Enter the Therapy Maze: Try to Remember Why You Entered in the First Place

As an Asian American, seeking mental health support can be a daunting task. This surprises me at times because being in therapy is now something that many people talk about openly, in media and in my personal life. This is progress because it wasn’t too long ago when therapy was regarded as something only for “crazy” or unstable people. Even though our attitudes have shifted and there is more acceptance of mental health issues as being part of ordinary life, that hasn’t resulted in greater access to or better navigation of mental health care. Here are some common challenges in finding high quality mental health care for Asian Americans.

• Insurance

Even if we as a society want better mental healthcare, we are still dealing with American insurance companies whose purpose is to make as much money as possible. One of the consequences of a profit-driven healthcare system is that therapists are generally underpaid by insurance companies, which results in therapists not wanting to take insurance and moving to a private pay business model when they can. This means that if you’re hoping to use insurance to cover your sessions and you want a specific type of therapist, you will be going on a quest—usually a lengthy and annoying one. Your insurance directory of providers will likely not allow you to filter therapists by specialization or degree/credentials or race/ethnicity. So you have to scroll through lots of random names without much information about the therapist. Sure, you can do an internet search for the therapist to see if they have a website or Psychology Today profile with more information. However, that’s a lot of time and energy spent on just finding out basic information about a provider who may not even have room for you in their schedule once you get around to contacting them.

The reality is that many of the best therapists in private practice are not incentivized to take insurance because the reimbursement tends to be much lower than private pay. The better the therapist, the greater the word-of-mouth marketing, the more referrals they have coming in, and therefore the less they need insurance clients when they have clients calling them to pay their full fee. Also, even when therapists take insurance, what many therapists are not necessarily going to be transparent about is the fact that many of us reserve a relatively small portion of our schedule for people wanting to use insurance. We simply cannot make a decent living filling up all our available time slots with visits that will reimburse us at the lowest rates in the industry. For me personally, I went to school for so long (both Master’s and PhD) that it would make no economic sense for me to see more than a tiny fraction of people through insurance.

Practitioners like me end up having insurance waitlists for people who would like to use their insurance and are willing to wait until one of those insurance slots becomes available because another client has moved on from therapy for one reason or another. This is not an ideal situation for the client because they are waiting for an uncertain period of time to receive mental health care. And it’s not ideal for the therapist because there’s concern about how the people on the waitlist are faring. I always encourage people to seek care elsewhere and provide referrals but it’s possible that their insurance might not be taken or the referrals may not be as good of a fit for various reasons.

Bottom line: insurance does not pay therapists a living wage which means many therapists will either not take it or only see a small fraction of their schedule through insurance. This presents challenges to finding a good therapist who is a good fit for you that is covered by insurance.

• Scheduling

Therapists have uniquely restrictive schedules because they see clients on a weekly or bi-weekly basis which means many of the hours of their work week are already spoken for. When a therapist has an opening, that time may not work with a prospective client’s schedule. Scheduling a client can be challenging not just because of the client’s work schedule but also because they have privacy only during certain parts of the day or they may not have the bandwidth to do therapy at a particular time.

• Stigma

Social media might give us the impression that we are all airing our mental health laundry in public. However, that doesn’t mean the people in your immediate family and closest circle of friends are seeing a therapist. There might be people in your closest circle who are taking antidepressants but you may not know because they have chosen to not disclose it. The cultural stigma in Asian communities remains formidable for many people and the lack of open discussion about mental health problems continues to create the false impression that people do not experience these problems. Stigma can also take the form of “It’s okay if other people need this but I shouldn’t.” This is something I’ve heard a lot over the years and it has caused people to avoid seeking help when they needed it. Like any other problem in life, with mental health, the longer you put off the problems, the more intractable they become.

• Lack of Representation

It’s actually not that easy to find an Asian American therapist that can take you on. Even if you live in an area that has a large Asian population, there are additional barriers such as insurance and therapist availability that may prevent you from connecting with the therapist that is the best match for you. Asian Americans are under-represented in the mental health professions, which is part of the problem faced by many Asian American therapy consumers. They are looking for clinicians who “get them” and based on the stories I hear from clients, a non-Asian therapist can get so many things wrong. There’s the preaching and judgment about codependency to a person coming from a more collectivistic culture. There’s the characterization of Asian parents as “cold” or “emotionally unavailable” without the nuanced understanding that care is shown in different ways in Asian communities. There’s the lack of acknowledgment that Asians face a lot of racial micro-aggressions and discrimination in the workplace and in academia. These are just some common examples—the list can go on and on. Bottom line: lack of representation in the mental health professions leads to lower quality of care for Asian Americans.

• A “Good Therapist”

  Many of my friends and family members have asked me, “what should I look for to find a good therapist?” My answer: it’s all about the fit. My therapist may not be your ideal therapist, just as your ideal therapist may not be your sister’s ideal therapist. This means that we are looking for someone who can vibe with us in a way that makes us feel comfortable, safe, secure, and like the time we spend with them is worthwhile and productive. I’ve also heard a lot of people talk about good therapists vs bad therapists. I do believe there are many bad therapists out there. In my personal experiences with training and supervising and teaching, I can certainly recall the many times I thought, “I would not want that person to be my therapist.” But I tend to believe it’s about fit more than it’s about objectively good or bad therapy. Full disclosure though: I myself have seen a few therapists who I thought were not that skillful perhaps because of where they were in their career or how they trained or because their intellectual curiosity did not extend beyond the conventional therapy space. But I also acknowledge it’s hard to be a therapist to other therapists (that’s a whole other can of worms). Bottom line: you have to shop for a therapist who is a good fit for you.

Are You Still There?! Don’t Give Up!

If you’re not totally demoralized by the information above, here are some places that might help you find a good fit for therapy.

Here’s Asian Mental Health Collective’s directory of AANHPI therapists in the US (they have one for Canada too).

I still find this Huffington Post article to be informative and helpful.

I have more resources at the bottom of this Asian Americans service page.