If you are a counsellor, you will always be faced with the challenge of counselling someone who comes from a different culture. So, what do you do if you feel you are unequipped to take these clients on? Will it be too difficult to work with someone who speaks a different language, or who comes from a vastly different culture? How can you be sure that you are giving them the assistance they require? Should we avoid these clients, or refer them elsewhere? There may be several factors that can hinder a counsellor’s willingness to engage with certain people, but we have a responsibility to be of service (where appropriate) to everybody who seeks our help. This resource is for those counsellors who want to learn how to better work with immigrants of varying cultural backgrounds – especially those who have experienced significant hardship. It will offer context regarding who you can expect to be counselling, and address some common concerns among counsellors.

Australia as a Multi-cultural hub

Alongside New Zealand and Canada, Australia has been dubbed one of the world’s major ‘immigration nations’ – an estimated 29.8% of our population are born overseas (ABS, 2020). In the last two decades, immigration has been the highest in Australia’s history, and rates are expected to continually increase by 1.8% per annum to reach 5.6 million born-overseas residents by 2047 (ABS, 2019). Furthermore, this means there will be more migrants in Australia than in any other OECD country (OECD, 2017). Considering this, it is inevitable that mental health professionals will have to develop their therapeutic practices in order to assist our increasingly diverse population.

Who are we counselling?

Those who achieve permanent residency generally do so by one of two avenues: the Migration Program for skilled migrants and families, or the Humanitarian Program for refugees and those seeking asylum (APH, 2017). Both programs have eligibility criteria that must be met before a person can be considered for settlement, and these can be taken into account in order to understand the contextual features of our clients’ lives. The Migration Program includes the skilled migrant, employer-sponsored skilled worker, business skills, business talent and regional sponsored migration programs. The Humanitarian Program includes refugee visas, Special Humanitarian Program visas for long-standing Australian residents who do not hold citizenship but have been assessed to need protection, and safe haven visas (APH, 2017). Knowing the avenue through which residency was acquired can give us clues as to how best to attend to a client.

What are the common mental health concerns?

The majority of refugees identified by the UNHCR are escaping war and violence; these include Syrians, who make up 30% of all refugees, and Afghans, who make up 27% of all refugees (UNHCR, 2021). Studies have shown that about 50% of refugees develop a mental illness as a result of traumatic circumstances (Shawyer, 2017); this ranges from PTSD, major depression, anxiety, and a prevalence of self-harm that is many times higher than the general population (Hedrick, et al., 2020).

Once settled in Australia, there are many more perceived challenges. These can include: processing recent traumatic events, cultural adjustment and discrimination, economic hardship, racism and xenophobia, criminalisation of migrant communities, language barriers, loss of family networks and support systems (kinship), and housing insecurity – among many others (Kirmayer, 2011).

More specifically, migrant women face uniquely challenging circumstances as they may be vulnerable to an intersection of gender-based violence from their own country and also from Australia (Kirmayer, 2011). They are also at a greater risk of experiencing domestic and family violence within the LGBTQI+ community (Ghafournia, 2011). These phenomena can occur because, in addition to common prejudice and bigotry, they can find themselves caught between societal expectations; people integrate certain expectations from their native culture, and then have trouble identifying and assimilating to those of a new culture. This can result in violence in response to perceived cultural transgressions.

What to expect as a counsellor

The first thing for us as counsellors to understand when thinking about our multicultural clients is that every individual comes from a unique context. We need to be aware that each individual has their own cultural identities, values, norms and beliefs. When we think about culture, we do not look only at race or ethnicity; we also consider class, age, gender and sexual orientation. These aspects help us to get a clearer understanding of who the client is so that they feel more comfortable culturally and we can communicate with them appropriately (Dillon, et al., 2008).

There are numerous common concerns that counsellors may have regarding cross-cultural practice. We explore some of the below.

“I have no experience working with clients from other cultures.”

