Considerations for Working with South Asian Therapy Clients

When we think about mental health treatment, phrases that often come up include “setting boundaries,” “culturally informed care,” “self-care,” and “individuation.” However, these interventions can look very different when working with South Asians from a wide range of cultural backgrounds and generational lines.

Western and Eastern Approaches to Therapy

Western approaches to mental health therapy often view the patient as an individual and do not always take into account the family and environmental context. They often focus on helping the patient identify and fix personal problems without considering how personal and cultural factors influence the ability to talk about and change these personal problems. For South Asians specifically, boundary setting may look different to someone who considers a collectivist perspective. And self-care may involve the entire family or community, including neighbors, family friends, religious leaders, and extended family members.

Generational lines

First-generation immigrants likely have different views on mental health and therapy than their second-generation counterparts. The former may believe the latter are “too Westernized” if they try to mention therapy. And even when they are in therapy, the concepts of mental illness and emotional distress may look and sound different. Many South Asians often experience and even report somatic symptoms (e.g., digestive problems, body aches, headaches, fatigue) that could indicate they are suffering from some form of emotional distress. But these symptoms, particularly among women, are often overlooked by health professionals.

Seeking therapy

Ideas of shame and rejection can also influence whether and how a person seeks help. People may turn first to local communities, who may not have the knowledge to support them and may respond with comments or suggestions that may only exacerbate the problem. It can be difficult to realize that this is not helpful if a person is unwilling to reach out to a mental health professional or is unaware of the resources available. The ability to express oneself in the language in which one feels most comfortable and authentic can also play a significant role in deciding whether to seek or continue with mental health services.

Marginalized voices in South Asian communities

These issues can be further exacerbated as the voices of the marginalised are often further silenced. Many South Asian communities today highlight a patriarchal viewpoint where the voices of women, queer people, and young or single children are silenced. Stereotypical norms can also influence a person’s ability to feel comfortable in their own skin and express themselves in ways that are not considered acceptable in their communities. That’s why understanding the unique needs of the person in front of you, with their varied history, cultural influences, and perspectives, is vital to providing mental health care.

Suggested approaches

When working with South Asian clients, keep the following questions in mind:

• Why is my client coming to see me? What do they hope to get out of therapy? Keep in mind that it may not be a reason with a clear end goal or timeline. For some, the goal is the opportunity to vent, express themselves, and be in community with someone who will listen.

• What kind of experiences has this client had in his/her country and/or family of origin that influence who he/she is today and what might he/she be willing to share?

• How does my external presentation (e.g., how I look, speak, express myself) influence their perception of my ability to help and understand them? Do they feel that I can understand their perspectives?