Never the Patient
Assessing Mental Health Accessibility and Stigma through Self-Reflection
I remember logging into my first therapy session, my breath held in anticipation as I clicked the hyperlink, which led to a screen with a throbber and, below it, my reflection staring back at me. I exhaled. Although I’d researched how to prepare for my first session, I still didn’t know what to expect for the next hour. I knew my therapist’s name, but was unfamiliar with her face and certainly clueless about her history. In the moments leading up to the video call, I rehearsed how I would introduce myself. How I might describe what concerns I wanted help with.
Self-doubt kicked in.
What if my concerns aren’t concerning enough for therapy?
What if my therapist and I aren’t a good fit?
What if I don’t actually need therapy at all?
It was December 18, 2020. In the summer of 2020, I graduated college, started a full-time job, and moved to a new city. Considering that in addition to the pandemic and ongoing political unrest, it seemed that all signs were pointing towards therapy. I wasn’t the only one in need of mental health support, but rather I was among hundreds of American adults who have turned to therapy since the start of the pandemic, be it telehealth or through a mobile app. There have been so many requests for in-take appointments that some therapists have had to place clients on waitlists or turn them down altogether. I experienced both occurrences: two waitlists and one turndown. Six weeks after my initial request for an in-take appointment, I met my first therapist. Although the wait to meet her felt long, my therapy journey has been far longer.
Growing up, I conceptualized therapy in the image of a silver-haired adult on a cushioned chair who would ask, “And how does this make you feel?” I watched films like Harriet the Spy (1996) that depicted therapists and their patients alike as white and usually wealthy. Ticking neither boxes, I assumed therapy wasn’t for kids like me, no matter how much of myself I saw in Harriet.
We were both ill-tempered kids who felt misunderstood by their parents and classmates. On the surface, however, we couldn’t be more different. Harriet was a white sixth-grader with a financially privileged New York City upbringing. In contrast, my family and I most resembled a handful of the film’s minor characters: an Asian family who Harriet spies on. They’re grocery store owners with limited-English proficiency who chaotically provide comic relief, and a juxtaposition to the stiff dynamic of Harriet’s family, mid-way through the film.
As Vietnam War refugees, my parents wouldn’t have known how to schedule a child psychologist appointment for me the way Harriet’s parents did for her. My parents believed that poor mental health was something to whisper about, to hide. Something curable through prayer, not through treatment. However, my parents likely have undiagnosed mental health needs, having been displaced from their homeland and needing to adapt for survival in a new country. Since I grew up in the United States, certainly not in the same circumstances they lived through, my parents saw no reason for me to express any emotion beyond contentment. With a roof over my head and food on the table, how could I possibly be depressed or anxious?
In high school, I was so fascinated by the subject of psychology that I considered majoring in it. I pictured myself as the silver-haired adult in the chair, but still, never the patient. Until college, that is. During my college orientation, my orientation leader informed our group of the vast resources within Campus Health, including Counseling and Psychological Services. She told us that the college experience is ripe with mental health concerns and that counseling could help. Don’t be ashamed to ask for help, she said. Anxiety, stress, and burn-out are just a few of the concerns students might experience, she continued, even within their first semester. With Campus Health just a walk away, it dawned on me that, for the first time ever, therapy felt within reach.
Having to balance classes and other responsibilities, however, proved to be more than I bargained for. Thus, the walk to Campus Health felt too long, yet another responsibility I had to manage. It didn’t help that my university’s counseling services had a negative reputation for being inaccessible to low-income students, something I learned within my first semester. On a few occasions during my first year, when I was feeling at my lowest, I searched online for local therapists. I eventually discovered that I had to narrow my search down to someone who accepted my insurance. Still, my eyes couldn’t believe the costs I saw per session. Unemployed and unable to ask my parents to lend me the money, I abandoned the idea altogether.