Cultural training will equip you with the skills to work effectively with your client. For many of us this will involve becoming more aware of our own attitudes and prejudices, as well as learning some basic communication techniques (Dangar, 2011). Barriers or gaps in understanding will likely be resolved quite quickly as your client adapts to local customs, while you simultaneously become more familiar with their cultural background. You and your client will grow in sensitivity to each other, and you will come to mutual understandings as your relationship develops (Sue, et al., 2009).

One thing we must account for is that some counsellors can have trouble empathising with certain groups because they do not fit into their own cultural identity (Dillon, et al., 2008). Janet E. Helms put forth a racial identity model that is useful for understanding how the counselling process can be informed and influenced by the differences between the client and the counsellor (1995). She focuses on how people who identify as white can often be unaware of the nature of their racial biases, and can see themselves as somewhat of a default race; dismantling this bias opens us up to being more receptive and empathetic to others.

“I’m not sure how my client’s culture affects their mental health.”

One’s cultural background can affect their mental health in a variety of ways; each area of the world has a unique history that has developed into a unique assortment of conditioned beliefs and customs. (Pajares, García-Moreno, & Moya-Alvero, 2014). Research that inspects the relationship between culture and mental health has helped to inform counselling practices all over the world. For example, Mental Health First Aid USA found that people carry certain stigmas that are prescribed by their culture’s religions, societal expectations, and more (2019). Often, opening up a discussion about a client’s upbringing and culture-specific experiences is all it takes for counsellors to construct meaningful therapeutic experiences (Dangar, 2011)

While a counsellor may understand the mental hardships of certain demographics – for example LGBTIQ+ people – that understanding may only be applicable to their own culture (Dillon, 2008). For example, a transgendered person who was raised in Australia may have had a very different experience than someone who was raised in Malaysia or Philippines. Familiarising yourself with the various cultural factors that can affect your clients’ mental health will encourage a more understanding and helpful therapeutic relationship.

“My client seems to distrust me and/or my counselling approach.”

Trust is the cornerstone of a healthy counsellor-client relationship (Mackey, et al., 2010), but we might encounter clients whose past experiences have compromised their ability to form trusting relationships (attachment theory has a great framework to explore this further). People of certain ethnic backgrounds may have experienced a number of different forms of oppression and exploitation, resulting in avoidance behaviours when it comes to being vulnerable (Weise, 2013); this can be frustrating for counsellors as they try to build open channels of dialogue. A way of bridging this is to not only make your client feel welcome and comfortable in your practice, but also to involve yourself in the life and culture of the client (Weise, 2013). For example, this could involve building rapport with relevant community/family groups. This results in a deeper understanding of the client’s circumstantial nuances, allowing you to tailor the counselling process to suit their personal preferences.

Additionally, cultural differences can contribute to miscommunication surrounding certain issues or processes; this could happen on an interpersonal level, or it could occur at an institutional level. For example, a client from a country with a culture of respecting their elders may have trouble confiding in someone who is younger than them – this conflict could result in creating a tenuous relationship in which anxieties are formed about believing their counsellor has authority over them (Helms, 1995). To build trust during these misalignments in values, it is effective to acknowledge and respect the differences between your client and yourself, while also emphasising the similarities.  

In summary

It would be folly to not include cross-cultural counselling skills in your practice. These skills will help you to become more aware of the different ways that people experience life, and will enable you to communicate with them more effectively. With practice, you will also start to understand and appreciate your clients’ cultural differences and the specific mental health issues associated with it, allowing for open dialogue and mutual understanding. It takes a degree of self-awareness and open-mindedness to effectively counsel people from other cultures, but with some perseverance anybody can incorporate these skills into their counselling, and open themselves up to new ways of thinking!

Professional Development Tip

The Mental Health Academy offers a vast range of short professional development courses on working with diversity (see a list here). You can access all courses, plus more, as an MHA member. If you are not yet a member, learn more about how to join here.


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