As much as seeking services for mental health issues is stigmatized and shamed, taking medication for assistance is often met with hesitation. When a primary care doctor prescribes medication for a physical medical issue, many people will take it without question. Yet, when it comes to taking medications for mental health-related issues, there seems to be a negative outlook on the idea.
The most common questions I have been asked are: “How is it going to help? Does it even work? Do I have to? What if my parents/family are against it?” To help put those considering or currently taking medication at ease, I have provided some tips below on the general types of mental health medications, how to deal with side effects, what to do if you are thinking of stopping your medication, what questions to ask your mental health professional, and how to find a psychiatrist in your area.
“I was worried that they wouldn’t work. I was discouraged when one medication didn’t work and so I didn’t try another one until a year later.” – Anonymous, 30
When addressing a need for a psychiatric evaluation, psychologist Dr. Swati Sharma approaches clients by introducing the topic first.
Dr. Sharma starts off with, “Have you considered a psychiatric evaluation?”
She noted that it does not mean that they will be on medication, but it would be helpful to seek medical consultation to further assist with treatment.
Mental health medications tend to be more effective when combined with therapy. Generally, medicine can reduce symptoms. However, it is important to remember that a medication that works for one person may not work for another. It may take you longer to find the one that works best for you. Therefore, it is very important to be aware of potential side effects. When the ideal dose is obtained, an antidepressant may take 4–12 weeks to achieve the maximum benefit. It may be possible for one or two symptoms to improve in the first few weeks. For more information related to treatment visit The American Foundation for Suicide Prevention.
When providing psychoeducation about medication to my patients, I tend to share that some medications may be taken for a short amount of time, some for longer, while other patents may have to take them for life. It is understandable that there is hesitation surrounding taking medication. Psychiatrist Dr. Bikram Sharma believes in medication management in conjunction with therapy.
Dr. Bikram Sharma reported, “I will suggest therapy first and if they are not improving, then I would have an open and honest conversation about medications to address the root of their hesitancy.”
General Types of Medications
Antipsychotic medicines are primarily used to manage psychosis, such as schizophrenia.
Most commonly used to treat depression
These medications are used to treat a variety of chronic and acute anxiety issues, from generalized anxiety to panic attacks.
Mood stabilizers are used primarily to treat bipolar disorder, mood swings associated with other mental disorders, and in some cases, to augment the effect of other medication.
Typically they are used to treat intense, repeated shifts in a person’s mood, which may be common for those experiencing bipolar, schizophrenia, or borderline personality.
Stimulants and related medicines:
Stimulant medications are often prescribed to treat children, adolescents, or adults diagnosed with ADHD.
If you’re having trouble with a medication or experiencing unpleasant side effects, don’t suffer in silence. The most important thing you can do is speak up and share your concerns with your provider. Read the packet provided with your medication at the pharmacy. Don’t be afraid to ask questions. You should know what you are taking and how the possible side effects can affect you.
“When antidepressants are started or doses are increased, some patients, especially children, adolescents and young adults, may experience increased anxiety, agitation, restlessness, irritability or anger, which may lead to suicidal thoughts or attempts. These should be outlined by the doctor before the treatment begins.” – AFSP
If You Are Thinking About Stopping Your Medication…
First of all, don’t stop your medication immediately! Talk to your provider before taking any action. Be prepared to discuss why you want to stop your medication. Together, you can develop an appropriate and safe plan to discontinue or adjust your medication. One approach can be to reduce the dosage slowly and taper off.
One factor impacting people stopping their medications is that they temporarily feel better, but this can lead to the return of symptoms. That is a big no-no! Before you stop, have a conversation with your provider!
If your current medication is not working, remind yourself that it is fairly common for people to try a few different medications before finding the one that works best. Don’t give up if one medication doesn’t work.
When combined with any mental disorders, alcohol and drug abuse can increase suicide risk. When being treated, be honest about your alcohol or drug intake for the safest treatment and the best chance of getting better.