Throughout my first year of college, I attended workshops led by Asian American students, the themes of which fell under the umbrella of the AAPI experience spanning from identity to mental health. Though I’ve always been around other Asian Americans through my K-12 schooling and church, being in these workshops was the first time I understood what community meant. Here, I would connect the dots of my personal timeline to the greater AAPI historical timeline. I would understand when and why the term “Asian American” was coined. And, in conversations about mental health, I would hear anecdotes of parents who stigmatize mental illness at home and therapists who misunderstand non-Western cultures. Having been misunderstood by authority figures in the past, I couldn’t imagine being treated as such by someone with whom you’re so vulnerable.
Cultural barriers deter many Asian Americans from receiving mental health support. Other barriers include stigmatization, language gaps, and a lack of awareness of available services. Because of these deterrents, our community is far less likely to seek mental health support than white Americans, despite many of us having mental health needs. In a mental health study conducted in 2007, researchers from the University of Maryland School of Public Health found that Asian American participants reported several common stressors that impacted their overall mental health. These include:
Racial or cultural discrimination
Difficulty balancing two different cultures
Societal pressure to live up to the Model Minority myth
Parental pressure to be academically high-achieving
I can attest to experiencing these stressors as well, especially in college. As a student, I sought several mental health services and resources, including group therapy and Talkspace, an online therapy service. While I wanted to try face-to-face therapy, I wasn’t drawn to a single local therapist in the pool of names and headshots I saw on Psychology Today. This should come as no surprise, considering the limited options in my small, predominantly white college town.
As soon as I moved to Philadelphia from North Carolina last year, my therapist search began again. I Googled “therapist of color Philadelphia” and scrolled through the seemingly endless options: options I never had before. Many therapists accepted my insurance, while others operated on a sliding scale, meaning I could pay what I was able. It took months to refine my search and contact therapists, until finally I was on the waitlist for one. The psychotherapy center where they worked catered to patients of color and LGBTQ+ patients. This, of course, excited me. And I was even more delighted to be paired with a therapist who was also Asian.
In just seven months since starting therapy, I can attest to the magic of having an Asian American therapist. The beauty of a racially affirming space I have always yearned for, and a therapist who just gets it. With her, I can share freely about my identity as a Montagnard and Asian American, as well as my relationship with my family. With her, I’m met with head nods and words of affirmations. She understands my experiences as a first-generation American. The stress of it, the burden, and the potential. She affirms that living between two cultures is indeed a constant battle and that she’s proud to see me doing my best to navigate it all.
While I would like to sprinkle the magic of having a culturally competent therapist to everyone seeking professional help, I also acknowledge that my experience is rare, and that therapy is not a one-stop shop for meeting all of your mental health needs. According to the American Psychological Association, “in 2015, 86 percent of psychologists in the U.S. workforce were white, 5 percent were Asian, 5 percent were Hispanic, 4 percent were black/African-American and 1 percent were multiracial or from other racial/ethnic groups.” This statistic is striking, considering there are 23 million Asian Americans.
However, these statistics are continuously changing, as will conversations around mental health in Asian American communities. We know that Millennials and Generation Z are more likely than previous generations to seek mental health support and to report mental health concerns. Therapy, and mental health overall, are shedding negative stigma. Services are increasingly more accessible and culturally competent to systemically under-resourced populations. Whether you’re the silver-haired adult in the chair, the patient, or just starting your therapy journey, our generations are shifting the narrative around mental health. And I couldn’t be prouder of us.
How are you shifting the narrative around mental health?
To start, or continue, your therapy journey:
National Queer & Trans Therapists of Color Network: Advancing healing justice by transforming mental health for queer and trans people of color.
Brown Girl Therapy: First/largest mental health community for children of immigrants.
Rest for Resistance: Rest for Resistance strives to uplift marginalized communities, those who rarely get access to adequate health care or social support. This includes Black, Indigenous, Latinx, Pacific Islander, Asian, Middle Eastern, and multiracial persons.
Asian Mental Health Collective: AMHC aspires to make mental health easily available, approachable, and accessible to Asian communities worldwide.
South Asian Therapists: We are the largest South Asian mental health community in the world.