Cambodian American Eden Teng was born in a refugee camp on the border of Thailand and Cambodia a few years after the Cambodian genocide. She moved to America at the age of 6 with her mother and aunt.
Teng credits her own resilience in the transition to America to her exuberant mother, who wore what she wanted and was not afraid to defy societal norms—even when it was embarrassing for a teenage Teng.
But as she was growing up, Teng also witnessed the negative effects of historical, racial and inter-generational trauma on her mother’s well-being. Teng often felt confused as to why her mother’s emotions could spiral out of control for no reason, or why she had so many health problems.
When Teng first encountered psychology in college, she realized that her mother’s past was directly related to her emotional and physical health. (Scientists are learning that stress and trauma are sometimes linked to chronic diseases, such as high blood pressure, diabetes, and kidney disease.)
It was this realization that compelled Teng to become a physician; In 2018, she started her graduate studies in Seattle.
But when COVID-19 hit and the Black Lives Matter movement went into full force, communities of color had a more public conversation about their struggles in America, Teng says. began to feel differently that she was entering. , She began to notice that tackling certain issues, including race and immigration, was not prioritized in her clinical training – even though she knew how important they were in shaping her life.
“I didn’t get representation, and I didn’t feel like in my family history it was considered,” she says, adding that she was studying under teachers who were predominantly white. “I just felt the silence in my history [and] I have my own experience in the work I was doing.”
Teng’s graduate program is not the only one. Therapy in the US is a predominantly white field – 80% of psychologists, 63% of counselors and 59% of social workers are white, according to Data USA, a website that produces visualizations of public federal data.
Many of the founding ideas, techniques, and schools of practice of medicine were developed by white scholars or physicians. As a result, the field has marginalized the experiences of people of color, therapists, and patients. Microaggressions are also widespread in psychiatric practice, the researchers note, and many immigrants report not attending therapy because of language barriers, lack of insurance, and high costs.
So Teng wanted to take a new approach. For her, it means joining a growing movement of other counselors hoping to change the practice of therapy, to make it more accessible and relevant to people of color — and ultimately — to help them find treatment.
Embracing the Practice of ‘Decolonizing Therapy’
Teng was initially inspired by people such as Dr. Jennifer Mullan, who refers to this work as “decolonizing therapy”, a process of addressing structural racism and other forms of oppression that therapy brings to many marginalized communities. prevents him from serving.
Teng says, “I think the best way to describe decolonized therapy is that it’s really making space to examine the layers of external pressures, stresses, and oppressions.”
She gives examples of microaggressions in the workplace, or job interviews. “There are opportunities that are not given to you because of your identity,” she says, “but if we look at it through the lens of self-esteem, it’s like, ‘There’s something wrong with you. You just have to be aware of it. I need to think better.” yourself, okay? like you Need to be more positive.”
But for people of color, that framework of being “more positive” doesn’t always work. This does not account for racism, xenophobia and other forms of discrimination directed towards them. “The challenge,” explains Teng, “is to recognize that how you’re feeling about yourself can also be internalized oppression.”
Teng’s practice in decolonizing therapy digs into family history, helping her clients of color understand how their ancestors’ historical oppression affects them. She says this is true for people in her own community, who experienced genocide when the Khmer Rouge regime killed some 2.2 million people. “When we’re talking about Cambodian refugees and immigrants, there’s a history here that’s so terrible, rich, and devastating.”
Teng learns that the children of Cambodian refugees who have lived through the genocide may struggle with guilt. “Among first-generation or second-generation Cambodian Americans, it’s the experience that your parents gave up or went through a lot,” she says. “They have experienced tremendous loss. And keeping spirit of their sacrifices, we feel that we need to perpetuate that loss and that grief and that pain.”
Capturing a parent’s pain goes into tricky territory, says Teng. “We also feel that we have to overcome this by striving to be perfect or to be so successful that we’re becoming millionaires … versus actually dealing with the gentleness of grief, and the feelings that are being held And passing.”
using culturally responsive techniques
To answer these issues, Teng has developed a few approaches that are different from the way she trained. First, Teng often brings family into his practice.
