When Culture Gets Pathologized in Therapy

I sat on the couch in my therapist's office, my hands flying through the air as I spoke, leaning forward passionately. My gaze was intense. My therapist crossed her legs and turned away from me slightly.

What is it like being Middle Eastern culturally in the Midwest.... it ain't easy! If I express myself honestly—passionately, like a Middle Easterner might—I come across angry. At worst, I get pathologized and my therapist thinks I'm dysregulated, not in control of my emotions.

One therapist snapped, "You're intimidating as hell and you need to stop it."

I was stunned. “What am I doing?” I asked, completely oblivious to how she was interpreting my behavior.

“I don’t know. But you need to stop it,” was her only reply.

People go into therapy hoping to be understood, but when you face a cultural mismatch with your therapist, there are often misunderstandings, value clashes, and you may even experience microaggressions from your own therapist—if not open aggression, as was the case in my last example.

My story isn’t unique. Research has consistently shown that cultural differences shape how therapy is experienced. Studies in multicultural psychology demonstrate that behaviors interpreted one way in one culture can be seen as threatening or “abnormal” in another. For example, Middle Eastern, Mediterranean, and Latinx communication styles often rely on passionate speech, expressive gestures, and strong eye contact. In Western clinical spaces, these same traits may be misread as signs of hostility or poor emotional regulation (Ridley, 2005).

This isn’t simply about style, it’s about power. Therapists hold the authority to label, diagnose, and define what counts as “healthy” behavior. When a therapist mistakes cultural expressiveness for pathology, it creates harm. Clients can feel silenced, shamed, or even punished for showing up authentically.

The Role of Cultural Humility

The mental health field has begun to recognize that “cultural competence” alone isn’t enough. Cultural competence implies that once a therapist learns a checklist of cultural facts, they’re prepared. In reality, culture is dynamic and lived. That’s where cultural humility comes in.

Hook and colleagues (2016) describe cultural humility as a commitment to lifelong learning, self-reflection, and openness to being taught by the client. Rather than assuming expertise, therapists practicing cultural humility acknowledge power differences and invite clients to define what respect, safety, and understanding look like in the room.

For someone like me, that would mean my therapist recognizing that intensity in my voice or movement doesn’t necessarily mean I’m angry, it means I care deeply about what I’m saying.

Unfortunately, when therapists lack cultural awareness, the result can be microaggressions. Sue et al. (2007) define microaggressions as subtle, often unintentional slights or invalidations directed toward marginalized identities. In therapy, that can look like dismissing a client’s experience, pathologizing their cultural norms, or minimizing the role of racism, sexism, or xenophobia in their life.

Microaggressions in therapy don’t just sting in the moment, they can disrupt trust and make clients less likely to continue treatment. As Owen et al. (2014) found, clients who experienced microaggressions in therapy reported weaker alliances with their therapists and more negative outcomes overall.

Moving Toward Safer Spaces

For therapy to be truly healing, cultural responsiveness can’t be optional, it has to be central. That means:

• Therapists must practice cultural humility, not assume competence.

• Clients should feel empowered to bring their cultural identity into the room without fear of judgment.

• Training programs need to address power, race, and culture not as electives, but as core to ethical practice.

When these changes happen, therapy can become what it’s meant to be: a place where people are fully seen, not forced into someone else’s mold.

Therapists Are Human Too

Therapy is a relationship. Even the best-trained therapists will miss things sometimes because they’re human. It can feel exhausting to raise cultural misunderstandings on top of everything else you’re working through, but if you’ve been in therapy for months and your therapist has otherwise been effective, it may be worth trying to work through it. Bring it up.

Once you've discusssed the cultural gap, once way to bridge that gap is by listing books, articles, podcasts or even art, food and music that shed light on your cultural background or lived experience. Many therapists are open to learning, and when they do, the therapy can become even stronger. If you sense your therapist is willing to understand where you’re coming from, that effort can build trust and deepen the therapeutic alliance.

If, however, you bring it up and nothing changes—or worse, you feel dismissed—then it may be time to move on. The alliance between client and therapist is one of the strongest predictors of success in therapy. If it isn’t there, your healing deserves a place where it can be. If you'd like to read the articles mentioned, a resources section is below.

Resources

For readers who want to learn more about culture and therapy, here are some accessible starting points:

• Hook, J. N., Davis, D. E., Owen, J., Worthington, E. L., & Utsey, S. O. (2013). Cultural humility: Measuring openness to culturally diverse clients. Journal of Counseling Psychology, 60(3), 353–366.

• Sue, D. W., Capodilupo, C. M., Torino, G. C., et al. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271–286.

• Owen, J., Tao, K. W., Imel, Z. E., Wampold, B. E., & Rodolfa, E. (2014). Addressing racial and ethnic microaggressions in therapy. Professional Psychology: Research and Practice, 45(4), 283–290.

Ridley, C. R. (2005). Overcoming unintentional racism in counseling and therapy: A practitioner’s guide to intentional intervention. Sage.