Things Left Unsaid: The Power of Cultural Competence

Sometimes in therapy it’s the things you don’t have to say that make the difference.

Unspoken understandings that can be communicated with a look or a gesture truly make the experience meaningful and help connect the client with the therapist.

This is why cultural competency is so important. Each culture, and even sub-culture, has unwritten (and often unspoken) rules for behavior and expectations for interactions. If you as a therapist are not familiar, it can feel like a disconnect. At best, it can be a feeling of “missing something” and at worst it can create a feeling that you and the client are not even speaking the same language.

The transgender community is a community with its own culture, expectations, rules, and norms. It was not until recently that I was able to truly appreciate how understanding these norms – without having to talk about them – is of value to my clients.

A few weeks ago I was seeing clients, and as usual I had a lineup of six clients that identified as non-cisgender* individuals with a wide variety of sexual orientations. By the end of the day I had worked on anxiety, depression, family relationships, and work/life balance, but not once had I spoken directly about gender identity or sexual orientation.

It was clearly understood by both myself and my clients that they are part of a particular subculture, and we both understand the rules of that culture. They know from being a part of the culture, I know from years of working within that culture. It was that night that it became exceedingly evident to me that sometimes, the most important part of having cultural competency as a therapist isn’t what you say, but rather about what can be left unsaid.

I was also able to experience the opposite while working for a brief period within the Orthodox Jewish community. While working within that very specific culture, I often had to check in with a colleague or supervisor to determine what was appropriate and expected within that culture. Treatment did not flow as smoothly as clients stopped frequently to explain aspects of the community norms that I was unaware of. Words, phrases, social customs were all foreign to me and became topics that had to be explained, which, of course, used valuable therapy time.

While it can be argued that these experiences also help build the therapeutic relationship by allowing the client to be the “expert” they are also easy points for the client to detach from the emotions that they are feeling and assume the role of instructor. I found that clients sometimes used these opportunities to deflect from talking about difficult material. In the beginning, when I didn’t know the information and I hungered to understand, I allowed these diversions to go on longer. The more cultural competency I gained within the community the less frequently I would allow those conversations to eat away the minutes.

At this point, my clients know that by coming to see me they will not have to educate me on the norms, rules, or expectations that they face on a daily basis. They will not need to explain to me what it means to be trans or the subtle (and not so subtle) ways that it might be impacting their lives. These things are understood. We can focus on the struggles they are facing without having to pause for me to be educated. We can move forward together without my questioning if something is or is not the norm for the culture of the individual. They know I will not pathologize their experiences. This is the true power of cultural competence.

*cisgender is a term for someone who identifies as the gender they were assigned at birth.

Dr. Melissa Farrell

Melissa Farrell, PhD is an adjunct faculty member at MSP who specializes in the treatment of children, adolescents, and families. Particularly those struggling with gender or sexual identity issues. She currently sees clients out of Great Lakes Psychology Group