Lessons from a Russian Therapist: 10 Things You Should Know About Your Patient From Russia

As clinicians, we always strive to really understand and “get” our patients on a deeper level. We are well aware of the importance of building a strong therapeutic rapport as well as the strong correlation between such rapport and the overall effectiveness of treatment.

For these reasons, I wanted to share my knowledge and expertise about working with Russian immigrants who have moved to the United States in the last few decades. In doing so, I wholeheartedly hope it might help those clinicians who happen to work with this population to understand their thinking process, and even potential ambivalence about seeking or receiving therapeutic care.

Let me start by explaining my own personal background first. I am ethically Russian, but I was born and raised in Kazakhstan. It is a really big country in Central Asia that used to belong to Soviet Union until its collapse in 1990.

As a couples therapist with the Russian/Kazakh cultural background, I have experienced challenges of immigration on a personal level. I came to the United States at the age of 20 to travel, learn a new language, and experience a new way of living. I did not intend to move here at all, but here I am, 13 years later, with a full counseling practice doing what I love.

I have  had the opportunity to work with Russian people and people of other ethnicities in my counseling practice. I believe that some important insights about the Russian community can help other clinicians who work with this population to understand their patients on a deeper level–or at least create space for curiosity and exploration.

The population of the United States is racially and ethnically diverse and many clients in mental health care come from racially/ethnically heterogenous cultures. Therefore, clinicians and researchers often emphasize the need for ethnically and culturally sensitive mental health services.

Ethnicity and Race More Important to Minority Population

One research shows that ethnic minority clients place more value on issues regarding ethnicity and race than white clients do. These individuals tend to feel less satisfied with treatment. They also report less confidence in their provider and poorer quality of care, which suggests that ethnic minority clients highly value the culturally relevant aspects of mental health interventions and they can affect how these people respond to services.

As clinicians, we need to understand our patients on every level. Therefore, we need to respond to these ethnical issues as well.

So, how can you implement the ethnical responsiveness when your client is an immigrant from Russia or former SSSR? Here’s a few insights to help you understand your Russian patient’s background.

1.  Russian People Have History Strains

To understand the Russian mentality regarding psychological counseling, you need to know about the country’s history a bit. In the era of Soviet Union that lasted from 1922 to 1991, mental health services and counseling were exceptionally rare. Both people and government were rejecting them and individuals with mental health issues were treated by medical doctors, not mental health professionals.

2. Mental Health Stigma

As expected, this background created a stigma toward mental illness. Russians diagnosed with severe mental illnesses were often sent to psychiatric hospitals with no confidentiality, so their records were often disclosed. They had no right to privacy, which often led to stigmatization and limited opportunities in life.

3. Russian People Are Reluctant to Seek Mental Health Support

So, instead of seeking professional mental health help, Russian people have commonly sought help from “healers” who would prescribe herbs and similar natural remedies. Even today, most Russians rarely see a doctor for their mental health problems.

4. Cultural Challenges

If you work with Russian immigrants, you need to take into consideration cultural differences and challenges that Russians face when coming to the U.S., such as cultural shock, language barriers, loneliness, homesickness, unemployment, etc.. Consider these factors as they also call for ethnically-specific approach in counseling with a client who immigrated from Russia. Everyday struggles of a life in a new country can provoke anxiety, depression and other mental health issues that need to be resolved in therapy.

5. No Sugarcoating, Please

Russian people are pretty straightforward; they highly value truth and do not like sugarcoating things. Furthermore, they prefer a direct and blunt way of speaking and do not care about personal space as much as American clients do. So, keep this in mind when working with Russian clients – it will help you build a healthy, constructive relationship with them.

6. Russians See Doctors as the Authority

Furthermore, your Russian client will probably see you as a figure of authority, and follow your advice readily. This may be good stuff. However, they may also expect you to take responsibility for their issues, so person-oriented psychotherapy approaches may not be the best option for these people.

7. The Attitude Towards Dating

Russian people in general do not do much “casual dating” and prefer serious relationships with high future prospects.

8. The View of Marriage and Gender Differences

However, in Russian culture, a view of marriage somewhat differs between men and women. You’ll find that men often view marriage as a loss of freedom and tend to get engaged in affairs, while women see marriage as a manifestation of a happy life. Also, Russian men prefer independence and try to live up to standards of masculinity norms while women are often seen as inferior and dependent gender. Russian male clients may be a challenge as they rarely speak about their emotions and mental health issues.

9.Masculinity Stereotypes

Similarly, many Russian boys are raised in the atmosphere where displays of emotions and vulnerability are not encouraged. The combination of these factors often results in dysfunctional dynamic in Russian families, making family and marriage counseling an imperative need.

10. Drug and Alcohol Addiction

In addition, many people with the Russian background struggle with drug and/or alcohol addiction and a lack of sexual education issues, so these factors should also be considered when providing counseling to your client who immigrated from Russia or another former SSSR country.


Both clinical practice and research suggest the need for ethnically and culturally sensitive mental health services. Research shows that patients who feel that issues regarding ethnicity and race are important tend to feel less satisfied with treatment, have less confidence in their provider, and reported poorer quality of care.

These research findings suggest that culturally relevant aspects of mental health interventions are significant to ethnic minority clients and can affect how they respond to services.

Because of a lack of experience with counseling and the understanding of it, psychotherapy remains new to most Russian immigrants in the U.S. In addition, cultural attitudes toward mental health services and mental illness stigma have been integrated in many Russian patients, which can make them resistant to counseling. Because of these challenges, counselors who work with Russian immigrants need to be aware of and ready to manage the cultural aspect of counseling.


Lessons from a Russian Therapist: 10 Things You Should Know About Your Patient From Russia


APA Reference
Baechle,, I. (2019). Lessons from a Russian Therapist: 10 Things You Should Know About Your Patient From Russia. Psych Central. Retrieved on October 22, 2020, from


Scientifically Reviewed
Last updated: 15 Feb 2019
Last reviewed: By John M. Grohol, Psy.D. on 15 Feb 2019
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