Cultural Sensitivity

Berlin and particularly Neukölln are places of diverse identity-related characteristics. This pluralism offers encounter, development, opportunities, and challenges. Questions of identity often play a significant role in psychotherapy and counseling, especially in this location and at this time. Identity characteristics can profoundly influence how we perceive ourselves and others, as well as how we are seen and treated in the world. I strive to integrate the often complex influences of such characteristics into our collaborative work to understand and validate individual experiences. Current studies and contemporary discourses emphasize the positive therapeutic effect that arises from integrating cultural factors and practicing cultural sensitivity. Therapeutic institutions now explicitly advocate for proactively addressing these factors and integrating them into treatment.

Why am I making the aspect of culture explicit?

1. BIPOC, ethnic minorities, expatriates, or individuals with migration backgrounds significantly underutilize psychotherapy and counseling services compared to individuals from the local cultural majority.

This is due, among other reasons, to insufficient awareness of healthcare system options, a lack of culturally specific services, or fears of discrimination, which can also occur within the healthcare system.

2. So that patients/clients who consider this aspect important can recognize that I intend to take them seriously.

It happens, for example, that BIPOC, ethnic minorities, expatriates, or individuals with migration backgrounds hesitate to engage with a white and/or German therapist. They wonder if they can be safe from discrimination, if their life experiences are known, taken seriously, and understood. Whether they can openly discuss discrimination, racism, and disadvantage. Whether they can articulate their perceptions openly without causing offense or being punished. Whether the different aspects of identity and privileges could complicate the relationship.

I cannot guarantee that negative experiences will not occur with me. I have not lived your life experiences, I do not know your living conditions as well as you do, my knowledge of cultures is limited, I have blind spots, and I make mistakes. However, my intentions are to take you seriously, acquire expertise, continue to develop, and apologize if I have behaved insensitively. It is important to me that you can openly discuss your experiences. I value cultural diversity and want to support you in feeling secure, confident, and comfortable in your identity experiences.

3. To clearly state that cultural factors can play a significant role in the development, maintenance, and interaction with mental health issues.

Antisemitism, discrimination, racism, and marginalization are not fictions but structural, institutional, and interpersonal realities. How these are interpreted and processed is personally and potentially clinically relevant, but they are not perceptual disorders or distortions of reality. I consider it an ethical and professional duty to address this openly. 

4. Because psychotherapy can also be culturally blind.

For example, most models have been developed from and with regard to a Western/white middle-class perspective. However, concepts from other cultures (e.g., regarding values and appropriate behavior) can differ significantly. Diagnostic methods rarely offer culturally specific comparison samples, which can make interpreting test results difficult. There are difficulties in communication, not only on a linguistic level but also concerning different meanings (e.g., metaphors, "organ codes"). Lack of knowledge and biases can have serious consequences. Therefore, if cultural aspects are not adequately considered, there may be misdiagnoses and mistreatments in therapy.

How do I envision culturally sensitive therapy?

1. How you choose to address the cultural aspect will always be up to you.

This is a personal decision that falls under the therapeutic principle of patient/client autonomy. My role can only be to present various perspectives and their consequences. As someone privileged in terms of race/cultural aspects, it is not my place to expect a certain attitude from you. As a psychotherapist, coach, or supervisor, your well-being is entrusted to me, and the only question that matters to me is what approach is beneficial for you.

2. Do we need to emphasize these aspects?

No, certainly not. My intention is not to force this aspect but to be ready for it if you wish to address it or if it seems relevant. Categorizing or divisive thinking in terms of "me vs. others" (ingroup vs. outgroup) can lead to feelings of isolation, alienation, lack of connection, or belonging. Some individuals may experience heightened distress through an emphasis on topics such as discrimination and racism. Additionally, some individuals may not consider the cultural aspect personally relevant, and I consider that equally legitimate.

