Am I a Culturally Competent Therapist?

March 20th, 2018 by Nana Amoh

Photo by Charisse Kenion

If you are a mental health provider who works with diverse clients, you have probably asked yourself if you are a culturally competent therapist. Before you asked yourself this question, you likely thought about what qualifies as a culturally competent therapist and whether cultural competence can even be formally assessed. As helping professionals, we are tasked with counseling, teaching, consulting, and advocating for our clients using modalities that are consistent with our clients’ life experiences and values (Sue & Torino, 2005). We use our knowledge, awareness, and skills to acknowledge and to affirm the cultural variability embedded in the lives of individuals, couples, families, and communities. Admittedly, doing of all this can be challenging. Nonetheless, ascertaining whether our provision of culturally specific services is appropriate, sensitive, and relevant for our clients is something that we must do routinely. Assessing cultural competence is critical, because culturally competent delivery of healthcare services is associated with better quality of care and better health care outcomes among culturally diverse individuals (Anderson, Scrimshaw, Fullilove, Fielding, & Normand, 2003). Conversely, lack of cultural competence has been associated with misdiagnoses, underutilization of services, mistrust of healthcare and healthcare professionals, and poor health outcomes in minority populations (Suite, La Bril, Primm, & Harrison-Ross, 2007).

As mental health providers, we have an ethical obligation to ensure that we are utilizing culturally appropriate skills in our therapeutic work with clients. By engaging in regular self-evaluation, we can become more attuned to our strengths and weaknesses as culturally sensitive therapists. The Cultural Competence Self-Evaluation Form (CCSE)—developed by Anthony J. Marsella, Ph.D., Emeritus Professor, University of Hawaii—is a measure that can help you reflect on your current level of cultural competence. Your results should specifically help you recognize areas of competence that you have mastered as well as areas of competence where you may need improvement.

We’ve added the scale below for therapists who wish to see where they are in their own goals towards cultural competence. Remember, that no matter where your score falls, we are all evolving and learning!

Cultural Competence Self-Evaluation Form (CCSE)

Therapist: Ethnocultural Group __________________________

Client:     Ethnocultural Group: __________________________

Rate yourself on following items to score your “cultural competence” for this client:

Very True                   True                Partial True                Not True         Unsure

4                           3                         2                                  1                               U


  1. ____ Knowledge of group’s history
  2. ____ Knowledge of group’s family structures, gender roles, dynamics
  3. ____ Knowledge of group’s response to illness (i.e., awareness, biases)
  4. ____ Knowledge of help-seeking behavior patterns of group
  5. ____ Ability to evaluate your view and group view of illness
  6. ____ Ability to feel empathy and understanding toward group
  7. ____ Ability to develop a culturally responsive treatment program
  8. ____ Ability to understand group’s compliance with treatment
  9. ____ Ability to develop culturally responsive prevention program for group
  10. ____ Knowledge of group’s “culture-specific” disorders/illnesses
  11. ____ Knowledge of group’s explanatory models of illness
  12. ____ Knowledge of group’s indigenous healing methods and traditions
  13. ____ Knowledge of group’s indigenous healers and their contact ease
  14. ____ Knowledge of communication patterns and styles (e.g., non-verbal)
  15. ____ Knowledge of group’s language
  16. ____ Knowledge of group’s ethnic identification and acculturation situation
  17. ____ Knowledge of how one’s own health practices are rooted in culture
  18. ____ Knowledge of impact of group’s religious beliefs on health and illness
  19. ____ Desire to learn group’s culture
  20. ____ Desire to travel to group’s national location, neighborhood

Total Score: = _____________________________________

80-65: Competent: Sufficient to begin clinical work

65-40: Somewhat Competent: Proceed with Caution. Continue learning.

40 or Below: Caution. Risk of Diagnostic, Assessment, and Therapy Errors

This measure is, at best, a beginning for increasing sensitivity to the issue of defining, understanding, and applying “cultural competence” to optimize therapeutic interventions.

Appeals to the word “research” are problematic because the research is characterized by many limitations. Too often we mistake the terms “empirical” and “quantitative,” for rigor and accuracy. Care is needed!   We must not make a fetish of “science.”

There is an important difference in knowledge and ability in the ratings. The measure should be taken as a source of information for considering the pro and con of clinical work.

Competence must also be considered within the context of the service system constraints. Clearly, subjective and objective evaluations should be used in the decision.

The best safeguard for optimum success and healing is constant appraisal using client, professional, and family. These are not redundant.

Continue learning more about ethnocultural considerations in mental health.

Source: Twelve Critical Issues for Mental Health Professionals Working with Ethno-Culturally Diverse Populations. APA PSYCHOLOGY INTERNATIONAL * October 2011

Anthony J. Marsella, PhD, Emeritus Professor, University of Hawaii

© AJM (2009) Atlanta, Georgia. Free use


Anderson, L. M., Scrimshaw, S. C., Fullilove, M. T., Fielding, J. E., & Normand, J. (2003).

Culturally competent healthcare systems: A systematic review. American Journal of Preventive Medicine24(3), 68-79.

Sue, D. W., & Torino, G. C. (2005). Racial-cultural competence: Awareness, knowledge, and skills. Handbook of racial-cultural psychology and counseling: Training and practice2, 3-18.

Suite, D. H., La Bril, R., Primm, A., & Harrison-Ross, P. (2007). Beyond misdiagnosis,

misunderstanding and mistrust: relevance of the historical perspective in the medical and mental health treatment of people of color. Journal of the National Medical Association99(8), 879.

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