Therapy Talks

Breaking Barriers & Navigating Stigma: Mental Health In Eastern Cultures with Manroop Sohal

January 03, 2023 Switch Research Season 1 Episode 52
Therapy Talks
Breaking Barriers & Navigating Stigma: Mental Health In Eastern Cultures with Manroop Sohal
Show Notes Transcript

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Join host Hailey Kanigan as she and guest Manroop Sohal tackle the large stigma attached to mental health in Eastern cultures and the unique challenges that come with providing therapy to South Asian patients. From assumptions that the term "mental" implies there is something wrong with you, to a lack of language for discussing mental health issues, Manroop navigates the difficult barrier of cultural norms while building close connections with her patients. Tune in as we explore these issues and work towards destigmatizing mental health in Eastern cultures.

In This Episode:

  • Manroop gives personal examples of cultural friction within her experiences in therapy. 
  • Examples of both "individualist" and "collective" culture.
  • The importance of understanding a client's culture and beliefs.
  • Finding your way as a first generation Canadian while embracing and respecting your cultural roots.

Manroop Sohal aims to customize therapy for each client, recognizing that each person brings unique experiences that require exploration to determine the best treatment approach and plan. Manroop's practice is based in the humanistic and psychodynamic modalities, incorporating elements of person-centered and existential therapy. She works to uncover various factors that may be impacting a client's situation and worldview, including current and childhood experiences and patterns, impact of family, culture, societal positions and more. Manroop creates an accepting, compassionate, and non-judgmental environment in which clients can engage in introspection and self-reflection.

Find Out More About Manroop:

Hello everyone. Welcome back for another episode of Therapy Talks. I'm Haley and I'm really looking forward to discussing our topic today. But before we get into it, I wanted to offer you all a wonderful promotion code. So all therapy talk listeners can get 20% off of Switch Live, which is a wonderful therapy platform offering a variety of webinars, information and courses that you can take at whatever pace you.

So you can use code therapy talks for 20% off of your purchase. But before we get to it, I have one more promo code to offer for you today. In partnerships with Switch research, I wrote the Emotions guided Journal. This journal was a creation of all things about emotional regulation. I wanna offer you 30% off with code Haley 30 at the purchase of your journal at checkout.

So why don't you take a look and see if it's a fit. Today INS episode we have Man Ru Sohow. She joins us today to talk about all things cultural competency within therapy. She encourages clients to speak up for their needs, for clinicians to make sure they have adequate competency in education within different communities, and she really wants to reduce the stigma of mental health by opening up this wonderful conversation.

Man, Ru and I actually met at a therapist social about a month ago, and it was really wonderful because I was speaking to the therapists there and hoping that more individuals would be confident and brave to join us on the podcast. And man, Rupe was someone that was very kind and volunteered because you have a wonderful topic that we would love to deep dive today a little bit.

And so I think that's so grateful that you're, I'm so grateful that you're willing to join us and talk about this topic. , what was like this topic that you were hopeful to discuss today? Yeah, for me when you had mentioned that, we'd love to have therapists on the podcast, the first topic that kind of came to my mind was talking a little bit about cultural competency.

And I know that's a very broad topic, and of course I will get into more detail about it. But for me I identify as a first I'm a first generation Indian Canadian, so my parents are immigrants from India. And I have had a personal struggle with finding my cultural footing, trying to navigate who I am here as a Canadian and who I am at home as an Indian and all these different things.

And how counseling really plays into that and having clients come from similar backgrounds because of, the cultural piece and seeing the importance that it. Had for myself over the course of my life and now with my clients, it's been, it's something that was striking me as something that we need to talk about more so that.

Other therapists and clients know what to look for what it actually means to be culturally competent and just opening up the conversation there so that it's not oh, we learned it in school so we should know it. And it's more of a, oh, it's different when we actually are in the process of practicing it with actual human beings.

, definitely. And if you're open, I would love to hear some of your personal experiences to help listeners and other therapists listening more, conceptualize that experience as. Sure. Yeah. Personally I went into counseling to be who I needed throughout my life. So whether that be, as a child, as an adolescent, as a young adult, and now as an adult just figuring out needing that extra space of having someone that just gets it.

And I think that for a long, long time I had. Understanding of, I really like therapy cause I really like having that safe space of talking about what's going on and talking about my experience. But a lot of the time I would be spending my time Taking time away from that and advocating the person that I was talking to on Oh, but this is a cultural thing, so if I'm having a dilemma or a big feelings or big thoughts about something, I would have to take him step back and take a step back from what was actually going on.

