Gordon C. Nagayama Hall, Ph.D.

Life in the Intersection


What Does Culturally-Adapted Therapy Look Like?

U.S. and Japanese psychologists adapt therapy to incorporate social contexts.

Posted May 29, 2018

Source: cegoh/Pixabay

If I am going to try a new Japanese restaurant, it matters what kind of food is served. I want food that is authentically Japanese. My grandparents were from Japan and I have lived in Japan. So, I want food that is intended for me.

Many people of Asian ancestry who seek psychotherapy want an approach that is intended for them. But most therapy is not intended for people of Asian ancestry. But some therapists culturally adapt therapy. And research indicates that culturally-adapted therapy works better than standard unadapted therapy.

In a new study, my colleagues and I wanted to identify how therapists culturally adapt therapy for clients of Asian ancestry. We were interested in how therapists in the United States and Japan adapt cognitive-behavioral therapy (CBT) for depressed clients. CBT is evidence-based and one of the most widely-used treatments worldwide for depression.

We interviewed 11 psychologists in the United States and six in Japan. All had treated at least 10 clients of Asian ancestry. Seven of the United States psychologists and three of the Japanese psychologists were women. The psychologists were of Asian ancestry other than two White psychologists in the United States.

The most common cultural adaptation of CBT was a focus on social contexts. These contexts included the family, community, or work. A focus on social contexts is consistent with interdependence in Asian cultures. This is different from the standard CBT focus on an individual’s thoughts and feelings.

A case example from a Japanese psychologist demonstrated the importance of social context. A researcher in his 40s was depressed because of intense pressure to succeed. He was the chonan, the oldest son who was expected to take care of his parents. Part of taking care of his parents was attaining economic success so that his parents would not worry about him. The psychologist’s intervention was to develop more realistic expectations of being the chonan. This involved evaluating the client’s actual success and if his parents were actually worried about him.

An unadapted CBT approach might question why a man in his 40s was still worried about his parents’ opinion of him. The intervention might encourage independence from his parents. “Think for yourself” would be the approach instead of considering his responsibilities as a chonan. Yet, a commitment to one’s family is beneficial to people of all ethnic backgrounds.

Asian Americans are less likely to use mental health services than any other ethnic group in the United States. Perhaps this is because they don’t believe the therapy that is offered is intended for them. Culturally adapted therapies are more effective than unadapted therapies. And they may be the type of “food” that Asian Americans want.


Campos, B., Ullman, J., Aguilera, A., & Dunkel Schetter, C. (2014). Familism and psychological health: The intervening role of closeness and social support. Journal of Cultural Diversity and Ethnic Minority Psychology, 20, 191–201. doi: 10.1037/a0034094

Hall, G. C. N., Ibaraki, A. Y., Huang, E. R., Marti, C. N., & Stice, E. (2016). A meta-analysis of cultural adaptations of psychological interventions. Behavior Therapy, 47(6), 993-1014. doi: 10.1016/j.beth.2016.09.005

Hall, G. C. N., Kim-Mozeleski, J., E., Zane, N. W., Sato, H., Huang, E. R., Tuan, M., & Ibaraki, A. Y.  (in press). Cultural adaptations of psychotherapy: Therapists’ applications of conceptual models with Asians and Asian Americans. Asian American Journal of Psychology.

Substance Abuse and Mental Health Services Administration (2015). Racial/ethnic differences in mental health service use among adults. HHS Publication No. SMA-15-4906. Rockville, MD: Substance Abuse and Mental Health Services Administration.