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need to attune to these sociodemographic variables. Some have even proposed the use of culture‐specific strategies in counseling and therapy (American Psychological Association, 2017; Ivey et al., 2014; Parham, Ajamu, & White, 2011). Such professionals point out that current guidelines and standards of clinical practice are culture‐bound and often inappropriate for clients of color and other minoritized individuals. Which view is correct? Should treatment approaches be based on cultural universality or cultural relativism? Few mental health professionals today embrace the extremes of either position.

      Proponents of cultural universality focus on disorders and their consequent treatments and minimize cultural factors, whereas proponents of cultural relativism focus on the culture and on how the disorder is manifested and treated within it. Both views have validity. It would be naive to believe that no disorders cut across different cultures or share universal characteristics. Likewise, it is naive to believe that the relative frequencies and manners of symptom formation for various disorders do not reflect the dominant cultural values and lifestyles of a society. Nor would it be beyond our scope to entertain the notion that various diverse groups may respond better to culture‐specific therapeutic strategies. A more fruitful approach to these opposing views might be to address the following question: Are there ways to both examine the universality of the human condition and acknowledge the role of culture in the manifestation of both the presenting concern and the treatment approach? Recently, researchers have systematically addressed the question. Mounting evidence supports the superiority of culturally adaptive treatment interventions compared to culturally universal ones (Hall, Ibaraki, Huang, Marti, & Stice, 2016; Hall, Berkman, Zane et al., 2021).

THE NATURE OF MULTICULTURAL COUNSELING COMPETENCE

Clinicians have oftentimes asserted that “good counseling is good counseling” and that good clinical practice subsumes cultural competence, which is simply a subset of good clinical skills. In this view, they would make a strong case that if Dr. D. had simply exercised these therapeutic skills, he would have worked effectively with Gabriella. Our contention, however, is that cultural competence is superordinate to counseling competence. How Dr. D. worked with Gabriella contains the seeds of a therapeutic bias that makes him susceptible to cultural errors in therapy. Traditional definitions of counseling and psychotherapy are culture‐bound because they are defined from a primarily White Western European perspective (Gallardo, 2022; Thalmayer et al., 2021). Let us briefly explore the rationale for our position.

      THE HARM OF CULTURAL INSENSITIVITY

Although there are disagreements over the definition of cultural competence (Mollen & Ridley, 2021), many of us know cultural insensitivity when we see it; we recognize it by its horrendous outcomes or by the human toll it takes on our marginalized clients. For some time now, multicultural specialists have described Western‐trained counseling/mental health professionals in very unflattering terms: (a) they are insensitive to the needs of their culturally diverse clients; do not accept, respect, and understand cultural differences; are arrogant and contemptuous; and have little understanding of their prejudices (Ridley, 2005); (b) clients of color, women across race and ethnicity, and lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals frequently complain that they experience microaggressions in counseling (Hook et al., 2016; Owen, Tao, & Drinane, 2019); (c) discriminatory practices in mental health delivery systems are deeply embedded in the ways in which the services are organized and in how they are delivered to minority populations, and are reflected in biased diagnoses and treatment, in indicators of dangerousness, and in the type of people occupying decision‐making roles (Desai et al., 2021); and (d) mental health professionals continue to be trained in programs in which the issues of ethnicity, gender, and sexual orientation are ignored, regarded as deficiencies, portrayed in stereotypic ways, or included as an afterthought (Ponterotto et al., 2006; Ratts & Pedersen, 2014).

      GOOD COUNSELING IS CULTURALLY RESPONSIVE COUNSELING

As we have discussed, values of individualism and psychological mindedness, and the use of rational approaches to solve problems, have much to do with how competence is defined. Many of our colleagues continue to hold firmly to the belief that “good counseling is good counseling,” dismissing in their definitions the centrality of culture. The problem with traditional definitions of counseling, therapy, and mental health practice is that they arose from monocultural and ethnocentric norms that excluded other cultural groups. Mental health professionals must realize that “good counseling” uses White EuroAmerican norms that exclude most of the world's population. In a hard‐hitting article, Arnett (2009) indicates that psychological research, which forms the knowledge base of our profession, focuses on Americans, who constitute only 5% of the world's population. He concludes that the knowledge of human behavior neglects 95% of the world's population and is an inadequate representation of humanity. Discouragingly, a follow up of the original article reveals that very little has changed in the 12 years following those findings (Thalmayer et al., 2021). It is clear to us that good counseling takes into consideration the cultural context in which counseling occurs and the cultural realities of the client and counselor.

      BY THE NUMBERS

      The need for mental health services far outpaces the numbers of professionals available. As of 2017, the number of helping professionals in a particular area is listed below.

       Counseling and clinical psychologists—166,000

       Mental health counselors—130,000

       Marriage and family therapists—42,880

       Substance abuse counselors—91,040

       Educational, vocational, and school counselors—271,350

       Rehabilitation counselors—119,300

       Psychiatrists—25,250

       Source: Based on Grohol (2019).

UNDERSTANDING THE THREE DIMENSIONS OF IDENTITY

      All too often, counseling and psychotherapy seem to ignore the group dimension of human existence. For example, a White counselor who works with an African American client might intentionally or unintentionally avoid acknowledging the client's racial or cultural background by stating, “We are all the same under the skin” or “Apart from your racial background, we are all unique.” We have already indicated possible reasons why this happens, but such avoidance tends to negate an intimate aspect of the client's group identity (Apfelbaum, Sommers, & Norton, 2008; Neville, Gallardo, & Sue, 2016). Dr. D.'s responses toward Gabriella seem to have had this effect. These forms of microinvalidation will be discussed more fully in Chapter 4. As a result of these invalidations, a client of color might feel misunderstood and resentful toward the helping professional, hindering the effectiveness of counseling. Besides unresolved personal issues arising from counselors, the assumptions embedded in Western forms of therapy exaggerate the chasm between therapists and culturally diverse clients.

The concepts of counseling and psychotherapy, for example, are uniquely EuroAmerican in origin, as they are based on certain philosophical assumptions and values that are strongly endorsed by Western civilizations. On the one side are beliefs that people are unique and that the psychosocial unit of operation is the individual; on the other side are beliefs that clients are the same and that the goals and techniques of counseling and therapy are equally applicable across all groups. Taken to its extreme, this latter approach nearly assumes that Persons of Color, for example, are White, and that race and culture are insignificant variables in counseling and psychotherapy (Sue & Spanierman, 2020). Statements such as “There is only one race,

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