A client mentions a video game you have never heard of.
Another describes a family expectation that does not fit neatly into the frameworks you learned in graduate school. Someone describes work, marriage, identity, religion, or responsibility in values different from your own.
What happens next?
For GoodTherapy member Hansel Wong, the answer begins with curiosity.
“Just be curious.”
It may sound like simple advice, but in Hansel’s work, curiosity is not merely a conversational skill. It is part of how therapists communicate respect, recognize cultural context, and build a relationship in which clients feel understood.
Hansel is a counselor and supervisor based in Adelaide, Australia. Originally from Kuala Lumpur, Malaysia, he began his practice in one multicultural city before continuing his work in another. Moving between the two required more than adjusting to a new location. It challenged him to reconsider what clients may want from counseling and what therapists may miss when they assume everyone is working toward the same version of healing.
His experience has led him to a central belief:
“Human connection can promote healing and co-regulation.”
For Hansel, techniques and modalities remain important. But therapy becomes meaningful when clinical knowledge is paired with genuine interest in the person sitting across from you.
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Video Interview: Watch the Conversation with Hansel WongWatch Hansel Wong’s Member Spotlight interview. |
What Moving Across Cultures Teaches You About Counseling
Hansel began practicing in Kuala Lumpur, a fast-paced urban environment he describes as highly driven and achievement-oriented.
Many of the millennial clients he worked with were trying to reach a particular milestone. They wanted to progress in their careers, prepare for marriage, buy a home, improve their relationships, or move into the next stage of life.
After moving to Adelaide, Hansel encountered clients who were sometimes more interested in acceptance, balance, and understanding their present circumstances. Rather than immediately searching for the next milestone, they might be exploring how to feel more content with where they were.
While these observations were broad and should not be treated as fixed descriptions of either population, the important lesson was recognizing that he had been carrying assumptions about what clients wanted from therapy.
“Coming out of this glass bowl and seeing another side of the world expanded my understanding. Different cultures bring different values.”
A therapist may believe that a client needs to become more independent, set stronger boundaries, slow down, pursue a promotion, leave a relationship, or communicate more openly with family.
But before encouraging any of those outcomes, the therapist needs to understand what independence, family, success, responsibility, and healing mean to that client.
The clinical question is not only, “What would help this person change?”
It is also, “What would meaningful change look like in this person’s life?”
Why Curiosity Belongs in a Therapist’s Clinical Toolkit
A therapist’s professional development often focuses on treatment modalities, certifications, interventions, and clinical techniques.
Hansel encourages the counselors he supervises to think more broadly.
“Understanding the values, beliefs, and history of different cultures can be as valuable, important, and practical in counseling sessions as learning a different modality, tool, or technique.”
This does not mean therapists need to become experts in every cultural background their clients represent. It means they should be willing to learn about the histories, family systems, communities, interests, and everyday realities that shape a client’s life.
For Hansel, that includes learning beyond what is traditionally considered clinical material.
He recalls supervising a counselor whose client had begun talking about video games. The counselor was not a gamer and had limited knowledge on the topic. Hansel’s first response was not to redirect the conversation but to be curious about the game.
“What video game was it? Was it an open-world game? Was it a platform game? What was the name? Go search it up. If you can, play it. When a client starts talking about something niche, being able to pick it up and say, ‘I know what you’re talking about,’ immediately builds connection.”
Without curiosity, a therapist may hear only a hobby. With curiosity, they may recognize an important part of the client’s emotional and social world.
What to Know Before Your First Therapy Session
Curiosity is what a good therapist brings to the room. But what about the person on the other side of it, someone weighing up a first session? Here too, Hansel likes to lower the stakes. He compares starting therapy to seeing a physical therapist, a family doctor, or even going to the gym.
“No one is going to hand you a diagnosis or a label at the door. It is simply time with someone whose job is to hold a safe space for whatever you bring. And if it does not feel right, it was one hour of your life. Think of it like reaching a checkpoint in a game. You get to unload for a bit, pause from life, take a break, and then you click play and go through it again.”
For anyone who has been putting it off, that reframe can be the difference between booking and closing the tab. If you want a fuller picture, here is what to expect in a first therapy session.
What if Nothing Is Wrong, but Something Feels Off
Not everyone arrives with a clear problem. Sometimes nothing is obviously wrong, yet something feels off. Hansel hears this constantly, and his first suggestion may surprise you. He recommends a physical check first, because the body often registers strain before the mind does.
“Often the body can signal things faster than the mind can catch on. You feel the aches and pains before you realize you’re coming down with a fever. Mental health can work the same way.”