Questions to Ask Your Primary Care Doctor or Psychiatrist:
What is my diagnosis (if you are not aware)?
What is the name of the medication? Is it a “brand name” or generic?
When will the medication begin to work/how soon will I see results?
Should I take the medication with food?
What are common side effects that occur with this medication?
Do I need to get anything done prior to taking this medication or while I’m taking it?
Are there any medications, foods, or supplements that I should avoid while on this medication?
How long will I be taking this medication? If I stop taking it, what are the chances of my symptoms returning?
Will my symptoms worsen once I stop? What should I do if I want to stop?
What should I do if I miss a dose?
Can I have beer, wine, or other alcoholic drinks while taking this medication?
July 7, 2023September 10, 2023 11min readBy Ushma Shah
BGM literary editor Nimarta Narang is honored to work with author Ushma Shah in this utterly creative and novel, pun not intended, story about a young woman who has just moved to the United States with her husband, and her trusted diary. Ushma is a short story writer and an aspiring novelist. She has her short stories published in a few anthologies and online literary magazines like Kitaab and The Chakkar. She was born in Mumbai and raised in Mumbai and Cochin. She has an MBA and works in the corporate world. Work and life have given her the opportunity to live in multiple cities in India. She currently resides in Seattle and goes by the handle @penthythoughts on Instagram.
She is the kind of person who doesn’t like to go into stores without a purpose. But she sometimes does. And that’s how she becomes a hoarder. She also prefers only tried and tested places. The kind where she doesn’t have to go out empty-handed. The urge to not disappoint people is strong. So she ends up buying useless things. Like a snow globe with a turnkey. Or 12. She loves the tiny magical people and animals in it. Rotating. Glowing. Musical. But I am deviating from the point. Who am I, you ask? I am her. A piece of her. She takes me everywhere. Writes down her thoughts in me. Writes how her day was. That’s why I know her so well. Why am I telling you all this? Because she hasn’t written for a week now. Longest she has gone in half a decade. I don’t understand it. She won’t tell me anything anymore and I am just so curious. No, curious is the wrong word. The intensity is just not right. I am impatient. Restless. Maybe even hurt, too? I see what she does. How she looks. But that’s just not enough. Not for me. Her confidante for five years and suddenly it’s all poof.
Human addiction is a true addiction. I was superior for those glorious thoughts that nobody knew about her. She doesn’t look happy. She opens and shuts me, picks me up and then back down. In her new Michael Kors bag she bought recently at a premium outlet mall. She always wanted to see a new country. 32-years-old and she had never visited any country other than the one she was born in — India. She should be happy she is finally here. She couldn’t stop chirping about it when they got their visas approved. She and her husband. She has been here for three months now. Initially, she was happy. But then the euphoria died down and anxiety kicked in. The last thing she wrote was: “I haven’t had a bath for a week now.” Her husband is too busy with work to notice. The new project takes up most of his time. Plus navigating life in a new country is a project in itself. I hear him not understanding why an appointment is required for a self-guided tour of the apartments. And that they have appointments only till 5 p.m. which means they have to go house hunting during his office hours. Downtown Bellevue mostly has apartments for rent that are managed by corporations rather than individuals. But at least he is okay with the cold, having survived Delhi weather all throughout his life. It also doesn’t help that she is not used to the cold, having lived in Mumbai all her life. It only needed to turn 22 degrees Celsius in Mumbai when she used to set off; removing her sweaters and jackets from the untouched-for-a-year cupboard. So house hunting is a major bummer, painstaking process even for her. In a place where it always drizzles but doesn’t bring the smell of wet mud. Everything around her is concrete. Asphalt. Sterile.
One day on their way back, they visited the Meydenbauer Beach Park along Lake Washington. I saw a hint of a smile. The first one in a week. The pine trees are a solace. They stand strong, holding their ground at maybe a 100 feet. She cranes her neck back and tries to catch a look at the tip. Making her feel dizzy. She feels like she is falling back. Tilting her five feet frame. She removes her feet from the shoes. She looks at the rounded stones. Big stones. The size of an ottoman big enough to comfortably sit on but hard enough to not sit for long.
