back to winter 2026 newsletter 
By Amal Khan, AMFT

Working with South Asian clients in the Bay Area often means sitting at the crossroads of two cultural operating systems. On one hand, there is the Western mental-health framework that treats boundaries as the bedrock of emotional well-being: clear, explicit, individuated, and consistently enforced. On the other hand, there are South Asian cultural norms in which boundaries are fluid, implicit, relational, and deeply embedded within collective responsibility.

One everyday example makes this cultural difference visible long before a client enters therapy: hospital visitation norms. Around the world, South Asian families are among the most likely to gather at a hospital in large groups when a loved one is ill. Waiting rooms fill with extended family, neighbors, and community members, who see their presence as essential to care. Illness is a collective event, not an individual one. Being physically present communicates loyalty, love, and communal responsibility. In contrast, Western hospital culture typically discourages large gatherings, prioritizing privacy, individual autonomy, and minimal disruption.

These divergent norms show up directly in the therapy room. When Western boundary models meet collectivist family expectations, they don’t simply differ—they collide. And when they collide, the therapist’s cultural attunement determines whether the client finds clarity or walks away feeling misunderstood, pathologized, or ashamed.

Understanding the South Asian Boundary Landscape. South Asian boundaries are not necessarily weak—they are simply built for a different purpose. While Western boundaries emphasize the individual as the primary unit of identity, South Asian cultures emphasize belonging, continuity, and duty. Common features of South Asian boundary norms include:

• Implicit and relational boundaries: Limits are expressed through context, tone, and shared understanding, not direct statements.
• Obligation as love: Sacrifice and showing up—physically and emotionally—signal connection.
• Role-based hierarchy: Elders traditionally hold authority, and deference is a sign of respect.
• Collective decision-making: Family input on major life choices is not only normal but expected.

To a Western-trained clinician, these may resemble codependence or enmeshment. But in context, they reflect a coherent cultural value system oriented toward interdependence rather than individual autonomy. Misinterpreting these norms can unintentionally pathologize a client’s identity, family system, or culture.

Western therapeutic models view boundaries as clear, explicit, assertive and centered on personal needs and limits. For many South Asian clients, these ideas are appealing but emotionally loaded. Sentiments run from “I want boundaries, but I don’t want my parents to feel abandoned”, “Saying no feels disrespectful”, “If I advocate for myself, will I look ungrateful?” to “I feel torn between my values and what therapy is telling me.”

This isn’t resistance—it’s cultural complexity. Asking a South Asian client to adopt Western-style boundaries without translation is like giving them instructions in a language they don’t speak.

The incongruence felt by clients when these two systems don’t match usually surface via three major differences that therapists see repeatedly;

A. Directness vs. Indirectness
Western boundaries rely on straightforward communication. South Asian norms rely on nuance. “Just tell them how you feel” can feel culturally unsafe, even rude.

B. Autonomy vs. Filial Duty
Many clients hold deep commitments to parents and elders. Individuation does not mean separation—it means fulfilling one’s role with integrity. A model that prioritizes autonomy over duty risks invalidating core values.

C. Emotional Logic vs. Cultural Logic
Some behaviors are not driven by emotion but by cultural roles: living with parents into adulthood, financially supporting relatives, or involving elders in decisions. From a Western lens, these may seem like boundary violations; from a South Asian lens, they are moral obligations.

Culturally Attuned Boundary Work: What Actually Helps. Therapists can help clients develop boundaries that reduce distress without asking them to sever cultural ties, as follows;

• Reframe Boundaries as Care, Not Defiance. Instead of, “You have a right to say no,” try “This boundary protects the relationship so you can remain connected in healthier ways.”
• Normalize the Cultural Complexities. Clients often feel guilt or shame. Affirming the cultural landscape reduces this burden- “Of course this feels hard—you’re navigating two value systems at once.”
• Introduce “Soft Boundaries.” These are gentler, indirect, and culturally compatible, such as “Let me get back to you,” “I wish I could, but I’ll help with ___ instead,” essentially choosing tone over confrontation. Soft boundaries preserve harmony while building autonomy.
• Explore Cultural Safety and Cultural Risk. Boundaries have social consequences. Asking “What feels safe?” or “What feels too risky?” or “What is one small step that feels respectful and protective?” can help clients proceed thoughtfully.

Clinical Reflections for Therapists. Supporting South Asian clients means holding cultural humility and recognizing that Western models are not morally superior—they are simply rooted in different philosophies. Therapists can strive to:

• Avoid assuming the Western model is the universal standard
• Validate the guilt that emerges when cultural values and therapeutic suggestions diverge
• Help clients build boundaries that strengthen rather than threaten family relationships
• Understand that integration—not assimilation—is often the goal

When we honor cultural meaning-making, we create therapeutic space that feels safe, dignifying, and accurate to the client’s lived experience.

Holding Two Worlds With Compassion

South Asian clients navigating boundaries in Western contexts are not failing—they are culturally bilingual. They are learning to speak two emotional languages without a guidebook.

Our work is not to choose autonomy over duty or directness over respect. Our work is to help clients build bridges:

• Between autonomy and belonging
• Between individuality and family
• Between their inherited values and their emerging sense of self

When we approach boundary work with cultural attunement, we help clients create boundaries that allow them to stay connected without losing themselves. That is the true heart of cross-cultural therapeutic practice—and it begins with us.


Amal Khan, AMFT, is a Bay Area therapist who works with individuals and families, with a focus on culturally attuned care for South Asian and Muslim clients. As the daughter of Pakistani immigrants, she brings a deep understanding of collectivist family systems and the complexities of navigating Western therapeutic models alongside inherited cultural values. Her work centers on attachment, boundaries, and relational healing across generations.