Consequences of 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 or express inappropriate comments derived from false stereotypes (Summers & Nelson, 2022), 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. 

Benefits to lesbian, gay, and bisexual clients

Initially, research on cultural humility explored whether this mindset benefited clients who identified as members of racial or ethnic minorities.  More recent studies, however, have explored whether the cultural humility of health practitioners also benefits lesbian, gay, or bisexual clients.

For example, in one study, published by Jennings and Sprankle (2024), in the Journal of Homosexuality, 333 participants completed a survey. The study assessed whether the cultural humility of therapists improved their therapeutic alliance with lesbian, gay, or bisexual clients. All participants identified, at least partly, as lesbian, gay, or bisexual and had attended therapy.  This survey included

• an adaptation of the Cultural Humility Scale (Hook et al., 2013), comprising items like “[My therapist” is genuinely interested in learning more [about my sexual orientation]”,
• the short variant of the Working Alliance Inventory (Hatcher & Gillaspy, 2006), comprising 12 items that assess an affective bond with the therapist, such as “I feel that my therapist appreciates me”, collaboration on goal setting, and the provision of useful tasks, such as “What I am doing in therapy gives me new ways of looking at my problem”,
• questions that assess the degree to which their sexual orientation is central to their identity and the extent to which they are proud of this identity.

Cultural humility was positively associated with all facets of working alliance, with correlations exceeding 0.6.  That is, if practitioners exhibited cultural humility, their lesbian, gay, and bisexual clients were more likely to feel a bond with this therapist, collaborate effectively on setting goals, and perceive the suggestions of these practitioners as useful (Jennings & Sprankle, 2024).  Presumably,

• these clients felt more willing to disclose information that is relevant to their sexual orientation,
• hence, the therapists, in collaborations with the clients, could more readily offer advice or insights that consider, rather than disregard, sexual orientation,’
• alternatively, the therapists were less inclined to express comments that could be perceived as derogatory.

Neither the degree to which the sexual orientation of participants was central to their identity or the extent to which they were proud of this identity moderated these relationships. 

Benefits to practitioners: Decreases in burnout

The cultural humility of health practitioners may not only benefit the clients but may also benefit the practitioners.  For example, as Cardenas (2025) revealed, in an unpublished dissertation at the California Baptist University, health practitioners who exhibit cultural humility are not as susceptible to burnout as other clinicians.  In this study, 149 mental health practitioners completed a series of measures including

• the Multidimensional Cultural Humility Scale (Gonzalez et al., 2020), comprising five subscales such as an openness towards diverse perspectives, a tendency to seek feedback, and self-reflection,
• the Oldenburg Burnout Inventory (Khan & Yusoff, 2016), comprising 16 items that assess burnout in mental health practitioners, comprising items like “Sometimes, I feel sickened by my work tasks” to measure disengagement and “During my work, I often feel emotionally drained” to measure mental exhaustion,
• the Compassion Scale (Pommier et al., 2020), designed to measure the degree to which mental health practitioners experience kindness, mindfulness, and concerns about suffering during clinical practice, exemplified by items like “My heart goes out to people who are unhappy”.

Overall, cultural humility was inversely associated with burnout.  Compassion mediated this association.  That is, cultural humility was positively related to compassion, and compassion was negatively related to burnout.  The effect sizes were deemed as moderate.   Arguably,

• when mental health practitioners demonstrate cultural humility, they are more likely to understand and appreciate the challenges of their clients, fostering empathy,
• because of this empathy, health mental health practitioners feel genuinely inspired to assist these clients,
• the sessions no longer feel like obligations; instead, practitioners experience a calling that incites engagement rather than burnout.

Cultural humility in supervisors

Professional development

In all industries, the degree to which individuals develop their capabilities and attributes significantly depends on the support and advice they receive from supervisors.  This role of supervisors is especially apparent in the health sector.  To illustrate, as research has revealed, if supervisors demonstrate cultural humility, the clinicians they supervise are more likely to disclose their concerns and other information candidly (Cook et al., 2020).  These disclosures are likely to improve the relationship, enabling supervisors to assist health practitioners effectively. 

In one study, conducted by Cook et al. (2020), the participants were 107 counsellors who had completed their masters but were receiving supervision to fulfill professional accreditation.  These participants received surveys in the mail.  The survey included

• the Cultural Humility Scale–Supervision Version, adapted from the measure that Hook et al. (2013) constructed to gauge the degree to which the supervisors of these participants exhibited positive features of cultural humility, such as respect and interest in learning, as well as refrained from negative features such as assumptions and a sense of superiority,
• the Supervisee Nondisclosure Scale (Ellis & Colvin, 2016), designed to assess the extent to which participants disclosed information to their supervisor, such as shame about their life or skills, unfavourable attitudes towards clients, or concerns about their supervisory relationship,
• other questions about their supervisory experience, such as average duration of sessions.

