Here’s how some therapists deal with structural racism in their practices
Cambodian American Aiden Teng was born in a refugee camp on the border of Thailand and Cambodia a few years after the Cambodian genocide. She moved to the United States with her mother and aunt when she was six years old.
Teng attributes much of her resilience in moving to the States to her exuberant mother, who dressed whatever she wanted and wasn’t afraid to defy social norms—even when it was embarrassing for Teng’s adolescence.
But as she grew up, Teng also witnessed the negative effects of historical, ethnic, and intergenerational traumas on her mother’s well-being. Teng was often confused by how her mother’s feelings could spin out of control for seemingly no reason, or why she had so many health issues.
When Teng first encounters psychology in college, she realizes that her mother’s past is directly linked to her emotional and physical health. (Scientists are learning that stress and trauma are sometimes linked to chronic diseases, such as high blood pressure, diabetes, and kidney disease.)
It was this realization that forced Teng to become a healer. In 2018 she started her graduate studies in Seattle.
But when COVID-19 hit and the Black Lives Matter movement took full effect, with more communities of color having a public conversation about their struggles in the United States, Teng says she began to feel differently about her training and the career she would enter. . She began to notice how dealing with certain issues, including race and immigration, were not prioritized in her clinical training—even though she knew how important they were in shaping lives.
“I didn’t feel like an actress, and I felt like a lot of my family history wasn’t thought through,” she says, adding that she was taught under mostly white teachers. “I just felt silenced in my own history [and] My own experience of the work I was doing.”
Teng’s graduate program is not the only one like this. Therapy is a predominantly white field in the United States—80% of psychologists, 63% of counselors, and 59% of social workers are white, according to Data USA, a website that creates visualizations of federal public data.
Many of the foundational ideas, techniques, and schools of therapy practice were developed by white scholars or practitioners. As a result, the field has marginalized the experiences of people of color, therapists and patients say. Researchers note that microaggressions are also prevalent in psychiatric practice, and many immigrants report not attending therapy due to language barriers, lack of insurance, and high costs.
That’s why Teng wanted to take a new approach. For her, that meant joining a growing movement of other counselors who hope to change the practice of therapy, to make it more accessible and appropriate for people of color—and eventually—to help them find healing.
Adopt the practice of “decolonization therapy”
Teng was initially inspired by people like Dr. Jennifer Mullan, who referred to this work as “decolonization therapy,” a process to address the structural racism and other forms of oppression that prevent the therapy from serving many marginalized communities.
“I think the best way to describe decolonizing therapy is that it really lends itself to an examination of the external pressures, pressures, and layers of oppression that my clients have endured and survived,” Teng says.
She gives an example of microaggressions in the workplace, or job interviews. “There are opportunities that aren’t given to you because of who you are,” she says, “but if we look at it through the lens of self-esteem, it’s like, ‘There’s something wrong with you. You just need to think better yourself, right? You are You should be more positive.”
But for people of color, the framework of being “more positive” doesn’t always work. It does not take into account racism, xenophobia and other forms of discrimination against them. “The challenge is realizing that how you feel about yourself can also be internal oppression,” Teng explains.
Teng’s decolonization therapy practice delves into family history, helping her clients of color better understand how their ancestors’ historical oppression affected them. She says this is true of people from her community, who experienced genocide when the Khmer Rouge regime killed around 2.2 million people. “When we talk about Cambodian refugees and migrants, there is a horrific, rich and devastating history here.”
Teng finds that children of Cambodian refugees who experienced genocide can struggle with guilt. “In first-generation or second-generation Cambodian-Americans, there is an experience that your parents either sacrificed or had too much,” she says. “They’ve experienced such a huge loss. And we have this sense of their sacrifice, we feel like we need to take that hurt and that grief and that pain.”
Clinging to a parent’s pain leads to tricky territory, Teng says. “We also feel we have to transcend that by being perfect or striving for success so much that we’ve become millionaires… vs. being truly with the kindness of grief and the emotions that are kept and passed on.”
Use culturally responsive techniques
To respond to these issues, Teng has developed some methods that differ from the way she was trained. First, Teng often brings the family to practice.
