What It Takes to Be a Culturally Responsive Therapist
Summary
After reading this article, therapists will:
Understand the critical cultural competencies needed when working with immigrant mental health, including training in culturally appropriate care, recognizing systemic oppression, and developing cultural humility
Learn evidence-based approaches for cultural adjustment therapy to support clients navigating acculturation stress, language barriers, and adjustment difficulties
Discover how to address language barriers effectively through professional interpreters and pre-session planning to preserve the therapeutic alliance
Have access to key resources available for immigrants including legal support, mental health directories, and advocacy organizations
Have an awareness of how to handle immigration trauma including trauma-informed frameworks, such as narrative therapy and safety planning for clients facing ongoing threats
Develop strategies for how to work with interpreters, including selecting mental health-informed translators and maintaining emotional attunement during sessions
For therapists currently working with immigrant mental health, creating a safe, culturally responsive space for clients has never been more critical.
With the current rise in mass deportation efforts throughout the U.S., many clients are experiencing increased mental health impacts due to immigration-related stressors.
In this era of heightened U.S. Immigration and Customs Enforcement (ICE) activity, clients, families, and communities are navigating direct impacts on their family dynamics, mental health, sense of safety, stability, livelihood, basic human rights, and peace.
The possibility of facing life-altering, unexpected, traumatic uprooting through unjust causes or methods creates legitimate and profound concern.
This article explores important considerations for therapists working with immigrant mental health, including evidence-based approaches to cultural adjustment therapy and practical strategies for supporting this vulnerable population.
Cultural competencies needed
By understanding what cultural competencies are needed, learning how to handle immigration trauma, knowing what resources are available for immigrants, and developing skills in how to address language barriers and how to work with interpreters, therapists can create safe, affirming spaces for clients who are immigrants to heal and thrive.
According to the American Immigration Council, one out of every seven Americans was an immigrant as of 2023, comprising about 14% of the U.S. population. These 47.8 million people represent diverse cultures who may be impacted by immigration-related stress.
Research from the U.S. Committee for Refugees and Immigrants indicates that "restrictive and punitive immigration policies are directly associated with adverse mental health outcomes among undocumented immigrants, including increased rates of depression, anxiety, posttraumatic stress disorder (PTSD), and substance use."
This highlights the critical need for mental health support when working with immigrant mental health concerns.
To best support clients navigating these challenges, developing cultural competency is essential for understanding the unique issues affecting this population.
Developing essential cultural competencies
Cultural competency development when working with immigrant mental health can include:
Obtaining additional training in culturally appropriate care for people from various ethnic, racial, and cultural backgrounds
Pursuing continued education on issues of racism, identifying prejudice (especially when implemented through policy), and understanding the impact of ethnic and cultural stereotypes
Learning to recognize macro and microaggressions, racial and language profiling, and various presentations of systemic oppression and injustice
Examining and challenging personal biases concerning politics, policies, race, and culture
Understanding systemic impacts is crucial. There have been many documented cases where the lines have blurred between legal policy and lawless protocol, negatively impacting both undocumented immigrants and U.S. citizens.
Both groups have reported racial profiling from ICE agents, where immigration status, legal compliance, and criminal history are assumed rather than properly and lawfully verified.
ProPublica reports more than 170 cases in recent years where U.S. citizens were detained at raids and protests.
When systems operate through lawless protocols, safety and justice are compromised, potentially increasing the number of immigrant clients and citizens seeking support due to immigration-related injustice and trauma.
The role of cultural humility
Vivian Chung Easton, LMFT, describes cultural humility as "acknowledging one's own biases, being open to learning from clients, and valuing the unique cultural experiences they bring to therapy." This approach allows therapists working with immigrant mental health to better understand clients' lived experiences of injustice.
Cultural humility is "a continuous process of self-reflection and self-critique, allowing therapists to build genuine, trusting relationships with clients from diverse backgrounds," Easton explains.
This sensitive understanding enables therapists to challenge biases and help clients from a place of empathy, validation of their oppression, and advocacy for justice.
