In any counseling relationship, therapists’ own values, assumptions and identities play a role in the way we perceive and interact with the client. I think it’s no news that we need to be conscious of these assumptions so that it does not impair our work with the client. But, particularly while working with South Asian women, I believe this work is extremely crucial for counselors to be aware of what we may assume about the client based on their identities. Brown women, specially, have generationally held the impact of various assumptions and stereotypes being thrown at, and them having to meet these assumptions. To be the care taker of home and family, to be soft, timid, sacrificing, adjusting. etc. These are all qualities that have been part of her identity all her life.

What can especially be harmful, and yet very common, is when these assumptions/expectations are played out within the counseling relationship. However, the expectation that we as therapists are bias free and exempt from any assumptions is not the goal. We know that we all make assumptions and that it is only human to have certain beliefs about people who belong to your same or different identity.

I call for us to think for a few minutes about what assumptions may come up for us before we begin to work with a Brown woman. These assumptions could be about her personality, about what issues she may bring up or about her presentation.

Feminist therapy

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 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. A therapy which fails to address power issues in people’s lives, works, automatically to reinforce 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 rather face the impact 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, caste, social class. Etc can play a huge role on 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.

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 their own 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 directive 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 can we 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 psychoeducation 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 it’s 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.

Eg. I identify majorly as a South Asian, Indian woman from an upper class and raised in an urban modern society. These identities can be helped to explore my own experiences of being a woman, challenges faced through these identities and aspects of privilege that come with it.

Providing a space for the client to explore and give thought to their identities can help increase their awareness about self as well as the issues they are experiencing.

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 client hold voice right since the beginning of the counseling relationship and create a safe environment. I believe this is especially crucial in a South Asian context, given the stigma around exploration and processing of our gender and sexual identity.

Processing identities that are salient to them and opening up space to share other identities can help clients either 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.

Collaboration

One of the initial and ongoing process 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 psychoeduction, it is important to process the power dynamics in the relationship and model consent within the relationship:

“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 directiveness. South Asian women are often asked to respect people in authority and not be defying. We, too, as therapists may end up reinforcing these patterns, and instead need to do our own exploration with engaging in psychoeducation with collaboration and continue checking in with client’s internal process.

Hold context around starting therapy

A lot of thought goes into seeking therapy for a South Asian woman. 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 by 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 lot of thought 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 t South Asian therapist?

Explore reasons that led them to choose you

When a client comes in for therapy, she has probably given a lot of thought on the therapist background. She may choose to see a non-south asian woman because of past and internalized fear from receiving judgement from 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 us as therapists, it’s important to create space at the beginning of the relationship to ask the client what led them to choose you as the therapist.

“What were some factors that played a role in the decision making and what may be some concerns that she may have around starting this relationship with you, based on shared identities?”

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 particular client we work with in order to design culturally appropriate interventions. As a lot of research has asserted, not all Asians are alike and within group differences among Asian groups is often overlooked.

There’s lot of information and knowledge around Indian groups, that tend to be generalized across other communities from South Asia such as 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.

Ongoing informed consent

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 client’s relationship with her parents or caregivers. This can particularly bring guilt or shame for the client as it may 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 client to hold value in her own voice.

Safe and comfortable space

A primary component in the counseling experience is the provision of safe space within which south asian women can discuss salient issues. Equally important, as noted by Sue & Sue, is the counselors’ ability to employ culturally appropriate helping skills and interventions. Counselors must pair these skills and interventions with knowledge of topics that are relevant to the presenting concerns, age, ethnicity and other identities of the client that they are serving. Because identity development is significantly influenced by cultural voices, it is important to support and make space to process different parts of her identity and how it impacts her.

Focus on Confidentiality

Speaking of guilt and shame caused by seeking therapy or talking about family, the counseling relationship needs to be focused on building trust — to help support client’s courage to seek therapy as well as emerging feelings out of it.

A way to build trust, as is so important in our profession, is the focus on confidentiality. Chung (2004) explains that focus on confidentiality is crucial in working with any Asian American group because disclosing family matters to outsiders is frowned upon. While working with South Asian women, it is important to stress the counselor’s responsibility of confidentiality that can help play a role in building trust in the relationship.

Personal Disclosure

Even within a safe environment, South Asian women may still exhibit a dis-inclination to share personal information. Therapists can draw upon the value of collectivism and take time to build trust in the relationship.

When appropriate, if a therapist is from a south asian background, they may choose to disclose their own process of identity exploration or the way their identity has played a role in navigating the world. When appropriate, therapists can model disclosure by sharing their own family experiences which can prove beneficial in developing the therapeutic alliance with South Asian women, who may value that closeness in the relationship.

It is still important to continue to hold consent and incorporate feedback when the client may be reluctant (verbally or nonverbally) to disclose, especially because of the cultural value of respect for authority figures (i.e the counselor).

Goal setting

Individual goal setting may be consistent with western culture. It is important for therapists to collaborate with clients on therapeutic goals and hold consent. It is important to refrain from imposing our own thoughts on what the client should work on, but rather to create space for the client to process what her goals may look like and help guide them.

The process of forming goals can be overwhelming for some clients who may have had past trauma of being silenced or experience difficulties with asserting their needs. Counselors can keep goal setting as an ongoing process in therapy, and continue to incorporate consent and feedback throughout the process.

Examining values and beliefs

Therapy can support south asian women in differentiating between their own values and the expectations from the society. Even though collectivism is a value within the 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 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 client 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 to feeling stuck in the expectations from 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.

Ability to challenge cultural norms

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 it’s 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.

Clients may look at you with the idea that you are aware about the way south asian families function, and may want to move on. However, statements like “you know how our culture is” and moving away from processing the impact of this culture can prevent us from missing a lot of information about the client’s needs.

It is important to pause and explore with client- What about the culture feels impactful? How does this impact the self esteem and the way they view the world.

South Asian women are bounded 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 once again 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 also to be able to challenge it. There’s more likelihood that they need it to be challenged and more so from someone who understands what they are going through.

You can also check out this article on Brown Girl Magazine where I elaborate on the relationship between Feminism and therapy with South Asian women.