To be like, oh, let me give you some background on this, which is what we're taught is what we're supposed to do. The client is the expert. They're gonna educate you on their experience and no matter how much you can identify with someone or understand their perspective, or if you come from similar backgrounds, they will always have a different experience.

That will always be the case, but I found that it was taking away from my. Therapeutic benefit by having to explain, oh this is what I meant by this, or this is what's, this was culturally inappropriate and that's why it's bugging me, or this is how it plays a role in my cultural identity and that's why this is happening.

And it felt like I was defending a lot of what I was going through. And not to mention just having that experience as a 14 year old or 13 year old that is already a teenager and having so many problems. Just fitting in and finding who I am and then adding this added component of no one really gets it cuz there's not an identity that can say, I've been there and I also dealt with that.

And I get that this cultural component and you having to figure out who you are to your parents and who you are at school or who you are with your friends or your cousins. It's. . And I found that it was really, it got to a point where it was frustrating. . And then that obviously goes into that conversation of client counselor fit and everything.

But for me it was just, I didn't really have anyone that just got all of these different aspects of my life that were impacting how I was feeling and who I was, and it felt just very alienating and I. I think a lot of us therapists get into the field cause we wanna reduce that alienation and that isolation that clients can feel.

But for me the cultural aspect of it was the most alienating which kind of led me to here. . I think that's such an important thing to note is because one of the main reasons therapy can be so healing is having another person saying, I get you. I understand. I can resonate with you and truly resonate with that.

And I don't know if anyone's told you, cuz you're in the beginning of your practice but you highlight this so well, is sometimes new therapists are like, I'm not sure exactly what my niche is. And I always say to them, your niche is a reflection of. In whatever shape or form. And so you are really emphasizing that like you're wanting to be able to offer that safe space that others within your similar cultural background can really resonate and feel and understood and not have to defend some of these things that come up.

. Yeah. Yeah. Yeah, it's been a very niche thing, especially having the experience and having the opportunity to work with more easternized cultures. And that's not even just limited to the South Asian community, just in general. Like seeing that enmeshment of individualistic and collectivists in Western and Eastern and seeing how it works, it did become a niche because I would leave therapy with certain clients and I'd be like, wow, like that, what felt amazing for, and I would get great feedback from those clients too, cuz there was just that Understanding component where it's like, at least I don't have to explain it and I can say it, and you'll, if you have questions, of course you'll ask, but you know the foundation of it, and that was making a lot of difference.

And you really highlight this other wonderful idea that sometimes would be conceptually what a niche would be in terms of practice would might be anxiety, depression, these presentations that know no race or gender or sexual orientation, but really there is a niche within specific culture and ethnicities.

Yeah. Yeah, definitely. And so when you highlight saying these differences, could you maybe give some tangible examples of like when you say individualism versus collectivism and that east versus west? Yeah, so a lot of the times with like collectivists and e individualistic, we find that there's different importance given to different components of your life.

When we learn about it, we're taught, individualistic, it's more you're independent, you ra raised within your family, and then you go off and you're your own person and that shapes who you are and your identity is you. Whereas with collectivist culture, A lot of eastern cultures, a lot of European cultures are collectivists.

And it's really just, there's so much importance given to family. You're interdependent, not independent, right? A lot of it is you raised me and now I'm gonna help you or, you've done this for me and now I'm gonna repay that to you. And so it can get really confusing. When you're raised one way it's, it makes a lot of sense, right?

So if I was raised primarily Collectivists in a collectivist culture and say I was raised back home in India with my parents, I would identify with it. There wouldn't be any other thing. It would feel really foreign. But having that, okay, now I'm here and my parents are collectivists and they have these expectations of me and my identity is being shaped by them and what my family expects.

What the community exe expects and what societal norms within that culture are. And then enmeshing that. But also I was born and raised here. And I have friends that, they move out when they're 18 or, they don't really think about future planning with their parents in mind or, and it's really different.

And of course every individual experience is really different, but, Culturally, this is just such a broad, like an understood thing or this is how we work, this is how we function, and it can get really difficult trying to find that balance between here's my individualistic identity and here's my collectivist identity, and I'm gonna f form something in between that works for me.

And that leads to a lot of. Problems just with people pleasing and, having to, knowing when to say no. Setting boundaries. There's a lot of different things that come on because you get to a point where you might not be honoring what's, what holds true to you and what means something to you because you're honoring this identity that you have in the collectivist culture.

