Everyone needs a therapist. At least, that’s the trending notion amongst modern WEIRD (Western, Educated, Industrialized, Rich, and Democratic) people.

As I mentioned in “Do I need Therapy?”, understanding yourself is like understanding a country—sometimes, you need to look from the outside in. We can do that through meditation, psychedelics, travel, social bonds (which we explored last week), and therapists.

Yet, many people aren’t convinced therapists are the best option because shrinks can be sales-driven, “usually need therapy themselves,” or create a dependency link. Of course, one could argue that therapists teach you techniques for being self-dependent. The problem is that the techniques that work in one culture can be detrimental in another.

In his book Crazy Like Us: The Globalization of the American Psyche, Ethan Watters argues that applying Western mental health treatments globally has often led to less effective outcomes for mental illnesses in non-Western regions and may have unintentionally introduced conditions to areas where they were previously didn’t exist.

For example, anorexia did not manifest in the same way in Hong Kong until the concept was recently introduced, leading psychiatrists and clients to interpret certain symptoms through a possibly mistaken Western lens. Similarly, posttraumatic stress disorder (PTSD) was not prevalent in Sri Lanka after the 2004 tsunami until Western aid workers (with good intentions) convinced locals that they must be experiencing it.

As the social historian Edward Shorter puts it:

Each culture provides a "symptom pool" of recognized and discussed symptoms that lead people to express their inner conflicts in a familiar language. Providing people with different conceptions of mental illness may lead them to express their own psychological difficulties in symptoms that are consistent with those conceptions.

That’s why it’s essential to understand how healing practices differ around the world before suggesting a therapy that has worked for you.

Western psychotherapy typically traces its origins to Western Europe, notably Sigmund Freud, who launched psychoanalysis in the late 19th century. Freud proposed that psychological difficulties often stem from unconscious conflicts and fears. He argued that these issues are best treated by exploring memories and traumatic experiences in depth during individual sessions, with the therapist helping to interpret them. And yes, Freud’s interpretations sometimes came down to a young boy's desire to eliminate his father and to have sex with his mother. So, let’s move on.

When psychoanalysis reached the United States in the 20th century, Carl Rogers modified it, emphasizing a client-centred approach where therapists aid in self-discovery. Since then, many psychotherapeutic approaches have emerged, the most common being cognitive behavioural therapy, which involves restructuring thoughts and alleviating adverse reactions through controlled exposures. Additionally, biological explanations and treatments for mental disorders have become more prevalent in psychiatry. Despite their diversity, these Western perspectives commonly rely on the client's ability to engage in a psychological discourse grounded in shared cultural meanings.

Yet, for similar reasons a Westerner hires a therapist, an Indigenous person might turn to a family member.

One study explored the indigenous healing practices commonly used in 16 societies in Africa, Asia, South America, the Middle East, and the Caribbean. The researchers found two indigenous models of healing common across these cultures.

First, the family plays the most crucial role in resolving mental health problems. Families share the individual's problems and are the key source of guidance, particularly from elderly members. They also often bear the stigma associated with mental illnesses. For example, in Saudi Arabia, the perceived stigma and shame attached to mental illnesses lead families to shelter a disturbed individual until the problem becomes unmanageable. At this point, they may seek help from extended family and the community.

Now, this might be the Westerner in me, but I agree with Chris Guillebeau that we need to open up about mental illness and depression, which is precisely what I’m doing through travel therapy.

By opening up to Westerners who went to therapy, I started to feel like I have deep-rooted traumas, masochistic tendencies, and enmeshment problems. The language and labels helped me analyze and discover certain parts of my character. Yet, it’s opening up to people from cultures where the word “trauma” isn’t used daily that makes me feel human and healed.

Sometimes, all the mental health language makes me feel worse off than I actually am. It makes me believe I need a therapist when, really, I need to live healthy and share stories with people from different cultures to realize how human and “normal” my experiences are.

On the other hand, I’m very much a Westerner regarding my analytic style, and I’m not sure the second model in non-Western societies—spiritualism and religion—would work for me.

