What it means to have a culturally responsive therapist and why it matters

I consider a few factors when I’m looking for a new therapist: therapeutic approach, experience level and whether they’re queer or at least LGBTQ+-affirming. I also prefer to work with female or gender-nonconforming therapists.

The last two criteria carry a lot of weight for me. If I have to explain or defend my queerness, or my experience as a woman, I won’t feel safe, I won’t feel understood, and the deeper self-exploration and insight that can ensue when such a foundation is there is unlikely to happen.

Because I’m white, though, I never have to worry about whether a therapist will understand my racial or ethnic identity, even if they aren’t white themselves. To say that whiteness is centered in the U.S. is an understatement; as the late sociologist Ruth Frankenberg put it, “[W]hite people are not required to explain to others how ‘white’ culture works, because ‘white’ culture is the dominant culture that sets the norms. Everybody else is then compared to that norm.”

The mental health workforce is disproportionately white. In 2020, for example, 83% of American psychologists were white. Therapist training programs spend relatively little time teaching cultural literacy, which means Black, Latinx, Asian and Indigenous people are left with a relatively limited pool of therapists who either understand the nuances of their culture through lived experience, or go out of their way to learn about non-Anglo cultures.

A 59-year-old Group Therapy reader wanted to know how to confront this barrier to adequate mental health care: “How do I find a therapist that would understand my culture? I am Indian American, and there is always a stigma for seeking therapy.”

What is culturally responsive therapy and why is it important?

I spoke with three people who’ve made it their life’s work to connect people to culturally responsive therapists, and they shared a lot of helpful information that I’m excited to share with you all.

But first, I’d like to explain what it means to be culturally competent and why it’s so vital to the therapeutic process.

A therapist who is culturally sensitive is “always learning,” said Adriana Alejandre, a Los Angeles-based psychotherapist who founded Latinx Therapy in 2018 with the mission to destigmatize mental health in the Latinx community. Even if the therapist shares your racial or ethnic identity, they understand that no two households are the same, and they are eager to learn about the diversity in your community. At the same time, the therapist should at the very least have broad knowledge of your culture’s values and integrate that knowledge into their work with you.

“I automatically think of the word ‘collaborative,’ ” Alejandre said. “The therapist is really working with the client to understand their cultural expectations, beliefs about what progress looks like, and that the therapist isn’t mirroring any harmful expectations and pressures from the client’s society.”

For example, a culturally responsive therapist will know that many people from marginalized communities, immigrants and first-generation Americans prioritize education, Alejandre said. “We might not think of this as cultural, but as a daughter of immigrants, I can say that there really is pressure for you to succeed, and sometimes that can affect your mental health,” she explained.

A therapist working with East Asian clients should keep in mind the role of filial piety, the Confucian concept of respect for one’s parents, elders and ancestors. “As an Asian, I know everything is driven by family duty,” said Jeanie Chang, a psychotherapist in North Carolina who specializes in AAPI mental health. “So if someone comes in depressed, I will ask, ‘How is the family taking it?’ And I’m not asking mundane questions like, ‘Why are your parents so paranoid about schooling?’ ’’

If you’re experiencing racism or microaggressions in the workplace or in your social circle, such a therapist might be able to help you name that experience, and contextualize how prejudice harms your mental health, Chang said. “Therapy isn’t only about mental health disorders,” she added.

Being witnessed and understood is an integral part of therapeutic healing, said Meag-gan O’Reilly, a Bay Area clinical psychologist and a facilitator with the Black Emotional & Mental Health Collective (BEAM). “If I have multiple situations with my therapist where they’re looking at me incredulously, don’t understand my worldview or why things are a struggle, I won’t be getting that human element of healing. And I won’t be able to trust their interventions,” O’Reilly said.

The importance of seeing a culturally responsive therapist goes beyond the therapeutic relationship. Research has shown that people of color are often erroneously diagnosed with mental illness because therapists and psychologists lack understanding of the situations and contexts in which a person of color has lived.

The tests and systems used to diagnose people were developed primarily for middle-class white people and may not accurately reflect the experience of people from marginalized communities. So a culturally competent therapist will know that so-called evidence-based practices (including cognitive behavioral therapy) can be pathologizing for people of color if they aren’t used thoughtfully, Alejandre said.