But by the end of the visit, she looked worse. That night she wrote and I was thankful for the visit. The first sentence read: I feel claustrophobic. She has lived in Mumbai all her life and never knew that subconsciously the sea made such a big impact on her psyche. The sea, unending in its view. Its waves crashing and rebelling against the rocks gave her a sense of space even though she lived in a one-room kitchen apartment. The warmth. She missed the warmth, although sometimes too stifling. The sweat, and the saltwater smell. There was much to be thankful for here in Bellevue, even though there were no crashing waves and it was 45 degrees Fahrenheit today. The sand, too cold. But there was peace, there was calm. But what about the sounds that she craved, the feeling that stimulated her senses? That accompanied her every morning: the ‘tring tring’ of the cycles, the ‘tip tip’ of the water overflowing from the tank after it was filled. The daily TV news her Ma watched. The smell of her morning chai with grated ginger. The ting ting of her small bell during pooja. These are the things that she does not write but I know her. I know how to read between the lines.
But somewhere I have failed her. I must have. If she did not find comfort in writing. For how could she have gone on without it for a week? How could she? She is as used to me as I am to her. Or at least I thought that.
But now is not the time to feel irritated. She has started writing again. I was overjoyed; I thought everything would be back to normal now. How naive was I? A few lines in, and I am worried. I am also worried that my annoyance will seep through the pages and into her hands. She writes: I miss my place where the duration of the days and nights are almost the same throughout the year. A place where I don’t have to see a 4:30 pm sunset. Or a sunrise after 7:30 am. Nobody prepared me for less than 10 hours of daytime. I feel like I took the sun for granted. When I first came here in October, the sun set at around 7 p.m. Every day, the sun set a little early from then on. 6:50, 6:43, 6:22, 6 p.m., 5:54 p.m. And then on November 6 came the thing I was least prepared for. The Daylight Savings. I would gain an hour, they said! What I gained was a sense of doom. Because the clocks were set back by an hour, the sun set before 5 p.m. every day from then on.
The seasons are what make me. Why then, am I afraid of the seasons? No matter what the weather, the weather is constant. It is constantly too hot, or too cold or just not warm enough or just not cool enough. Every day in itself brings a new season.
“Oh, there is a heavy rain forecast for the whole day today.”
“Do you know it’s going to snow today?”
“Amazing weather! Isn’t it a perfect day to travel?”
Seasons are a universal language, everyone understands it. It transcends manmade boundaries. Just as I am feeling the cold under the layers of clothes I wear. A breeze rippling through the surface of the lake water makes me shiver. If the seasons are what make me, why do I feel cold and sad. Maybe because I long for a different weather. Having grown up in a tropical city, my body is not used to the cold. But is that all? The great reason for the hollow? It can’t be. And I am restless because I can’t figure it out. If not this, then what else? What else could it possibly be?
When she writes this I figure it out. I am always able to figure her out. Her mind does not want to go there. Because after all, this is the life she chose. Of course, how could I have been so blind?
