CBT in an Intercultural Setting: A Framework for Collaboration

Emel Stroup, PsyD, Beck Institute Faculty

Cognitive Behavior Therapy (CBT) is a highly adaptable and empirically supported form of psychotherapy. Its emphasis on structured, goal-oriented, and evidence-based principles enables it to effectively transcend cultural boundaries. However, when applying CBT in an international or intercultural setting, clinicians often face challenges related to differences in interpersonal dynamics and cultural values. This article explores how CBT inherently addresses these complexities without requiring modification, demonstrating its utility as a multicultural framework. Dr. Stroup focuses on using CBT to treat clients from the dominant culture of Turkey and adaptations would likely be required in many countries, including the US, when clients experience discrimination because they are a member of a non-dominant culture, religion, race, etc.

Addressing Interpersonal Dynamics in Cross-Cultural Therapy: Social and Authority Status Differences

One of the common challenges in intercultural therapy settings is navigating relationships influenced by cultural perceptions of social and authority hierarchies. In some cultures, individuals may view therapists as authority figures, expecting directive guidance rather than collaboration. While this perception can initially seem at odds with the collaborative ethos of CBT, it underscores the importance of adhering to foundational CBT principles, particularly the process of “socializing the client to the therapy.”

With patience and consistent reinforcement, clients from cultures valuing authority hierarchies can become comfortable with the collaborative framework of CBT.

The collaborative nature of CBT allows therapists to gradually bridge these gaps. By emphasizing the shared goals of therapy and inviting the client to take an active role in identifying and addressing their concerns, therapists empower individuals to move beyond traditional hierarchical dynamics. Socialization includes clear explanations about how CBT works, why collaboration is essential, and how the therapy is tailored to the client’s needs. With patience and consistent reinforcement, clients from cultures valuing authority hierarchies can become comfortable with the collaborative framework of CBT.

Therapists should avoid assuming that directive approaches are the only effective means of engagement. While cultural adaptation is valuable, the goal should be to ensure that the client understands and participates in the therapy process rather than altering the therapy’s foundational structure.

Navigating Cultural Values in Goal Setting: Respecting Divergent Values

Cultural values often shape clients’ perspectives on mental health, relationships, and self-improvement. Therapists may encounter scenarios where a client’s values differ significantly from their own. Rather than attempting to resolve or align these differences, CBT inherently addresses this issue by placing the client at the center of the therapeutic process.

CBT’s commitment to client autonomy ensures that therapy focuses on goals meaningful to the client, as defined by them. The therapist’s role is to guide clients in clarifying their values and translating them into actionable goals, rather than imposing their own assumptions about what those goals should be. This approach prevents cultural value differences from becoming barriers and maintains the therapy’s person-centered focus.

For example, if a client from a collectivist culture prioritizes family harmony over individual achievement, the therapist works within this value framework. The client may choose goals related to improving communication or managing stress for the sake of their family. These culturally relevant goals align seamlessly with CBT techniques, such as cognitive restructuring and behavioral activation.

Why CBT Is Inherently Multicultural

CBT is not a one-size-fits-all approach, but it doesn’t require fundamental alterations to accommodate cultural diversity either. Its principles, such as collaboration, goal-oriented focus, and evidence-based techniques, are universally applicable. Instead of modifying CBT to fit cultural contexts, therapists can use its flexibility and structure to address cultural nuances effectively.

• Collaboration Enhances Engagement: Collaboration naturally aligns with diverse interpersonal dynamics by empowering clients to take ownership of their progress, regardless of cultural norms.
• Client-Defined Goals Encourage Relevance: Allowing clients to dictate the direction of therapy ensures alignment with their cultural values and life priorities.
• Evidence-Based Methods Ensure Adaptability: Techniques such as cognitive restructuring and problem-solving are versatile tools that apply to a wide range of cultural challenges without losing their efficacy.

Practical Strategies for Intercultural CBT

• Invest Time in Psychoeducation: Explain CBT concepts clearly and in terms that resonate with the client’s cultural background. Use simple analogies or culturally relevant examples to enhance understanding.
• Foster a Collaborative Spirit: Take time to invite and encourage active participation. Be patient and ensure the client feels empowered rather than directed.
• Check Assumptions: Remain aware of potential cultural differences but resist the urge to assume what the client values or needs. Instead, ask open-ended questions to understand their unique perspective.
• Focus on Universality of Methods: While respecting cultural contexts, highlight how CBT principles apply universally. Demonstrate how the techniques address their concerns effectively within their framework.

Conclusion

CBT’s inherent flexibility makes it a powerful tool in international and intercultural therapy settings. By emphasizing collaboration, respecting client autonomy, and applying evidence-based techniques, therapists can navigate challenges related to interpersonal dynamics and cultural values without modifying the therapy’s core principles. Instead of viewing cultural differences as obstacles, therapists can see them as opportunities to enrich the therapeutic process.

CBT’s strength lies in its ability to meet clients where they are—both culturally and personally—allowing them to define their path toward mental well-being.