Culturally competent therapists continuously examine their own privilege, the power they hold as a mental health practitioner and how their beliefs and values may influence clients. They’re also open to feedback.

During the first session, O’Reilly asks clients about their intersecting identities, class status (and how that might have changed over time) and spirituality. And she shares her own, too. “I let them know I’m a first-generation Jamaican American, bisexual, I use she/her pronouns, and I will make blunders sometimes,” O’Reilly said. She invites clients to alert her if she says anything that’s insensitive to how they understand and move through the world.

“That invitation is even more important for a white therapist working with a nonwhite client,” O’Reilly told me.

So how do you find one?

Here are some tips on how to find a culturally competent therapist, from this week’s experts:

• A great place to start are mental health directories, including Latinx Therapy, National Queer & Trans Therapists of Color Network, BEAM (Black Emotional and Mental Health), the Assn. of Black Psychologists, Inclusive Therapists, and Asian Mental Health Collective.

Alejandre also recommended Immigrant Rising’s Mental Health Connector, which links undocumented people in California with free and culturally responsive therapy. Additionally, members of Latinx Therapists Action Network commit to providing mental health services on a sliding fee scale for those in need for a maximum of 12 sessions. You can also search for therapists who offer sliding-scale rates on the other directories.

“If you find a therapist who seems like a good fit but their rate is too high, ask them who is eligible for their sliding-scale rate and what that looks like,” Alejandre said.

• If you have insurance, contact that company and ask what filters they have for providers, Alejandre advised. “Sometimes they have filters for background or specialty,” she said. “If they don’t have a filter for background, you can do some extra research to find out who identifies with your background among the list of providers they give you.”

• If you belong to a church or another religious community, Chang recommends speaking with leaders about which organizations they know of that provide low- or no-cost therapy. These aren’t necessarily religious organizations, but agencies that specialize in working with people in your community. We listed a number of such organizations in our mental health resource list for L.A.-area residents.

OK, so now you’ve found one or more promising candidates. Therapists usually provide 15-minute free consultations so you can decide whether they’ll be a good fit. Here are some questions you can pose to screen for cultural competence, experts said:

• “Have you worked with _____ people before?”
• “How do you treat _____?”
• “What’s your opinion on ______?” (Insert your fears and values, like antiracism, social justice, immigration, etc.)”
• “We don’t have the same cultural background. How do you go about educating yourself to be a culturally responsive therapist?”

A note on stigma

Our reader also mentioned the negative stigma around therapy in their community. This is true in so many, if not most, cultures. It’s a real barrier to care, so I asked the experts how they address this stigma with clients.

Chang said about half of the people who reach out to her for support are hiding the fact that they are seeking therapy from their family members. With those folks, she’s extra patient. “It might take them more time to formulate their thoughts, because they aren’t used to talking about their emotions. But I know that for them, coming into therapy at all may have been a huge feat.”

Some stigma existed historically for protective purposes, Alejandre notes. She helps her clients process what function mental health stigma served in their family or lineage.

O’Reilly reminds her clients struggling with such stigma that everyone around them will benefit from their wellness. “I even tell my Black clients, ‘When you’re an ancestor, what do you want to pass on? More grind until you break? Or wellness, or dare I say — leisure?’ I chip away, knowing that it’s a big cognitive mountain.”

. . . . . .

Regardless of your cultural background, I hope you walk away from this newsletter feeling empowered to seek the mental health care you deserve. That we all deserve!

If you’ve had good experiences with culturally competent therapists, send us a note about what that was like. We love hearing from you.

Until next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation.

See previous editions here. To view this newsletter in your browser, click here.

More perspectives on today’s topic and other resources

Talking about mental health can be hard within Latinx families. My colleague Karen Garcia interviewed Latinx Therapy founder Adriana Alejandre and others to understand how and when to start conversations about mental health, how to set expectations and why these conversations are important.

Some therapists are helping patients heal by tackling structural racism. Many of the founding ideas, techniques and schools of practice of therapy were developed by white scholars or practitioners, and as a result, the field has marginalized the experiences of people of color. Microaggressions are also pervasive in psychological practice. A growing number of mental health professionals are trying to shift this culture.

With research showing that LGBTQ+ people have a higher risk of developing eating disorders, more care providers are creating specialized treatment to address these disparities and ensure people get the tailored care they need.

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