This article examines the role that attitudes which originate in a cultural context play in the therapeutic process. Attitudes toward sameness and difference are explored, especially those attitudes that reflect culturally encoded expectations. Assumptions that the analyst and patient are similar to one another may mask culturally embedded biases and attitudes toward difference, particularly unconscious expectations that “others” will assimilate to the dominant group. Such unrecognized attitudes may obscure opportunities for empathic contact and connectedness, play a role in defining the therapeutic dialogue, and perpetuate a larger culturally based system of pathological accommodation. The role that a hermeneutic attitude plays in cultivating cultural dialogue is illustrated clinically.