Scholars have long emphasized the importance of cultural responsiveness in therapy; however, the evidence for the multicultural competence (MCC) model is mixed, and most extant research is quantitative in nature. The purpose of this phenomenological study was to gather insight into what therapists focus on during conceptualization without prompting for multicultural information. We conducted a qualitative study to examine therapists’ multicultural case conceptualization and diagnosis to better understand therapists’ cultural processes. The research questions were: What do therapists attend to in case conceptualization, and how does it influence diagnosis? How do these diagnoses influence intervention? Semistructured interviews were conducted with seven White practicing psychotherapists who were asked to provide a case conceptualization in response to a vignette. Participants’ interview data (inclusive of their case conceptualization and answers about their thought processes) was analyzed, and six themes emerged: MCC, systems of support, controlling images, biological factors, multicultural orientation, and focus on cognitive therapies. Implications and future directions are discussed.