As the findings showed, if supervisors exhibited more of the positive features of cultural humility, such as respect and interest in learning, the participants were more inclined to disclose information to supervisors (Cook et al., 2020).  As research has revealed (e.g., Ladany et al., 1996), when health practitioners do not disclose information to their supervisors, they tend to be dissatisfied with this supervisory arrangement. 

Intention to leave

The cultural humility of supervisors might also affect the attitudes of staff towards their role.  For example, in an unpublished doctoral dissertation at Walden University, Whitfield (2023) revealed that staff are not as inclined to leave the organisation if their supervisor exhibits cultural humility. 

Specifically, in this study, 114 staff, working in multicultural settings, completed a series of measures including

• the multidimensional cultural humility scale to assess the degree to which supervisors demonstrate five distinct facets of cultural humility: openness to diverse perspectives, self-awareness of values that could affect interactions with diverse staff, an egoless mindset that is unconcerned about status, supportive interactions, and self-reflection,
• seven questions that assess the degree to which the participants intended to leave the organisation, such as “Would you want to quit this job if it were possible?”,
• the Authentic Leadership Inventory (Neider & Schriesheim, 2011) to gauge the extent to which supervisors exhibit four facets of authentic leadership: a potential moderator.

As hypothesised, when their supervisors exhibited cultural humility, the participants indicated they were less inclined to leave the organisation, but authentic leadership did not significantly moderate this association.  Presumably, supervisors who demonstrate cultural humility can more readily accommodate the needs of diverse staff, cultivating a more uplifting and supportive culture. Unlike most other studies in this field, this research was not confined to the health sector, demonstrating the significance of cultural humility across industries.

Cultural humility in everyday life

Cultural humility in relationships

Cultural humility might also improve the quality of romantic relationships, especially relationships in which the two individuals do not share the same culture. For example, in one study, conducted by Ramos et al. (2026), 102 university students, whose romantic partner did not share their ethnicity, race, religion, or political party, completed a series of measures.  These measures included

• the Cultural Humility and Enactment Scale, adapted to suit couples and assess cultural humility,
• the Couple’s Satisfaction Index-4 (Funk & Rogge, 2007), designed to assess the degree to which the participants regarded the relationship as satisfying, rewarding, warm, and happy,
• the Cultural Conflict Scale (West et al., 2024), administered to measure the extent to which the participants and their partner experienced conflict because of their cultural differences, comprising five items like “How often do you feel angry or resentful towards your partner over cultural differences between you?”, and
• the Index of Cultural Inclusion (Killian, 2013), utilised to gauge the extent to which the participants and their partner shared their cultural background and beliefs with each other, comprising items like “My partner feels very comfortable talking with me about the family and culture that they come from”.

As hypothesised, cultural humility was positively associated with relationship satisfaction and negatively related to conflict that emanates from cultural differences.  Furthermore, cultural sharing mediated these relationships (Ramos et al., 2026).  Thus, in couples who do not share the same ethnicity, race, religion, or political affiliation, cultural humility may engender the deep, respectful conversations that prevent conflicts and improve relationships.   

The benefits of cultural opportunities and cultural comfort

Cultural opportunities

According to the seminal framework of multicultural counselling orientation (Davis et al., 2018), or MCO, cultural humility—in which practitioners adopt a mindset in which they want to learn from their clients and appreciate their experiences—manifest in two behaviours, at least within counselling settings.  These two behaviours are called cultural opportunities and cultural comfort (Davis et al., 2018).  Specifically

• cultural opportunities are moments, during therapy, in which clients share cultural beliefs, values, or experiences and the practitioner, seamlessly and authentically, integrates these perspectives into the therapeutic experience,
• cultural comfort is the capacity of practitioners to discuss cultural matters with ease and openness, devoid of defensive reactions.

Research has verified the benefits of these cultural opportunities. In one informative study, Owens et al. (2016) administered an online survey to 247 clients of 50 therapists who operated at a university counselling centre.  The survey included

• the Cultural Humility Scale to measure cultural humility,
• a measure that uncovers cultural missed opportunities, comprising questions like “I wish my therapist would have encouraged me to discuss my cultural background more” or “My therapist avoided topics related to my cultural background”,
• the Patient’s Estimate of Improvement (Hatcher & Barends, 1996) to assess the degree to which clients felt that psychotherapy had improved various facets of their life, such as relationships, work, productivity, and so forth, comprising questions like “To what extent have your intimate relationships improved or gotten worse over the course of therapy?”,
• the Schwartz Outcome Scale-10 (Blais et al., 1999)—a control variable to measure wellbeing, epitomised by items like “I am generally satisfied with my psychological health”.