From there, he notices two common patterns.
Some people have carried stress for so long that it now feels normal, and they no longer register the weight of it. Others have finally built a stable, safe life, and it is that very safety that lets older, unprocessed experiences rise to the surface. Feeling off, in other words, is rarely random. It is often a signal that something is ready to be looked at.
Therapy is where you can put words to it and make sense of what is underneath.
How to Find a Therapist Who Truly Gets You
If connection is what makes therapy work, how do you find it? Hansel answers from both chairs. As a therapist, he wonders who will walk through his door. As a client, you are looking for someone you can genuinely open up to.
“What’s important at the end of the day is to feel like, hey, I can sit down with this person and have an honest chat about life. That’s really the crux of it.”
Shared background, gender, or faith can help you feel understood, but it is not the only path. Someone quite different from you can offer a fresh perspective. He notes a nuance familiar in smaller communities: sometimes people prefer a therapist from a different background, because a shared one raises the odds of being recognized through a friend or a relative. What matters most, he says, is whether you can imagine that honest conversation.
How to Choose a Therapist from an Online Profile
Choosing from a directory can feel like a lot, since you are often judging someone from a written profile alone. Hansel sees that as an advantage rather than a limitation, because a thorough profile tells you a great deal.
“Comb through the bio and find the therapist who specializes in what you’re looking for, whether that’s a specific approach, an age group, or a particular area they work in.”
Clients often know what they are after, whether that is a method like EMDR or acceptance and commitment therapy, a certain age range, or experience with a specific community. Read closely and match those specifics to your needs. A detailed profile is exactly what makes that possible, a useful reminder for any therapist writing their own. You can compare approaches and specialties across the GoodTherapy directory.
How to Reach Someone Who Does Not Believe in Therapy
Many people run into this wall, often with a parent, a partner, or an older relative who simply will not discuss mental health. Hansel notes that the cultures he has worked in are deeply multicultural, so there is no single attitude to push against. Rather than argue anyone into it, he starts where their interest already is.
“Lean into the things people like to talk about, work, relationships, and slowly weave in. Sounds like anxiety. Sounds like depression. Slowly but surely, people realize it’s not that big a taboo to talk about.”
Work stress, burnout, a breakup, a divorce. These are approachable, everyday topics people are often willing to discuss. The move is to follow that thread and gently name what you hear, rather than leading with a clinical label that closes the conversation down. It is a kind, practical approach for anyone with a loved one who treats therapy as off-limits.
Men’s Mental Health and the Myth That Therapy Is a Sign of Weakness
Ask Hansel which belief about therapy he would most like to correct, and he goes straight to the one that keeps so many people away, especially men: the idea that seeking help means you are weak. It is a stigma he cares about deeply, and one he has watched hold men back from support they need.
“The people I’ve sat across from and spoken with about their emotions, with such brutal honesty, are the strongest people that I know.”
Putting difficult emotions into words is not a failure of strength, Hansel argues. It is one of the hardest and bravest things a person can do. Men seek therapy at lower rates than women, a gap shaped more by cultural expectations around masculinity than by any lower need for support.
Hansel extends the same grace to therapists themselves.
“For therapists, we always feel like we need to be this perfect pillar of mental health. We are not. We are just two human beings sitting in front of each other, talking about life in a way that regulates each other’s emotions.”
The difference a therapist brings is training, ethics, the right questions, and a safe space. Beyond that, the work is human on both sides. That belief also shapes how Hansel guards against burnout, and his approach is refreshingly plain. A supervisor once showed him that decompressing after a hard session could be as simple as playing a game on his phone, no special technique required. For Hansel it is running along Adelaide’s beaches, tending his plants, and time with his wife and daughter.
GoodTherapy explores this in depth in the stigma around men’s mental health, and you can learn more about the challenges men face on our men’s mental health page.
Therapy Is Two People Talking
Across every question, whether about culture, curiosity, a first session, or the courage it takes to walk in, Hansel keeps returning to the same quiet truth. Strip away the fear and the jargon, and therapy is two people talking, one of them trained to make that conversation safe and useful. That is reassuring if you are nervous about starting, and grounding if you are the one holding the space.
“It doesn’t mean you’re weak to come in for therapy. It means you’ve taken a really tough step, and that requires strength.”
Hansel Wong is one of the counselors you will find on GoodTherapy. You can read more from the Member Spotlight series, including spotlights with Brooke Pomerantz and Annette Popernik.
Find a therapist who gets you Whether you are looking for support or building your own practice, GoodTherapy is where thoughtful therapists and the people who need them find each other.
