Culturally adapted and decolonial therapies

Domain XV · Nature, philosophy, social & rites of passage · Bernal, Bonilla, Bellido · 1995

What it is

This is a family of frameworks and stances, not a single manualised therapy. Two traditions sit together here. Culturally adapted therapy takes an existing evidence-based treatment and changes it, systematically, so that it fits a client's language, values, context and community. Bernal and…

Format

• The sources give no fixed session count or phase timetable for individual therapy, so none is stated here. The phases below combine the CFI sequence, Bernal's dimensions and the decolonial stance into a working order for one clinician. The ordering is unless a source is tagged.
• Phase 1: Engagement and cultural assessment (early sessions). Goal: understand the problem in the client's own terms and context. Format: the 16-question core CFI, in seven sections: cultural definition of the problem; causes; stressors and supports; role of cultural identity; self-coping, past…

Who practises it, and how they are trained or regulated

• Phase 0: Clinician preparation (before and throughout). Goal: examine your own cultural position, power and training biases. Cultural humility is described as "a lifelong commitment to self-evaluation and self-critique". Mullan asks Eurocentrically trained clinicians to look at both their privileged and their oppressed parts. Move on: you never finish this phase. It continues in supervision alongside every later…
• Evidence status (one line, as the reviews state it): across 78 studies, a meta-analysis found culturally adapted interventions outperformed other conditions (g = 0.67). Against the same unadapted intervention the advantage was medium (g = 0.52), but only nine studies made that comparison. A systematic review of adapted CBT for Latin American patients questioned whether adaptation is always needed, and stressed…

Evidence status, as the guide reports it

• Phase 3: Choosing and adapting the treatment. Goal: decide what evidence-based or culturally grounded approach to use, and what to change across Bernal's eight dimensions. Decide whether the changes are peripheral (engagement, delivery, therapy framework) or core (adding, modifying or replacing a…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• replacing the client's term with a diagnosis too early. Working: the client recognises their own language in your summary.
• polite reassurance that hides discomfort. Revisit later. Working: the client raises concerns about the relationship spontaneously.
• module fatigue; distress when going into migration or persecution history. Working: the formulation gains specific, usable detail.
• borrowing sacred imagery the client did not offer; clumsy translations. Working: the client starts using the shared metaphor themselves.
• the client minimising discrimination to protect you, or because they expect disbelief. Working: they bring examples later without being asked.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.