And the same might happen individualistically, where you might feel guilty because you're not really honor. Things and you wanna be a certain type of person because the people around you are like that and it feels normal and it feels good, but you feel guilty cuz it's not what's expected and it's not what's happening or surrounding you.

So a lot of the times, even just. Mental health in itself can present so differently within these two cultures just because it's, it, they're just so different from one another. , I really see that. And so for myself, even when I identify as a Caucasian woman in Canada in this very individualistic, it was like, oh, okay.

I'm gonna grow up and I'm going to go home, like peace out like, and I'm gonna go and forage forward, which is all wonderful things, but it doesn't necessarily mean that I can truly 100% resonate or understand what that more collective culture experience would be like, right? And so it would be easy for me to be curious or confused or not understanding of that other experience because it's not something that I have.

Yeah. Yeah. And that's that lived experience component of therapy as well, where a lot of the time, a lot of therapists that have, they choose these niches that we were talking about because of who they are and what they've lived through. And you'll find all these things where people are saying these things because, oh I experienced this, or a loved one experiences and it sparked something in me.

And that was kind of the same with this, where, you find a lot of clients. It's Why do I feel so guilty? Because I'm going on vacations and my parents are home and they're getting older and I don't know what to do. If, am I taking them? Do I take them with me? How do I navigate that? Or why do I feel so guilty that I'm having these experiences that my parents never have to got to get or have because they were so busy making this life for me?

What do I owe them because they made this life for me and because they allowed me to get to where I am or why is. My family's opinion's so important to me. Why do I need my dad's approval? Or an older sibling's approval, or the community's approval what is going on here? Why is, and it sets a lot of.

Cognitive schema too. They establish really early on and they get maintained as your life goes on, because it's just, that's what's normal. That's what makes sense. And then having to go back and assess everything from day one onwards. It's really confusing and it's just very, it can bring about a lot of feelings and a lot of anxiety, and even some depression just dealing.

How do you, how do I find who I am while still honoring who I what I need? And still being a good daughter or a good son or good sibling, right? There's just so much that goes into who you become because of this. Coming from your personal experiences and your professional experiences, what would you suggest to someone on how to best manage some of these challenges?

Yeah, I think having a safe space to talk about them. For me, I have found that. There's just a lot of mental health stuff that comes along with it. Even just having a conversation, it's so tough to have it within. It's tough to have it with a friend that's individualistic and it's tough to have it with a friend that's very collectivist, right?

Because you're gonna be met with stigma around what you're trying to say. So having a safe space where you're able to, whether it be with a parent that you got along with, or a friend that just gets it and is from a similar identity, or even your therapist having a space where you. Wholeheartedly, just let out how you're feeling without having that shame associated with it will help to reduce that shame you're feeling.

And a lot of the time, shame is one of the most prominent things we feel. Guilt is one of the most prominent things we feel when we're navigating our identity because nothing makes sense and you're trying to figure for yourself out and the shame just creeps in. You just leave this little window for shame to creep in.

And I would. How I've navigated it is just having a really good community of people, whether it be my partner or my siblings. It's just having that, like this is what's going on, and having that validation of that's okay. It might not make sense to me. And you might have a therapist that might be like, I don't really, I don't get it.

Explain it. Let's talk about it. Let's explore it more. But having that safe space to. Let out all these thoughts that are going on out into the open so they're not eating away at you inside and setting a little bit of a, groundwork to how I'm gonna be, how I want to be. You really, again, highlight this idea of having a safe space as one of the best ways to manage it, and also just being able to have, like if you are in therapy and you feel like there is this cultural difference, what would you say to not only the clients but the therapists?

So what would be your advice or suggestion for both of those end of that experience? Yeah. For the therapist, definitely work within your competence. That's something that I will take to my grave. I have, it feels crappy definitely to not to be in that position where you're like, I don't think I know enough about this.

Cuz it can trigger that imposter syndrome that you're having already. And especially for me when being so new it's one of those things where I'm like, oh my goodness. If I don't know this, I know nothing. But having. Finding that balance between Yes. I'm curious and I'm gonna ask questions and having.

Enough perspective to be like, now I might not be benefiting the client. My curiosity might be taking over the healing of the client, right? Me asking questions and asking them to definitely, you're doing what's what you're taught to do, holding curiosity, holding them as the expert, but that might be taking away from their experience because of the fact that they're having to explain basic things that.

Second nature to them and now they're bringing it into therapy cuz they need to work through it and they have to tell you every single detail about it. So working within that kind of navigating and exploring when is it comfortable, when is it enough and when is it too much? When is aren't of these questions becoming too much?

