Lessons From a Cross-Cultural Therapist

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In a world that’s keen on spotlighting differences, there’s solace in our ability to connect with each other in ways that foster deep psychological healing. We can happen on such encounters through chance or practice, with kin or strangers, friends or therapists. It’s particularly poignant when a warm and safe holding environment that often heralds any healing emerges between people who, at first glance, are very dissimilar.

For psychotherapist Doris Chang, every therapeutic relationship is a cross-cultural one, given each party’s unique constellation of cultural identities and lived experiences. Efforts to bridge those differences are aided by two resources: 1) cultural intelligence and its relevant competencies, and 2) the ability to show up with curiosity and kindness for others.

Here are six questions with Dr. Chang on nurturing connections despite our differences.

Marianna Pogosyan: What are the key elements of successful cross-cultural psychotherapy?

Doris Chang: Effective cross-cultural psychotherapy comes down to balancing three things.

First—being self-aware of my worldviews that stem from my culture and my experiences, and how they show up in my perceptions and interactions with my patients. That’s my filter through which I receive the person and interpret their verbal and nonverbal communication. Self-awareness allows me to hold this filter, along with its biases, lightly.

Second—having content knowledge. A general understanding of what it means to live in my patient’s cultural world will allow me to gain key insights into the person’s experience. It means knowing something about the way that society is structured, how power is distributed, and where the person likely falls within that power structure. These variables will shape the likelihood of the person having experienced trauma or being elevated in their society.

Third—the ability to cultivate a connection with another person. That means being curious, receptive, compassionate, and having empathy. These competencies can facilitate putting ourselves into the experience of others and meeting them where they are.

MP: How can we form heart-to-heart connections with others despite our differences?

DC: In a sense, we’re trying to override our evolutionary tendency to see differences and categorize people as a member of one’s in-group or outgroup. We might even perceive others as a threat. When we feel this automatic elicitation of “othering,” we can use strategies to activate an alternative state that allows us to be more receptive, less guarded, and more compassionate. Here, contemplative practices can be useful. For example, research suggests that mindfulness can help us manage intergroup anxiety and fear, soften our perceptions of threat, and decrease our reactivity to automatically activated stereotypes and biases. Mindfulness can also help us find common ground by expanding our sense of self to encompass the other person and their experience.

We can develop skills to improve our ability to ask questions, challenge our assumptions, and actively listen to our patients. In clinical settings, we can shift to doing intakes that center on how the person makes meaning out of their experiences without jumping to assumptions based on our own experience.

When I train clinicians in mindful listening, they often realize how rarely they feel really listened to. In our daily interactions, people are mostly multitasking. Their attention is elsewhere. They’re waiting for you to stop talking so they can have their turn. Attuning to another person through deep presence and attention is a skill we all can cultivate.

MP: What in-the-moment strategies can help with attunement?

DC: Alongside paying attention to the other person, pay attention to what’s coming up for you. You might notice that tension is arising, or a worry that you’ll say something wrong. Notice the stories you tell yourself about the other person and how much of those stories are based on real-time data. When you track your experience this way, you may realize that your stories are based on your assumptions, biases, and past experiences.

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Try a technique that the late Stanley Sue, my mentor, called scientific mindedness. Hold your assumptions lightly, as a working hypothesis. Instead of asserting, “This person is like this!” we can be more scientific-minded and see if, over time, there’s enough evidence to support our assumptions. Observe how your own behavior affects the reactions of the person you are interacting with. For example, being dismissive with my conversation partner will elicit a different reaction than if I were kind. Be mindful of what you are putting into the relational space. This will also allow the other person to show you who they are with as much openness and honesty as possible.

MP: What are some challenges of cross-cultural psychotherapy?

DC: One key challenge is feeling that the clinician may not understand something core to the patient’s experience because they don’t have enough contextual knowledge. Furthermore, if the clinician is not self-aware enough about the ways in which they’re imposing their own understanding of the world onto their patient, it can cause harm and even exacerbate the patient’s symptoms.

MP: When can cross-cultural psychotherapy be advantageous?

DC: Some patients prefer to work with clinicians who are culturally different from them. In our studies, this had to do with their experience of being judged and discriminated against within their own communities. For example, some sexual minority patients sought out therapists who were culturally different, who they perceived as more permissive, more understanding, or less judgmental. In this way, cross-cultural psychotherapy might allow patients more room to explore things that might be stigmatized within their own communities.

Another advantage of cross-cultural psychotherapy is that it forces people to be explicit about their beliefs and values. Sometimes, when our convictions are held up to the light, we may discover that there is not enough evidence to support them. You might be explaining something to the therapist who knows very little about your culture and realize that something that had been a taken-for-granted aspect of your worldview actually doesn’t make much sense. One way to arrive at this insight about your own cultural programming is by verbalizing it to another person who doesn’t necessarily share this understanding.

For immigrant patients or those who are members of a minority group, they may find that they can also learn new ways of seeing things from working with a majority-group therapist. In these instances, some patients report feeling like their therapists are like cultural guides, because they help them decode or translate certain things about the broader society.

MP: What lessons on relating does cross-cultural psychotherapy offer?

DC: As a clinician, my stance is other-oriented. My priority shifts from expressing myself and feeling seen to an intense curiosity and attention focused on the other. That’s a beautiful orientation, because my own stuff recedes. I become less anxious, less self-conscious. I’m leading with the desire to really know another person. This intention shows up in the quality of our attention, in our body language, and in the questions we ask. That’s not a typical way of how we relate to others. Usually, we’re eager to be heard and to tell our stories. We can all try on this orientation, quieting the need to take up all the space and instead focus on trying to get to know the other person. To be on the receiving end of that kind, compassionate attention allows others to show who they are in ways that might help transcend our differences. We witness our common humanity. We see the goodness and purity in another person. We realize that we’re all struggling in some ways and doing the best we can.

Many thanks to Doris Chang for her time and insights. Dr. Chang is a licensed psychologist with Soho CBT+Mindfulness Center in New York City and an Associate Professor at the New York University Silver School of Social Work.