- the basics
Not to say that therapy is the only way to sort through distress or depression -- and it would be a mistake to think of it as a cure. It’s work you commit to doing, like going to the gym, and you can do it alone or by various other means, but it can make a big difference to have a trainer.
First thing to remember is that one therapist is not just as good for you as another. And that, as with trainers, you have the power to choose. So make a point of investigating your options before you settle in with one. Ask questions of their experiences working with histories and backgrounds like your own; ask them to explain to you their philosophies of working with clients. Listen for things that sound right -- or things that make you uneasy. Trust those reads even if you’re not completely sure why. Your working relationship with the therapist needs to be a comfortable one, because you’ll be telling her or him some uncomfortable things.
Start by contacting your insurance company, county or college health center, or even your primary care physician for a list of providers currently accepting clients. Teens, and others for whom privacy may be a particularly keen concern, may want to consult the note on rights to privacy at the end of this post.
Compile information about training and specialties, even race/ethnicity and gender, because these last may be important to you. Make calls next; it’s a low-key way to start because, a) you don’t need to go into detail about yourself on these calls; the idea is to get information about your potential provider. And, b) you’re not paying yet! So you can call multiple people without worrying about running yourself out of visits. Expect to get voicemail, and to leave a number where it’s not a problem for them to call back.
You can learn a lot on a phone call. I once spoke to a therapist whose website I’d looked up, and asked her to tell me a little more about her approach to a certain issue; rather than answer, she directed me to her website. I reiterated that I’d seen it. She again directed me to her website. I did not hire her.
Say you’ve narrowed down your options and arrive at your first appointment. If you find that visit goes badly, it’s still better to cut your losses and keep looking, than continue to work indefinitely with someone whose approach is ineffective or even counterproductive for you. Yes, I realize that it’s grueling, to sit down in front of stranger after stranger and launch into your history of hurts. But a visit not worth repeating may go horrifically -- such as did my encounter with an older Chinese woman who decided that her course of treatment would be to channel my mother -- or it could just be … uninsightful.
There are good practitioners and bad ones, definitely, but there being also the question of compatibility, I can’t tell you specifically what to look for, since what suits me may rub you entirely the wrong way. Something in that meeting, though, should actively strike you as promising. Maybe your prospective therapist asks a well-placed question, or responds with something that indicates he has really grasped what you’ve been saying. You will be asked personal questions in these first visits and it’s okay to say you don’t feel comfortable answering (after all, this is a perfect stranger), but pay attention to how she reacts to your discomfort.
It’s perfectly normal to meet several therapists before deciding on one with whom you feel a good rapport. You can even round back to an earlier person if you change your mind; it's their job (literally) not to take these decisions personally. But as with dating, “that didn’t suck” is not a high enough bar.
- cultural competence
It’s certainly not mandatory that your therapist be of your same race, ethnicity, gender, or sexuality. But it’s helpful to have compatible worldviews, because you don’t want to be hashing out (or worse, not hashing out) fundamental oppositions on the clock. And the more pronounced a role sociocultural factors have played in packing your baggage, the more important that the other person in the room understand what it’s like being Asian in your part of the country, or being the child of accented parents, etc.
This manner of “cultural competence” isn’t gained via the one-semester course on Asian American psychology, whereby budding counselors learn to expect that Asian parents are “traditional” and their children “assimilated.” Such stick-figure drawings of cultural otherness boil everything down to tautologies. To “explain,” for example, that immigrant parents do thus because they’re Asian (or fancy, “Confucian”), and second-generation kids do otherwise because they’re American, is like saying the sun shines during the day because it’s the sun, and the moon shines at night because it’s the moon -- and then treating this like a statement of genius. Thinking in cultural tautologies actually makes it impossible to analyze any of the physics of interpersonal or social dynamics, because it turns everything into a self-evident fact of (cultural) nature.
In other words, to someone whose primary referent is the Joy Luck Club, everything you say will sound like the Joy Luck Club.
Therapy is a kind of ready room, where you practice different moves and hatch new strategies for engagement. How well your therapist coaches you has a lot to do with how well he or she knows the social space you’re preparing for.
I’ve tended to choose therapists who are Asian, or from immigrant families, and who know along with me that the things which smell bad, or even look rotten, are not necessarily the things that hurt. Because if I’m to figure out where our lives misfired, it will not help to get my family wrong.
- Asian American paradigm
As I mentioned in the Resource Guide, however, a problem with many of the Asian-directed mental health services is that they conflate ‘Asian’ with ‘immigrant.’ This can compound and dangerously reinforce the immigrant perspective that the second generation has, well, no problems. Nothing to complain legitimately about.
Be careful with Asian immigrant clinicians. They can do excellent work if they have the critical wherewithal to resist the gravitational pull of their own cultural tautologies. But if, like the older Chinese woman I mentioned above and other immigrant practitioners I’ve heard report of, their idea of treatment is to tell you to suck it up, you should make your parents proud -- leave. They have just proven themselves not up to the task.
Know this: Such unself-reflexive behavior is unprofessional, and you have no obligation to let yourself be subjected to it.
All this is not to say that if you find yourself a second-generation Asian American therapist of your same gender or sexuality he or she will automatically be great. Nor that a therapist who isn’t any of these things will necessarily be clueless. But your therapist should be able to hear you -- in all the specificity and nuances of your experience -- and not insist on pinning you to a type.
- the idea
The trials of finding a good therapist are worthwhile if you’re someone who sometimes thinks no one could stand you if they knew: who you really are, how you really feel, how little you suspect you’re worth. This person, you have -- who won’t go away, won’t take it personally, won’t tell your friends, won’t be less there next time. It’s a powerful thing, the space she offers you: to practice banishing demons by saying aloud their names, and then to watch nothing die.
To each of my good therapists, thank you.
A note about privacy/confidentiality
Firm laws exist to prevent information regarding your treatment from being accessed without your explicit written consent. A good run-down of these is provided here, though it emphasizes California law; statements of the national code of ethics can be found here.
However, if you have heightened concerns for privacy, you’ll want to know how to manage those protections more actively. Below are a few tips, but the key is that if you have concerns -- whether about coverage, cost, or anything else -- ask upfront.
- Insurance: Ask where or how Statements of Benefits are delivered. The default is your home address; if this is problematic, ask about alternative arrangements.
- Therapist’s office: Ask your therapist what procedures the office uses to protect your privacy. For one, how and when will you want to be reached, if necessary?
- Minors: You’ll want to consult the Schools section of the Resource Guide for tips on where to start looking for help, as your resources are more limited if you are not going through your parents to seek counseling. Your primary care physician may be a particularly good place to start, though.
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Comments, questions, or stories can be posted below -- or sent privately to Sam at aamms[at]hyphenmagazine[dot]com.