And for the client? That's the same thing. Are you feeling like you're going and you're educating and you're having a lecture giving a lecture on what you're experiencing? Or are you actually navigating and working through how you're feeling? and it can be an awkward conversation, definitely, but sometimes it's what needs to happen because at the end of the day, you, that is your space.

And you need to be in a situation and in a space where it feels comfortable, it feels good, it feels like you're actually healing. You're getting the space and the time to heal and work through things rather than. Having to hold a lecture about, what's going on. And even though it's awkward sometimes you just have to embrace the awkwardness and have that conversation.

And I'm sure most therapists would be more than willing to have that conversation whether from their perspective or the client bringing it up first and navigating it together. Maybe you have a really good fit other than the cultural component, and that's something that the client's okay with and you're just stressing about for no reason or vice versa.

So just having an open conversation, like with anything about that certain. I think that's so valuable too, because I think clients often forget that they are in charge, . And I always say to clients, if there's something that I'm doing that isn't helpful for you, please let me know because I wanna do a good job and show up for you in the best way possible.

And sometimes doing the good job means that we aren't gonna be working together because I maybe can't meet that need. And so I'm gonna throw in a couple other ideas that came to my mind as well, is I really think there is the importance of that consult call where you. As a client really discuss like what you're looking for and the therapist can then also say what they're able to offer you at that time.

Another piece I would say for the therapist point of view as well is ensuring that you have supervision so that you have the opportunity to discuss what you're feeling and thinking in terms of. Your clients to ensure that you're on the right track and showing up in the best way possible. And thirdly, I think there is just a huge need for education and understanding, and does not mean that education will allow someone to be a hundred percent culturally competent, but I think it would do that job to help close that gap in some ways.

Definitely. Yeah. Yep, definitely. And When we talk about this idea of cultural competency, I think it also begs the discussion around the lack of information of what to look for in terms of manifestations of certain disorders and the impact of culture on the presentation of certain mental health challenges.

So I would love to hear your thoughts around that area as well. Yeah. I think this is one of the, again, one of the main things and one of the main reasons that I wanted to have this conversation so badly is it looks different, right? And a lot of the times, With certain cultures we here take a lot of what we know for granted.

Anxiety, depression, all these things are so commonly thrown around. They're said they're just terms that everyone uses without really even knowing exactly what they might mean or knowing what they mean or knowing a baseline of what they mean. But they're so widely. My most recent experience has been a lot of people that you know, especially within the South Asian community, don't really know what it means.

What is anxiety? I've heard it, but how do I know if I have it or what is depression? How do I know if I have it? Is depression, suicidality? Am I, if that's, if I feel like I don't wanna be here anymore, does that mean I'm depressed? Is that the extent of what depression is? Or if I'm just nervous? Is that anxiety?

What does that mean? These d. The fact that there's a lack of psychoeducation around, what does it actually look like? What is it that hinders a lot of how it manifests? I have found in my experience, a lot of the times depression manifests as headaches, right? A lot of physical ailments instead of the, we, a lot of the time we look for like low mood lack of motivation, all these things that we know that we should be assessing for.

Sometimes it's not so simple and it is, I just have really bad headaches. I have people that are, I have insane migraines. Doctors can't figure out what the, what's going on. I've had cts, I've had MRIs. They can't find what's happening. And then somehow it clicks in someone's brain that it could be depression, or they start, they say one right thing and it's okay.

Let's assess for that. And then say they're on medication or in in therapy and the headaches start getting less and less. And then it's Oh, okay. So those headaches that I've been suffering through that was depression. I always thought that wasn't depression. I thought that was just my body and my head hurting.

And then with anxiety, not knowing that, it could show up in your gut, it could show up physically, shaking or chest pains and all these things, and not knowing and turning to that medical model of something's wrong with my body. Let's go get some medication. Let's go to the doctor, let's go to the hospital.

Not knowing what to look for. It's so different and even just within. The South Asian community you're in general, having a lack of language to assign to what you're feeling leads to different ways of coping. So if you don't know that you're having these big feelings and that's could be impacting the addiction that you're experiencing, you're not gonna see it like that.

You're gonna see it as, I'm just coping in the way that I know best. And there is no explanation. Talking about it, opening up the conversation allows for explanations, allows for understanding, and that kind of reduces again, the shame, the stigma that people might be experiencing. And so again, there's this idea around the lack of language or lack of understanding or understanding what certain terms and concepts and challenges may mean.

