Key terms on this page (6)
- Cultural humility
- A lifelong practice of self-reflection, learning from clients and addressing power imbalances, rather than a body of knowledge to master.
- Intersectionality
- Kimberlé Crenshaw’s term for how identities such as race, gender and class combine to shape a person’s experience.
- Broaching
- The clinician raising race, culture or other differences openly in session, rather than waiting for the client to.
- Limited English proficiency (LEP)
- A person who does not speak English as their main language and has limited ability to read, write, speak or understand it.
- Qualified interpreter
- Someone who interprets accurately and impartially, knows the specialized vocabulary and follows ethics such as confidentiality.
- Cultural Formulation Interview
- A 16-question interview in the DSM-5-TR for understanding a problem through the client’s own cultural lens.
From competence to humility
For years, training talked about cultural competence, as if you could learn enough facts about a group to treat its members well. The trouble is that no client is an average of their group. In 1998 two physicians, Melanie Tervalon and Jann Murray-García, proposed cultural humility instead: an ongoing commitment to reflect on your own background, to learn from each person about theirs, and to address the power imbalance between clinician and client.
The professional codes now carry both ideas. The NASW code’s standard on cultural competence was revised in 2021 to call for self-reflection and cultural humility. Counseling programs teach the Multicultural and Social Justice Counseling Competencies, endorsed by the ACA. You will see the words used side by side; what matters is the habit underneath them.
Identity has many layers
A client’s identity is more than what you can see, and the parts that matter most to them may not be the ones you expect. The ADDRESSING framework, developed by psychologist Pamela Hays, is one practical way to make sure you ask about all of it, and to notice where you hold privilege and where you don’t.
Age and generational influences
What did growing up in their generation teach them about help, family and emotion?
Developmental disabilities
Has a developmental disability shaped their schooling, family or independence?
Disabilities acquired later in life
Has an illness or injury changed how they work, move or are treated?
Religion and spiritual orientation
What does their faith, or its absence, say about suffering and healing?
Ethnic and racial identity
How do race and ethnicity shape their daily experience, including in this room?
Socioeconomic status
What do money, class and education make possible or hard for them?
Sexual orientation
Are they safe to be open about who they love, at home and with you?
Indigenous heritage
Is there Indigenous heritage, history or community that matters to them?
National origin
Were they or their family born elsewhere? What did migration cost or give?
Gender
How has gender, and gender identity, shaped their expectations and choices?
Power in the room
Therapy is not a meeting of equals. You decide on a diagnosis, write a record the client may never read, and in some situations make reports to authorities. For clients whose communities have been harmed by health systems, police or child welfare, that power is not abstract. It can shape what they are willing to say.
Research on broaching suggests that clients often feel safer when the clinician raises difference first, simply and without making it the client’s job to educate them. It can be as plain as: “I’m a white therapist and you’ve told me you’re the only Black engineer at your firm. If anything about our differences gets in the way here, I want to hear it.” Not every client wants to talk about it, and that is their choice to make.
Language access and interpreters
Federal civil rights law (Title VI of the Civil Rights Act and Section 1557 of the Affordable Care Act) requires providers that receive federal health funds, which includes most who bill Medicaid, to take reasonable steps to give people with limited English meaningful access. The federal rule under Section 1557 spells out who may interpret: a qualified interpreter, not a bilingual colleague without training, not a relative unless the client asks for it privately (or as a stopgap in an emergency), and not a child except as a stopgap in an emergency. Many states and insurers add their own requirements.
Before your first session with an interpreter, try the check below.
Can this person interpret?
Can you do therapy in the client’s preferred language yourself?
Clinically fluent, not just conversational: could you hear grief, sarcasm or a disclosure of abuse in it?
The craft matters as much as the rule. Speak to the client, not the interpreter, in the first person. Keep sentences short. Brief the interpreter beforehand and check in afterward, especially after a hard session. If the client prefers an interpreter of a particular gender or from outside their small local community, ask; in a close community, an interpreter may know the family.
Three moments from training
Invented composites, not real people.
Thao
Counseling intern, community clinic
Language accessA client brought her 12-year-old to interpret. Thao thanked them, connected a video interpreter instead, and the mother disclosed what she had not wanted her son to hear.
Marcus
MSW intern, hospital
BroachingHe named the age and race gap with an older patient in the first session. She laughed, said nobody had ever asked, and told him about the doctors who had not listened.
Gabriela
MFT trainee, private group
HumilityShe assumed a family’s faith was the source of conflict. Asking with the Cultural Formulation Interview showed it was their main support, and the plan changed.