Around two weeks ago I observed her. Observed and observed for a few hours. A few days. Even then I knew something was amiss. She was writing but her heart wasn’t in it. It was dwindling. She doodled and dawdled. A sentence here. A sentence there. Then I was discarded on the coffee table in front of her. My observations, you ask? She scrolls through LinkedIn, going through a series of posts about the looming recession. She searches and applies obsessively to 50 job openings every day. And day after day, her laptop or phone chimes in with a rejection email. She refreshes. Refreshes. Refreshes. Every 10 minutes. Whatever she is doing. No matter if she is in the kitchen or the washroom or the living room. She is glued to her phone checking for a new email. A new job opening. She set her filters to relevant job openings… And then goes on to the painstaking process of filling her details out on different company portals. When she reached the USA, she was hopeful. Of finding a new job. Was very optimistic. She had worked with global companies in India after all. Surely that had to account for something. But with each passing day, the light within her dimmed just a little. Bit by bit. I hate to admit it but I didn’t come to this conclusion when I observed her. It struck me when I stopped and she wrote again. Sometimes I need a macro perspective after micro is too much. She is so inside her head and not on paper that she cannot understand. But I also don’t think it is as easy to pinpoint. It’s a combination of things in her life, culminating in a single point of paralysis. Even now, who knows? It’s just my opinion of a subject I don’t understand completely. She is talented enough to fool everyone around her. Her friends and family also do not know this about her. They think she is enjoying her break from work. They think she is immensely enjoying the exploration of a new country without a worry in the world. She hates admitting that she is miserable. She wants them to feel that she has got it all together. That her life is perfect. When they go through her social media profile, they find her happy pictures. Ecstatic even.
A couple of months ago when she was leaving for the USA, her office colleagues had warned her: “One of my sisters lives in the States. She is miserable there. Wants to come back but her husband doesn’t.”
“He has a high-paying tech job and all so he is okay. But he is on an H1-B visa without an I-140.”
“So? What does that mean?”
“Which means the spouse can’t work. So she can’t work.”
“I am surprised you didn’t know this.”
“I haven’t started my research yet on the visa types and job search. But I intend to.”
“It is very important to understand your options. It is not always as picture-perfect as it seems. My sister is busy doing all the household chores. And she is not happy. Her social life was here. She has no friends there. Only his work friends they mingle with.”
“I know about my visa type though. I can still work there.”
“Oh, honey,” she gives a sympathetic smile, “but everyone wants to convert into an H1-B once they go there. So there could be a brief period where you might have to be unemployed.”
“But that doesn’t matter. Because we intend to come back in a few years. We just want to experience a different work environment and culture and to have that thrill of living in a new country. But only for a few years.”
“Honey, they all say that. As I said, consider your options once you are there before you decide anything. Okay?”
“I will, thanks. I am sure my husband would also check about these things. It is a major decision after all.”
“Oh, I am sure he would.”
She was very emotional on the last day of her job. She had worked there straight out of B-school. She had met some people who would become close friends and some who were toxic. But on the last day, she knew she would miss them all. She didn’t think that saying goodbye would be this difficult. Her name on the desk and chair in bright white letters with a black background came alive with memories. Memories of birthdays celebrated, lunches ordered, huddles and meetings, apprehension of deadlines, the adrenaline rush of getting it done just in time, the accolades. It felt empty by itself if not for the people she surrounded herself with. Her friends.
Her colleagues. They motivated her and pushed her to give her best. Her manager was always an inspiration. Solving problems and giving solutions in a way she herself didn’t think was possible. She learned a lot from each of them. But she was excited to begin a new chapter. But the isolation in a new country was what she hadn’t counted on.
Her husband noticed when she hadn’t had a bath for a couple of days. He thought it could be laziness. When he asked her about it, she said she would. Her reply was curt, and tone grumpy, so he left it at that. After a week of the whole no-bath scenario, her husband thought it was time to have a talk. This wasn’t one of those phases she would overcome on her own. A little push. A little nudge would maybe do her some good. When he saw her refreshing her Gmail inbox for the umpteenth time that day, he said,
“You know, we came to this country to experience a new place, a new city.”
“Hmm.” Eyes glued to the screen.
“Don’t you think it’s time to do that?”
He places his hand in front of her phone.
“What are you so worried about?”
She looked at him for a moment before answering. “That I won’t find another job. Every day on LinkedIn, there is a new company that’s laying off or announcing a hiring freeze and I am worried that my career break will just go on longer.”
“But weren’t you always saying that you needed some time off to pursue your passion of writing?”
“All that’s good to talk about. But I need to focus on my career too.”
“I understand that, but the recession is not your fault. You are doing everything you can.”
“I need to do more.”
