The therapeutic communication between psychotherapist and client is highly dependent on their socio-cultural background. The purpose of this study was to examine the effects of culture on decision-making style of psychotherapists in three dimensions of decision-making: expedience vs. realism, individualism vs. collectivism, and long-term orientation vs. short-term orientation. The sample of this study consisted of 144 psychotherapists (40 Iranians educated in Iran, 33 Iranians educated in the west, 36 Americans, and 35 Canadians). Each of the participants were presented with three scenario that involved clinical challenging situations. For each area of decision-making a statement was considered and the psychotherapist was requested to rate them based on importance in his/her clinical decision-making. Findings indicated that the groups differed significantly on all dimensions with few exceptions when American and Canadian psychotherapists were compared. The decision-making style of Iranian psychotherapists was more with expediency, collectivism and long-term orientation, while the decision-making style of American and Canadian psychotherapists was more with realism, individualism, and short-term orientation. According to the results of current study, socio-cultural background of psychotherapists, as a frame of reference, significantly influenced their clinical decision-making style. •Culture, as an implicit frame of reference, influences the clinical judgment of psychotherapists.•Iranian psychotherapists are expedient and family-oriented in clinical decisions.•American and Canadian psychotherapists are realistic and client-oriented clinical decisions.•The socio-cultural background of therapeutic relationship influence on goals of therapy.