Therapist training taught me to catch myself on my own biases and to work through them. But I was never given the tools to cope with my own racial trauma as a brown Asian woman. I was never taught how to react to someone who was being racist to me, how to handle a client berating me. I would ruminate on these acts of racism perpetrated against me to the point of feeling constant resentment and anger. I was more angry at myself than the perpetrators because I felt like I should have done something. But why should I blame myself when they were the ones who were being prejudiced to me in the first place?
It was hard to seek validation from even my Asian friends, who should have understood me better than anyone. Often, they would invalidate my experiences, calling me “too sensitive” and “paranoid.” I was longing for someone to say, “I know that feeling. I’ve been there and you are valid.” I know it sounds ridiculous because I was learning to become a therapist, but at the time, I never considered therapy as a viable option for me.
My soon-to-be therapist classmates did not want to listen to me and other minorities on our experiences with racism. Some even defended other colleagues and professors who made off-hand racist comments to me. How can someone help marginalized clients, if they can’t even listen to their colleagues? And if these were the therapists of tomorrow, how could I expect the therapists treating patients today to be any different? I thought, if I got a therapist, they would do the same and have me convinced that my experiences with racism were all in my head. So I suffered in silence.
Previous research has suggested that suicide is the eighth leading cause of death for Asian-Americans (J.K.Y. Cheng et al., 2010).
Due to the lack of outreach and coping mechanisms, Asians are more likely to suffer from thoughts of suicidal ideation. The stereotype of Asians not seeking mental health services is well-known, but stigma is not exclusive to our communities. And stigma is only one of many barriers towards getting treatment.
Below, I give Asian Americans seeking mental health services a breakdown of the different kinds of cultural, institutional, and economic barriers they may face, and how to work around them. I also provide a guide for therapists on how to better treat clients of various Asian descents.
Before diving into the topic of Asian mental health, we need to define the types of trauma that affect us. These are “racial trauma” and “intergenerational trauma”.
- Racial trauma is the “traumatic response to an accumulation of negative race-related experiences” (Bryant-Davis & Ocampo, 2006; Comas-Díaz, 2016). This can range from facing microaggressions every day to physical attacks, especially by those in higher positions of power (i.e. police brutality and ICE). Racial trauma can result in hyper-vigilance and high stress. Because racial trauma is a new term, it is difficult to diagnose outside of PTSD.
- Intergenerational trauma is the “transmission of historical oppression and its negative consequences across generations” (Noormohamed, R., Ireland, L., et al, 2012). Inherited trauma caused by the historical events our families experienced either in their countries of origin or after immigrating. Because most Asian parents are immigrants, they are more likely to carry some form of intergenerational trauma. This particularly affects Southeast Asians due to war exposure and refugee status.
What are the common barriers to treatment for Asian Americans?
Traditionally, lack of mental health knowledge is inherited from Asia. Most immigrants do not know what a psychologist does. When my mother immigrated to the U.S. from the Philippines, she spoke of how therapy was not an option for most poor families due to high cost of treatment and lack of insurance. The inaccessibility of mental health services in their countries of origin forces many poor Asians to suffer alone. Poor Asian immigrants and refugees often suffer from pockets of trauma stemming from poverty while battling undiagnosed mental disorders. When lack of access to mental health services is normalized, it is then passed onto the next generation. But we’re greeted with many other barriers in the US.
J. Abe-Kim et al. (2007) stated, in their study, Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study, “Barriers identified as negatively affecting the use of mental health-related services include cultural barriers (e.g., stigma, loss of face, causal beliefs), culturally unresponsive services (lack of language match, lack of ethnic match, poor cross-cultural understanding), limited access to care (cost, lack of insurance coverage), and lack of understanding to services.” Because of all these barriers, it is difficult for Asian-Americans to seek out the mental health services they need.
It is also difficult for clinicians to provide appropriate services to both the Asian immigrant population and US-born Asian Americans. There is not enough data on both groups (J. Abe-Kim & et al., 2007). Our struggles are very different, and Asian Americans need services catering to both populations. Asian immigrants need providers that speaks their language fluently and is culturally competent. US-born Asian Americans need therapists who are more culturally sensitive.
Many Asians patients expressed dissatisfaction after utilizing mental health services due to the lack of cultural competence and sensitivity.
Asian clients have a higher drop-out rate in counseling than other minority clients. Non-Asian therapists are quick to jump to negative conclusions about us. They dismiss our parents as “emotionally-abusive” and our culture as “toxic”. Therapists should study the historical and cultural context of each Asian ethnic group. Rather, many treat every Asian face as a monolith. Most will not even entertain the idea of researching each Asian culture and the possible traumas that likely affect their patients. Adequate training and more diversity in mental health services are much needed.
What are the repercussions?