Is there also a bit of that cultural aspect in terms of the way that mental health is regarded, such as within the South Asian community? definitely. I actually, one of, one of the things that comes to mind is we call it mental health, and a lot of the times that mental word is associated with, oh, you're crazy within the community, right?

Mental, within the community means you're crazy. So even regarding that I'm having mental health issues, or I'm seeking therapy for my mental health. Might not even be issues, might just be wellbeing, mental health wellbeing, and it's taken as something is wrong with you, like you are written off because there's something wrong with you.

That's the con, that's the notion that surrounds it. And for a long time, and I think this could have been my own, me being naive a lot of the time, I was like, oh, because I know about it and because my people know about it, my family knows about it, my extended family knows about it. It's not that bad.

And then you meet people and that don't have the. Openness to talking about it. And maybe that exists because they don't have it in their family or they don't know how to name it within their family. So they know that one of her aunts was sad all the time, but they don't know what that is. She just had a lot of family stuff going on and that's what they discounted to her.

That's the explanation they have for it. And there's no other explanation. And some people, and some families don't have that, and they have that open conversation. So for a lot of the time I thought, oh, this is, it's widely known, the stigma's getting better. And then you get out there and you talk to more people and you're like, oh, the stigma is still the same.

There's still people that are. Quiet. A lot of the time when it comes to say intimate partner violence, a lot of the time they're quiet because it's not culturally talked about. You suck it up. And it's so quiet. It's, there's such a lack of conversation around it that people are suffering in silence, suffering alone because they think something's wrong with them.

They did. They bring it into themselves and it's not so much that something's happening to me and that's why it's hap that's why I'm feeling this way. It's something must be wrong. . And it's, the stigma is still insane around it. And I think a lot of the time just if there was a. An opportunity to just learn.

And if they even knows a motivation to learn more about it, that could help reduce a lot of the stigma that exists. Just knowing, you wouldn't shame someone for having to take cholesterol medication or having high blood pressure or anything like that. So why is there a shame around this mental health that's happening?

And if you're taking medication for depression or for anxiety, When it's the same type of thing, there's something that's going on within you internally, maybe around you environmentally as well, that needs some extra help. So why is there so much stigma? And it just comes down to the fact that people don't like talking about it.

And the more, the less people talk about it, the more hushed it becomes and it's easier to suffer in silence. So if I may paraphrase, you feel as though there is that lack of discussion around these experiences cause it's uncomfortable to talk about it, which means then there's less discussion, which means that there's more shame and judgment being held.

Yeah. Yeah. So simplistic. Very simplistically speaking. It would be almost as if we could have tolerance or be able to sit with uncomfortable feelings. Then we could also open up those conversations. . Yeah. Acknowledging and naming how we're feeling would help so much. Or, and a lot of the time we run from it too, right?

Run from how we are feeling and how what we are experiencing. So even just allowing yourself to yes, sit in a discomfort, name what you're feeling, and then move forward rather than pushing it down. Definitely would help a lot. I do find it. Generations go on and there's younger generations that are learning more about this within social media or with school, they're able to point it out more and open up that conversation, which I do think helps.

But it is that cusp generation where, they might have been either from India or immigrated here or just didn't have the time or the resources to learn about it. It gets really tough to. Acquire that knowledge later on cause you don't even know where to look half the time.

. And it seems like it's an issue that would be ongoing because you could say once the population in Canada continues to mature, maybe some of these challenges would slow. But we are gonna constantly have a wonderful. They say melting pot within Canada of all of these different ethnicity and races and things, and that's all wonderful.

So these issues will still be ongoing, which is why there is that need for a variety of therapists with a variety of backgrounds to fill those gaps and fill the right type of the therapist for the right type of client, and have that right fit. Yeah, exactly. Yeah. It's gonna be an ongoing thing. It's good that these generations are growing and kids are coming home and talking about it, and kids are more open to accepting when they have it.

At least that is something, and that kind of enforces parents to be like, oh, let me do some reflection too. Maybe I have this as well, or maybe my kid gets it from me. Having that is definitely great. But yes, as you said, like time goes on, populations are growing, they're meshing up and it's just, it's gonna, it's gonna be a prolonged thing.

It's gonna be something that has to be a consistent and constant conversation about this is a thing, let's talk about it. , and I love that you are just really. Driving home that message that we do need to talk about this th these sorts of issues. And that has been one of the best ways to minimize stigma because there is, has been stigma and there still is stigma in North American societies as well.

