What is culturally sensitive therapy and why can it matter for Turks living abroad? What to look for in therapy on family, shame, homesickness and identity.
Imagine telling a therapist that your mother phones you every day and hearing the comment, "That is very controlling behaviour." Perhaps for you these calls are both love and, at times, an overwhelming responsibility, and it is impossible to sum that up in a single word. Or imagine having to explain at length why not visiting your family during a religious holiday creates such a heavy sense of guilt. Culturally sensitive therapy is an approach that tries to understand a client's cultural background, values and life context, and treats them as a natural part of the therapeutic process. In this article we look at what culturally sensitive therapy is, why it can matter for Turks living abroad, and how you can look for the support that suits you.
What Is Culturally Sensitive Therapy?
Culturally sensitive therapy is not a particular school of therapy; it is an approach concerned with the therapist's attitude and way of working. In this approach, the therapist:
- Engages with the client's cultural identity, values and beliefs with curiosity and respect.
- Tries to stay aware of their own cultural assumptions and does not impose them on the client.
- Takes into account how factors such as family structure, social roles, religion, language and the experience of migration shape a person's difficulties.
- Knows that what is regarded as "normal" or "healthy" behaviour can vary from culture to culture.
- Sees the client not as a representative of their culture but as a unique individual.
The last point is especially important. Culturally sensitive therapy does not mean making generalisations such as "Turks are like this." Two people from the same culture can have very different values, experiences and needs. Cultural sensitivity involves understanding a person's culture while also exploring their own place and choices within it.
Signs That Your Cultural Context Is Not Being Understood
If you have the following experiences in your therapy, you may suspect that your cultural context is not being sufficiently taken into account:
- Your family relationships are repeatedly described as "unhealthy", "enmeshed" or "boundaryless"
- Your sense of responsibility towards your parents is seen only as a problem
- You feel uncomfortable when your religious or spiritual values are discussed
- You spend much of your sessions explaining the concepts of shame, ayıp or elâlem ("what other people will say")
- You feel the suggested solutions do not fit your life context (for example, "Cut ties with your family")
- You feel that your experience of migration and of discrimination is not being taken seriously enough
- You leave sessions with the feeling that "they didn't really understand me"
- You feel you have to defend your culture
These signs do not mean that your therapist has bad intentions or is inadequate. Often this is part of a mutual process of coming to understand each other, and it can be resolved by talking openly. Culturally sensitive therapy does not mean such misunderstandings never happen; it means that when they do, they can be approached with curiosity and respect. Being able to tell your therapist, "That interpretation didn't fit for me," is a sign of a strong therapeutic relationship.
Why Culturally Sensitive Therapy Matters: Cultural Context and Identity
Psychological difficulties are lived within a cultural context. Anxiety, depression, relationship problems and low self-esteem may be universal experiences, but how they are lived, expressed and given meaning can vary from culture to culture. For example, some people express emotional distress mostly through physical symptoms: "A weight has settled on my chest," "I feel tight inside." Understanding the emotional meaning of these expressions can make the therapeutic process easier. Similarly, expressions such as nazar (the evil eye), kısmet (fate) or "it was written in my destiny" carry valuable clues about how a person makes sense of what they go through.
The distinctive dynamics of the Turkish family. In Turkish culture, family is often at the centre of an individual's identity. Concepts such as responsibility for caring for parents, solidarity among siblings, kinship ties and family honour are important. These values can be both a strong source of support and, at times, a source of pressure and guilt. A culturally sensitive approach neither glorifies nor judges these values; it helps the client explore their own relationship with them.
The concept of shame and ayıp. The concept of ayıp is a powerful mechanism regulating social behaviour in Turkish culture. It can make it harder to express feelings, ask for help or open up family problems to outsiders. Understanding the effect of this concept on a person can make it easier to open up in therapy.
Identity between two cultures. People who grew up or have lived for many years abroad can feel caught between the values of two cultures. A split identity experience such as "Turkish at home, German outside" can be approached more holistically with a culturally sensitive approach. This topic is covered in detail in our article on identity between two cultures.
Experiences of migration and discrimination. The losses brought by migration, the difficulties of adjustment and experiences of discrimination can deeply affect a person's mental health. Taking these experiences seriously and understanding them is important for the client to feel safe.
Effects on Family, Relationships and Children
Understanding the cultural context is especially important in work on family and couple relationships.
In couple relationships: In Turkish culture, each partner's relationship with their in-laws is an important part of a marriage. Relations with the mother-in-law, family visits, and whose home to go to for religious holidays are frequent topics of argument between couples. In mixed marriages, these expectations can be hard for a partner from a different culture to understand.
In parenting: Families raising children abroad try to balance the values they grew up with against those of the culture their children are growing up in. Say parents do not want to let their sixteen-year-old daughter sleep over at a friend's house, while she says all her friends at school do it. A culturally sensitive approach neither sees the parents' values as "backward" nor interprets the teenager's wish as "becoming alienated from her culture." Instead, it tries to understand the concerns and needs of both sides and to find common ground.
In intergenerational relationships: Values, expectations and communication styles can differ between first-generation migrants and the second and third generations. Understanding these differences can help reduce tension within the family.
What You Can Do on Your Own
The following steps may help you with a culturally sensitive therapy process:
Reflect on your own cultural values. Which values are important to you? Which ones are a struggle? An awareness such as "Responsibility towards my family matters to me, but sometimes it overwhelms me" can clarify where to start in therapy.
