Considerations for Working with South Asian Therapy Clients

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

Western vs. Eastern approaches to therapy

Western approaches to mental health therapy often see the client as an individual and do not always consider the context of family and environment. They often focus on helping the client identify and fix personal issues without incorporating how personal and cultural factors influence both the capacity to discuss these personal issues and to change them. For South Asians specifically, boundary-setting may look different for someone when considering a collectivist perspective. And self-care may involve the whole family or community–including neighbors, family friends, religious leaders, and extended family members.

Generational lines

First-generation immigrants likely have different viewpoints on mental health and therapy than do their second-generation counterparts. The former may believe the latter are “too Westernized” if they attempt to bring up therapy. And, even when in therapy, 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 issues, body aches, headaches, fatigue) that could signal that some emotional distress is occurring. But these symptoms, particularly among women, are often overlooked by healthcare professionals.

Seeking out therapy

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

Marginalized voices within South Asian communities

These problems can become further exacerbated as often the voices of the marginalized are kept even more quiet. Many South Asian communities today highlight a patriarchal viewpoint in which the voices of women, queer individuals, and young and/or unmarried children are silenced. Stereotypical norms may also influence one’s ability to feel comfortable in their own skin and express themselves in a way that is not considered acceptable in their communities. This is why understanding the particular 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, consider the following questions:

• What is my client coming to me for? What are they hoping to get out therapy? Consider that it might not be a reason with a clear end goal or timeline. For some, the opportunity to vent, express, and be in community with someone who will hear them is the goal.

• What kinds of experiences has this client had in their country and/or family of origin that influence who they are today and what they may be willing to share?

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