All these characteristics of mainstream therapy can place culturally diverse clients at a disadvantage. For example, Native American and Asian American cultures do not always value verbalizations in the same way as White Americans. In traditional Chinese culture, many children have been taught not to speak until spoken to. Patterns of communication tend to be vertical, flowing from those of higher prestige and status to those of lower prestige and status. In a therapy situation, many Chinese clients, to show respect for a therapist who is older and wiser and who occupies a position of higher status, may respond with silence. Unfortunately, an unenlightened counselor or therapist may perceive such clients as being inarticulate, less intelligent, or resistant.
With regard to emotional expressiveness, many cultural groups value the restraint of strong feelings. For example, traditional Asian cultures emphasize that maturity and wisdom are associated with one's ability to control emotions and feelings. This applies not only to public expressions of anger and frustration but also to public expressions of love and affection. Unfortunately, therapists unfamiliar with these cultural ramifications may perceive these clients in a negative psychiatric light. Indeed, these clients are often described as inhibited, lacking in spontaneity, or repressed.
In therapy, it has become increasingly popular to emphasize expressiveness as a behavioral modality, as manifested by the proliferation of cognitive behavioral assertiveness training programs throughout the United States (Craske, 2010) and the number of assertiveness self‐help books published in the popular mental health literature. Such instruction fails to recognize that there are cultural groups in which subtlety is a highly prized art. Similarly, other cultural groups may place a higher cultural premium on politeness and a focus on others rather than self‐focused values such as assertiveness; one example is the traditional Latinx value simpatía, or the cultural value of communicating in the context of politeness, warmth, and interest in others’ feelings and well‐being (Rodriguez‐Arauz et al., 2019). Doing things that are perceived as less direct or assertive can be interpreted by a mental health professional as evidence of passivity and the need to learn assertiveness behaviors and skills. In their review of assertiveness training, Wood and Mallinckrodt (1990) warned that therapists need to make certain that gaining such skills is a value that is shared by a client of color and is not one imposed by therapists.
INSIGHT
Another generic characteristic of conventional psychotherapy is the emphasis upon insight. This approach assumes that it is mentally beneficial, if not necessary, for individuals to obtain insight as psychodynamic theory defines it: an understanding into one's own underlying psychological dynamics and motivations (Corey, 2013; Levenson, 2010). Educated in such traditions, many theorists believe that clients who obtain insight into themselves will be better adjusted. Although behavioral schools of thought may not subscribe to this, most therapists work toward insight to some extent in their individual practice, either as a process of therapy or as an end product or goal (Antony & Roemer, 2011).
Therapists must consider that this conception of insight is not shared or highly valued by all cultural communities. A person who does not value insight in the way that Western cultures understand it is not necessarily one who is incapable of insight; rather, many cultural groups do not value this method of self‐exploration. In traditional Chinese society, psychology has little relevance, and a client who does not seem to work well in an insight‐oriented approach may not therefore be lacking in insight itself or psychological‐mindedness. It is interesting to note that many Asian elders believe that thinking too much about something can actually be a source of problems. Many older Chinese believe the way to achieve to mental health is to “avoid morbid thoughts.” Advice from Asian elders to their children when they are frustrated, angry, depressed, or anxious may simply be, “Don't think about it.” Indeed, it is often believed that experiencing anger or depression is related to cognitive rumination. The traditional Asian way of handling these affective elements is to “keep busy and not think about it.” There can be class‐related differences as well (APA Task Force on Socioeconomic Status, 2007). People living in poverty may not perceive additional insight as the solution to their life situations and circumstances. Their immediate concerns may revolve around strategic reality‐oriented questions as “Where do I find a job?,” “How do I feed my family?,” and “How can I afford to take my sick daughter to a doctor?”
SELF‐DISCLOSURE, OPENNESS, AND INTIMACY
Most forms of counseling and psychotherapy prioritize one's ability to self‐disclose and to speak fairly openly about the most intimate aspects of one's life. Indeed, the ability to self‐disclose has often been discussed as a primary characteristic of a healthy personality. Clients who do not self‐disclose readily in counseling and psychotherapy may be seen as possessing negative features (i.e., being guarded, mistrustful, or paranoid).
Disclosure and intimate revelations of personal or social problems are not acceptable to some cultural communities. For example, Asian Americans may consider such admissions to reflect not only on themselves as individuals but also upon their whole family (Chang, McDonald, & O'Hara, 2014). Thus, the family may exert pressure on an Asian American client not to reveal personal matters to strangers or outsiders. Similar conflicts have been reported for Latinx clients (Torres‐Rivera & Ratts, 2014), American Indians (Thomason, 2014), and Polynesian Americans (Allen, Kim, Smith, & Hafoka, 2016). Moreover, people from marginalized communities may be reluctant to disclose to White counselors because of their previous experience of racism (Ratts & Pedersen, 2014). A therapist who works with an individual from a cultural background like these may erroneously conclude that their non‐disclosing client is repressed, inhibited, shy, passive, or resistant. All these traits are often seen as undesirable by Western standards.
The structure of the therapy situation itself may further work against intimate revelations for some clients. Among many cultures, including American Indians and Latinx Americans, when intimate aspects of life are shared, it would not typically be beyond close friends. Relative to White middle‐class standards, these deep friendships are developed only after prolonged contact. Once friendships are formed, they tend to be lifelong in nature. In contrast, White Americans form social relationships relatively quickly, and the relationships may or may not persist over long periods of time. Counseling and therapy also seem to reflect these values. Clients socialized within a White European American context often understand that they are expected to talk about the intimate aspects of their lives with a relative stranger once every week for a 50‐minute session—they are aware that that's what therapy is. To many culturally diverse groups who stress longstanding friendship as a precondition to self‐disclosure, this aspect of the counseling process may seem utterly inappropriate and absurd.
STYLES OF COMMUNICATION
Communication style refers broadly to those factors that go beyond the content of what is said. Communication specialists have historically found that only 30–40% of what is communicated conversationally is verbal (Ramsey & Birk, 1983; Singelis, 1994), meaning that a large portion of what is communicated in an interaction derives from nonverbal and other sources. In other words, what people say and do is usually qualified by other things that they say and do. A gesture, tone, inflection, posture, or degree of eye contact may enhance or negate the content of a message. Communication styles have a tremendous impact on our face‐to‐face encounters with others (Geva & Wiener, 2015). Whether our conversation proceeds in fits and starts, whether we interrupt one another continually or proceed smoothly, the topics we prefer to discuss or avoid, the depth of our involvement, and the forms of interaction (e.g., ritual, repartee, argumentative, persuasive) are all aspects of communication style. Some refer to these factors as the social rhythms that underlie all our speech and actions. Communication styles are strongly correlated with race, culture, and ethnicity (Garrett & Portman, 2011; Ivey, Ivey, & Zalaquett, 2014); gender has been found to be a powerful determinant