Twice a week, dozens of mostly Chinese immigrant older communities head to a tai chi class in South Brooklyn, New York, so they can flow along to the art form’s steady movements while dedicating a deep focus to every breath, every muscle.
Tai chi classes may not match the quintessential image of mental health treatment, but behind the soft background music and fluid motion are moments for participants to quell their anxieties and focus on wellness. They’re also able to skirt some of the stigma that can be attached to professional help, said Don Lee, the chairman of Homecrest Community Services, the nonprofit organization that hosts the classes.
Treatment that’s done through a Western framework, like traditional talk therapy, isn’t always inclusive of and as effective for everyone, often failing to honor Asian family dynamics, cultural values and racial sensitivities, experts said. But in recent years, other, more culturally fitting methods have been on the rise.
For example, the Asian American Mental Health Roundtable — a collective of organizations that offer both nonclinical and clinical services — has seen a growing need for mental health help, in part highlighted by the pandemic’s mental toll on the community. And it has resulted in an estimated 20% increase in the number of local organizations joining the roundtable since 2020, the majority of them pivoting to prioritize mental health access.
From tai chi and yoga to nurturing online mental health-focused communities aimed at the children of immigrants, a growing number of Asian American professionals are expanding the boundaries of mental health care for the community by championing supplementary or alternative methods that incorporate elements of their heritages.
“The further you are from Western culture — and that might be because of your immigration history, your age, your language capacities — the less likely that talk therapy would work, because you’re being asked to engage in a lot of things that just aren’t either natural or normalized,” said Kevin Nadal, a distinguished professor of psychology at John Jay College of Criminal Justice in New York. “There are a lot of therapeutic approaches that people from Asia … have been using that just aren’t labeled as therapeutic.”
That’s not to say talk therapy can’t be improved to better help Asian Americans, either, experts said. Given the trauma the racial group has experienced, particularly among elders who have often been through political upheaval and war, therapists should focus on slowly and patiently building trust, rather than expecting patients to immediately excavate their painful pasts, Nadal said. But the health care system should evolve to understand those needs, too.
“In an ideal world, a practitioner would be able to encourage a holistic approach where they might engage in some talk therapy, mixed with these cultural or indigenous healing practices, mixed with being mindful of your diet, nutrition, physical activity and whatever the person’s religious, spiritual practices are,” one professor said.
Experts say unpacking the challenges Asian Americans have finding effective treatment begins with the very basis of modern psychology, a study that was born and developed in Europe and the U.S. in the 1800s. While different therapeutic practices across cultures of color have long predated the field, professionals in the U.S. from psychologists to social workers undergo training that continues to be “focused on white European values,” Nadal said.
For those across Asian cultures — which often communicate emotion through actions rather than words and prioritize the collective and the family over the individual — how one-on-one talk therapy is conducted can feel uncomfortable, said Dr. Warren Ng, the medical director of outpatient behavioral health at NewYork-Presbyterian/Columbia University Irving Medical Center.
“The idea of communicating directly or explicitly can sometimes be challenging, because there’s also concepts related to shame or disrespect if we’re not considering everyone else before we consider ourselves,” he said.
In addition, therapists may interpret Asian American and Pacific Islander patients’ desire to consider their family members’ needs and involve them in their lives as being too dependent.
The scarce Asian American representation in the field doesn’t help, either. According to analysis from the American Psychological Association, Asian Americans make up just over 3% of the U.S. psychology workforce.
Ultimately issues collide, and Asian Americans who give talk therapy a try often either end up dropping out or are deemed by professionals as “difficult clients” who are unable to connect in the same ways that white people, or others who are seen as more “Americanized,” might be, Nadal said. A 2011 study of the landscape of Asian American mental health found that after initial contacts with mental health professionals, roughly one-third of Asian Americans drop out of treatment before their intake sessions. And the American Psychological Association similarly notes that Asian Americans who seek treatment are more likely to terminate it early.
In reality, Asian Americans aren’t the problem, he said.
“In an ideal world, a practitioner would be able to encourage a holistic approach where they might engage in some talk therapy, mixed with these cultural or indigenous healing practices, mixed with being mindful of your diet, nutrition, physical activity and whatever the person’s religious, spiritual practices are,” Nadal said.
The Asian American Mental Health Roundtable includes groups like Hamilton-Madison House and the South Asian Council for Social Services. They have offered yoga and tai chi classes to women’s empowerment groups. Some of the services that are geared toward seniors often host group activities like tea time and origami folding.
The organizations, led by the nonprofit Asian American Federation, aim to give people a “nonthreatening space” to process issues, and those with more serious concerns are connected with clinicians, said Joo Han, the federation’s deputy director.
Involving cultural practitioners has been integral to its strategy, Han said. Unlike in Western society, Asian cultures often see well-being in a holistic way, with little separation between the mind and the body. So when mental health issues arise, they usually show up in Asian Americans through physical, psychosomatic symptoms, she said. And it’s important for providers to recognize that.
“People will often come in and they might talk about stress or tension headaches, their stomach hurting,” Han said. “For providers who are attuned to understand the ways things show up in the Asian community …they can ask follow-up questions.”
Lee said that for many, the classes have become so essential to their routines and well-being that during the pandemic, many of the elders enlisted the help of grandchildren to set up webcams so they could continue the classes virtually without skipping a beat.
“We’ll find that often they become more relaxed, they talk to each other more, they become closer friends,” Lee said. “They gravitate towards that also because they’re actually part of a Chinese tradition that they — especially some of the folks who work their entire lives — really never had a chance to be part of.”
Another practitioner, Patrick Lin, runs a tech program for predominantly Asian elders in the New York City neighborhood of Jackson Heights, aiming to tackle feelings of loneliness and foster a sense of purpose, in which he pairs the seniors with mostly young Asian American high school students so they can learn navigating apps to working their phones. The classes, Lin said, center the cultural values of community and collective healing. Meanwhile, the youth volunteers learn patience.
“When I was seeing clients one on one for one hour each week, I realized that I was limited in what I could provide,” said Lin, who’s trained in psychotherapy. “I was already imagining all the possible community-based services that could tackle mental health issues.”
Other Asian American practitioners have used social media to destigmatize the subject and help guide community members in thinking about topics that often go unaddressed in mainstream mental health spaces.
One such example, Brown Girl Therapy, an organization founded by therapist Sahaj Kohli in 2019, has amassed more than 221,000 followers on Instagram for Kohli’s posts geared toward children of immigrants, particularly South Asian Americans. Through the platform, Kohli addresses issues from handling family and generational tensions to processing the grief that comes with feeling invisible and unacknowledged by society.
While second-generation Asian Americans may be better acquainted with the concept of mental health help, she said, they still contend with what she calls “thriver’s guilt,” keeping them from seriously addressing all aspects of their well-being.
Her platform, she added, has also helped introduce Asian Americans, who are scattered across the country in areas with little representation, to such concepts to feel less alone.
“It’s almost like mental health impostor syndrome,” Kohli said. “We are convinced that our parents and our elders went through something worse, so therefore our struggles don’t feel as valid.”