Psychotherapists' Discursive Constructions of Culture and Cultural Conversations in Therapy

Disparities in the quality of mental healthcare services for majoritized versus minoritized clients are pronounced, while therapists draw on intuition and wider societal ideologies rather than professional training to confront the question of how to address clients' cultural identities and backgrounds in psychotherapy. This signals a gap between theoretical calls for cultural sensitivity and the practical implementation of culturally responsive care. The current study explores how psychotherapists deal with the dilemma of how to conceptualize, address, and discuss 'culture' in their practice. Drawing on a critical social-psychological framework for discourse analysis, we analyzed 31 semi-structured interviews with psychotherapists in Flanders, Belgium, and present the discursive patterns they articulated on culture and therapeutic conversations interpreted as related to culture. Therapists construct the importance of these conversations and position themselves while perpetuating wider societal discourse on cultural diversity in their clinical practice, drawing from five different repertoires: an action hesitancy repertoire, an experience as expertise repertoire, a paternalistic repertoire, a self-evidence repertoire, and a de-culturalization repertoire. Each repertoire has specific strengths and pitfalls for effective therapy with minoritized clients. As therapists are primary authorities in diagnosis and treatment, their practices greatly impact care quality and have the potential to either uphold or challenge existing disparities in mental healthcare.