The Times spoke with several therapists, social workers, researchers and organizations that serve Thai and Asian Americans about how treatment and recovery can be tailored to their needs. These recommendations emerged from: meeting clients’ practical needs, involving families and communities in their care, and practicing mindfulness in community contexts.
Solve the actual needs of customers first
Gordon Hall, professor emeritus of psychology at the University of Oregon, explains that Asian Americans have high dropout rates from treatment. Helping them solve real problems can be a way to keep them engaged.
“[Some therapists] The first three weeks may be spent on [a client’s] “But for many Asian Americans, they might be wondering: What do my thoughts and feelings have to do with the conflict I have with my mom, or with my boss asking for a raise?”
Natyra Na Takuathung, a case manager at Asia Pacific Counseling and Treatment Center, works with psychiatric social worker Wanda Pathomrit to help clients, many of whom are Thai immigrants, apply for social benefits. Pathomrit meets with clients to understand their mental health anxieties, and Na Takuathung can help them apply for programs like CalFresh or CalWorks.
Pathomrit explained that she incorporates case management into her treatment process because many clients who suffer from depression, trauma, or avoidant behaviors may have difficulty maintaining a relationship with a case manager or following up on referrals. Rather than differentiate between roles, she uses real-world situations—in public social services or drug treatment centers—as opportunities to develop coping skills, practice emotional regulation, and develop self-compassion.
“Through in-the-moment coaching, I help clients gain confidence and self-esteem while receiving services,” Pathomrit said. “For high-need, high-risk cases, this intensive approach is not ‘extra’ – but is critical to progress.”
But Na Takuathung explained that some clients are hesitant to accept help because they believe doing so would place a “burden” on society.
“They have this idea that if they don’t ask for public benefits, then they are ‘good immigrants,'” Na Takuathung said. “They will think that it is better to work hard and make money by themselves. Even if it is not enough, they will work quietly.”
Na Takuathung said the choice is ultimately up to them. But she explains how the programs can reduce their stress and remind them they don’t have to feel guilty.
“You have lived in this country. You have contributed to this country,” Na Takuathung said. “You deserve kindness.”
Involve family in care
In a study of cultural therapy approaches for Asian Americans, Hall and co-author Jenny Hong explained that Western-based approaches tend to emphasize individualism and personal reflection.
“You go in, you have to talk about your problems, you have to tell a stranger within 50 minutes what’s going on inside you, and it heals you by speaking out about your inner experience,” said Hong, a clinical associate professor at Stanford University School of Medicine.
In contrast, many Asian communities are rooted in collectivistic cultures, where identity and health are deeply intertwined with family and group harmony.
“If you’re in a community, everyone is expected to take care of you and you are expected to take care of them, and if you have a problem, it involves your whole team,” Hall said. “A very individual approach … may prevent Asian Americans from seeking treatment.”
As chief clinical officer at the Richmond Area Comprehensive Services Center, one of the first agencies in the country to address the need for culturally competent services in the Asian American and Pacific Islander community, Christina Shea observes the value of involving family members in an individual’s care.
“If you are with [a client] “In Western psychology, that helps because it’s a whole,” Shea said. “But if you work with people from Southeast Asia [and] You work with one person and that’s not enough. That’s not a unit because that person is connected to the family. “
Phramaha Dusit Sawaengwong sees these dynamics all the time as a monk at the Thai Temple in Los Angeles. He often observes conflict when the high hopes and expectations of immigrant parents conflict with their children’s own career ambitions.
Monk and secretary Phramaha Dusit Sawaengwong stands inside the temple at Wat Thai in Los Angeles.
(Juliana Yamada/Los Angeles Times)
Language barriers can exacerbate disagreements. A common Thai word used to describe pain is hua òk ja tàek, meaning one’s chest (heart area) is about to break. But parents with limited English proficiency may have difficulty communicating this emotion to their children.
“[They] I want to say something, but [they] Don’t know what to say,” he said.