How to handle immigration trauma with trauma-informed care
Developing a social justice-informed framework in your clinical approach can help prevent re-triggering oppression and provide emotional safety for clients processing traumatic events.
This includes becoming knowledgeable about how oppressive systems manifest their impact on interpersonal and intrapersonal levels.
This knowledge equips clinicians to give language to clients' experiences of microaggressions, racial profiling, fear mongering, abuse of power and resources, systematic family separation, inhumane and degrading protocols, and ethnic stereotyping. In turn, this validates, reassures, and empowers clients while they process traumatic experiences.
Understanding the scope of immigration trauma
Immigration trauma when working with immigrant mental health can include:
Traumatic transition between a client's home country and the U.S.
Wrongful detention and aggressive arrests
Traumatic deportation
Family separation
Being wrongfully targeted by ICE based on race, appearance, occupation, or language
Therapeutic approaches for immigration trauma
Allowing clients to reclaim their voice by telling their story through modalities like narrative therapy or trauma-focused cognitive behavioral therapy (TFCBT) can support healing work.
Considering the ongoing threat of family separation or deportation as an unresolved stressor, it's important to:
Reassure clients of confidentiality
Develop a safety plan
Identify community support and resources for stability of basic needs
Build coping skills
Provide advocacy support
What resources are available for immigrants and their families?
Connecting clients to resources is a crucial component of working with immigrant mental health.
Here are key organizations providing support:
Legal and advocacy support
The Immigration Legal Resource Center provides immigration law training, education on policy, and advocacy support to immigrants.
The International Rescue Committee offers assistance to refugees and immigrants, including help obtaining green cards, financial assistance, job training, and preparatory classes for citizenship tests.
The Los Angeles County Office of Immigrant Affairs provides a Know Your Rights Resource Hub, making local resources accessible to immigrant communities.
Mental health resources
Organizations like United We Dream connect undocumented individuals to a mental health directory for free and low-cost therapy services.
The American Psychological Association has provided advocacy on the policy level with the U.S. Senate for humane immigration policies that protect unaccompanied immigrant minors from the risks of human trafficking and psychological impacts on their mental health and well-being.
When to address acculturation stress in treatment
Migrating to a new country and adapting to a way of life different from one's home country can be a profound culture shock.
Understanding when to address acculturation stress is essential when working with immigrant mental health.
Understanding acculturation stress
Immigrant clients may face stress while:
Adjusting to new cultural differences and norms
Navigating language barriers
Managing the tedious process of pursuing citizenship
Experiencing social isolation and difficulties seeking community while away from family, friends, or a stable support system
Facing discrimination and prejudice
This constellation of stressors is called acculturation stress.
Incorporating acculturation into treatment planning
It's helpful to explore adjustment difficulties and determine when to address acculturation stress in the intake process.
This allows you to:
Normalize and validate clients' experiences
Provide coping strategies and resources
Formulate a more comprehensive diagnosis and treatment plan that incorporates the impact of acculturation stress
Cultural adjustment therapy: A framework for supporting immigrant clients
Cultural adjustment therapy is an evidence-based approach specifically designed to support immigrant clients through the adjustment difficulties of acculturation stress. This therapeutic framework is particularly effective when working with immigrant mental health concerns.
Implementing cultural adjustment therapy into your practice
When incorporating cultural adjustment therapy, consider these key principles:
Client as cultural expert
Remain flexible and adaptable, recognizing the client as the expert in their own culture. Welcome clients to inform the therapeutic process with their unique cultural needs and perspectives.
Validation and normalization
Cultural adjustment therapy normalizes the challenges of adapting to a new culture while validating the real difficulties clients face. This reduces shame and isolation.
Strengths-based approach
Focus on the resilience, courage, and strengths clients demonstrate through their immigration journey. Cultural adjustment therapy emphasizes adaptive coping rather than pathologizing normal responses to extraordinary circumstances.
