I am a Latinx (a person who is ethnically from a Latin American or Caribbean culture) living with co-occurring mental health conditions. It took quite some time for me to realize that my constant depressive state, trauma responses, insomnia and other symptoms all fall under the title of “mental health disorder.” I use disorder instead of condition because in my community, that is what it is called. Perhaps this confusion of terms is another reason why many do not come out as people living with mental illness.
I consider myself lucky. I learned about getting help for my deep anguish as a young person in high school. I am also queer, and in my late teens and early 20s, I found myself using mental health services without knowing that’s what it’s called. I didn’t know because I was connected to a multiservice agency for gay and lesbian youth in New York City.
I am now middle-aged. I realized some time ago that no matter how much mental health service I received, those who were providing therapy were not always culturally competent. They all assumed a standard therapy modality was going to work for me. Sadly, that was just wrong.
Why is Cultural Competency Important?
When I became middle-aged, my mental health declined, despite being in therapy with a trauma therapist. My therapist was a white woman who proclaimed to have worked with people with trauma histories. But she was less aware of the specific or “different” needs of a person with trauma that crossed many intersections. I don’t ever recall the therapist asking me about my racial or ethnic background, or understanding how I presented queerness as a Latinx person. I had felt for so long that no one understood me and that I was this strange, different person. And I could not endure the difficulty of a therapeutic relationship in which I had to do so much teaching.
Treating complex trauma requires many years of therapy focused primarily on safety and building a solid relationship between the therapist and the client. Unfortunately, the first therapist who attempted to deal with these complex issues could not handle the countertransference–or the emotional entanglement–with me and decided she was no longer going to work with me. This happened while I was an in-patient in 2010.
I left the hospital in search of a therapist. I looked tirelessly for a queer or person-of-color therapist, but I could not find one. I finally settled on a new white therapist who also focused on trauma but spoke a bit more about her version of intersectionality. I am still with this therapist, but also recently started with a black, male, queer therapist. I always am searching for the therapeutic connection of having someone who understands my background.
What Would Make Therapists More Culturally Competent?
I’ve learned that mental health providers still have a lot of work to do to serve people of color and people who cross many intersections, as I do.
For example, it is not okay for a client to have to explain every detail for why they are distressed when depression does not present in the same way as it might for majority culture folks. My depression has at times displayed itself as anger because not only am I physically depressed, but I am also up against a society and its constant barrage of micro- and macro-level aggressions that do not allow me to be merely depressed. I also have to face the fear of racism and other discrimination as I am trying to get better.
For those who are like me—looking for mental health services that addresses their cultures and backgrounds—let us continue to ask more of those who are charged with helping us maintain our mental health. Let us continue to ask them to:
Stop saying that people of color do not seek mental health services. Many people of color don’t access mental health services because they can’t find therapists who look like them or have a language that resonates with their cultural experience. I have never had a therapist or psychiatrist who was from my community or worked in my community.
Address race in therapy sessions.If your client is from another race and ethnicity, it is wise to address that in the first sessions. Making believe that we are all just one human race does not align with how our society actually views race.
Don’t rely on a translator. Providing a translator does not mean your words are being interpreted correctly. Translation and interpretation are two different things.
Update the therapeutic method to a person’s culture. Therapy modalities should reflect a person’s background and culture–especially because the expression of some mental health disorders in people of color may be slightly different than those of the majority culture.
At this point in my life, I am lucky that I have found a queer person of color therapist that I have formed a therapeutic relationship with. While my other therapists helped me when I needed guidance and psychoeducation about all my diagnoses, it’s also important to have a therapist who simply understands. Now it’s time for more folks from different intersections to come out and be therapists for those of us who struggle because we are not seen, heard or understood.
Sebastian Martinez is a queer, Latinx living in a small town on the East Coast. They are also a mental health therapist primarily working with youth and adolescents with co-occurring disorders, including trauma. Sebastian lives with the co-occurring disorders of Complex PTSD and MDD. They co-parent two children.
Originally published July 2019