Cultural Safety in the Therapy Room

Cultural safety in therapy means you can bring your whole self into the room, including your culture, faith, race, family and migration story, without having to explain or defend it. The idea comes from nursing in Aotearoa New Zealand. It asks the practitioner to examine their own culture and power, and it holds that safety is defined by the person receiving care.

Therapy is political. We cannot pretend that race, class, gender, and power do not enter the room with us. They do.

Where does the idea of cultural safety come from?

Cultural safety was developed by the Māori nurse and educator Irihapeti Ramsden and Māori nurses in the 1990s. In 1992 the Nursing Council of New Zealand made it a requirement in nursing and midwifery education (Curtis et al., 2019).

What makes it distinctive is where it puts the attention. Earlier ideas such as cultural awareness or cultural competence focused on the practitioner learning about other people's cultures. Cultural safety turns the gaze around. It asks the practitioner to examine their own culture and the power they hold, and to notice how these shape the encounter.

A review by Curtis and colleagues proposed a definition in which safe care is something "defined by the patient and their communities" (Curtis et al., 2019). In other words, it is not up to me to declare the room safe. It is up to you to feel whether it is.

Can a therapist ever be neutral?

A therapist who claims to be "neutral" is often just defaulting to the dominant culture's view. If I ignore the reality of racism or minority stress in your life, I am failing to see you fully.

Neutrality sounds fair. In practice, a counsellor who does not think about culture still has one. It shows up in what they find normal, what they find odd, and which choices they quietly assume a healthy person would make. Living with extended family, deferring to parents on big decisions, praying before a difficult conversation: these can be read as problems simply because they are unfamiliar.

So I would rather name my position than pretend I have none. I am a trainee counsellor, and I bring my own background, training and blind spots into the room. Saying so out loud is part of the work.

What is minority stress?

Minority stress is the extra strain that comes from belonging to a group that faces prejudice. Ilan Meyer described it in relation to lesbian, gay and bisexual people, and the idea is now often applied more widely. It includes obvious events like discrimination, and quieter ones: expecting rejection, staying on guard, hiding parts of yourself to stay safe (Meyer, 2003).

For many people from minority backgrounds, this is ordinary daily life. You might notice it as tiredness after a day of being the only brown woman in every meeting. You might notice it when someone praises your English, or asks where you are really from. Each moment can seem small. Together they add up.

If you have moved to another country, there may also be acculturative stress: the strain of adjusting to a new culture's rules while still carrying the old ones. The living abroad and migration resources gather trusted outside reading on this.

What does cultural safety look like in a session?

Imagine you mention that your mother-in-law lives with you, and the conversation simply carries on. No raised eyebrow, no assumption that you must want her to leave. You talk about what it is actually like for you, which may include love and frustration at the same time.

Or imagine you describe a comment at work that stung. Instead of being asked whether you might have misread it, you are given room to say what it felt like and what it stirred up.

You might also say that a word from your own language doesn't translate, and the counsellor stays with what it means to you, instead of reaching for the nearest English equivalent.

In my practice, cultural safety means you don't have to explain or justify your existence. It means we can talk openly about how the world treats you, and how that impacts your mental health. You don't have to leave your culture at the door.

How does this fit with person-centred therapy?

Person-centred counselling rests on trying to understand your experience from your own frame of reference. Rogers (1957) described empathy as sensing the client's private world as if it were your own, without losing the "as if" quality.

That is a good foundation for cultural safety, but on its own it is not enough. A counsellor can sincerely believe they are understanding you while filtering everything through their own cultural lens. This is why congruence matters here too: being honest, with myself first, about where my understanding stops.

It is also why I try not to treat culture as a side topic. For many people, family and faith are simply part of who they are.

Empathy and congruence are two of the three core conditions Rogers described, alongside unconditional positive regard. Held together, they ask me to understand your world, accept it without conditions and stay honest about my own. My page on person-centred counselling explains how this works in sessions. If your family sees the self through relationships rather than independence, the glossary entry on collectivism and the reflection on the myth of independence explore why that isn't something to be "fixed".

What can you ask a counsellor about culture?

It is reasonable to ask questions before you start. You might ask:

• How do you think about culture and family in your work?
• Have you thought about how race and power show up in counselling?
• What would you do if you said something that hurt or misunderstood me?
• Will I have to explain my background before we can talk about anything else?

A counsellor who takes cultural safety seriously should be able to answer these calmly, without defensiveness. If you would like to know more about how I approach this, you can read my page on counselling for South Asian women and families, or the page on identity and belonging more broadly. My page on counselling for immigrants covers migration and bicultural identity, and the guide on how to find a South Asian therapist looks at what research says about cultural matching.

You don't have to make yourself smaller to fit a therapy room. When you are ready, you can book a first session.