Psychotherapy, as a cultural activity, faces the challenge of adapting to historical changes and emerging issues. In this article, a multilevel approach to psychotherapeutic intervention that encompasses the individual, relational, and contextual dimensions is proposed. The approach is based on an historical-cultural theoretical framework that integrates constructivist, systemic, and semiotic components to broaden perspectives for psychotherapy. The primary purpose is to integrate concepts derived from cultural psychology to structure ideas related to the theoretical understanding of intervention. A conceptual elaboration is presented to address the extension of the mind into the social and cultural contexts in continuous exchange between the self and others, as an essential vital process. First, the central concepts of semiosis, development, temporality, and dialogicality are presented as theoretical principles that guide this approach. The article elaborates on the cultural semiotic model as a framework to guide therapists' understanding of the issues prompting individuals to seek psychological consultation and change, proposing therapeutic aims, conceptual tools for intervention, and strategies for building the therapeutic relationship. The relevance of this theoretical proposal for psychotherapy, as cultural mediation cuts across individual, relational, and contextual levels, is discussed.