The stress in the young man’s voice was palpable when he finally said, “I don’t even know where to begin to look for a therapist. I just know I need to talk to somebody.” Through the tension, I sensed his willingness to start the process of healing from the issues he’s struggled with in the past that have become amplified by the trauma he’s experiencing in the present.
In the midst of the COVID-19 epidemic, many people are feeling overwhelmed by the extra weight of the uncertainty and stress it’s brought into their lives. The fear of what we know about the virus is amplified by the fear of all that we don’t know. Confused, anxious, and isolated, more and more people are questioning if they need professional help to sort through their feelings—and more people are accepting they need and want help from a therapist.
When people experience issues that diminish their well-being, they’re either willing or unwilling to do the work required to heal. Anyone who is willing to start their reparative journey, and undertakes therapy, has made a choice to push through the fear that is required to get started on their path. The young man with whom I was talking was clearly ready and willing. But, that had not always been the case for him.
The changes the epidemic brought to his day-to-day life escalated issues he’d been experiencing for years. Isolation and social distancing exacerbated his symptoms.
#Background
The young man with whom I was speaking was not a person I met directly through my clinical circles, but rather the son of one of my best friends from high school. I once knew his mother well, but decades had intervened. Several months prior, his mother and I reconnected on Instagram. Then, three weeks into the COVID-19 pandemic, she reached out to me in a direct message on the platform. “Hey. I hope this finds you and your family healthy. I was just checking out your website. My son needs some help. He’s drinking a lot and having panic attacks. Would you be willing to talk to him?” I responded back indicating my wiliness to help. Of course, I was happy to talk with him. So, I asked the question that I ask everyone who is seeking therapy: “Has he been in therapy before?” Her response was honest and helpful. “I insisted he see someone when his father and I divorced just over 15 years ago now. He hated it and I don’t think he got much out of it. To be honest, I think it was a total waste of time and money.” It’s a clinical history I’ve heard time and time again. In it, a person starts therapy at someone else’s insistence, unwilling to put in the effort to find a reparative journey. In this resentment and resistance they meet with a therapist who is unable to mirror back key features of their being. As a result of the experience, the person’s resistance to the therapeutic process hardens, and they become more convinced that no one can understand them or hold the enormity of their pain.
“When he went into therapy 15 years ago, was the therapist a woman or a man?” I asked, seeking more information.
“A woman. Someone his high school guidance counselor recommended.” Again, I was not surprised. The field of mental health, and in particular the niche profession of Marriage and Family Therapy (LMFT) within which I’m licensed to practice, is populated primarily by females.
“Does it matter?” she shot back before I had a chance to type out my reply.
“It can,” I finally responded. “What’s most important is that the client feels seen and valued by the therapist— they need to feel safe in their physical presence. When a person starts therapy at someone else’s suggestion and there’s a hesitance about the process, they have to feel a connection with the therapist, otherwise it’s not going to work and often causes their symptoms to worsen.” I looked down at my phone as the dialogue box danced, indicating she was typing in her response. What eventually came through was confirmation that her son had not received care that could have moved him in a reparative direction, “Well, that was definitely not the case with the woman he saw. Will you talk with him and help him find the right person to help him now?”
#SafelySeen
When people start the therapeutic process, it can be for a variety of issues: anxiety, depression, confusion over one’s sexuality or gender identity, marital conflict, a substance use disorder, or a personality disorder such as narcissism. These issues keep individuals trapped in self-defeating, destructive patterns of relating to themselves and others. People often think their issues will just go away over time or that they can sort them out independent of outside resources. But in most cases, they don’t; and, they can’t. In spite of their best efforts and good intentions, the issues usually grow stronger and more destructive as time passes. By the time a person is ready and willing to seek help, they have realized that, on their own, they can’t resolve their issues and move their life forward. That is precisely the moment when a person has the greatest need to be seen and heard by a therapist. Culturally competent care is critical to this process.
#CulturalCompetency is more than #Empathy
Clinical experience that is grounded in cultural competency is central to the ability to treat a client in a way that helps them move forward in a direction of healing and hope. Culturally competent care requires therapists to diligently work to identify a host of markers that define a client’s cultural identity. These markers consist of the traits, habits, beliefs, values, and perceptions that collectively make up the client’s life. While at first blush this may seem like nothing more than empathy, it’s not. Empathy is the capacity to understand another person from their internal point of view. Cultural competency, in contrast, is a much broader concept. It entails the capacity to see people not only as they see themselves, but also to understand how they are viewed by the outside world. Historically, the field of psychology has focused on cultural competency rather narrowly. Feminist psychology looks at the pernicious forces of patriarchy, while LGBTQI psychology looks at the perniciousness of homophobia. My work, both as a researcher and clinician, expands on these constructs to include every manifestation of a distinct cultural identity—regardless of how it manifests itself in a client’s life. My belief is that everyone has a unique set of cultural markers that have affected their identity and how the world sees that identity. Being seen and heard as a person with a distinct cultural identity is required for successful therapy.
As this relates to my high school friend’s son, before I could recommend him to an appropriate therapist, I needed to sort out who he was from a cultural point of view. Factors in this analysis included where he lived, and his level of education. I needed to discern as best I could where he was on the socio-economic scale, his sexual orientation, even his political views. The goal in this investigation was to provide him with care that would meet him where he was, honor his identity rather than lead to feelings of shame, and most important- incorporate his identity into his treatment and after care.
#HolisticCare
The need for culturally competent care in the delivery of mental health and medical services was important before the COVID-19 pandemic. Today, in the midst of the chaos, pain, uncertainty, and loss that a pandemic brings with it, finding a culturally competent therapist is of paramount importance. Now, more than ever, we need to feel holistically seen and heard by our clinical partners—it’s the key to building trust and feeling safe.
If you are considering starting therapy to help you navigate these times, prioritize finding a therapist who will broadly assess and look at the cultural factors that affect your identity. Interview potential therapists—ask how they assess their clients, and how they use that assessment to build a treatment care plan. If a therapist leans toward a treatment paradigm that really hinges on a patient’s own self-reports and diagnoses, then ask whether that therapist will be able to help you uncover the issues that may have roots deep in your cultural identity. Determine if that therapist will see you expansively for all facets of your complex identity or squeeze you into a formulaic box. Keep looking until you find one that offers the former.
#ACommunityUnitedByCOVID19
This pandemic has put tremendous stress on all of us. Our well-being is strained under the pressure of COVID-19, but the individual, community, and global awareness that it has brought presents a opportunity to heal by embracing the cultural markers that reflect who we are as part of a diverse, multicultural, multi-expressive community. We have an unprecedented chance to use the vulnerability inherent by this pandemic strategically to move ourselves, the people and the world we love in a reparative direction. Let’s take it.
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Cultural competence, culturally competent, cultural competency, holistic care, COVID-19, coronavirus, epidemic, social distancing, quarantine, isolation, isolated, stress, trauma, anxiety, anxiety disorder, pain, therapist, LMFT, licensed marriage and family therapist, well being, panic attacks, binge drinking, substance use disorder, anxiety, depression, narcissism, personality disorder, shame
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