Since parents often come to temples for counseling help, he advises them to allow their children to absorb all the different opportunities available to them to shine.
“Don’t expect … just for them to learn,” Sawaengwong said.
Support can extend beyond the home.
Danielle Ung, assistant professor of counseling and health psychology at Bastyr University, is studying the impact on the mental health of Southeast Asian students during and after the COVID-19 pandemic. She works with patients to identify communities where they can find support, thinking of communities as “concentric circles around the person.”
“Community can mean friends, extended family, adoptive family, or even the neighborhood where you live,” Ong said.
Pam Evagee and Ta Sanalak are volunteer teachers at Thai Temple, coordinating Thai language classes and cultural programs to promote communication and understanding among family members. They ask parents to understand how living in the United States affects their children’s beliefs, while explaining to students the importance of learning traditional customs since they grew up where their parents did.
“We understand the parents because we are Thai and we understand the children because we live here [in the U.S.] It’s been quite a while,” Sanalak said.
Families can also support each other at Thai Temple.
Evagee explains that some children may be the only Thai students in school. At the temple, they can develop friendships with other Thai students who understand the challenges they face. Many parents cook meals for their children together at temples while sharing advice on dealing with conflicts within the family.
Mindfulness is a core tenet of Buddhism. According to the Pew Research Center, 90 percent of Thai adults identify themselves as Buddhist, and many Thai Americans continue to practice the religion.
Hall believes that many Western therapies incorporate mindfulness, but the focus remains on the individual, while Eastern mindfulness therapies focus on the self within the community.
“There’s something called lovingkindness meditation, where you focus on people who are doing things for you,” Hall says. “You may think of your mother and your gratitude to her for taking care of you [her] What with you [owe] she. “
Buddhist monk Phiphop Phuphong often used this method when visiting people who were sick or hospitalized.
A diabetic man who had both legs amputated expressed deep sadness at the loss and felt ashamed of “being a burden” and felt dependent on his mother and sister. Phuphong guided him through mindfulness practices that helped him find peace in his new reality while encouraging him to stay strong for the sake of his mother and sister.
“Your body is your gift,” Puphong said through a translator. “Take your thoughts back to your home.”
Health policy and training have come a long way
The Los Angeles County Department of Mental Health serves underserved communities. It supports cultural competency through translation and interpretation services, cultural and linguistic inclusion services, and employee bilingual bonuses. But language is just the beginning.
“We’re trying to cover all the bases, but I do think there’s still a lot of work to be done,” said Dr. Lisa Wong, the department’s chief. “And I don’t think we’re going to make huge progress unless we bring a more diverse workforce into the mental health field.”
Recruiting clinical professionals from diverse racial backgrounds is difficult because many recent immigrants and their children choose high-paying careers instead of the mental health field, Huang added.
Furthermore, much of the training and education for practitioners is still based on Western concepts of mental health and recovery. Carl Highshaw, executive director of the national association, explained that many of the evidence-based models were developed based on research on primarily Eurocentric populations. California Chapter of Social Workers.
“While these models have value, they often fail to capture the reality of immigrants and collectivist cultures,” Hayshaw said. “We need to adapt and co-create interventions that respect cultural traditions, family systems and community networks.”
Hong appreciates that many therapists now acknowledge clients’ cultural backgrounds. Equally important, she said, is finding ways to not stereotype.
“Not all Asian Americans respond to problem-solving, and not all Asian Americans are collectivist or interdependent,” Hall added. “[Some] Might really want a mainstream cognitive behavioral approach. They want to talk about their thoughts and feelings, and it might actually help them. “
Hall said what works for the Thai community and Asian Americans will work for other communities as well.
For Highshaw, cultural competency “is not optional,” especially in a state as diverse as California.
“Go beyond a one-size-fits-all approach,” he said. “Ensuring interventions reflect the lived experiences, values and strengths of the communities we serve…is an ethical responsibility.”
Interpreter Supakit Art Pattarateranon contributed to this report.
