Therapists, Cultural Competence Isn’t Just Ethnicity, It’s Geography, Too

Therapists, Cultural Competence Isn’t Just Ethnicity, It’s Geography, Too

In the field of mental health, we’ve long talked about cultural competence through the lens of ethnicity, race, gender, sexuality, and language. And absolutely, those dimensions are essential.

But in today’s hyper-connected world, where therapists are increasingly licensed across multiple states and seeing clients from every timezone via video call, we have to address one critical, often-overlooked aspect of identity: regional culture.

Where someone grows up and where they live now isn’t just a backdrop, it’s a deep part of how they experience the world. The cultural norms of a small fishing town in coastal Maine are not the same as those of someone trying to survive the gig economy and gridlock of Los Angeles. The suburbs of Detroit carry a different rhythm and history than a conservative pocket of Texas or a rapidly gentrifying neighborhood in Atlanta.

Regional culture shapes how people communicate, cope, seek support, define success, and process stress. It shows up in therapy, whether we’re attuned to it or not.

And this isn’t theoretical for me. I was born and raised in Michigan. I’ve lived and worked in Nevada for over 15 years, went to grad school in Hawaii, and even spent time in Australia as a high school exchange student. I don’t claim to be an expert in any of those places, but each experience shaped me, deepened my empathy, and reminded me that cultural awareness is not a destination but a discipline. One that must include geography.

So let’s be real with ourselves:

Are we truly equipped to serve clients from the states we’re licensed in?

Because expanding licensure may expand our reach, but have we expanded our competence with it?

It’s not enough to be legally allowed to practice in a state.

The real question is: Do you understand what it means to live there?

• Do you understand what it feels like to survive in Los Angeles- not just the glamor, but the burnout, the housing crisis, the cost of living, and the overstimulation of urban sprawl?

• Do you grasp the unique challenges of life in a small coastal town- where isolation, limited access to care, and tight-knit communities bring their own dynamics?

• Do you understand what it’s like growing up in the suburbs of Detroit- a place shaped by economic turbulence, generational factory work, racial tension, and a deep-rooted Midwestern politeness?

These aren’t fun facts- they’re foundations. They affect trust, rapport, and the client’s sense of being truly seen.

We wouldn’t dream of treating veterans without some understanding of military culture. The same principle should apply to regional culture. Clients shouldn’t have to spend half their sessions educating us about their environment just to feel understood.

Because regional culture affects:

• How people experience trauma and safety

• How mental health is perceived (and stigmatized)

• The role of religion, politics, and family in daily life

• The language clients feel safe using

• Their trust (or distrust) in “outsiders” and systems of care

Even state licensure reflects regional values.

Michigan, for example, mandates continuing education in human trafficking and implicit bias. Nevada requires CEUs in suicide prevention, ethics, and DEI. That’s not random- those requirements reflect the priorities and lived realities of each state.

If we care about quality care, not just convenient care, we have to take these differences seriously.

We don’t have to be from everywhere, but we do have to be curious, informed, and humble. That means seeking out training, reading between the lines of state culture, learning from local communities, and asking better questions.

Cultural competence isn’t a box to check.

It’s a responsibility.

And it should include geography. Therapists, Cultural Competence Isn’t Just Ethnicity — It’s Geography, Too