“You need to get the bigger picture. Zoom out. You have a glorious opportunity to work on your writings. You have notebooks filled with stories. Don’t you think it is time you polished the pieces and submitted them somewhere?”
“What I need to do is get a job.”
“You will get it but the time that you have right now, in between jobs, is hard to come by. Think about it. You can try to do what you always talked about doing. Or was all that just big talk?” I could see, she took the bait.
She considered. “Hmm,” was all she said.
“I also found something for you.”
He had searched for a public library nearby. A magnificent three-storied red brick building standing beside a park. Just a mile away from their home. She could get herself a membership there. I thought this was an amazing idea. She had always wanted a house near a library. I could tell that this piqued her interest even if she feigned indifference to her husband. She wanted to see it first. I could see it in her eyes. And here I thought that the husband was too busy to notice her worries. I guess he was letting her be. Well, I couldn’t have guessed it. I can’t read his thoughts.
The next morning, she woke up to her alarm at 7:30 a.m. and had a shower. She was ready by 8:30 a.m., in time for the library to be open by 9 a.m. She was armed with her warmest winter jacket and a beanie. Wandered around the streets on her way to the Bellevue library. Taking in the strollers with their prams and pets. Warm coffees in their hands. In 10 minutes, she was standing in front of the library and was not disappointed. Covered with floor-to-ceiling glass panes, she could peer inside as she walked to the front door. She was also pleasantly surprised at a life-sized bronze statue of Mahatma Gandhi just outside the library; in the midst of now barren trees. There was ample seating space inside. Aisles and aisles of books: classics, romance, historical fiction, new interesting fiction and non-fiction sections, choice reads, monthly picks, and a dedicated holds section for reserved books.
Her husband was right. Isn’t this what she always wanted to explore? Read and write. Write and read. Surround herself with books and pages. She had found her place. She touched her fingers in reverence to the cracked paperbacks, reminding her of the piles of books she left behind at her place in India. She borrowed a few novels and set off with them and me in her backpack. Couldn’t resist a warm cup of coffee from a cafe she spotted. Picked a window-facing table overlooking a park. She read as she finished her coffee. A good girl’s guide to murder was a page-turner. It was the first time in months that she had ventured out on her own. She felt at ease. At peace. Her breath, a little lighter. A little deeper. She saw two dogs playing outside. Free and wild. She picked up her phone and googled bookstores and art galleries around. She found that a couple of independent bookstores nearby also host monthly book clubs and writing clubs. She signed up for them and started off in the direction of the art gallery.
I was happy. She was bouncing back. One step at a time.
In July 2022, Sania Khan’s life was ruthlessly taken from her by her ex-husband. Sania was a young, vibrant South Asian woman – a creator and photographer who had the courage to step out of an abusive marriage, even in the face of community norms that discourage women from speaking out. While this tragedy seemed to stir a consciousness in the South Asian diaspora that we can no longer justify the status quo, it is far from the only such incident. Just months later in December of 2022, Harpreet Kaur Gill was stabbed to death by her husband in Vancouver. While the most extreme cases like those of Sania Khan and Harpreet Kaur Gill are highlighted by mainstream media, a small body of research provides evidence that intimate partner violence experiences are equally, if not more, prevalent in South Asian communities than the general population in the US or Canada. That’s why we need to do more as a community and throw light South Asians and intimate partner violence.
Despite the identification and investigation of these norms in South Asia, there’s so much we still don’t know about diaspora communities, especially in relation to South Asians and intimate partner violence. In the US, South Asians have become one of the fastest-growing populations, but we remain unaware of how the stresses of raising a family in a different culture, and the weight of growing up between two worlds, affect these norms, expectations, and experiences among South Asian immigrants, the second generation and beyond.
In this article, we’ll take a deeper look at how these norms are enacted to influence intimate relationship dynamics, discuss the recent rise in intimate partner violence, and explore the work that researchers, policymakers, and program implementers can do to address violence in South Asian diaspora communities.
