The Need for Culturally Adapted Interventions
Developed by Dr. Aaron T. Beck in the 1960s and 1970s, Cognitive Behavioral Therapy (CBT) is "a form of psychological treatment that involves efforts to change thinking patterns for a range of problems including depression, anxiety disorders, alcohol and drug use problems, marital problems, eating disorders, and severe mental illness" (American Psychological Association, 2017; Beck & Fleming, 2021). In research, CBT has always been considered the gold standard for psychotherapy due to its being one of the most used evidence-based psychological interventions for depression, whereas the relapse rate is lower in comparison to patients treated with pharmacotherapy alone (Gautam et al., 2020; Marlotte et al., 2023; Herring et al., 2023; Huey et al., 2023).
The study by Marlotte et al. (2023) reported that adolescents who received CBT for depression increased their awareness of how they interpret situations and were encouraged to engage in more pleasurable activities.
However, a challenge that remains to this day with CBT implementation is that it was initially developed within a Western perspective (Beck et al., 2021). In contrast, numerous studies have addressed the issue of the appropriate application of CBT for BIPOC individuals suffering from depression, emphasizing that CBT that is based on a Westernized perspective may not be well-suited to the worldviews and practices of BIPOC communities (Huey et al., 2023; Kunorubwe, 2023; Marlotte et al., 2023; Ishikawa et al., 2023; Mishu et al., 2023; Jones, 2025).
The Efficacy of Culturally Adapted Intervention
Multiple studies highlight that culturally adapted interventions can lead to better outcomes in treating symptoms of depression, specifically for BIPOC adolescents (Huey et al., 2023; Ishikawa et al., 2023; Mishu et al., 2023). The study by Ishikawaka et al. (2023) reports that CBT was previously not widely known or practiced in Japan, yet a careful cultural adaptation of CBT had demonstrated efficacy in treating depressive symptoms in Japanese adolescents. However, as reported by Nittas et al. (2024), another challenge with CBT implementation is that cultural adaptations are risky, time-consuming, costly, and require a clear definition of culture and careful selection of relevant cultural elements. Despite its time-consuming and costly nature, the investment in culturally adapted CBT has been proven to be beneficial, as numerous studies, such as Huey et al. (2023), Ishikawa et al. (2023), and Mishu et al. (2023), have demonstrated effective results in reducing depressive symptoms in BIPOC adolescents. Because Westernized CBTs have been widely disseminated in mental health graduate schools and clinical settings, mental health professionals and clinicians must deviate from dominant norms rooted in White, Cisgender, and Heteronormative standards and shift towards a decolonizing approach to counseling to help them view and value a diverse range of clients as whole individuals (Huey et al., 2023; Marlott, 2025).
Strengthen the Mental Health Workforce Through Institutional Reform
The shortage of BIPOC licensed professional counselors and clinicians remains a significant problem, as reported by Huey et al. (2023), fueling mental health disparities within BIPOC adolescents. To illustrate, Black adolescents and their caregivers have been reported to question the genuineness of a therapist due to past experiences of racial discrimination, leading to a cultural mistrust of a non-BIPOC therapist among licensed professional counselors and clinicians (Castro-Ramirez et al., 2021; Lindsey et al., 2024). Considering the significance of the cultural mistrust that Black caregivers and adolescents have reported, I recommend that mental health clinics, hospitals, and schools prioritize racial matching and offer families the opportunity to choose culturally compatible providers.
However, according to the study by West et al. (2023), many families reported language barriers and often found it challenging to locate bilingual and/or bicultural clinicians. The lack of BIPOC licensed professional counselors and clinicians creates an additional barrier to offering racial matching as an alternative for families who prefer someone who is culturally compatible. Interestingly, higher education institutions can perpetuate institutionalized forms of racism, oppression, and inequity for BIPOC graduate students. To demonstrate, according to the study by West et al. (2023), a survey of 300 White and BIPOC graduate students and faculty in clinical psychology doctoral programs revealed that BIPOC graduate students reported fewer recruitment and retention efforts, a weaker sense of belonging, and a greater perception of discrimination.
The disadvantages of BIPOC student applicants can explain the shortage of racially and ethnically diverse clinicians, such as biased admissions selection processes, financial barriers, suboptimal mentoring, limited research opportunities, and discrimination (West et al., 2023). Accordingly, I recommend that mental health graduate programs reconsider their admissions selection process and prioritize retention-focused support for BIPOC graduate students by providing mentorship, scholarships, and loan forgiveness to students who are culturally compatible and dedicated to serving BIPOC adolescents.
Mandate Cultural Competence & Cultural Humility in Trainings and Practices
Research highlights that many graduate students reported not feeling prepared with the knowledge, awareness, and skills needed to provide culturally sensitive care (Huey et al., 2023). Given the research, the shortage of licensed professional counselors and clinicians trained in culturally competent care now suggests that mental health graduate programs may not be providing their students with adequate training (Huey et al., 2023; Galan et al., 2024; Salinas et al., 2025). Consequently, licensed professional counselors and clinicians who lack cultural competence contribute to mental health stigma, which affects help-seeking beliefs and behaviors among depressed BIPOC adolescents (Adebayo et al., 2024). Licensed professional counselors and clinicians can provide a safe environment for clients to express themselves in culturally authentic ways by acknowledging the impact of culture on how they interpret and interact with the world and those around them (Marquette University, 2023; Naeem et al., 2023). During the 2013 legislative session, Oregon passed House Bill 2611, requiring licenses to complete four hours of culturally competent continuing education (CCCE) every two years (State of Oregon, 2016). Although Oregon already mandates a few hours of CCCE every two years, I propose that these laws should also require clinical supervision and address White privilege, color blindness, and anti-racism in coursework. Policymakers must also reassess mental health policies and commit to increasing funding across categories such as mental health graduate programs, culturally adapted intervention research, and workforce pipelines