“This may mean that we include parents in the sessions so that we can hear from their perspective,” she says. “When we’re in that space, there are so many opportunities to shed light on the effects of being a child of immigrants. And through that lens — being like a first-generation immigrant — we can discuss that loss.” Which is very much linked to the pitfalls parents navigate.”
Teng supports children and parents in openly discussing experiences such as racism and genocide in a safe and validating environment. She says that many survivors of the genocide had to suppress their feelings. “And so, when you have experience suppressing them [painful] Emotions, you’re also suppressing joy and connectedness, belonging.”
She says that letting her clients and their parents experience the full spectrum of emotions can be healing. ,[They] can allow positive connectedness and relationships to feel meaningful.”
Teng also works against the stereotype of the isolated physician-specialist. She makes it clear to her clients that she may not have all the answers, and prefers to be transparent with her clients about her own intergenerational trauma. “When we can be really together with the pain, we know we’re in this together,” she says. “I am part of this collective healing journey with my clients.”
Growing recognition of the role of historical trauma
Like Teng, Ramona Beltran became interested in decolonizing therapy because of the issues she was seeing in her native community. She identifies as Xicana of Yaqui and Mexica descent and is a professor of social work at the University of Denver.
When she was early in her career, many of her family members passed away before reaching the age of 60, and she asked herself what the connections were between the trauma of her community and her history of health.
When Beltran entered a doctoral program 20 years ago to study historical trauma, she was not taken seriously at first, she says — such as when she gave a few presentations on the theoretical framework of historical trauma and healing. “I remember this [presentation] Where they sent me feedback, and a lot of people said, ‘It’s political. It is ideological. This does not count as research. There is nothing empirical about it. It doesn’t sound like real academic work.'”
Now, Beltrán says things have changed, “I teach a whole class on historical trauma and healing, and it’s always one of those classes that fills up immediately,” she says. “And that, to me, is progress.”
When she was working on her master’s degree in social work, she says, she noticed that all the evidence-based styles of practice she’d learned in grade school weren’t enough.
“They were like this kind of mainstream approach to therapy coming from predominantly white, predominantly middle-class families,” Beltrán recalls. “And so maybe they will be translated into Spanish, but for me, what I was seeing was that those practices weren’t really generating much healing.”
Now that she teaches, Beltrán emphasizes that decolonizing can take different forms, depending on the experience of the therapist and the shared experiences of the community the therapist is trying to reach.
She highlights three key aspects of culturally responsive therapy: building authentic relationships, ensuring community representation, and reconnecting with one’s cultural background. Like Teng, Beltran is particularly interested in working with clients to see their culture as an intermingling power rather than a victim.
The Growing Need for Culturally Responsive Medicine
While therapists like Beltran and Teng are committed to making therapy more inclusive, communities of color continue to struggle to access therapists. Teng has too many people contacting her that she can’t help. “I’m only licensed to watch people in my area, and many people are interested. And it breaks my heart every time I’m not able to provide assistance.”
She notes that this is especially common for clients living in areas where few therapists are available. “I had one recently from Kansas, who was like, ‘We don’t have any Khmer therapists anywhere in the state.’ But, unfortunately, I am not able to provide that service.”
Teng knows what it’s like to lack access to medical care. “I don’t have a therapist of my own who practices the way I do until recently,” she says.
But recently there have been some steps in the right direction, Teng says. Organizations such as Inclusive Therapists created the BIPOC Therapy Fund to provide financial support for at least four initial sessions for people of color. The Asian Mental Health Collective also created the Lotus Therapy Fund to provide financial assistance to Asian therapy seekers for eight sessions.
And the largest professional organization of psychologists in America is promising to make a change, too. Last year, the American Psychological Association issued a formal apology for its role in “failing to promote, promote, and challenge racism, racial discrimination, and human hierarchy in America.”
The APA promised to support more research focused on non-Western perspectives, provide greater access to culturally competent training, and create more opportunities for people of color to enter the field of psychology. This August, the organization committed $1.1 million to a new Racial Equity Fund to meet these three goals.
Teng says she hopes to see more funds devoted to helping people of color access therapy that recognizes their histories and experiences.
“There’s no way we can just say we’re going to look at this from a cultural lens without really looking at it from a historical, intergenerational lens,” she says. “And so, it has to be comprehensive and interconnected in order to truly respect the human being in front of you.”