Social Norms and Violence in South Asian Diaspora Communities
Why does it take catastrophic events to serve as a call to action? For one, the “model minority myth” continues to portray South Asians in America (who originate from Bangladesh, Bhutan, India, the Maldives, Nepal, Pakistan, and Sri Lanka) as a healthy and wealthy group. As a child of Indian immigrants, I always thought this was just a frustrating trope that lived rent-free in my head next to the eternal question, “Log kya kahenge?” (What will people say?) However, I have realized that this constant worry is not just an innocent preoccupation. It’s the result of a dangerous spiral beginning with the portrayal of South Asians as a model minority and the need to maintain that well-to-do image. This only reinforces the traditional gender norms that overlook men’s perpetration of violence and encourage women’s silence, crippling any efforts to understand the scope of the problem and draw attention and resources to address it.
The Impacts of COVID-19 on Intimate Partner Violence
Prior to the start of the COVID-19 pandemic, the frequently-uttered phrase among researchers, practitioners, and advocates alike was “one in three” — one in three women ages 15-49 experiences physical and/or sexual violence inflicted by an intimate partner in their lifetime. Under the cover of the COVID-19 pandemic however, rates of violence against women rose dramatically, prompting UN Women to call for recognition of this “Shadow Pandemic.” During the height of the pandemic, the social isolation that came with lockdowns and quarantine procedures to curb the spread of disease made home a more dangerous place for an increasing number of women. As communities seek to rebuild, the inequities in access to and use of potentially lifesaving services have deepened. Now more than ever, it is critical that we shine a light on the many intersections of our society to prevent South Asian women’s experiences of intimate partner violence from being pushed even further into the shadows.
First and foremost, to better understand South Asians and intimate partner violence, we need better data disaggregated by racial/ethnic group. Since the 1980 Census, only those of Indian origin have had a fill-in bubble.All other South Asian groups have to write something in, decreasing their participation. South Asian communities in the US are not a monolith and they are certainly not all of Indian origin. This perception, fed by our lack of data, likely privileges the Indian community in America and limits the visibility of other South Asian communities.
More accurate information will help us better understand where the need is greatest. We can make a stronger case for more equitable resource allocation, improve South Asian language materials for survivors, and enhance provider training programs, accounting for the specific cultural implications of disclosing and seeking treatment for violence in South Asian communities. Public health researchers should increase efforts to understand the prevalence of experiences of violence, the environmental factors that make South Asian women in America vulnerable to experiences of intimate partner violence, and how it impacts their health.
While outstanding organizations such as Narika in California and Sakhi in New York are leading the charge in raising awareness, running active helplines, and providing support, they cannot be the sole safe space for survivors. While the system’s failure to protect Sania is not an isolated incident, it has served as a wake-up call.
All South Asian women in America should be able to be healthy and safe and lead lives free from violence, coercion, or abandonment. To achieve this, we need better data, more research, culturally-tailored resources, and appropriate legislative action that will allow for prevention, screening, and treatment efforts to finally take root.
Traditionally, psychotherapy has let women down. This is not to say that women and other minority group members have never received help, but rather that the therapy they received made little attempt to address the root causes of their problems. In focusing narrowly on the personal and individual, which a lot of mainstream approaches focus on, they ignore the big picture and miss the point. An alternative approach — feminist therapy — can help challenge the norms and support South Asian women in a more comprehensive way.
A therapy which fails to address power issues in people’s lives automatically reinforces oppression. Feminist therapy is a way to look at people as part of society and not merely as individuals. As more people of marginalized identities realize that the cause of their mental and emotional difficulties are not individual factors but structural, they are seeking more thoughtful therapists and counselors. Feminist therapists are aware of the cultural dynamics that uniquely affect women and keep these at the center of their practice.
Feminist therapy has a lot to offer to women of color, particularly South Asian women. It is formed on the assumption that social forces impact, and these forces include the many identities that a South Asian woman holds — including race, ethnicity, caste, etc. Feminist therapy can help support our clients and us as therapists to conceptualize the client’s difficulties, as not just stemming from internal sources, but as an outcome of the deep-rooted patriarchal system.