“This may mean that we include the parents in the sessions so that we can hear from their perspective,” she says. “When we’re in this space, there are a lot of opportunities to shed light on the effects of being the children of immigrants. And it’s through that lens—of being someone like first-generation immigrants—that we can discuss the harm that is very much related to the harm that parents experienced.”
Teng supports children and parents to openly discuss experiences such as racism and genocide in a safe and documented environment. She says that many who survived genocide had to suppress their feelings. Thus, when you have experience suppressing those [painful] Emotions, you also suppress joy, connection, and belonging.”
She says allowing her clients and their parents to experience the full range of emotions can help with healing. “[They] It can allow for positive, meaningful connections and relationships.”
Teng also works against the stereotype of the discrete therapist as an expert. She has made it clear to her clients that she may not have all the answers, and would rather be transparent with her clients about her generational trauma. “When we can come to terms with what’s really hurting, we know we’re in this together,” she says. “I am part of this collective healing journey with my clients.”
Growing acceptance of the role of historical trauma
Like Teng, Ramona Beltran became interested in decolonization therapy because of the problems she was seeing in her native community. Known as Xicana, she is of Yaqui and Mexica descent and is a professor of social work at the University of Denver.
When she was just beginning her career, many of her family members died before they were 60 and she found herself questioning the connections between her community’s history of trauma and their own health.
When Beltran entered a doctoral program to study historical trauma 20 years ago, she wasn’t taken seriously at first, she says — much like I did a few presentations on the theoretical framework of historical trauma and healing. “I remember this [presentation] Where they sent me the comments, and a lot of people were like, “This is political. It’s ideological. It’s not research. There’s nothing empirical about this. This isn’t like real academic work.”
Now, Beltran says things have changed, “I teach a whole class on historical trauma and healing, and it’s always one of the classes that fills right away,” she says. “And that, to me, is progress.”
When she was working on her master’s degree in social work, she says, she noticed that all the evidence-based practice methods she learned in grad school weren’t enough.
“They were just like this kind of mainstream approach to therapy that was created out of mainly white, middle-class families,” Beltran recalls. “And so maybe it will be translated into Spanish, but for me, what I was seeing was that those practices weren’t really generating much healing.”
Now when you teach, Beltran stresses that decolonization can take many different forms, depending on the experience of the therapist and the shared experiences of the community the therapist is trying to reach.
She highlights three key aspects of culturally responsive therapy: building authentic relationships, ensuring community representation, and reconnecting with one’s cultural background. Like Teng, Beltran is particularly interested in working with clients to help them see their culture as a form of intergenerational strength, rather than suffering.
Growing need for culturally responsive therapy
While healers like Beltran and Ting are committed to making treatment more inclusive, communities of color continue to struggle for access to healers. Teng gets a lot of people calling her who she can’t help. “I’m only licensed to see people in my area, and there are a lot of people who are interested. It breaks my heart every time, as I can’t provide support.”
She points out that this is especially common for clients who live in areas with few doctors available. “I had one from Kansas recently, who was like, ‘We don’t have any Khmer healers anywhere in the state. Unfortunately, I cannot provide this service.
Teng knows what it’s like to not be able to access treatment. “I myself did not have a psychotherapist practice the way I did until recently,” she says.
Teng says there have been some recent moves in the right direction. Organizations such as Inclusive Therapists have created the BIPOC Therapy Fund to provide financial assistance for at least four initial sessions for people seeking color therapy. The Asian Mental Health Group has also set up the Lotus Therapy Fund to provide financial support to Asian treatment seekers for eight sessions.
The largest professional organization for psychologists in the United States also promises to make a difference. Last year, the American Psychological Association issued a formal apology for its role in what it described as “the promotion, perpetuation, and failure to challenge racism, racial discrimination, and the human hierarchy in the United States.”
The APA promised to support more research focused on non-Western perspectives, provide more access to culturally competent training, and create more opportunities for people of color to enter the field of psychology. In August, the organization committed $1.1 million to a new Racial Justice Fund to implement these three goals.
Teng says she hopes to see more money dedicated to helping people of color access treatment that acknowledges their histories and experiences.
“There’s no way we can just say we’re going to look at this from a cultural perspective without actually looking through a historical intergenerational lens,” she says. “And so, it has to be inclusive and interdependent in order to truly honor the human being in front of you.”
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