Mental illnesses are often perceived as being rooted in an underlying spiritual problem, and treatment is often left to traditional healers, such as shamans.

An example of this spiritual conception of mental illness can be seen in the Yoruba of West Africa. In Yoruba thought, the person is viewed as the union of the ara (body), emi (mind/soul), and ori ("inner head"), each of which comes into existence by specific gods. The emi, however, has no personal characteristics, and the individual's unique qualities come from the ori, which is viewed as a deity. When the Yoruba want to understand someone's mental afflictions, they use divination to understand what has gone wrong with the individual's relationships with the gods.

Such different kinds of attitudes toward mental health treatment are not just evident in traditional societies; differences also exist between Western and Japanese psychotherapies.

Two notable therapies from Japan, Morita and Naikan, contrast with Western approaches.

Morita therapy, aimed at treating anxiety and depressive symptoms, involves isolated bed rest, light manual activities like sweeping, heavy labour such as chopping wood, reading Moritist literature, life training, meditation, and therapist sessions. The goal of Morita therapy is not to change the client's symptoms but to change the person's perspective on the symptoms and to come to see them as a natural part of who they are. People are cured when they learn to live productively despite their symptoms.

In contrast, Naikan therapy aims to provide clients with insights into their past by encouraging them to appreciate the kindnesses of significant others. It is used to treat addiction, depression, and sociopathy, particularly in Japanese prisons. Through guided introspection, clients reflect on the kindnesses they received, especially from their mothers during childhood, and consider how little they have given in return. The goal is to help clients reinterpret their unchangeable past through gratitude and guilt, thereby providing new meaning to their lives.

Considering the cultural diversity in how mental illnesses are presented and understood, it seems logical that therapists would be most effective if matched with clients from similar cultural backgrounds. This allows clients to communicate in their own language, feel better understood, and be more likely to stick with their treatment.

However, the therapeutic benefits of this cultural matching of therapists and clients appear to be relatively modest and can serve to ghettoize therapists from different backgrounds. Plus, as a third-culture kid whose home isn’t rooted in geography, I’ve noticed my mental health improve through travel therapy and talking to people from different cultures than my own.

So, what should therapists do when they encounter a client from a different culture background?

They need to increase their cultural competence—precisely what I help people do here at Born Without Borders.

Therapists must first recognize their own cultural influences to consciously manage their defences, interpretations, and projections when interacting with clients from different cultural backgrounds.

Second, therapists should develop knowledge about their clients' cultural backgrounds and the expectations that they likely have for the counselling relationship so that they can interact with their clients most effectively.

Third, the therapist should develop the appropriate skills to intervene in the therapy sessions in a culturally sensitive and relevant way.

At the same time, therapists need to know when to generalize from the client's culture to the mainstream culture and when to focus on the client's individual needs. After all, each person is unique and cannot be defined solely by their culture, as everyone interacts with their culture differently. Plus, clients often experience multiple cultures, so therapists must consider how clients integrate these diverse cultural influences with their individual traits.

So, how does a therapist learn to do all this?

A cultural consultation service. This involves a team of psychiatrists, psychologists, social workers, psychiatric nurses, medical anthropologists, and trainees who regularly discuss cases referred by therapists needing expert advice on multicultural clients. The team includes interpreters, consultants, and culture brokers to address specific cases, providing insights on issues beyond many therapists' expertise, such as unique family systems, cultural identity issues, migration stresses, and the impact of torture or war.

As you can imagine, that’s for people who can wipe their asses with hundred-dollar bills. Luckily, you accessed such information and people at a fraction of the cost by subscribing to Born Without Borders.

You can make the community even stronger and save money by referring friends or getting a group subscription. Culture is multi-faceted and continuously changing, so the best way to increase your cultural competency is to grow the Born Without Borders community. Sharing my work helps us to increase diversity, limit polarization, and create an online home for the inescapably foreign.

At the end of every journey, I write a book. My first one, Living with the In-Laws, is available on Amazon. Paid subscribers get a free Kindle or PDF edition, and founding members get a signed paperback.

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