Tell your therapist about your cultural background. If your therapist comes from a different culture, it can be useful to briefly describe your family structure, your values and your migration story in the first sessions.
Say so when you feel misunderstood. Saying, "This topic has a different meaning in my culture," can broaden your therapist's perspective.
Ask questions when choosing a therapist. In the first meeting you can ask about the therapist's experience of working with clients from different cultures and how they approach cultural issues.
You do not have to defend your culture. The aim in therapy is not to justify your culture but to understand your needs. You may want to keep some of your values and question others; both are legitimate.
Be compassionate towards yourself. Living between two cultures can be demanding. Experiencing this difficulty is not a shortcoming in you; it is the natural result of a complex life experience.
Prepare your own "cultural dictionary". Note down the words and concepts that matter to you but lose their meaning when translated into another language: vefa (loyalty), kırgınlık (hurt resentment), hasret (longing), mahcubiyet (a shy, apologetic embarrassment) and so on. Next to each, write in a few sentences what it means to you. This exercise can be a way of describing your inner world both to your therapist and to yourself.
Do not see your values as "all or nothing". While keeping a value, you can adapt it to your own life. For example, while keeping the value of respect for parents, you can choose not to make every decision depend on their approval.
Say a thirty-year-old man living in Austria feels caught between his family's expectations and his own wishes about the decision to marry. When he describes the situation to his local therapist, he is asked, "Why do you attach so much importance to your family's approval?" and feels he has to defend himself. When he talks about the same issue with an approach that takes cultural context into account, the question changes: "What does your family's approval represent for you, and what do you feel when you are afraid of losing it?" This second question can help a person reach their feelings without having their values judged.
Not having to explain everything in order to be understood is sometimes the first step of healing.
When Should You Seek Professional Support?
You may consider speaking to a mental health professional in the following situations:
- If inner conflicts about identity, belonging or cultural values are making your life difficult
- If you feel caught between family expectations and your own wishes
- If you have been experiencing sadness, anxiety or loneliness for a long time
- If there are recurring conflicts in your couple or family relationships because of cultural differences
- If experiences of discrimination have affected you deeply
- If you felt misunderstood in therapy you have had before
If you have thoughts of harming yourself or ending your life, call the emergency number of the country you are in: 112 in EU countries, 911 in the USA and Canada, 999 or 112 in the UK, 000 in Australia. Online therapy is not an emergency intervention service; in situations of severe risk, local emergency services and psychiatric services are necessary.
The mental health services in the country where you live are also valuable resources, and many therapists there are experienced in culturally sensitive work. Mother-tongue support does not have to replace these services.
How Does Mother-Tongue Online Therapy Work?
Mother-tongue online therapy can be a form of culturally sensitive therapy; however, speaking the same language is not enough by itself. What matters is that the therapist listens to the client's individual experience with curiosity and is able to question their own assumptions. Coming from the same culture can sometimes lead to the illusion of "I understand you"; for this reason a good therapist treats the shared culture as a starting point but keeps listening to the client's own particular story.
In mother-tongue therapy, some topics may need less explanation: the meaning of religious-holiday visits, kissing the hand of an elder, saying hakkını helal et ("forgive what you are owed"), the culture of hospitality, the concepts of gurbet (life far from home) and sıla (home and homeland). This shared ground can help the therapeutic relationship form more quickly. However, this is not guaranteed; some people also feel anxiety about being judged when they work with a therapist from the same culture. This too is something that can be talked about. For more on difficulties with language, see our article on therapy in a foreign language.
Work in mother-tongue online therapy usually proceeds like this:
- Assessment: We talk about the difficulties you are experiencing, your family structure, your migration story and your cultural values.
- Work based on Cognitive Behavioural Therapy (CBT): For example, the origins, function and effect on you of a belief such as "A good child always does what their family wants" are examined. The aim is not to push you to change this belief but to make it more flexible and more in line with your own values.
- Values work: We explore which cultural values are meaningful to you and which ones restrict you.
- Communication skills: We work on setting boundaries with family or a partner, expressing needs and managing conflict.
For online sessions, a quiet and private room, headphones and a secure internet connection are enough. A suitable time is set with the time difference in mind. Payment is made online; pricing is in Turkish lira and payment by international card is possible. You need to check the terms of your insurance in the country where you live for any reimbursement. For more information, you can look at the pages on online therapy and Turks living abroad.
Frequently Asked Questions
Do I necessarily need a Turkish therapist for culturally sensitive therapy?
No. Many therapists from different cultures can also work in a culturally sensitive way. What matters is the therapist's curiosity, openness and willingness to understand your experience. Some people, though, find it more comfortable to work with a therapist from the same culture who speaks their mother tongue.
Will the therapist try to change my cultural values?
In culturally sensitive therapy the aim is not to change your values but to help you understand your relationship with them. You decide which values to keep and which to question.
Is culturally sensitive couple therapy possible in mixed marriages?
Yes. In mixed marriages it is important to take both partners' cultural backgrounds into account. In couple therapy, the values and expectations of both sides are explored, and the aim is to find common ground.
I felt misunderstood in my previous therapy. Should I try again?
Feeling misunderstood in one therapy does not mean that therapy is not right for you. Working with a different therapist or a different approach can offer a new experience. Sharing your previous experience with your new therapist can also be part of the process.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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