It just does improve the more that we talk about it and help individuals to feel less alone in that experience. Yep. So when we think about these counseling relationships between the therapists and clients, like what are some considerations that should be held? . Yeah. I find that when I'm working with people that, are from similar backgrounds as myself especially since I do offer services in Punjabi, I do get clients that speak Punjabi.

There's a difference. And again, that cultural competency comes into it where considerations that you would make maybe if you were. Working with a Caucasian individual won't be the same, and that's how primarily therapy is based and how we're taught it, but it won't be the same in different cultures.

So if I'm working with someone who is also Punjabi like myself, There's a simple thing of, when you meet somebody, you give them a hug. Where does that come in with your therapist? Where does that aspect of I just met you, we hug to show respect, to show acceptance. Where does that come in with therapy?

Because I, you are telling me a lot about your life and then you're walking out with not so much as a handshake. And it's so confusing as a therapist to even navigate that. And I remember the first time it happened to me, I was just like, How do I draw that boundary between, I wanna build this rapport with you, but I also have to have a boundary because I'm in a professional setting and I'm not your family member that you're meeting that you can just treat the same as you treat everybody else.

But then also considering that we have different hierarchies to how we approach elders. . So what if I'm counseling someone that's older than me? Does that change the language that I'm using with them? Do I use their full name? Do I use their first name? Do I, we call everybody older than us, uncle or auntie.

Do I say that? So there's so many different considerations that you have to explore within it, and it can get really difficult because ethics comes into it and all of this stuff, and it's just so tough to. Apply what you learn to actual practice when you're doing it. I found that a lot of the times I would be in supervision being like, I don't know what I'm doing.

Like what? Like how do I navigate this? And it's that understanding of you and your client know what works best within your client counselor relationship, right? A lot of the times we can set those boundaries of, like we're taught. I'm not gonna initiate anything. I'm gonna hold these strict boundaries.

But a lot we also have to honor that if that's something where the client is just, I really need this right now. That it's gonna happen. And it's it's just navigating that understanding of, because we are from similar backgrounds, it's gonna be a little different for us. I think that also plays into Kona is on the smaller.

and of town sizes. And the community of course is growing. But a lot of the times there's a chance you might run into people more frequently than other clients because you're from the same community might be at similar events or friends of the same family or something. And of course it brings into that definite conversation of we don't acknowledge each other when we're out and about.

And. I won't, because I don't wanna run that risk of someone knowing who I am to you. And if it's all on you, it's the balls of your court and all of these things. And it's tough to navigate. Especially being newer, I think it's really tough to navigate wanting to keep that door open, wanting to open that conversation and also, Being that I don't wanna go to her because what if she tells somebody because she's also this from the same culture and she might know someone I know and it might get out and expressing that importance of confidentiality and that all these other things that kind of come naturally to us when maybe we're counseling other clients, but in the same culture, it can get really difficult within the same community.

It can get really d. I think those are some really wonderful examples and some of them I actually have never thought about myself, so I appreciate that knowledge because it's helping me to really reflect on some of these things. Cuz I can definitely relate with this idea of as a younger person, I like to go out and do fun things and I say to them, you may see me at a restaurant having a drink with a friend and I'm a human being and I wanna ha go and have fun, for example.

And so this prevalence of acknowledging I will not acknowledge you. Unless you acknowledge me, and I've even, I know it sounds awful, but I've even ducked down different aisles of the grocery store so that this person can feel that sense of privacy and confidentiality. But you're highlighting it even more so when you're in the same community and say, may perhaps you're attending the same functions or gatherings at different institutions that certain cultures may gather at.

And that's so important in that regard. And again, that point around physical touch, like we're very much taught within counseling that physical touch is a rare occurrence and it only needs to happen in very rare circumstances. But again, with that cultural area, it might be something that is needed to show a sense of respect or connection.

Yeah. Yeah. And it can get tough navigating and juggling that again, Eastern and Western where we're taught within Western, within the Western lens, and applying an Eastern lens to that and being like, okay, but I have to shift this a little bit. And we, a lot of therapists customize therapy to the client, and I find with this, it's a lot of customization, just being like, I'm not gonna, I'm not gonna sit here and say that this is gonna be a daily thing and we're gonna do this all the time, because that professionalism definitely has to exist because, again, in the same community, you of have to draw that strict boundary of I am not just, a family friend that is not my identity with you.

I am a professional in this setting, and you are here with the service in mind and having that conversation, but then also navigating. You just told somebody about their li about your life that you haven't ever done and you are feeling a lot of, a lot and you're walking away and you just come back and wanna give me a hug.