3. What is my professional perspective on cultural aspects?

Cultural identity always arises in relation to specific marked groups, which are judged as equal or unequal based on certain characteristics. It thus emerges through differentiation of (perceived) commonalities and differences with (groups of) others. The comparison criteria used are essentially arbitrary but historically significant. For example, a person may be perceived as a Person of Color in Germany but as white or light-skinned in Africa or South America, leading to vastly different experiences of privilege. I view cultural identity aspects as cognitive categories shaped by social experiences that can be made relevant in interactional and societal contexts. Certain aspects (e.g., skin color, nationality, language) can bring about similar experiences and privileges, such as in terms of power and resources.

An important current theory in the analysis of cultural aspects is intersectionality. This theory examines and describes the interactions between various identity characteristics and their consequences (e.g., in terms of privilege and discrimination) for the individual. For instance, individuals may be privileged in some aspects (e.g., cisgender and heterosexual) and disadvantaged in others (nationality, skin color). Moreover, bearers of the same characteristic (e.g., homosexual) may have very different experiences due to various other characteristics (e.g., coming from a secular upper class vs. a traditional religious working class background). Another important theory influencing my work is poststructuralism. This theory posits that knowledge cannot be unequivocal and objective but is influenced by discourses, power relations, and social conventions. Poststructuralism emphasizes the seemingly infinite variety of interpretations and perspectives.

4. How can the cultural aspect be appropriately considered in therapeutic work?

The necessary differentiation takes place in the tension between often fuzzy concepts, often also in dualisms that can be pleasantly simplifying but also insufficiently complex. It is about questioning (individually or together) where similarities and differences with marked groups of people are perceived. To what extent one wants to adapt or differentiate oneself, or whether the qualities of both groups can be maintained and integrated (as in the concept of Afro-German or Viet-German identity, for example). The influence of culture on the individual, according to the general view of theorists, should neither be denied (personalization) nor overemphasized (culturalization) in this process.

5. How will such an engagement affect me?

This cannot be predicted with certainty. My therapeutic task will be to notice, provide feedback on, and reflect with you on any effects. It often involves an intensive examination that sharpens or alters one's perception of relationships. This work can feel rewarding, characterized by feelings of security or empowerment, but it can also be accompanied by feelings of fear, anger, or confusion.

To calm such experiences, resorting to mindfulness and self-care can be helpful. For example, the perspective of shared humanity (which is an important factor in Compassion Focused Therapy) can provide a helpful balance if feelings of detachment or fragmentation become uncomfortable.

What are typical experiences of individuals whose appearance or background does not align with the cultural majority?

Some typical behaviors from others:

  • Microaggressions and insensitivity 
  • Constantly being asked about or related to one's "actual" origin
  • Having to provide information (e.g., about one's stance on Israel)
  • Having to ask for consideration because one's perspective is not being taken into account (e.g. not eat pork)
  • Having to educate others about culturally sensitive behavior 
  • Othering; being marked as different from the so-called majority society
  • Stereotypes and prejudices regarding the identity characteristic
  • Idealization, positive discrimination, or exoticization
  • Discrimination, disadvantage, racism

Some typical experiences of marginalized individuals:

  • Constant feelings of exhaustion, tension, nervousness, or anger ("racial stress")
  • Loneliness, lack of belonging, lack of representation
  • Identity conflicts, or conflicting expectations placed on oneself
  • Low self-esteem, strong sense of responsibility, high pressure to perform (here internalized racism can play a role)
  • "Imposter syndrome" or "self-handicapping": the persistent feeling of not being good enough and therefore ceasing one's efforts for fair treatment
  • Family entanglement, intergenerational conflicts (e.g., due to "traditional" vs. "modern" attitudes), intergenerational trauma 
  • Inhibitions to visit certain places, groups, or activities
  • Subordination to authorities or institutions
  • Suppressing one's own emotions (such as anger) out of fear of being perceived as aggressive or threatening (attributable e.g. to anti-Black and anti-Muslim racism)

However, the cultural aspect can also play a role for privileged individuals. For example:

  • Fear of making mistakes and hence having "fear of contact" with certain individuals/groups
  • Feelings of shame or guilt: for historical or current events, privileges, or prejudices