How to get ahead before and during school
- Run the ADDRESSING list on yourself first. Notice the dimensions where you have never had to think about your identity.
- Practice one sentence for broaching difference that sounds like you, and try it in role-play before you need it.
- Read the Cultural Formulation Interview and use it in full with at least one practicum client.
- If you speak a second language, ask your program how it assesses clinical fluency; some sites pay a bilingual differential.
- Look for a practicum site that serves a community different from your own.
What to read
- Counseling the Culturally Diverse: Theory and Practice (Sue, Sue, Neville and Smith), the standard textbook.
- Addressing Cultural Complexities in Practice (Hays), where the ADDRESSING framework comes from.
- Ethnicity and Family Therapy (McGoldrick, Giordano and Garcia-Preto), chapter by chapter on cultural groups, read as a starting point, not a script.
- Tervalon and Murray-García, “Cultural humility versus cultural competence” (1998), the short paper that changed the field’s vocabulary.
Myths worth dropping
Myth
“Being colorblind is the respectful approach.”
Actually
Ignoring difference often leaves clients feeling unseen. Acknowledging it, and asking, usually builds trust.
Myth
“A bilingual colleague can interpret in a pinch.”
Actually
Interpreting is a trained skill, and the federal rule for many providers requires a qualified interpreter, not just a bilingual one.
Myth
“Cultural training is a box you tick in one course.”
Actually
Programs weave it through every course, and the codes treat it as a lifelong part of competent practice.
Next · Step 11
The brain, the body and substances
Therapy happens in a body: stress, sleep, medication and substances all change what you see in the room. Next, what a therapist needs to know about each, without prescribing.
Questions people ask
What is the difference between cultural competence and cultural humility?
Cultural competence suggests a body of knowledge you can master about groups of people. Cultural humility, a term from Tervalon and Murray-García in 1998, treats it as a lifelong practice: reflecting on your own background and biases, learning from each client about their culture, and noticing the power imbalance between clinician and client. Most programs now teach both, and the professional codes use both terms.
Can I use a client’s family member as an interpreter?
It is best avoided in therapy. Under federal rules for providers that take federal health funds, an accompanying adult may interpret only as a stopgap in an emergency, or if the client asks for that in private, with a qualified interpreter present, the adult agrees and the request is documented. A minor child may not be relied on except as a stopgap in an emergency. Use a qualified interpreter whenever you can.
Do I have to share a client’s background to help them?
No. Many clients do choose clinicians who share part of their identity, and that matters to them. But therapists help clients from backgrounds very different from their own every day. What counts is curiosity, honest acknowledgment of difference, and a willingness to be corrected.
Is culture tested on the licensing exams?
Yes. The counselor, MFT, social work and psychology exams all include questions on diversity and culturally responsive practice, usually as part of a clinical scenario rather than as a separate topic. Expect questions on interpreters, on cultural factors in diagnosis, and on what to do when your own values conflict with a client’s.
Sources
Checked 28 October 2026. Courts have stayed or vacated some provisions of the 2024 Section 1557 rule, chiefly those on gender identity; the language-access section, §92.201, is in the current eCFR text. HHS lists the rule’s status on its Section 1557 page.
- 45 CFR §92.201 (Section 1557 of the Affordable Care Act) — Meaningful access for people with limited English proficiency: qualified interpreters, and limits on relying on adult companions and minor children.
- HHS Office for Civil Rights, Section 1557 — The rule, its status and HHS guidance on language access.
- US Department of Justice, Limited English proficiency — Title VI language-access information; since July 2025 DOJ has suspended LEP.gov and its guidance pending new guidance under Executive Order 14224.
- HHS Office of Minority Health, National CLAS Standards — The 15 National Standards for Culturally and Linguistically Appropriate Services in health and health care.
- Tervalon and Murray-García (1998) — “Cultural humility versus cultural competence,” Journal of Health Care for the Poor and Underserved 9(2).
- NASW, 2021 amendments to the Code of Ethics — Standard 1.05, cultural competence, revised to include self-reflection and cultural humility.
- American Psychiatric Association, Cultural Formulation Interview — The DSM-5-TR core interview and supplementary modules.
- ASWB, Social Work Licensing Exam Guidebook (2026) — The 2026 content outlines, in use from 3 August 2026: diversity and social justice sit under Values and Ethics.
- ACA, Multicultural and Social Justice Counseling Competencies — Ratts and colleagues (2015), endorsed by the American Counseling Association.