Frequently Asked Questions
English tends to provide a robust variety of descriptions for mental health issues, whether they’re represented in the DSM or not. For the most part, we can talk about trauma, adverse childhood experiences, anxiety, and depression and trust that other people understand the feelings and sensations we describe.
But sometimes clinical terminology may not fully convey our emotions. Or perhaps we are experiencing so much at once that we have to use multiple concepts to describe our emotions.
Other cultural traditions may describe mental health issues through a spiritual lens that honors centuries of traditions and customs. Some terms have fallen out of use, but others live on in different languages and healing practices. Learn more about how people around the world conceptualize mental health issues we may have never felt or perceived.
Multicultural Concepts of Mental Health Issues
1. Maladi Moun
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A Haitian concept that means “humanly caused illness,†maladi moun is a label that may be applied if it’s suspected someone has been harmed through another’s ill will. Also called “sent sickness,” it explains many medical and mental health issues in Haiti. It is believed feeling envy and malice toward another can cause harm in the form of depression, academic or social failure, psychosis, or an inability to perform daily life activities.
Because personal gain is assumed to be linked to another person’s loss in some way, economic success, high social status, intelligence, attractiveness, and good health are all seen as factors that can make someone vulnerable to attack. In other cultures, a similar concept has been called the “evil eye:†mal de ojo in Spanish and ma’occhiu in Italian.
2. Khyâl Cap
Khyâl cap, a Cambodian term that means “wind attacks,†centers on the idea that khyâl, or wind, rises in the body with blood. It can cause symptoms such as panic attacks and psychosis, as well as a range of somatic experiences. Physical health issues that may occur include tinnitus, dizziness, difficulty breathing, palpitations, and cold hands and feet.
The experience of khyâl cap may closely resemble a panic attack. Khyâl attacks might have a trigger like being in crowded spaces or some other stressful situation. But they may also happen without warning.
3. Kufungisisa
Learning about other cultures can help us increase our knowledge around mental health concepts and expand the vocabulary we use to describe mental health issues. This can help us increase our acceptance of others and broaden our worldview.
Many of us can likely relate to the experience of “thinking too much.†This concept is described in various ways across many different cultures, countries, and ethnic groups. The Shona people of Zimbabwe call this kufungisisa. It is seen as a cause of many concerns, including physical distress. For example, a person might say, “My heart is hurting because I think too much.â€
Related mental health concerns include anxiety, panic, irritability, and depression. Ruminating on thoughts related to upsetting social situations, marital woes, or financial difficulties may lead to excessive worry. If a person cannot perform typical tasks due to this state of worry, they might also refer to kufungisisa as “brain fog.â€
4. Taijin Kyofusho
Taijin kyofusho, which means “interpersonal fear disorder†in Japanese, is a form of social anxiety related to feelings of inadequacy or low self-esteem. Someone with taijin kyofusho might avoid interpersonal situations because they believe their appearance or actions are offensive or intolerable to others. They might be concerned about their level of body odor, level of eye contact, bodily movements, facial expressions, or blushing. Because these are physical concerns, taijin kyofusho sometimes encompasses aspects of body dysmorphia.
5. Nervios, Attaque de Nervios:
People of Latin descent, in both Latin America and the United States, may use nervios to describe general distress. Generally, it is a response to stressful life experiences or circumstances that make one vulnerable. Symptoms of nervios include both emotional and somatic distress, such as irritability, nervousness, difficulty sleeping, head and neck pain, dizziness, and stomach problems.
Attaque de nervios is a more acute form of nervios. This term describes a “fit†or episode of intense emotional upset. Anger, grief, anxiety, dissociation, and even suicidal ideation may be elements of this experience. A person might also experience physical symptoms such as fainting or seizure-like spasms. Variations on these experiences are echoed in Greek, Sicilian, Appalachian, Haitian, and other cultures.
How Do These Concepts Impact Mental Health Care?
Learning about other cultures can help us increase our knowledge around mental health concepts and expand the vocabulary we use to describe mental health issues. This can help us increase our acceptance of others and broaden our worldview. But these concepts and terms are not standalone issues relevant only to certain cultures. Differences in the ways people understand mental health and experience distress can have a huge impact on the way they search for care, as well as the relationship they develop with care providers.
Stigma and lack of access to health care continues to disproportionately affect cultural minorities. In addition, people of color and other members of marginalized populations may be more hesitant to seek help when they are in distress. There are many reasons someone might shy away from pursuing mental health treatment. Among them may be the fear that therapists may not understand (or even try to comprehend) the nature of their concerns through the lens of their culture or heritage.
