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Abstract. Formal psychotherapy in Ghana is gaining momentum. Concerns about the over-reliance on Western theories bring the suitability of associated clinical interventions into question for Ghanaian, non-Western clients. We interviewed 27 clinical practitioners (including clinical, counseling, and health psychologists) practicing in an urban setting to explore cultural challenges they faced and to identify cultural adaptations they made in their practice. Our participants reported navigating cultural barriers to therapy such as potential clients seeing therapy as an unfamiliar resource, resistance due to mental illness stigma, linguistic barriers, and hierarchical and age norms associated with help-seeking. Our sample identified attention to the following as routine in clinical practice: charismatic Christian and African cosmological worldviews, cultural expectations of helping and interdependence, and family involvement in “individual” therapy sessions. The findings have implications for future psychotherapy practice and training in Ghana and similar Low and Middle Income Country (LMIC) contexts, as well as for clinical work with African immigrants.