As hypothesised, cultural humility was inversely related to cultural missed opportunities.  And these cultural missed opportunities were negatively associated with the degree to which patients felt the psychotherapy had improved their life—especially if the cultural humility of therapists was limited.  Accordingly, if practitioners embrace cultural humility, they are not as likely to overlook helpful opportunities to integrate cultural perspectives into therapy. Consequently, their clients are more likely to feel the therapy has been successful.  Future research is warranted to explore whether these benefits of cultural opportunities extend to other settings.   

Cultural comfort

The cultural comfort of practitioners can also benefit clients, such as decrease their distress (Bartholomew et al., 2021) or diminish the likelihood these individuals will discontinue therapy prematurely (e.g., Owen et al., 2017).  Bartholomew et al. (2021), for example, conducted a longitudinal study to explore whether the cultural comfort of therapists diminishes the distress of clients.  In this study, 48 clients of a doctoral training clinic, completed an online questionnaire before and after each session they attended.  In particular

• before each session, to measure symptoms of distress, these participants completed the Counseling Center Assessment of Psychological Symptoms–34 (Locke et al., 2012), comprising items like “I feel worthless” or “I drink more than I should”,
• after each session, to measure the degree to which participants felt the clinician demonstrated cultural comfort, these individuals completed the Therapist Cultural Comfort Scale (Pérez-Rojas, Bartholomew, et al., 2019)—in which participants, in response to the stem “When important parts of my culture come up or are discussed, my therapist”, indicated the degree to which the practitioner demonstrated various behaviours or mannerisms such as “seems comfortable in our interaction” or “stumbles with words” [reverse-scored].

Across 476 sessions, the data revealed that, when the cultural comfort of therapists increased, the level of distress that clients experienced subsequently decreased (Bartholomew et al., 2021).  This study, therefore, compellingly reveals that cultural comfort may improve therapeutic outcomes.  Presumably, when therapists demonstrate they feel comfortable when discussing cultural matters—sometimes manifesting as cultural references (Gundel et al., 2020) or cultural language (Pérez-Rojas, Brown, et al., 2019)—clients do not feel the need to suppress their identity, values, or beliefs.  Clients can thus disclose more information about themselves, facilitating the therapeutic alliance.

Cultural comfort and hope in clients

Some research has explored why the cultural comfort of practitioners may improve outcomes for patients.  Bartholomew, Pérez-Rojas, et al. (2025), for example, proposed and verified the possibility that cultural comfort may evoke a sense of hope in clients.  Specifically,

• when practitioners demonstrate cultural comfort, clients feel the therapy is tailored to their values, needs, and circumstances rather than generic (cf Gundel et al., 2020),
• clients thus feel that, in concert with the practitioner, they may be able to uncover opportunities or pathways to fulfill their aspiration, despite the discrimination or other impediments they may usually experience,
• this awareness of opportunities or pathways to fulfill some aspiration, coupled with the confidence or agency to pursue these opportunities or pathways, is the cornerstone of hope (Snyder, 1994; or an alternative perspective, see Tong et al., 2010). 

Clients who experience hope often thrive during psychotherapy. Hope overrides the usual sense of demoralisation or despair that some clients feel about their life.  Individuals who experience hope become motivated to complete the activities that are necessary to achieve their goals (Bartholomew et al., 2021; Snyder, 2002; but see Coppock et al., 2010). 

Bartholomew, Pérez-Rojas, et al. (2025) conducted a pair of studies that verify these arguments. In the first study, 45 clients, receiving therapy at a university clinic, completed two measures after every three sessions.  These measures comprised

• the Therapist Cultural Comfort Scale (Perez-Rojas et al., 2019), in which participants, in response to the stem “When important parts of my culture come up or are discussed, my therapist”, indicated the degree to which the practitioner demonstrated various behaviours or mannerisms such as “seems comfortable in our interaction”,
• the Hope for Change Through Counseling Scale (Bartholomew et al., 2015), comprising items like “Counseling helps me identify ways to improve my well-being” to measure pathways and “Thinking about the changes I can make in my life through counseling is exciting” to measure agency.

Across 168 sessions of data collection, cultural comfort was positively associated with hope for change.  The second study generated similar results, but showed the findings extend to participants who are Black rather than White.  Furthermore, in this second study, cultural comfort was positively associated with hope for change even after controlling both cultural humility and cultural opportunities.