The support gap

Cultural and identity issues are among main barriers for Asian American youth seeking mentaal help.

Content warning: mentions of amti-Asian violence, irregular eating

Medill first-year Cate Bikales can recall the fear she felt whenever her grandmother went out alone to buy groceries in the past few years. The rise in anti-Asian violence since the start of the COVID-19 pandemic amplified Bikales and her family’s anxieties over experiencing attacks, with older people and women becoming the most ta rgeted groups.

This was just one concern Bikales has talked about with her current counselor — an Asian American woman — during therapy sessions that she didn’t feel comfortable discussing with her first therapist, a white man.

In years past, psychologists noticed a troubling trend among ethnic minority groups. Ethnic minorities sought out therapeutic services relatively less, with worse outcomes in therapy compared to white clients, according to the American Psychological Association.

For Asian American youth, cultural stigma and a lack of shared identity within therapy spaces can become insurmountable barriers to accessing mental health resources or making the most out of them.

Bikales says she values having a therapist who shares similar identities with her.

“She has the experiences that allow her to know what I’m talking about and the issues I am dealing with,” she says.

But it can be challenging to match with a therapist who shares similar identities, especially due to the scarcity of Asian American representation in the field. According to the APA, Asian Americans make up just over 3% of the U.S. psychology workforce.

New York University professor of applied psychology Sumie Okazaki says Asian American adults often improve more mentally when they are treated by practitioners who match their ethnicity or language.

“Which isn’t to say that only Asian American providers can do a good job providing mental health services for Asian American clients,” Okazaki says. “But I think there’s something to be said about feeling understood without having to do lots of explanations, [which] can reduce a sense of barrier to counseling.”

The APA also says cultural humility — the awareness and acknowledgment of a therapist’s limitations when it comes to “understanding a client’s cultural background and experiences” — is important.

Therapists engaging in cross-cultural conversations had deeper understandings of their patients’ needs and emotions as well as their cultural experiences, according to a 2013 article in the Journal of Clinical Psychology. When Marriage and Family Therapy graduate student Kayla Zhang was a first-year at the

University of Wisconsin-Madison, she says she felt overwhelmed after she tore her ACL from skiing and signed up to receive counseling at her university. However, a lack of cultural understanding drove her away from her first therapist.

“The therapist [was a] white therapist and whatever I talked about, it just doesn’t feel like we clicked,” says Zhang, an international student. “The language [was] a part of the barrier, but also the cultural insensitivity was another barrier of that therapist.”

Zhang currently provides counseling at the Family Institute at NU, and she says she recognizes the importance of therapists with diverse backgrounds.

Now, Zhang’s therapist is a Black woman. Although they do not share the same ethnic identity, she says the therapist’s understanding of their cultural differences allows Zhang to have fruitful therapy sessions.

“Even though we have very different identities, she’s very gentle and curious about cultures and can understand people with BIPOC backgrounds,” she says.

In the same way, Weinberg thirdyear Victoria Tran understands the need of having a therapist who shares comprehension of culturally specific issues.

Tran sought out therapy in 2022 because of her complex relationship with her mom since she started college. Although her therapist is Asian, Tran says she sometimes feels a barrier talking about her relationship with her mom because of their generational gap and the fact that her therapist does not identify as an American.

“There are definitely some nuances that come with being a first-generation American that cannot be captured as well if your therapist doesn’t come from the same background, even if they might be Asian themselves,” Tran said.

Tran has been receiving therapy since December. She says though her mom was initially willing to pay for the weekly expenses, she became reluctant to continue covering the costs as Tran kept receiving therapy.

Because of her mom’s opposition to Tran continuing therapy, she eventually cut down on the frequency of sessions from weekly to monthly in April.

“She seemed to think that therapy was sort of a one-anddone thing, where I go for a couple of sessions and then eventually all my problems will be fixed,” Tran says. “But what I think she didn’t realize was that a lot of these issues have been building up for years of insecurity or years’ worth of my complex relationship with her.”

The possible cultural stigma and unfamiliarity of talking deeply about emotions in many Asian American families makes some youth reluctant to bring up the topic of mental health at all, according to Isok Kim, University at Buffalo associate professor in the School of Social Work.

Having to receive parental permission or financial support for mental health services can also become a barrier for those who hope to receive therapy without their parents’ or guardians’ knowledge, Kim says.

“[Receiving mental health help] is especially more challenging for younger folks, because there’s a whole lot of things about intergenerational challenges and how that plays into the delay of the treatment,” Kim says. “How do you advocate for the children and young adults’ mental health, when the very term ‘mental health’ that we’re using is alread y stigmatized?”

Such is the case for Weinberg first-year Alison Bai, who has been receiving weekly therapy sessions through a clinic that takes NU-SHIP, the University’s student insurance program. In addition to the insurance, she pays $20 out of her own pocket for these sessions, which she started during Winter Quarter, because she says she wants to avoid having to tell her parents about her heightened anxiety.

“With my parents, it might just make them more worried because I did start receiving therapy because of this specific situation, and I didn’t want to have to explain that to them,” Bai said.

“The mental health stigma is pretty bad in Asian culture, so they’ll think that something is wrong with me.”

Bai had initially tried to receive therapy as a sophomore in high school to treat her severe test anxiety. From the night before a math exam to the lunch period immediately before it, Bai says she was not able to eat.

However, when Bai asked her dad about potentially receiving therapy, she says he dismissed her, assuming she did not really need mental health support.

Now, she says she realizes that no matter how big or small the struggle, having a professional to talk to is helpful in any context.

“I think by mentioning that I go to therapy, it implants the idea in people’s minds like, ‘Oh, well, Alison’s going to therapy, then maybe I can try it out,” she says.