I have an unpopular opinion: being a South Asian American therapist does NOT mean you’re culturally competent to treat South Asian American clients! 

I know what you’re thinking: “WHAT?!?! I know what it’s like to be a Brown person in this country. OF COURSE I know how my clients feel”. 

Yes, and respectfully, no. 

You might have an idea, and of course our personal experiences can certainly shape our clinical work, and build rapport with clients. Representation in the field matters.

But that doesn’t necessarily mean you fully understand your clients. You can relate, but do you have a good handle on their clinical picture? 

Here’s how you can improve your case conceptualization and treatment planning with South Asian American clients: 

1.) Read!

When conceptualizing your client’s story, make sure you’re well read on discrimination, colorism, expectations of women, and minority stress. These traumas affect mental health!

It’s also worth reading how LGBTQ South Asian Americans face discrimination both within and outside of their communities. 

This can give you a lot of clinical insight about how their anxiety and depression show up in your clients’ daily lives! It can better inform the kind of tools you use with them too. 

Caste by Isabel Wilkerson is on my recommended reading list. When it comes to applying counseling skills, I also recommend Multicultural Counseling Competencies by Dr. Derald Wing Sue.

2.) Research! 

There isn’t a ton of research on mental health implications for South Asian Americans, but it’s growing, and some research studies have focused on South Asian immigrant and second-generation people in the UK and Canada.

When you can, make sure you take some time on a monthly basis to Google Scholar clinical questions you might have, like “Depression and South Asian Americans”, or “Eating Disorder Treatment for Pakistani Muslim women”. 

Take the time to read statistics about the prevalence of certain mental health disorders, like Major Depressive Disorder, OCD, PTSD, and Postpartum Depression, in South Asian American communities. 

You’ll be on the lookout for risk factors and catch things that your client’s previous therapists didn’t see. 

3.) Practice humility 

Go into your session assuming that you don’t know enough about South Asian cultures, because honestly, you don’t (yes, even if you’re of South Asian background). 

Also, not all South Asian American clients strongly identify with their culture, and that’s not always an issue that needs to be worked on. 

Some clients are OK not having a relationship with their culture and being South Asian is not an important part of their everyday lives. 

The South Asian diaspora is so diverse in culture, language, tradition, caste, geography, migration, and religion. Some South Asian Americans believe that their culture is very important to them, and some don’t. 

When it comes to culture and mental health, be open to wherever the client takes you and be curious without pushing. If you ask about their culture during the first session, pay attention to their verbal or nonverbal cues. 

If they express or appear uncomfortable, align yourself with their resistance and drop the topic! 

Regardless of what their relationship is with their culture, you have to gain their trust first, and over time, your client will broach the subject again when they’re ready, or if they want to. 

Remember that your client is ultimately coming to you to address their mental health symptoms, which may not be due to cultural stress. Like any client, they may be coming to you with mental health issues stemming from work, school, career, or relationships. 

Your client is MORE than their culture! When you make the focus only about culture, especially if they don’t want to talk about it, it shows that you only see them for their ethnicity, even if that’s not your intention.

It can be a micro-aggression! It can leave them feeling unheard or invalidated too. 

4.) Be honest and CURIOUS

It is OK to admit that you don’t know much about your client’s culture if that’s something that’s important to them and they’re seeking therapy for it.

If you ultimately know that your knowledge is limited and that you can’t help them, then it’s best you refer out. 

It’s sad to turn away a client, but if you refer them to someone who is better equipped, they will respect you MORE. 

You are a clinical expert, but you are not the expert of all the human experiences in the world, including culture. The client is the expert on their experience, and you are just a guide.

If your client still wants to work with you and trusts you enough to talk about their culture, follow up with open-ended questions to get a good understanding of why culture impacts their current mental health symptoms. 

You can use that information to help with treatment planning and understanding barriers to progress!

Also, please don’t be defensive. If your client feels comfortable enough to tell you that they were upset with something you said, set your professional ego to the side. 

You are not in trouble.

That they would bring it up to you means they trust you enough to handle feedback well. 

A simple, “Thank you for telling me”, or “You’re right”, or “I understand” can suffice. If it’s worth exploring their pain and anger, you can even say, “Tell me more about what that was like for you”. This should all be done with a ton of validation and empathy.

The best therapist is a boundaried one. You are practicing ethically by acknowledging what you can and cannot do. You SHOULD refer out if your client’s presenting concerns are outside of your training. Your job is to TREAT clients, not to SAVE them! 

5.) Consult with colleagues, (including me)! 

Like working with any client, transference and countertransference with your South Asian American clients WILL come up.

Contrary to what we’ve been told in grad school, countertransference is NOT a bad thing.  

Your countertransference can give you a lot of useful insight about what your client’s relationships are like outside of the office.

It gives you clinical info about how your client’s parents, siblings, colleagues, boss, friends, and romantic partners feel. 

And that info can help you identify the appropriate interventions to move your client closer to their goals. 

The most important thing is that you don’t act on your countertransference by projecting your personal feelings onto them. The session is not about your feelings; it’s about theirs. 

Make sure you’re going to your own therapy, and invest in the appropriate consultation to avoid becoming impaired. 

Was this helpful information for your practice? Comment below something that you’ve learned or gained ⬇️!

Looking to consult with a colleague?

Join my GROUP SUP! You’ll get: 

1️⃣Support from me to brainstorm ways to help your South Asian clients 

2️⃣Structured feedback from me and other South Asian therapists across the country 

3️⃣A private online group page where you can ask your cohort questions in between group supervision calls 

Expand your referral network and feel more confident with your clients! Schedule your free intro call below to see if GROUP SUP is a good fit for you.