Psychological treatments are an essential part of a comprehensive mental health service, and there have been a number of influential reviews of their effectiveness. Roth & Fonagy (2005), for example, concluded that psychodynamic interventions are helpful for borderline states and that family therapy is useful for eating disorders and in the treatment of children and adolescents. Cognitive–behavioural therapy (CBT) is an effective treatment for anxiety, obsessive–compulsive disorder (OCD) and depression, and in the management of hallucinations and delusions in chronic mental illness (Turkington et al, 2006). Expressed emotion work is effective in preventing relapse in schizophrenia (although it is rarely well resourced).

The ability to conduct psychotherapy effectively with racially and ethnically diverse populations is becoming increasingly relevant and is recognised to be important in addressing inequalities, which may also be patterned by differences in age, gender, class and sexual orientation. In this chapter we focus on culture and ethnicity.

Regarding the evidence base, few evaluations of the effectiveness of psychotherapy have included adequate numbers of ethnic groups (Alvidrez et al, 1996), and few studies report on adaptations of proven interventions for use by culturally and linguistically unique populations.

In many National Health Service (NHS) psychotherapy departments in the UK large numbers of people are treated, often by a few highly trained senior therapists and by psychiatry, psychology, social work and psychotherapy trainees under supervision. As few training experiences include attention to racial and cultural implications for effective psychotherapy, experienced and trainee therapists alike share the need to develop and adapt their interventions for a society that is increasingly racially and culturally diverse.