Culturally sensitive therapy – how can it work?

Topics surrounding mental health have now arrived in many parts of society. On everyones lips on TikTok, topic of many infographics on Instagram – content that is designed to make us think, reflect and that encourages us to engage in exchange. The importance of mindfulness, empathy awareness of needs to ourselves and others is often mentioned. It is also known that psychotherapy should be more accessible and that the lack of space needs to be addressed. In short: psychotherapy for all. But even today in 2023 it is still a fact that the psychotherapeutic care system is not designed to relieve the high proportion of people with a migration background – statistically more than a quarter of the German population, trend rising. Yet there are approaches that attempt to do just that

Culturally sensitive therapy

So-called culturally sensitive therapy focuses on engaging people who have grown up in and with other cultures in a way that is appropriately adapted and open. It is important to take into account that people with a migration background often bring with them different traditions as well as religious beliefs and are impacted by these. A different approach to health and illness or language barriers can also play a major role. The goal of culturally sensitive therapy is to give consideration to those affected in a holistic way. This means being sensitive to the particularities of everyday life and the needs of patients in order to improve care – or even make it possible in the first place. Intercultural, transcultural or culturally sensitive therapy are buzzwords that psychology students, prospective therapists and those interested in therapy encounter in articles and the occasional lecture – but that’s pretty much it. Even though universities receive funding to pursue research in the field they are still not a fixed component of university teaching. If topics such as flight and migration are discussed, this is usually done by white teachers who reproduce racist stereotypes in their work and cannot step outside of their perspective. In therapy, it can happen that those affected encounter therapists who have neither understanding, sensitivity nor sufficient competence, often scaring off those seeking help, or putting them under additional strain. This is not surprising: even if (prospective) therapists devote themselves to these relevant topics and want to incorporate them into their work, they are dependent on external workshops, seminars and further training. Trainees can receive credit for these, but they usually have to bear the costs themselves.

“Intersectionality remains an unknown word”

 White, privileged professors write manuals about and for disadvantaged, migrant and often racialised, non-homogeneous groups. What is neglected are sociological and demographic factors that significantly shape people’s lives. Yet it would be so important, especially in a country like Germany – whose history is steeped in the oppression of the „other“ – to convey these issues in a concrete and differentiated way. Only in this way can a realistic picture of society be presented and oppression actively countered. Structural disadvantage with regard to different aspects – poverty, ethnicity, sexism, ableism – thus become invisible. Intersectionality remains an unknown word. Migration and flight often imply changes and psychological trauma, but do not necessarily mean noticeable, manifesting psychological problems. Those affected can, however, be more susceptible to them depending on individual conditions and circumstances, precisely because they are often also affected by other circumstances that place an additional burden on them. At the same time, people with a migration background are put under even more strain: individually and structurally as well as emotionally. Experienced insecurity, lived pressure to integrate and assimilate, isolation, and lack of social support all have a negative impact on mental health.

Perspectives of people with migration background are missing in research

Available studies offer indications that those affected are generally confronted with poorer mental health, but they are rarely significant enough to be considered representative and thus able to create awareness. This is partly due to the fact that experiences of discrimination in connection with the mental health of people with a migration background are almost never recorded in research, which in turn considerably reduces the significance of the studies. Individual migration processes and their diverse causes, forms of development and the manifestations of mental illness may not be adequately captured by the usual diagnostic categories: these correspond to western criteria and definitions. Expressions of grief and fear can also differ between cultures and thus require a more dynamic diagnostic approach. In addition, more complex situations such as successive traumatic events and life situations are not taken into account. Post-traumatic stress disorder for example is diagnosed by recording a single event that begins and ends at a specific point. Yet many people it does not remain with one definable event. A traumatic flight involves multiple places, times, routes, languages, interactions, losses, emotions.

Deeds not words

So, what needs to change? First of all, it is important to advocate for further training to increase in number, gain more attention and be made accessible. Above all, it is crucial to establish culturally sensitive content at universities. Even if a research base already exists, more studies are needed that look at the connections between migration and vulnerability to mental disorders in Germany – without leaving out significant social factors. It is time to turn performative figureheads of universities that adorn themselves with research on flight and migration into deeds. And to dissolve structures that prevent reflective engagement. This article was also published in German