Therapists can better serve minority communities, especially those for whom English is a secondary language, by studying mental health concepts from other cultures, such as the ones listed above. Racial minorities, particularly older adults, tend to approach health care with different expectations of care providers, treatment preferences, and understanding of causes of mental health concerns. Many psychotherapists may not be aware these differences exist, let alone have an idea how to address these discrepancies during treatment. Accommodating these values is key to providing quality care for all people seeking help.
References:
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
- Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & AlegrÃa, M. (2012). Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry, 20(6), 533-542. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258470
- King, W. (2016, January 20). Inequality lingers in mental health treatment for minorities. GoodTherapy.org. Retrieved from https://www.goodtherapy.org/blog/inequality-lingers-in-mental-health-treatment-for-minorities-0120162
Complex posttraumatic stress, known as C-PTSD for short, is the result of prolonged series of traumatic experiences at the hands of someone the victim has a personal relationship with. The most common cause of C-PTSD is child abuse by a parent, stepparent, or other primary caregiver. However, it can result from a range of situations, including abusive relationships, abusive forms of imprisonment, and exploitative prostitution. C-PTSD has similar symptoms to posttraumatic stress (PTSD), but these are entwined with negative self-image, inability to control emotions, and certain personality disturbances.
The Rise of Cultural Competency
One of the most interesting aspects of working in the field of C-PTSD is the interface between cultural competency and complex trauma. Cultural competency has been a major trend within the mental health profession and, indeed, the health care field as a whole. The trend started as response to a number of studies in the 1970s which demonstrated that members of minority and marginalized communities were both less likely to seek out therapy for mental health issues and less likely to have successful treatment outcomes if they did so. While it had been naively thought that psychological research had revealed the nature of the universal human mind, experience demonstrated that many of its conclusions were highly culture contingent. What worked with people raised and acculturated in a Western cultural milieu did not always work with people from different cultural traditions.
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In response to growing awareness of this deficiency, the mental health care industry began promoting cultural competency initiatives designed to educate therapists in the cultures and mores of different minority groups. For example, learning about the differences between honor-shame societies and guilt societies allowed therapists to more effectively help people of Asian origin deal with anxiety and depression. With the expansion of culturally competent mental health services, many people gained access to effective psychotherapy for the first time and we came closer to the goal of a mental health system that serves all Americans.
However, there were two problems with the first wave of cultural competency activism, one logistical and the other more profound. The first is that the sheer diversity of human culture and the internal complexity of each branch of civilization makes it impossible for any one individual to become truly competent in all but a tiny fraction of them. True familiarity with even one culture is the work of years, even a lifetime. In short, training psychologists to achieve cultural competency in all the cultures present in a diverse country like 21st century America, then distributing them everywhere they are needed, is an impossibly complicated—not to mention expensive—task.
In practice, cultural competence training combines elements of both approaches: imparting a basic level of specific knowledge about cultural traditions that a given psychologist is likely to come across in their work so as to avoid likely pitfalls and, at the same time, cultivating a general attitude of flexibility and willingness to explore.
The second problem is that the first-wave approach to cultural competence is based on an artificial model of the world as divided into discrete, self-contained cultural units. This is an oversimplification for two reasons. First, cultural units are, in reality, composed of different subcultures. One may learn, for example, about “Chinese culture,†but there are profound differences between the culture of people from the Dongbei or Huanan regions. Similarly, the rhythms of life in Georgia and Montana are substantially different even for people who share the same ethnicity, religion, or politics. Within these subcultures, too, there are substantially different “sub-subcultures†all the way down to the level of a local town or even family. Decisions about where to draw the line between one “culture†and another are often based on arbitrary or political considerations rather than objective criteria.
Secondly, the static culture model ignores the reality of cross-cultural fertilization and the ability of individuals to cross cultural boundaries. Cultures are not static entities but dynamic, constantly evolving, compound forms, which develop precisely because individuals are able to transcend their cultural origins and incorporate new elements from others or of their own invention. Putting these two considerations together forces us to reimagine our concept of culture as a sort of spectrum, making the task of cultural competence as infinitely complex as the human experience itself.
In response to both practical and philosophical objections to the static model of cultural competence, a new approach known as cultural flexibility was developed. Instead of emphasizing specific forms of knowledge about specific cultures, the emphasis came to be placed more on openness and awareness about questioning assumptions. Instead of being a barrier to communication, with the right attitude and approach, cultural differences can be used as a tool to help the development of an effective therapeutic relationship between therapist and person in therapy. In practice, cultural competence training combines elements of both approaches: imparting a basic level of specific knowledge about cultural traditions that a given psychologist is likely to come across in their work so as to avoid likely pitfalls and, at the same time, cultivating a general attitude of flexibility and willingness to explore.
