Demystifying Psychotherapy: A Chinese-American Therapist’s Perspective

There are many misleading ideas about what therapy is and how the therapeutic process functions as a source of emotional support and stability in everyday life. It is understandable that there are also personal expectations and opinions of therapists in general.

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Common myths and misconceptions of therapy and therapists mostly come from misunderstandings and lack of knowledge which can oftentimes deter those who would like to begin therapy from doing just that. There are also many cultural aspects when thinking about why some would suggest that therapy is considered a bad or taboo topic.

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As we recognize and celebrate Asian American Pacific Islander (AAPI) heritage this month, it is important to recognize that there are many preconceptions about being in therapy from an Asian American cultural perspective. As a result, many individuals within the Asian American community who have considered or have been considered for mental health services have stepped away from the idea of seeking help.

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Many of these views stem from an underlying fear that seeking therapy automatically means that you are “crazy”, and that those around you would not just view you as bad, but also your family because of the emphasis that many AAPI cultures place on this value. The idea of finding external support might also contradict the value system of interdependence, which stresses the idea that family and community are at the forefront of meeting one’s needs. It is also important then to recognize the need for the AAPI community to understand the resources and benefits of having mental health support.

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Statistics for AAPIs

Because we are placing a focus on the AAPI community in this post, it will be helpful to have some understanding of the statistics of the Asian American population in the United States:

• The Asian American population has seen an increase by 72% between 2000 and 2015.
• As of 2019, about 6% of the U.S. population identify as AAPI at over 19 million people.
• Within that same year (2019), about 15% of the AAPI population reported mental health concerns at around 2.9 million people. 
• Serious mental illness has seen an increase from 2.9% (47,000) to 5.6% (136,000) in AAPI young adults between 2008 and 2018.
• Depression has increased by 3.6% in AAPI adolescents, nearly 2% in young adults, and nearly 2% in adults.
• According to Mental Health America, 8.1% of young adult AAPIs have had serious suicidal thoughts, 2.2% having a plan, and 1.8% making an attempt all in 2018.
• Substance abuse has also become more frequent in AAPI adults with mental health issues.

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For many in the AAPI community, feelings of doubt and unsureness can be commonplace when thinking about mental health services. People within the culture can feel uncertainty and discomfort about seeking external help for something that is happening internally.

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In this post, I will place an emphasis on some common preconceptions from the Chinese community specifically in order to understand the stigma surrounding important mental health needs. As a member of the Chinese American community, I believe that it is crucial to have an understanding of the misconceptions and beliefs about mental health within the community and the need to have such support.

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Common Themes and Beliefs

While many thoughts within the AAPI community might center around the idea that mental health issues are a Western concept, it is important to acknowledge that just like physical ailments, mental health affects everyone. Many AAPIs might try to justify beliefs that are untrue and walk away from the importance of taking care of the mind. Here are some of the walls that can lead to not seeking therapy for many Chinese people:

1. The “Power Through It” Philosophy

It is a common theme in Chinese culture that if things get difficult, the ideal solution is to “tough it out” and “power through” the struggle. The idea here is not unlike sweeping things under the rug; but eventually the rug will give out and we fall. More often than not, expressing emotions to an outsider like a therapist can be seen as a sign of weakness from the individual.

With this theme in mind, many Chinese people place it among themselves to keep strong and push away the idea of seeking professional support from third parties. However, being able to have a third party’s perspective to talk through certain topics can help us understand why, for example, we might place a heavy importance on getting through things on our own. Likewise, insight can also be gained on the impact that this mindset has on you.

2. The “Model Minority” Myth

This myth strongly enforces the idea that Chinese Americans, and all AAPIs, are integrated into Western culture, intelligent, successful, and have overcome racial biases. As a result, this stereotype places a strong expectation among AAPIs to act a part of Western culture. This misconception of AAPIs can also encourage them to hide away their historical backgrounds, deny the possibility of not being okay and are experiencing issues with mental health. 

The overwhelming violence recently intensified in many Chinese communities in the past few years would also suggest this myth as false. There are many issues that members of the AAPI community face that would validate the need for emotional support and to be able to express oneself vulnerably in a safe, therapeutic space. Even as violence may be experienced in their everyday lives, many in the Chinese community would still feel fear of seeking professional help for their own traumas in order to keep with the idea that they are “okay”.

3. Burdensome to Share Personal Feelings

Emotional vulnerability can often be perceived as a weakness or as complaining; making little effort to resolve problems. In many AAPI families, children may have been disciplined to control or hide their emotions. A strong expectation is to keep progressing regardless of the feelings we have in order to not be a burden towards the family household or others.

Although being emotionally vulnerable can be understandably difficult at times, learning insight and receiving emotional support from a mental health professional can be a strong source of validation for what we feel and experience. With the preference for self-reliance, some research has also indicated that this can result in stronger deterioration of one’s mental health without proper support.

4. Saving Face

One of the more crucial reasons for the lack of help seeking within the Chinese community is the value of face (面子: miàn zi). An important thing to understand about this issue is that while it can be difficult for anyone to speak of difficult issues in their lives, this is a deep value system within Chinese culture. Saving face ultimately means to not be put in a position of shame. It places focus on how we are subjectively perceived by others. That if someone were to discover that someone in their community were seeing a therapist, for example, that individual might be perceived as weak and placing shame on their family for not being able to solve the issue on their own or privately. So not only is the theme of saving face about the individual, but it also involves family, honor, and social standing.

5. Lack of Proper Resources and Understanding

Much like the views of societal standards and professions, many in Chinese culture have high expectations on those who are in the helping profession such as doctors and therapists. For some that do seek mental health support, a quick fix and looking towards the therapist to know the solution to every problem within one meeting is also part of that high expectation; along with the issue of insurance and financial concerns. It is important then to recognize the very  different cultural standards and expectations for those who are seeking counseling and therapy.

It can also be difficult for Chinese people to find a therapist who speaks the same language that they do. While Chinese itself is the name of the language, there are many different dialects in this umbrella that would make it difficult for someone to find someone who speaks their common dialect. Such that while some dialects might be mutually intelligible, others are not. It can be more comforting for Chinese Americans, for example, who speak Cantonese or Taishanese, respectively, to find a therapist who also understands and speaks that respective dialect as a way of finding mutual ground for community and connection.

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Closing Thoughts

In raising awareness for why mental health support is important, breaking through the barriers that prevent the Chinese American community from fully being able to utilize such support is also an important issue to discuss. This comes especially true as there are many myths that would have  members of the Chinese community reconsider seeking professional support.

While there are numerous Chinese identifying therapists, there are also members of the Chinese community that understand the need for mental health services and are willing to reach out. But there are also many who would consider other methods to be more effective and less shameful before seeking mental health support. As a result, negative stigmas can still impact the ability for many to seek help.