Can Therapists Be Trained for Cultural Competence?

According to the United Nations, more people than ever before live in a country other than the one in which they were born. Some of these individuals and families are economic migrants seeking a better life; others are political refugees escaping violent conflicts. Whatever the reason, moving to a new country and cultural space is often stressful. Indeed, many immigrants are susceptible to developing mental disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD) (e.g., Borho et al., 2020).

Most psychotherapists in North America and Europe readily acknowledge the mental health needs of migrants and refugees, but many of them feel unprepared to provide effective treatment. Doing therapy “across cultures” involves numerous challenges. Language barriers, cultural misunderstandings, cultural differences in emotional expression, conflicting beliefs about the origins of illness, and efficacy of treatments—the list is long.

A Course to Teach Cultural Competence

To address the mental health needs of immigrants, researchers have developed and empirically tested the effectiveness of workshops and courses designed to foster transcultural (TC) competence. In Germany, which has received large numbers of refugees from Syria, a team of researchers recruited 173 psychotherapists and psychiatrists to participate in a specially designed online training course. Before their selection, all participants indicated a desire to improve their transcultural therapeutic skills (Atzor et al., 2024).

The therapists were randomly assigned to one of two versions of the course—a guided training group (GTG) or a non-guided control group (CG). Participants in both groups completed the same set of six online training modules, but participants in the GTG also received personalized feedback (via online chat with an experienced trainer) and hands-on activities that included case studies, self-reflection exercises, worksheets, mastery quizzes, and more.

Participants completed a questionnaire designed to measure TC competence at three different time points: immediately before training, immediately after training, and three months after training. The questionnaire included 38 self-report items regarding the therapist’s awareness of clients’ cultural backgrounds, commitment to providing mental health services to culturally diverse clients, and perceived effectiveness in providing mental health services to culturally diverse clients.

Of the original 173 participants, 68 dropped out during the six-week course, and an additional 10 failed to complete the follow-up questionnaire three months later. A total of 95 therapists (41 in GTG and 54 in CG) completed all of the training modules and questionnaires.

For a study like this one that recruited motivated participants, the dropout rate was curiously high, which is a bit worrisome. Some therapists may have found the course to be more time-consuming than expected. Another possibility is that some therapists may have judged the course’s content to be less helpful than expected.

Interpreting Mixed Results

As predicted, most of the 95 participants reported higher levels of awareness and commitment after they completed the training. Similar increases were observed in both groups, the enriched GTG group and the control group that received the bare-bones, text-only curriculum.

Unfortunately, most participants who completed the training—even those in the enriched GTG group—did not report a higher level of perceived effectiveness. Given that increased therapeutic effectiveness is the main goal of transcultural competency training, this result was disappointing.

According to the researchers, the therapists in their study may have become more skilled but didn’t report a greater sense of efficacy because the training had given them a greater degree of cultural humility. In other words, the therapists may have recognized their limitations in intercultural contexts, a realization that might lower a therapist’s perceived effectiveness, at least in the short run.

That explanation has merit, but I favor a different interpretation. In my experience, cultural competency training programs typically focus on generic principles such as “acknowledge and control your biases” and “consider a client’s worldview when selecting treatments and goals.” Learning these principles can help therapists become more culturally aware and committed, but the principles are also difficult to implement. Controlling my personal biases and accessing my clients’ worldviews are easier said than done.

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The generic principles by themselves don’t give therapists the specific tools they need when working, for example, with a Syrian business owner or married Somali couple (Ibrahim & Dykeman, 2011). Therapists working with culturally diverse clients need a larger-than-usual toolbox filled with specific cultural knowledge (about Somalia, for example) and techniques that can be used to assess a client’s linguistic proficiency, migration concerns, changes in social status, acculturation strategy, religiosity, construal of self (independent or interdependent), views on gender roles, and more. Unfortunately, most cultural competency training programs fail to include these crucial components.