Cultural Competence and Complex Trauma
One of the most difficult and fascinating areas within the field of culturally competent psychology is the issue of trauma—and complex trauma in particular. While there are many things that are so horrific that virtually anyone would be traumatized by experiencing them, it is clear there is a great deal of cultural variation in what is considered traumatic around the world, as well as how this trauma affects people. To take a superficially extreme example, among the Mursi people of Ethiopia, about a year before marriage, which often takes place as young as 15, a young woman will have an incision of about half an inch made in her lower lip, usually by her own mother (and, of course, without anesthetic). A wooden chip will then be inserted into this incision, which is replaced with successively larger objects until, finally, a clay disk of up 20 centimeters in diameter is inserted in time for the wedding day. It is safe to assume that a typical Western adolescent would find this experience at the very least somewhat traumatic. It is also apparent that, whatever we may think of their views on the relationship between the sexes, the Mursi women are not traumatized by this procedure, or, at least, do not display the typical symptoms of traumatization.
It is of course unlikely that an American psychologist will work with a person sporting a lip plate. If it were to happen, however, it would raise many interesting questions about the nature of childhood trauma. Child abuse exists in every culture and, presumably, the Mursi are no exception, but in dealing with such a case, a therapist would have to be extraordinarily careful not to project their own culturally modulated impression of what constitutes a traumatic experience. Complex trauma represents one of the most delicate and sensitive areas for cultural competence training, and more research is needed to guide best practices regarding the universality and cultural subjectivity of potentially traumatic experiences.
References:
- Berman S. L. (2016). Identity and trauma. Journal of Traumatic Stress Disorders and Treatment 5:2. doi:10.4172/2324-8947.1000e10
- McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10.
- Tummala-Narra, P. (2014). Cultural identity in the context of trauma and immigration from a psychoanalytic perspective. Psychoanalytic Psychology, 31(3), 396-409. Retrieved from http://dx.doi.org/10.1037/a0036539
- Wilson J. P. (2007). Cross-Cultural Assessment of Psychological Trauma. New York: Springer.
Cultural issues can heavily affect women’s sexuality, according to a study published in Sexuality & Culture. They are particularly salient for women who are lesbian and bisexual.
Prior Research
Previous research focused on the way individual factors affect sexuality. For instance, a 2016 study showed women who endorse benevolent sexism are less likely to assert their sexual needs. They are also more likely to tolerate sexual selfishness from their partners.
A 2017 study found relationship issues often prompt women to feign orgasms. They may be prioritizing their partner’s ego or avoiding an argument. Sometimes women fake orgasms to end sex sooner.
Despite the breadth of research on female sexuality, the Sexuality & Culture study is one of the first to compare desire in heterosexual and non-heterosexual women.
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Cultural Factors in Women’s Sexuality
This study involved interviews with 31 women ages 20-69. The researchers interviewed women identifying as bisexual, heterosexual, and lesbian. Questions focused on the relationships between women’s sexual desire, their identity, and their experiences.
Cultural themes played a key role in women’s sexual experiences. The most prominent themes included:
- Gender roles: The gender binary, relationship dynamics, and body image concerns
- Religion: Spiritual beliefs regarding sex and gender
- Cultural shifts: Changes in sexual taboos and expectations
- Minority stress: Heteronormativity, stigma, and coming out
These cultural themes affected a diverse group of women. However, their role was most prominent among women who identified as non-heterosexual. The researchers suggest this disparity occurs because non-heterosexual women must face challenges related to both sexism and heteronormativity. Compounded stigmas seem to increase their sensitivity to cultural expectations.
To empower women’s sexual expression, advocates should be mindful of how systems of privilege affect sexual desire. Individuals experiencing distress or difficulty relating to these issues may find it beneficial to discuss them with a counselor or therapist.
References:
- LGBQ* women’s sexual desire particularly impacted by social and cultural pressures. (2017, December 06). University of Kentucky News. Retrieved from https://uknow.uky.edu/research/lgbq-women-s-sexual-desire-particularly-impacted-social-and-cultural-pressures
- Rosenkrantz, D. E., & Mark, K. P. (2017). The sociocultural context of sexually diverse women’s sexual desire. Sexuality & Culture. doi:10.1007/s12119-017-9462-6