A number of psychologists argue for integrating cultural and gender sensitivity into the therapy process because of the significant influence that such factors can have on therapy. Those who favor multicultural therapy models focus on cultural specificity—that therapy should be adapted to specific cultures due to differing cultural norms, expectations, and identities. Proponents of multicultural models contend that psychological processes are not universal, but culturally specific.

Cultural Specificity

Those who believe in culturally specific treatment point to differing standards across cultures for what is deemed normal and what is deemed abnormal, or psychopathological. In some cultures, for example, hallucinations are considered a form of spiritual communication; those who experience hallucinations are respected or even revered, rather than labeled "crazy." 

Those who support cultural specificity also point to the problem of power in defining what is normal or pathological. The majority of "universal" standards for what is deemed normal or pathological are determined by European-American psychology. These standards hold a great deal of power, yet are very biased, since they come almost entirely from a European-American perspective. Advocates of cultural specificity argue that this reflects a power imbalance which denies many individuals culturally appropriate care.

Cultural Influences on Therapy

Culture  and gender can influence the therapy process in a number of ways. For example, different cultural groups communicate in different ways. African-Americans have been found to use significantly more non-verbal communication and non-verbal cues. If a Caucasian therapist is trying to encourage a client to communicate verbally in a session, the therapist may misunderstand the non-verbal communication cues given off by a client of another race. Culture will also influence factors such as how trust is built in the therapeutic relationship, how help-seeking behavior manifests (or doesn't manifest, or how quickly), how therapy is viewed (for instance, if being in therapy is considered stigmatizing or shameful), how emotions are expressed, what is considered appropriate to discuss or express, and many other factors.

The Sociocultural Model and Multicultural Therapies

The sociocultural perspective looks at you, your behaviors, and your symptoms in the context of your culture and background. As our society becomes increasingly multiethnic and multiracial, mental health professionals must develop cultural competence, which means they must understand and address issues of race, culture, and ethnicity. They must also develop strategies to effectively address the needs of various populations for which Eurocentric therapies (therapies with a strong European or Western bias) have limited application. For example, a counselor whose treatment focuses on individual decision-making may be ineffective at helping a Chinese client with a collectivist approach (or more group-based approach) to problem-solving (Sue, 2004).

This sociocultural perspective integrates the impact of cultural and social norms, starting at the beginning of treatment. Therapists who use multicultural therapy work with clients to obtain and integrate information about their cultural patterns into a unique treatment approach based on their particular situation. This approach also examines how certain ethnicities in the United States are less likely to access mental health services than their White middle-class American counterparts. Barriers to treatment include lack of insurance, transportation, and time; cultural views that mental illness is a stigma; fears about treatment; and language barriers.

Gender and Therapy

A number of research studies have also found gender to be an important factor in how an individual communicates. The ways in which men and women are socialized in Western countries determines how they will express themselves, how they will experience and express their emotions, and what is considered normal or abnormal. For instance, aggression in men is somewhat normalized in the United States, but it is generally considered problematic or a sign of "imbalance" in women. At the same time, people raised as female are encouraged to talk about feelings (such as sadness, love, hurt, fear) much more than males are; those raised as male are often taught to repress these feelings or keep them hidden. Symptoms of depression will often manifest very differently between men and women due to how each gender is socially taught to channel their emotions (for instance, depression in men will often manifest as increased irritability or anger). If a therapist fails to take into account the differing ways in which males and females are socialized, and how this manifests psychologically, they might misunderstand and misdiagnose what a client is encountering.

Depression and gender

This statue by Antun Augustincic depicts a woman who is depressed. Due to gender socialization, men and women may express depression differently, which is an important consideration when planning a course of therapy.