Visions Journal

Supporting those from collectivist backgrounds

Saira Sabzaali, PhD, RCC

Reprinted from the Don't Erase Me: Why culture matters in mental health issue of Visions Journal, 2026, 21 (3), pp. 5-6

As mental health clinicians, we don’t always know the latest cultural references or understand the complexities and unspoken expectations of every person we meet. But if we have a general understanding of how people from collectivist backgrounds position the self (or the “I”) and understand suffering, we can avoid some pitfalls.

Here’s an example. A client looked at me with tears in her eyes: “No one’s ever got it like this before.” I had just shared a rough visual sketch on my whiteboard of the mother–son relationship in South Asian culture. I highlighted how filial bonds (children’s loyalty to, and connection with, parents) have trumped romantic relationships for generations in her family system.

We moved on to reminisce about a scene in a well-known Bollywood movie from the 90s where the guy simply won’t make the girl his bride unless every member of her family (even her old-fashioned, unreasonable, hard-to-please father) is fully supportive of the relationship.

We shifted to discuss her current experience living in a joint-family household with her in-laws and brother-in-law’s family. She told me about how the advice from her last therapist had been to “Just move out.” Phrases like “Set boundaries” or “Focus on your own peace” feel like rotting mangoes to my client. She swallows them to be polite, but she’d never choose them herself. It’s not what she’s asking for, and she definitely doesn’t share them with anyone else.

While this vignette is a composite symphony of a variety of encounters from many people who come to me for mental health support, moments like this play out in my practice month after month, and year after year. As a South Asian therapist working mostly with culturally diverse clients, I have had to navigate the delicate disconnect between the individualism and independence of Western psychology, and the group-focused, contextual nuances of my clients’ day-to-day experiences.

Mental health care was not designed for collectivism

Many underlying assumptions in mainstream psychology don’t fit with a collectivist worldview, where the greatest value is in the group, not the individual. The basic difference relates to identity. According to an important study by Markus and Kitayama,¹ in collectivist cultures, the “I” (what these researchers called the interdependent self) is embedded in a family and community context.

So when “I” look for mental health support, “I” am not a discrete entity separate from my context. When “I” come, my whole family (and sometimes my whole cultural community) is coming with me! That means how I talk about myself, my life, my dreams and my loved ones will happen through a filter. For the interdependent self, identity is relational, and interpretations and decisions about one person’s life are not always made just by that person. This is different from the independent self that’s part of European cultural values, and a core idea that modern psychology is based on.

Experts in our own lives

There have been countless moments when a client comes to a realization in a session, and then we explore what this new perspective could mean for their loved ones. We navigate how, or whether to, talk about these new insights with those in their social web. That’s because, for them, well-being includes responsibility and belonging, not just personal growth. As Monique Peck, a founding member of The Expansion Project, writes, “Healing is never just personal.”²

In her book But What Will People Say?, Sahaj Kaur Kohli talks about her dance with external validation versus internal knowing, and how her mental health journey with a culturally attuned practitioner helped her find a third way between “all about me” and “all about them.”³

For example, many first- and second-generation immigrant children from Asian, South Asian and Middle Eastern cultures have been taught from a young age to defer to authority, especially for anything health-related. This can mean clients from those backgrounds will feel uncomfortable questioning or pushing back against mental health clinicians if they see us as “the expert.”

To address this, during the first session, I let clients know that in my approach to mental health, I believe people have their answers already waiting inside them. My job is to help quiet some of the internal noise so they can reconnect to that inner wisdom.

Throughout sessions, if I notice they’re starting to credit me with their progress, or pushing for me to give them advice, I gently remind them that they are the one doing the work between sessions, and they are the expert on their own life.

Fostering curiosity

My responses above would likely work with a client from any background. But this approach is especially empowering to someone who is culturally conditioned to dismiss what they are experiencing if someone more “qualified” is present.

In this way, the therapeutic relationship becomes the testing ground for showing up in a new way with a whole category of people. It means cultural assumptions can be looked at with curiosity and openness, without either of us having to convert the other into our way of seeing the world.

My hope for mental health professionals is you will continue to ask the questions about what assumptions underlie your approach, and for people seeking out support, that you will find a practitioner who really gets you, even if they’re from a cultural background different than your own.