A number of challenges are associated with providing counselling and psychotherapy to newcomers. Health care providers need to understand the complex cultural issues that may come into play, and be ready to adapt treatment plans and make use of cultural resources to customize treatment (Bhugra et al., 2011;Tummala-Narra, 2016).
Because newcomers may be unfamiliar with counselling or psychotherapy, some may not believe that such services apply to them or will be useful for them. It is usually more acceptable to the refugee or immigrant if they are asked if they would like to access services to discuss issues they are concerned about.
Communication for giving and receiving information is strongly influenced by people’s cultural backgrounds, including both verbal and non-verbal communication as well as the degree of emotional expression. Specifically, there are significant differences between low-context and high-context cultures in terms of the importance of the explicitness and context of the messages exchanged (i.e., gestures, body language, verbal and non-verbal messages). For example, high-context cultures (e.g., Brazil, Spain, China) tend to focus on underlying context, tone and meaning in the message, whereas low-context cultures (e.g., Canada, the United States, the United Kingdom) use explicit communication styles to avoid the risk of confusion.
In some cultures, the open discussion of personal feelings and problems is against traditional norms. Clients from cultures with indirect styles of communication may also consider direct questioning rude and thus not worthy of a complete response.
Metaphors are often culturally based and may have different meanings for people of different backgrounds.
Therapists and clients may have different expectations of what therapy can offer and their respective roles in therapy. Refugees and asylum seekers may see therapists and counsellors as authority figures who can help them stay in the country and/or provide social support and other non-medical outcomes. Therapists/counsellors need to discuss realistic expectations about achievements and outcomes.
Therapists and clients may hold different underlying values, which can affect all aspects of therapy. For example, pride tends to be more highly valued in Western culture, while it may be interpreted as self-centredness and arrogance in some other cultures.
Sex and religious issues may be taboo in many cultures, and thus need to be approached particularly cautiously in therapeutic encounters.
If clients are not able to understand and converse fluently in English or French, therapy/counselling in those languages is not possible. Evidence suggests that programs provided in clients' native language are more effective (Chowdhary et al., 2014; Dossa & Hatem, 2012; Griner & Smith, 2006).
Low literacy can affect therapies that require reading and writing, such as cognitive-behavioural therapy (CBT), and can limit the usefulness of self-help materials and rating scales (Bhugra et al., 2011; Murray et al., 2010).