Cognitive behavior therapy is the treatment of choice for a wide range of mental health difficulties in the United Kingdom, Europe, North America, Australia, and New Zealand, but research evidence suggests that access to this therapy and clinical outcomes for patients is worse for patients from Black and minority ethnic (BAME) backgrounds compared with patients from white majority communities in most of these countries. This chapter looks at the changes that services and therapists can make to adapt the way that they work to ensure that access and outcomes for minority communities improve. Some of these changes are modest, such as ensuring that therapists acknowledge ethnic and cultural differences; however, some might need more extensive adaptation such as developing family system maps that take into account the beliefs, practices, and migration histories of different family members or understanding how spiritual beliefs can be incorporated into treatment plans. This chapter provides a practical and accessible framework for adaptation and suggests further reading to support the development of therapist skills in trans-cultural assessment and treatment of mental health problems when working with patients from BAME communities.