That is something that you had wanted. And it also just depends, obviously, like what context it's in and who it is that's doing it, and the level of comfort within both parties. Of course. Having that, I think it's one of those things where it's uncomfortable at first, but having that, that understanding that could happen also helps to just make sure that you are more, a little bit more prepared.

For sure. Definitely. And because of, there's a lack of opportunities for more therapists within certain communities in smaller communities. It just begs that idea of knowing where to draw that line of who is someone that maybe is too close to you or your family, for example, and who isn't, and being able to maintain those strong boundaries so that their confidentiality, their respect and comfort is seen and heard and valued.

Yeah, definitely. And that's where that, that consultation call comes into it where it's do you have any concerns? Maybe they know you and you don't know them, and that's a problem to them. Or maybe you know them and they don't know you, and that's a problem to you. And it's just, and that happens with any client.

But having that Time and space to have those conversations and make sure that everything is a good fit and that again, that brings in that fit. Just making sure that you're assessing different variables to what is important to you and your personal journey of healing and getting the best.

The most therapeutic benefit that you can get. Because again, this is a, it's an investment emotionally, financially with time it's an investment and you wanna be in a space where you're going and feeling this is doing something for me and this is something that I wanna continue doing.

And I think, again, that can put a lot of pressure on therapists as well, especially with this cultural component part of it. Just opening that conversation to, I know this, and how comfortable are you telling me about this and how do we navigate this together? For sure. Encouraging the advocation from the client.

And I always also tell clinicians that if you're saying no to clients, That means you're building a good practice because you're willing to put the needs of the client before your own. If that means that you aren't the right fit or don't have the right competency level for that specific case, and that is okay because then you are opening yourself up to the clients that.

Really do fit within your area of competency and allowing that client, and that's why it's so important to be able to have other clinicians in your network that you can refer to or that other resources or trying to have a variety of Different professionals that you can create that holistic approach with.

And so again, if you're saying no, that means you're on the right track of the clinician sometimes. Definitely. Definitely. Yeah. And I, and again, I think even just considering like what kind of therapy works for different clients as well, sometimes you might, they, there might be a therapy that you know works and you don't practice that way.

And that can be enough of a way to be like this client. And I don't do that, and my practice looks completely different, so maybe this isn't the right fit. So just having that conversation, I find. Actually at that social that we met at one of the other therapists was telling me about this new study that they're doing where they're evaluating the effectiveness of C B T within South Asian community.

So these like different therapies that they're applying to specific demographics, I think. Say I knew nothing about C B T and even though I'm from the same culture, that might not be beneficial if that client needs that. So even, you might have a few things, but be missing a few marks as well.

So I think it's just really important to consider the wide perspective on it. For sure. And even just how we in the psychological community really value C B T in a lot of ways. And we give it a lot of props and because it's accessible and it's a wonderful variety of coping skills that an individual could use.

But we also then think and this is no Just, or harm to Aaron Beck himself, but he was a Caucasian male who identi, who created a wonderful therapy in the United States and in that, as wonderful, but does not mean necessarily it was in the way that was culturally competent of all cultures in all shapes and forms.

Yeah. Yeah. And that's with any therapy too, right? Sometimes it does take that time of. Zooming out a little bit and seeing like who was this? Who was this made to address? What was this made for? What concerns, what population? Who were the participants that they were practicing this with? And it might work, but you might have to change it. And I find that a lot of the time, even in when I'm providing psychoeducation, I have to bring in a variety of things. Because first of all, explaining it in Punjabi can be really difficult cause you're finding words to explain what this means.

And you know it so well in English, but you don't know it in Punjabi. And. You have to mesh a multiple things to get that, this is what I mean by this and this is how I'm gonna explain it to you. And even just with say c b t it's really easy to explain that you're gonna do this and this is the exercise you're gonna do and this is how it works.

But providing that same thing in Punjabi too, and using language that works for the client it can be difficult. And so that kind of brings into that sometimes it's just like how we would change our approach if we're working with youth. They just prefrontal cortex isn't developed enough to understand the concepts of an adult will understand.

Having that same thing of like cultural all culture also brings in the same considerations of they just might not have the, under the foundational understanding that is required for those specific therapy. And yeah, I find I have to shift, I work from humanistic, so I explore like a lot of life experiences and I find a lot of the time it's really difficult to have that conversation with more Eastern clients because it.

I don't wanna talk about it. Like, why do I need to talk about what happened 10 years ago? And it's whoa, if this is important, this is where it's coming from. Let's open it up to what's comfortable. And yeah it's an interesting, it's an interesting way to work and trying to find that balance of how am I gonna make this work for us?