Feminist therapy is the key to a progressive approach towards mental health care. There is a lot of awareness about feminism nowadays and women encourage feminist approaches to therapy. Feminist approaches look at how social and political forces interact with our own identities. Feminist therapy especially puts in a lot of emphasis on how our intersectional identities such as religion, family dynamics and social class plays a role in our own gender identity. Feminist therapy can help support our clients and ourselves as therapists to conceptualize the client’s difficulties as not just stemming from internal sources, but rather face the impact of the deep rooted patriarchal system.
Here are some important aspects of a feminist approach to therapy, whether you are a therapist or someone who wants to start therapy themselves:
Therapists’ own biases
Therapists, while working with South Asian women, as with any other client, need to put in their own personal work in understanding the assumptions and biases that they may hold towards these identities. If a counselor holds bias that a South Asian woman is timid, or doesn’t know what she wants, it may cause the counselor to take in a more direct approach rather than a collaborative one.
South Asian women are often being told what to do. Hence, therapists who may choose to be more directive rather than collaborative, may often reinforce the position of power and authority onto a South Asian woman reflecting what she faces in the world. South Asian women, especially who may have not been exposed to therapy, may look at counselors from a view of receiving advice or guidance. It is through our own ability to explore and process our biases that we can help challenge this narrative for the client, and help take a more collaborative approach.
Exploring identity work
It is important for a therapist to be aware about gender, sexuality and the intersectional aspects of feminism; about how sexual minorities, caste, religion impact gender in influencing the kind of experiences that women face. The counseling relationship is a space for clients to process the identities that are the most salient to them. We can start off with providing some context and psycho-education around the purpose of understanding these identities. Helping the client process different identities that are important to her can help take a more holistic approach to understand her difficulties. We can help provide information around how every identity that we hold impacts us in some way or the other, because of its interaction within the social context. This can also be a time when a client may self-disclose about their own identities, if comfortable and appropriate, to model this understanding.
Ask instead of assume
It is considered best practice with every client to ask their preferred pronouns; as well as identities they would like to highlight at the beginning of the counseling relationship.
Asking, instead of presuming, can help clients hold their voice from the beginning of the counseling relationship and create a safe environment. Processing identities that are salient to them and opening up space to share other identities can help clients share openly about how they choose to identify with their gender/sexual identity. It creates space for clients in the process of exploring their identities, to get curious about their identified gender/sexual identities for the first time.
One of the initial and ongoing processes of feminist therapy is educating women from a collaborative aspect. Providing psycho-education about their rights, consent, impact of patriarchy and other systemic factors promotes empowerment. While providing psycho-education, it is important to process the power dynamics in the relationship and model consent within the relationship by exploring the question: “What is it like for you to hear this information from me?”
We as therapists can be considered as guiding forces, but we should also be mindful that we are providing this guidance and information from a collaborative aspect rather than enforcing authority or being direct. South Asian women are often asked to respect people in authority and not defy them. We, too, as therapists may end up reinforcing these patterns, and instead need to do our own exploration by engaging in psycho-education with collaboration and continuing to check in with the client’s internal process.
Hold context around starting therapy
A South Asian woman puts a lot of thought into seeking therapy. The cultural stigma towards mental health can have an imperative impact on her recognising that therapy could be a potential need to take care of herself. Along with the courage that it takes to reach out to a therapist, either openly or whilst keeping it hidden from her family, there may also be a potential element of what kind of therapist do I want to see. Especially for South Asian women living in the US/UK or other Western countries, there may be a significant deliberation that goes into seeing a white therapist v/s a person of color therapist v/s a south asian therapist.
Can we think of potential factors that may prevent a South Asian woman from reaching out to a therapist who may hold similar cultural identities ?
Can we think of potential factors why a client may want to work with a South Asian therapist?