Systemic awareness
Cultural adjustment therapy incorporates understanding of how systemic factors—including immigration policies, discrimination, and economic barriers—impact individual mental health.
How to address language barriers in therapy
When there is a language barrier, addressing it appropriately is essential for effective cultural adjustment therapy and working with immigrant mental health overall.
The importance of professional interpretation
When considering how to address language barriers, it's crucial to elicit the support of a professional interpreter—not only for direct translation, but also contextual translation of clinical and cultural nuances.
While some clients may feel more comfortable utilizing a family member for translation support, this may not always be clinically appropriate. For example, some bilingual children of immigrant parents serve in the important family role of providing translation in daily conversations.
However, in a clinical context, this creates issues around:
Confidentiality
Potential perpetuation of parentification or adultification
Inappropriately exposing children or youth to traumatic details while translating an adult's clinical processing
This can create increased negative impacts on youth's mental health and family dynamics when the need for interpretation overrides providing children with age-appropriate conditions for their own processing and support.
Best practices for addressing language barriers
When addressing language barriers, it's clinically appropriate to:
Discuss with the client the language barrier and the need for a professional interpreter
In some cases, refer the client to a clinician who can provide services in the client's primary language (particularly if too much clinical context gets lost in translation)
Provide translatable written explanations of these considerations early in consultations or intake
How to work with interpreters effectively
Understanding how to work with interpreters is a critical skill for therapists providing cultural adjustment therapy and working with immigrant mental health.
Selecting mental health-informed interpreters
When considering how to work with interpreters, selecting a mental health-informed interpreter is essential. Some clinical terms don't translate neatly into every language, so navigating the closest adaptation to convey similar meaning must be cohesive between therapist, translator, and client.
Clinical implications and nuances are best translated when prior context is understood, especially concerning critical information like diagnosis, risk management, and limits to confidentiality.
Pre-session planning with interpreters
In my associate work in community mental health, I found that having case consultation and pre-session planning meetings with interpreters prior to meeting with clients helped best prepare for complex scenarios.
Just as clinical language and nuances may get lost in translation, cultural language and nuances in the client's dialect may also be lost, and some non-verbal contextual cues may not be captured in the translation process.
Maintaining the therapeutic alliance
Similar to the game of telephone, some clinical content and cues may be lost in the passing of information through an interpreter.
To assist in preserving the therapeutic alliance and increase the possibility of catching non-verbal cues that may be clinically valuable, maintain:
Direct eye contact with the client (not the interpreter)
Present, attuned body language oriented toward the client
Emotional attunement to the client as if speaking to them directly, even while interpretation is occurring
This practice helps preserve the therapeutic connection central to effective cultural adjustment therapy.
Building culturally responsive practices
Working with immigrant mental health requires therapists to develop specialized competencies, challenge personal biases, and implement culturally responsive therapeutic approaches.
Cultural adjustment therapy provides an evidence-based framework for supporting clients navigating the complex challenges of immigration, acculturation stress, and potential trauma.
In this current political climate, the need for culturally humble, trauma-informed therapists working with immigrant mental health has never been greater.
These considerations for working with immigrant mental health will be a great asset in your transformational work and the meaningful impact you could have on someone’s healing journey, fight for justice, family unit preservation, adjustment process, and establishing pillars of community safety.
By implementing these strategies and continuously engaging in self-reflection and cultural learning, you can provide the high-quality, compassionate care this vulnerable population deserves.
Sources
American Immigration Council. (2023). Immigrants in the United States.
American Psychological Association. (n.d.). Immigration.
Easton, V. C. (2025). Cultural humility in counseling: Key strategies for mental health professionals.
International Rescue Committee. (n.d.).
Los Angeles County Office of Immigrant Affairs. (n.d.). Know Your Rights Resource Hub.
ProPublica. (n.d.).
Rogers, R. G. (2025). The dire mental health effects of restrictive immigration policies. The U.S. Committee for Refugees and Immigrants (USCRI) Report.
United We Dream. (n.d.).
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