Cultural Misunderstandings

Are you drinking plenty of fluids?
Patient thoughts: I wonder why he is asking me that, what it is with these people and water I don’t like the water here. It’s too cold. I don’t know what’s wrong with people here that they drink that. Really??? And what happens when you drink the cold water?

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Patients thoughts: What does he mean, what happens? Everyone knows that drinking cold water is not good for you. Maybe I should see a different doctor. I hate cold water; I put it in the microwave to heat it up before I can drink it.

In this case, the cultural misunderstanding occurred when the doctor failed to understand that some cultures learn and believe from an early age that drinking cold water can be detrimental to the body and they are discouraged from drinking it (Fauzi, 2008). This resulted in the patient becoming dehydrated because he was hesitant to drink the tap water as it was much cooler that they were used to. The patient found it inconvenient or impossible to heat water up at work or at school where there was no access to a microwave, so he just didn’t drink at all. Even without this knowledge, the doctor could go on to make suggestions of other liquids besides cold water that he could substitute to keep him well hydrated. However, knowing this information could have prevented him from making the patient feel awkward or uncomfortable.

These misunderstandings cross over into the psychotherapeutic process as well. Misunderstandings happen from many reasons including but not limited to a lack of cultural knowledge, and inability or desire to see and understand differences in others as well as in ourselves. Specific clinicians, known as Universalist clinicians tackle these issues under the pretense that these cultural differences should remain out of the spotlight when it comes to psychotherapy. They believe in highlighting similarities rather than differences and feel that if general factors are present, therapy will have a positive outcome regardless of ethnicity, context or race. They basically choose to overlook the cultural differences.

One the other side of the fence we have Particularist clinicians , which in sharp contrast to the universalists believe that cultural differences have a significant impact on individual experiences. They feel that these factors strongly determine how people define themselves as well as how they relate to others (Marcos, 1979). They view these differences as insurmountable obstacles and recommend that clients seek out therapists of their own cultural background in order to be successful in treatment.

The type of clinician, known as the trancendist clinician, recognizes the importance of bringing cultural differences to the forefront and developing specific plans of action to do so. From their perspective it is felt that these differences can be “transcended”, or simply put, that clinicians can develop cultural competencies allowing them to effectively provide treatment strategies to clients from many different backgrounds other than their own (Angelou, 2012).

It’s pretty clear that psychotherapy today adheres to a more trancendist perspective when developing and working through treatment plans for clients with diverse cultural backgrounds. There are several recommendations on how to effectively address culturally diverse clients. First , clinicians and professionals should view cultural differences as dynamic, complex, and subjective There are some very obvious characteristics such as accents , color of skin, or socioeconomic status that can be immediately categorized as culturally different, but the how they are interpreted or what these differences mean are subjective.

Beyond this , cultural differences are very complex , including a multitude of variables ( age , gender, language, religion, education level ) and it is crucial to consider all these factors when determining how they come together to define someone’s identity. Finally, perceptions of the therapist as well as the client are what constitute cultural differences as dynamic as opposed to static. As therapist and client progress through treatment what was once considered a cultural difference may fade into the background as other issues and factors come to the surface (Angelou, 2012). In this respect , therapist are encouraged to constantly explore how meanings can change , rather than operate on the pretense that once the cultural difference is defined and understood , that it is no longer necessary to explore.

Another way to reduce cultural misunderstandings is to address similarities before discussing cultural differences. Clients and therapist may not only differ on many cultural attributes, but may also share some of those cultural characteristics. A helpful approach would be to identify commonalities before delving into the differences. This could be extremely beneficial to the client, and the therapist’s knowledge of similarities may help reduce a client anxiety or ambivalence. It also serves to build rapport, making the client feel more secure and accepting about sharing information and getting to the root of underlying issues.

Cultural differences should be addressed as assets. Unfortunately many people from culturally diverse backgrounds have experienced how the majority misconstrues their differences as deficits. In the U.S. alone , members of a non dominant groups , such as anything but Caucasian, homosexual, disabled, non Christian, and female to cite a few, are often viewed as deficient, whereas male heterosexual white Christians are viewed in a more favorable light. Whenever possible, clinicians should make attempts to study how these differences relate to the client’s strengths, rather than perceiving them as weaknesses. Many of us value differences and consider them assets; however this is sometimes a harder message to convey during therapy considering the way that people view differences from dominant groups as a problem.

Although there are many different ways to address the issue of reducing cultural misunderstandings, the last one I will identify may be the most important. It is imperative to have a well versed, culturally competent therapist. There are three common dimensions to this. First and most obvious, the therapist attitude and beliefs about cultural different individuals set the stage for the success of the psychotherapy. Clinicians should deeply explore their feelings about prejudices and cultural biases before attempting to move forward with the treatment of a culturally diverse client. There are many different avenues a therapist can take to become more culturally competent such as reading and education, seeking out advice or supervision from more culturally competent colleagues, attending cultural events and exposing one’s self to people of different cultures. A willingness as well as a genuine desire to learn about different cultures is important as well as the understanding that this learning can be a lifelong process.


Angelou, M. (2012). Addressing cultural differences in the psychotheraputic process . Retrieved from

Fauzi, S. (2008). Doctor meets patient: The effect of cultural memory on the medical interview. Retrieved from

Marcos, L. R. (1979). Effects of interpreters on the evaluation of psychotherapy in non-English-speaking patients. American Journal of Psychiatry, 136, 171-174.

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