Cultural humility
Introduction
The cultural humility of counsellors significantly improves their working alliance with clients, explaining about 60% of the variance, as Zhu, Luke, et al. (2025) revealed. Specifically, in this study, the researchers utilised Amazon Mechanical Turk to recruit adults who were receiving counselling or psychotherapy. Over 600 participants completed the survey. The survey included
- the cultural humility and enactment scale (Zhu et al., 2022), such as “My counsellor is open to changing their views on cultural issues”,
- a short variant of the working alliance inventory, such as “What I am doing in therapy gives me new ways of looking at my problem” (Hatcher & Gillaspy, 2006),
- the real relationship inventory (Kelley et al., 2010) to gauge the quality and sincerity of the relationship between the client and therapist, such as “I was open and honest with my therapist”, and
- the Barrett–Lennard relational inventory to measure whether the client perceived the therapist as empathic, such as “My counsellor usually senses or realizes what I am feeling.”
As hypothesised, cultural humility was positively and strongly associated with both the working alliance and the quality or sincerity of the relationship between the client and therapist. When counsellors and clients have developed a strong working alliance, in which they agree on therapeutic goals and tasks as well as establish an emotional bond, clients are more likely to benefit significantly from the sessions (for a meta-analysis, see Flückiger et al., 2018). The degree to which the therapist was perceived as empathic partly mediated these relationships.
Several accounts could explain why cultural humility enhances the perceived empathy of therapists. For example
- when therapists demonstrate cultural humility, they are more likely to be curious and interested in the client—and this curiosity or interest might foster understanding and empathy,
- when therapists demonstrate cultural humility, they are not as likely to reach premature, and thus misguided, conclusions about clients, again fostering understanding and empathy.
A systematic review
Since the 2010s, many other studies have also explored the associations between cultural humility, therapeutic alliance, and psychotherapy outcomes. Accordingly, Orlowski et al. (2025) conducted a systematic review and meta-analysis to characterise these relationships more definitively. To distil the relevant literature, the researchers first entered keywords that revolve around cultural humility, working or therapeutic alliance, and treatment, clinical, or therapy outcomes into three databases: PsychINFO, Medline and ProQuest Dissertations and Theses. The researchers used Chat GPT to optimise the search string. This procedure uncovered 13 cross-sectional studies that fulfill the selection criteria, all of which were conducted in the US between 2013 and 2023.
Before conducting the meta-analysis, Orlowski et al. (2025) applied the Joanna Briggs Institute or JBI Checklist to evaluate the quality of these cross-sectional studies. Although all the studies utilised valid measures and statistical techniques, six of these studies did not control other variables appropriately. The meta-analysis then revealed that
- cultural humility was positively and highly associated with measures of therapeutic alliance, r = .66,
- cultural humility was positively and moderately associated with measures of therapeutic outcome, r = .39,
- the funnel plot and Egger’s test, conducted using the robumeta package in R (Fisher & Tipton, 2015) did not unearth evidence of publication bias—such as the tendency to exclude non-significant relationships,
- although the effect sizes were heterogenous, no significant moderators were uncovered.