By trying to fit Asians into a box, even a positive one, it erases Asians who have learning disabilities or who do not have an interest in school. When Asians are expected to be studious and intelligent, we are put under more stress to be a “good Asian”. We’re pressured to succumb to the very stereotypes that we are trying to deviate from. An even greater consequence is that Asians are less likely to be correctly diagnosed by clinicians. Some believe we are invincible against mental illnesses. They are more likely to blame our parents’ culture for our depression and trauma.
A therapist is someone who builds a trusting relationship with you. When that person invalidates your traumatic experiences, you feel more betrayed and alone. The one person who should have been your confidant ends up contributing to your trauma. So, a dissatisfied Asian client will have difficulty detecting racial trauma and instances of racism. Our mental health deteriorates not because of our parents’ culture, but because we know we won’t get the adequate help we need. Poverty aggravates the symptoms of trauma, and low-income Asians are most affected by trauma due to lack of access to care.
What can clinicians and therapists do to better serve Asian clients?
“Asian-Americans are 3 times less likely to reach out for help compared to their white counterparts” (J.K.Y Cheng et al., 2010). It’s important to educate Asian communities about what resources are out there and what they provide. Laurie Meyers (2006) insists that therapists should “go where the people are.” She suggests domestic violence prevention organizations go to nail salons to spread awareness. Similarly, counseling services could reach out in schools exclusive to Asian populations like Chinese Grammar Schools. It’s important to reach out to Asian adolescents so they can get the help they need at an earlier stage in their life.
The services provided should also cater to all Asian cultures. Many Asians patients expressed dissatisfaction after utilizing mental health services due to lack of cultural competence and sensitivity. The needs of Asian clients will vary, as stated above. Non-Asian therapists can begin by reaching out to colleagues from their patients’ cultures. They may be familiar with the traumas exclusive to that population. And of course, when a client speaks of instances of racial trauma, they are looking for validation and want to be told it’s not their fault.
Mental illness can affect anyone, but it affects people of color in different ways. Asians are no exception to this, and providers must meet us halfway. It cannot be left solely to us to fix our issues. It is retraumatizing to have to educate a therapist on the struggles that we face. Forcing us to relive our traumatic experiences with racism, leaves us feeling more lost and mentally exhausted. Providers must remember that not all Asians are as well-adjusted as they appear. No one is “too smart” to suffer from mental illness or trauma.
What should you look for when seeking out a therapist that is compatible with you and how do you do so?
- When seeking out mental health services in your area, it’s always best to look at Psychology Today for therapist profiles. Race and age are not a strong factor in how well a therapist can serve you. It’s best to keep an open mind rather than limit yourself to only trying to find a therapist who shares the same background as you. Instead, find therapists who focus on cultural issues/culture + trauma/ethnicity, as well as other intersections of your identity that are important to you, like LGBT+.
- You may spend money on ten or more sessions of therapy. Include the cost of travel, your time and money, into deciding if a therapist is right for you. Don’t be afraid to verbalize what you look for in a therapist. Talk about the presenting issues you are dealing with now. Also keep in mind your insurance plan. Does your insurance cover the therapist of your choosing? Don’t let your financial status stop you from reaching out to someone who interests you. Many therapists will refer you to someone who fits your financial situation.
- Don’t be afraid to ask the hard questions upfront the first time you’re meeting a therapist. Ask what they think about intersectional issues. Ask what they think about structural oppression. When facing institutional barriers, our reasonable reactions need to be understood.
- Look at body language when you talk about your racial experiences. Are they engaging with you and asking questions about your experiences? Have they put in the extra effort to do their research about how to better understand your experiences and the community you’re from?
- At the end of the day, a therapist is another human with flaws and their own biases. You may not be compatible with them and the blame is not always on the client. Some therapists are unable to provide what you are looking for. Hopefully, that therapist can swallow their pride and refer you to someone who is a better fit for you and your situation.
Always remember to care for yourself and advocate yourself if you have to. And don’t ever be hard on yourself:
“Be compassionate to yourself because you’re trying to take care of yourself in a world that makes it hard. What you’re doing is really hard, but really important.” — Bryant (@mfbt)
- Abe-Kim, J., Takeuchi, D. T., Hong, S., Zane, N., Sue, S., Spencer, M. S., … & Alegría, M. (2007). Use of mental health-related services among immigrant and US-born Asian Americans: results from the National Latino and Asian American study. American journal of public health, 97(1), 91–98.
- Bryant-Davis, T., & Ocampo, C. (2006). A therapeutic approach to the treatment of racist-incident-based trauma. Journal of Emotional Abuse, 6(4), 1–22.
- Meyers, L. (2006). Asian-American mental health. Monitor on Psychology, 37(2), 44–46.
- Noormohamed, R., Ireland, L., Goulet, S., Cochrane, T., Daniels, C., Beatt, L., Thurston, W.E., Roy, A., Turner, D., & Morgan, C. (2012). Intergenerational trauma and Aboriginal youth: A scoping review. Calgary, AB: City of Calgary, Family and Community Support Services.