And yeah I think asking clients for feedback also helps a lot to, again, like you said, what's, tell me if I'm doing something that's not working for. Definitely for sure. And I do wanna bring up this one more topic here is this prevalence of like internet partner violence within the South Asian community and its relation to mental health.

Big topic, but I would love to just have a little, make sure we have some space for that today as well. Yeah. It's big within, collectivist again that brings in that collectivist eastern culture part a lot of the times. It's not something that women, if it's happening to women, they can easily identify voice.

I remember doing a research paper on this and working around what therapy is available, what does this look like, what are the cultural considerations of offering therapy to a woman that's dealing with intimate partner violence? And it's already so like difficult to talk about within any culture, in any community.

But then adding that added. You are family. You don't go against your family. If you go against your family, you not only lose your husband, but you risk losing your kids, your parents, your in-laws, your siblings. So much goes into it. I would like to hope that it's getting better, but it does definitely.

Create the space for, if I can't talk about it, it's gonna be inside me. And that can own an environment for depression, anxiety suicidality, right? We're having a lot of dark thoughts and nowhere where to put those thoughts, know where to voice those thoughts. And I think it's something that, again, even though it's so common and so many people experience it, so many women experience it.

They don't like talking. And it's just that stigma again, you don't wanna, you don't wanna air your dirty laundry, right? You don't wanna sit there and say, my husband's doing this because the community won't take it as, this is a cry for help. They will take it as, I'm gonna talk about this now cause this is something that's gossip.

And. that was, even research suggests that whereas that's happening and that refrains a lot of women from reaching out and just voicing what they're going through and then adding the whole, the part about there's, you might not even know what you're dealing with, there might, you don't even know that there's a name to this, that this isn't normal.

A man should not be hitting his wife, or my wife should not be hitting her husband or anything like that. But because of this whole, it's not good, it's not accepted. But it's being shut down. You might even have family, you have notice, and they don't do anything about it because it's just too much to take on.

You create that environment for more peop, for more comorbid disorders to make their weight in. And a lot of the time it can have very drastic consequences. To the point where, people do take their lives and I'm sure a lot of people can attest to that, where they've had some experience with some loved one or a family friend or something where that's happened, where there was just not a safe space to talk about it.

And I think that kind of, of course, I p V is one of the components, but just in general, because of the lack of knowledge and lack of conversation. That same thing comes in with men's mental health, where you know, men don't talk about it and there's this like stigma around it and this certain identity that men are supposed to uphold societally and culturally.

And then they turn to different things too, and they might also turn to suicide or addiction or some type of substance to cope. And it just creates a. For so many different ways to cope with it that aren't healthy when there is the space to talk about it. If we just reduce the stigma, we wrapped it a little bit, and if we just open up that conversation of this is not okay, let's talk about it.

Let's help you get through this and move through this. That is so powerful in terms of this idea that if we can just, again, reduce that stigma, create more cultural competent therapists that are willing to work with a variety of clients, and encouraging more individuals to pursue counseling as a career as well, to help fill those gaps and would just be such a huge offering to all communi.

Yeah. Yeah. It's just one of those things, again, of if a South Asian woman comes in, takes that first step coming in, it's not gonna be the same as walk leave, right? It's something that we might suggest or might work through a client like a Caucasian client with, of let's make a plan. It's not so simple because a lot of the times you're deeply rooted within this family. It's not so easy to just get up and leave, and it takes a lot of strength. And that strength is a lot of the times pushed down to the point where you're made to feel like you are inferior no matter what you do. And that, that reduces your self-esteem, that reduces your self confidence.

And then you can, you don't even feel like you can leave. And now you're faced with this client that's dealing with all these things and they also have that cultural aspect of it of. Culturally, I can't do this and I need support, and what does that support look like? And yeah, I just think that there's a lot of ways that we could help with that.

But it takes it takes a village to get those things in place and have groups open up or have just Educational sessions of this is what this is and let's talk about it so that it's just you now, and that's all you can really hope for and can't force anyone to do anything.

But allowing people to have a space where they could potentially explore what it would look like. That is, more than enough in this time right now. Definitely. And when you speak, I just see how much passion you have and I'm so happy that you're joining the community of counselors officially now that you've finished your program.

And I just wanna say thank you so much for all of your time, all of your knowledge. I can see that you're gonna have such a wonderful career ahead. Thank you so much. Thank you for having me. This was perfect. Thanks so much, man. Ru.