PPRNet Clinical summary: The Effect of Cultural Humility on Therapeutic Alliance and Outcomes

In recent years, cultural humility has gained traction as an essential stance for psychotherapists. Previously, scholars focused on multicultural competence, which recently has been criticized because of its exclusive focus on knowledge and skills. On the other hand, cultural humility focuses on the therapists’ way of being and their attitude toward a client. A culturally humble therapist is open and interested in reflecting on their own cultural context and learning and understanding the cultural context of their client. A culturally humble therapist approaches a client’s culture and identity with curiosity and respect. Cultural humility can foster meaningful cultural communications that could strengthen the bond aspect of the therapeutic alliance. Cultural humility may indirectly affect patient mental health outcomes through its impact on the therapeutic alliance. There is also some evidence of the negative effect of a non-culturally humble therapist who is ignorant or dismissing of clients’ identities. In this study, Orlowski and colleagues systematically reviewed studies examining therapist cultural humility and its association with the therapeutic alliance and patient outcomes. They found 13 studies representing 3367 clients and 1258 therapists. The correlation between cultural humility and the quality of therapeutic alliance was statistically significant and positive (r = .66, 95% CI = [0.64, 0.68], 95% PI = [0.20, 1.39]). Similarly, they found a statistically significant and positive association between cultural humility and outcomes (r = .39, 95%CI = [0.36, 0.42], 95% PI = [.0.18, 1.01]). Although the effects were heterogeneous, the authors did not find that client, therapist, or therapy characteristics affected the size of these effects. 

Practice Implications

A therapist who embodies cultural humility (curiosity, openness, and respect for one’s own and their clients’ identities) will likely foster better therapeutic alliances and patient mental health outcomes. Perhaps greater cultural humility increases the strength of the alliance which, in turn, produces better outcomes. This may be accomplished by openness to cultural conversations and discussing the impact of the therapists’ and clients’ culture on the therapeutic relationship. Clinicians might benefit from increasing their understanding of their identities and remaining open and curious about their clients’ identities. 

Orlowski, E. W., Moeyaert, M., Monley, C., & Redden, C. (2024). The effects of cultural humility on therapeutic alliance and psychotherapy outcomes: A systematic review and meta‐analysis. Counselling & Psychotherapy Research. Advance online publication. https://doi.org/10.1002/capr.12835.