Explore reasons that led them to choose you
When a client comes in for therapy, she has probably considered the therapist’s background. She may choose to see a non-South Asian woman because of past and internalized fear of being judged by other South Asian women in her life. Or a client may deliberately choose to work with a South Asian woman therapist for perceived similarities in identity. For therapists, it’s important to create space at the beginning of the relationship to ask the client what led them to choose you as their therapist. For clients, it’s important to ask questions about your therapist that are important to you.
Fostering environment for all their identities
Clients are fully seen and valued for all aspects of their identity, background and experiences. It also means that we ground our interventions from a systemic and anti-oppressive approach.
We constantly learn and evolve to provide responsiveness, humility and respect to our clients and really redefine the standard of care based on the identities and background of South Asian women.
Background of the client
Particularly while working with South Asian immigrants, it is important to know the background of the client we work with in order to design culturally-appropriate interventions. As a lot of research has asserted, not all Asians are alike and group differences within Asian groups is often overlooked.
There’s a lot of information and knowledge around Indian groups that tend to be generalized across other communities from South Asia such as those from Pakistan, Sri Lanka, Bangladesh, etc. It is important for counselors to be aware about similarities and differences across these cultures, and create interventions that are more specific to the client’s cultural background.
It is important to check in about how the interventions land with the client. We may use certain strategies from a Western perspective that go into exploring a client’s relationship with her parents or caregivers. This can particularly bring guilt or shame for the client as it may be in conflict with her cultural value of holding respect for her parents.
A lot of the deep respect and regard towards family comes in the form of loyalty and not speaking “ill” about the family with strangers. Reflecting on family, based on Western interventions, can sometimes make it challenging for clients based on their values. Checking in with clients on how these interventions feel, and making space for the guilt and shame to surface can once again help clients to hold value in her own voice.
Examining values and beliefs
Therapy can support South Asian women in differentiating between their own values and society’s expectations. Even though collectivism is a value within South Asian culture, it may not necessarily be an individual value to our clients.
South Asian women very often bear the burden of the value of collectivism where they have to meet family’s expectations, be in touch with other family members and engage in other collective activities. It is an expectation that has been imposed upon them. A therapy space can be a space for clients to explore what their own individual values look like. It can be a space for counselors to collaboratively work with clients in choosing what matters to them, even if what matters to them is to take care of the family.
In this essence, she now has had a voice in choosing how she wants to move forward as v/s feeling stuck in expectations set by others. When the client recognizes that she has a choice in exploring her own values and beliefs, there can be support around how to engage in behaviors that are based in these values. Sue and Sue (2008) has recommended discussion about values, beliefs and behaviors of their family and culture, so that clients can discover those that are for them, those with which they identify and those with which they are ambivalent.
The reason why a South Asian woman may choose to work with a South Asian therapist is to feel understood and not hold the burden of having to explain different cultural norms and expectations. When working with a therapist from a different racial background, clients may feel the need to explain and defend their own culture. It may feel difficult to hear about certain norms being toxic or problematic from someone who doesn’t share the same background as you.
When we as South Asian therapists work with South Asian women clients, we have the unique opportunity to validate the importance/meaning of these cultural norms, as well as challenge its problematic impact on our mental health. We have the context and ability to hold the community and cultural system accountable. It is important to hold the value of one’s desire to have a community and fellowship, as well as hold the impact of this collectivism on the mental health of South Asian women.
It is important to pause and explore: What about the culture feels impactful? How does this impact self-esteem and the way they view the world?
South Asian women are bound by the cultural value of adjustment and acceptance. Accepting our culture the way it is and moving on is what they have been taught to do across generations. The therapy room can be a good space for us to pause and help them choose what aspects of the community are helpful and what feels unacceptable.
This, in turn, can help with increasing their voice and control on their own value system. When they come to you looking for that cultural connection, you can hold space to both empathize with their cultural upbringing and to be able to challenge it. There’s more likelihood that they need it to be challenged and from someone who understands what they are going through.