagement across cultural lines.

Clinical settings example

Todd is an online mental health therapist who works with clients from diverse cultural backgrounds, making cultural competence essential to effective care.

He recognizes that some cultures prioritize family involvement in treatment decisions while others emphasize individual autonomy, so he asks each client about their preferences early on. He also understands that depression symptoms might be described primarily as physical complaints in some cultural contexts rather than emotional ones, which helps him avoid misdiagnosis.

By adapting his approach to each client's cultural framework rather than assuming everyone shares the same expectations about therapy, Todd builds stronger therapeutic relationships and achieves better treatment outcomes.

7-Step Plan to Build Your Cultural Competence Skills

Cultural competence develops through deliberate practice, not passive observation. These seven steps provide a structured approach to building skills you can apply immediately.

Step 1: Complete a self-assessment

 Start by identifying your cultural gaps, blind spots, and areas of discomfort. Ask yourself:

• Which cultural groups do I know least about?
• What assumptions do I make?
• When do I feel uncomfortable, and why?
• What privileges or disadvantages have shaped my worldview?

Step 2: Seek out diverse perspectives

 Actively expose yourself to different viewpoints through media, literature, and social circles outside your usual patterns. Read books by authors from various backgrounds, watch films from other countries, and follow diverse speakers on social media.

Step 3: Learn cultural norms and communication styles

Pay attention to non-verbal cues like eye contact, personal space, gestures, and other body language, which can vary widely across cultures. Study how context matters in communication, with some cultures valuing directness and others preferring indirect approaches.

Step 4: Practice adaptive communication

Adjust your formality, speaking pace, and language complexity based on who you're talking to. This doesn't mean oversimplifying or talking down to people. It means communicating in ways that connect with and respect your audience.

Step 5: Recognize and interrupt microaggressions

Learn to identify subtle discriminatory comments or behaviors and develop immediate, appropriate responses. You may use responses like "I don't think you meant harm, but that comment reinforces a stereotype" or "let's reconsider that assumption."

Step 6: Advocate for systemic change

Apply cultural competence at organizational levels by pushing for diverse hiring, inclusive policies, and equitable practices. Individual competence matters, but systemic change creates lasting impact.

Step 7: Embrace continuous learning

Transition from viewing cultural competence as an achievement to embracing cultural humility as an ongoing commitment. Stay curious, accept that you'll make mistakes, and remain open to growth.

Common Challenges and How to Overcome Them

Building cultural competence isn't without obstacles, and recognizing common challenges helps you navigate them more effectively.

Here's how to address the barriers that practitioners encounter most frequently:

"It can be challenging to be mindful of cultural competence when moving forward with working with clients. There's a hesitancy that anything can be misconstrued as a lack of consideration so overcompensation can occur. Finding the right balance of competency and humility is important. One way to help move past the hesitancy/overcompensation is to be honest with the client at the outset of therapy. Another strategy is to educate themselves about the culture the client is a part of so that relevant questions can be asked. Clinicians are considered experts in the field and so we tend to try to come off that way as well, but in cultural competency it is important to show that you may not know enough. It's important to remember that family units within the culture also work differently. Humility and vulnerability is necessary for clients of diverse populations to feel seen and listened to by others."
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- Talkspace Therapist, Minkyung Chung, MS, LMHC

Finding Culturally Competent Mental Health Support

When seeking online therapy, cultural competence should be a priority. Look for providers who demonstrate self-awareness about their own cultural background, ask culturally informed questions about your experiences, and create space for you to share your unique cultural context without making assumptions.

Many accessible mental health services now allow you to filter therapists based on cultural background, language, specialty areas, and therapeutic approach. This filtering helps ensure a better therapeutic fit and increases the likelihood you'll feel understood.

Talkspace prioritizes matching members with diverse providers trained in culturally responsive care, recognizing that representation and cultural understanding improve outcomes.

Finding the right therapist means looking beyond credentials to consider whether they demonstrate cultural humility. Do they acknowledge what they don't know? Do they ask about your cultural values and how these might influence treatment? Do they adapt their approach based on your needs? These questions help identify providers committed to culturally competent care.

Connect with a Talkspace therapist who values cultural competence and can provide care tailored to your unique background and experiences.

Frequently Asked Questions

How does cultural competence differ across professional settings like healthcare, therapy, and workplaces?

The core principles of cultural competence remain consistent, but application varies by setting. In healthcare and therapy, it focuses on understanding how cultural beliefs influence health behaviors, symptom expression, and treatment preferences. In workplaces, it emphasizes communication styles, team collaboration, and creating inclusive environments.

Can cultural competence be measured or evaluated in real-world practice?

Yes, cultural competence can be measured, though it's challenging. Self-report surveys assess knowledge, attitudes, and skills, while performance evaluations and member satisfaction surveys reveal whether diverse populations feel respected and understood. Combining multiple evaluation methods provides the most accurate measurement.

What are common mistakes people make when trying to practice cultural competence?

Common mistakes include treating cultural competence as a one-time checklist rather than an ongoing process, making assumptions based on someone's appearance, and lumping all members of a cultural group together. Other errors include ignoring aspects of identity beyond race and believing good intentions excuse harmful impacts. Avoiding these pitfalls requires humility and a willingness to learn from mistakes.

How can cultural competence help prevent bias, miscommunication, or harm in mental health care settings?

Cultural competence helps providers recognize their own assumptions and different communication styles, reducing bias and miscommunication through awareness and clarifying questions. It prevents harm by ensuring treatments align with cultural values rather than mistaking normal cultural differences for psychological disorders.

Can someone practice cultural competence without having personal experience in other cultures?

Yes, cultural competence can be practiced without personal cross-cultural experience through education, self-awareness, and learning from diverse perspectives. However, those without direct experience should practice even greater cultural humility, acknowledging the limits of their understanding and remaining eager to learn from each person's unique perspective.

Sources:

1. Gervin, D, Kuwahara, R, Lane, R, Gill, S, Moeti, R, Wilce, M. Practical strategies for culturally competent evaluation. Centers for Disease Control and Prevention. https://www.cdc.gov/national-asthma-control-program/media/pdfs/2024/05/cultural_competence_guide.pdf. Accessed December 2014.
2. Beach MC, Price EG, Gary TL, et al. Cultural competence: A systematic review of health care provider educational interventions. Medical Care. 2005;43(4):356-373.  https://pubmed.ncbi.nlm.nih.gov/15778639/. Accessed January 20, 2026.
3. Campinha-Bacote, J. The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing. https://www.vhwfresourcelibrary.org/resources/30_campina_bacote%20Cultural%20Competency.pdf. Accessed July 2002.

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