Advice on Starting Therapy: Written for Queer Desis (possibly useful for other queer people of color as well)
BY Naushaba Patel
My therapy background:
I got cheap and free therapy starting when I was 18. I started because a friend of mine was dealing with an eating disorder and I met with her therapist to learn how to help support her, and then kind of stayed with that therapist, focusing on caring for that friend mainly but talked about myself as well. It was free school therapy with an older white woman, who honestly didn’t know what to make of my cheery disposition and exuberance and lots of friends and good grades- she missed how high functioning depression and trauma works. She didn’t really believe that I could have problems or trauma history because it didn’t show up in the usual markers it does for white folks (if you have a great looking life but don’t feel good inside, know you’re not alone). I got therapy with other white therapists at the second college I attended. Same problem. I was an A student who wore colorful clothes- and they made it feel like I was using up space for students with “real problems” (I had “real problems” that had also been accumulating my entire life- I was just really good at performance). I had two white women therapists at my Master’s program as well (free therapy via school again). Again, same story. Maybe it should have been a sign that five white therapists had explicit conversations with me about how they were worried that I wasn’t finding therapy with them beneficial. I think it was a mix of the fact that I knew I wanted/needed therapy, but they didn’t know how to help people with my life experiences/identities, and I really also didn’t know how to help myself by being able to put down my performance/self-defense armor. Then I qualified for free therapy at a queer friendly place, and again, got white therapists who didn’t really know what to do with me. The white therapists didn’t understand Islam. Had one therapist call my queerness a “phase.” One pitied my “oppressive culture.” One tried convincing me I didn’t have depression even though I met all the DSM criteria. Had one therapist tell me she felt I was “assimilating” and “trying on an American coat," and that it was like her daughter’s kneecap readjustment in that it would sort itself out with some minor adjustment shortly. While all of these are some pretty terrible therapy bloopers and I acknowledge therapy is a western medicine model with a ton of flaws, and often is an individualistic prescription for structural issues, and can also sometimes cause harm- I still can't recommend it enough to people as a support tool. I am incredibly grateful for the personal growth I have done through therapy, both in just taking that hour weekly just to talk about myself without being in care-giving mode, and to work over the years to build up greater self-awareness of my own emotions and get supported through a lot of challenging life circumstances.
Some advice (take everything with a grain of salt):
Beginning therapy is a huge step!! Congratulation!! It is super daunting, will take so much work and energy and you’ll hate it a lot of the time because of the revelations that you’d rather keep buried inside yourself. However, you can make the choice of when to go and when to stop and what you want to work on- and doing self-work is a radically brave decision to make that you should give yourself a lot of love and cool points for!! It is ingrained in us for generations not to share personal thoughts and feelings and to not talk about emotional struggles or traumas– we just ignore the symptoms and push through and that becomes such a practice in our cultures that anyone trying to change the cycle is often shamed and condemned. So be sure to validate yourself for wanting to do self-growth work with intention, even with all the shame and stigma! That is a huge deal!!
You do not need to share that you are seeking therapy with anyone. It is okay to lie about where you went/go, if you want and are able to do so. It does not make you a bad person. There are ways in which therapists offices try to sometimes work with you in regards to billing/coding if you share bank accounts with family members/partners. Be sure to ask.
It is okay to get or not psych meds! It is and should always be your choice. If your therapist keeps pushing you to see a psychiatrist, you have a right to tell them to stop! If you feel that using psych meds will help you, know that it’s your choice and it takes a lot of courage to take meds and they do not indicate that you are weak or messed up or any of the terrible things people say. I drink chai every morning and it has caffeine, which alters my brain chemistry! The same as eating chocolate or red bull or alcohol. Why shame chemicals that help you have a more stable life but be totally fine with other chemicals? Why that double standard around self-care chemicals? You do not lose who you are with meds! In the ideal world (though good meds cocktails are hard to get to), they should help you be a more present version of yourself! You on caffeine is still you! Same principle!
If you are a desi (queer) femme or woman, you are probably particularly socialized to handle difficult life situations without as much as an “uff,” and look glamorous in the process. We are particularly socialized to never show any flaw and to always be serving with a smile. That level of performative existence takes a toll on your insides. You, too, deserve to receive therapy and care. It is not selfish to care for yourself, as if you’re taking away from some finite resource (even if you’re getting free therapy from grants or school, I promise, you attending therapy is helping to pay for therapist’s salaries through these grants. So chill out!).
You are allowed to interview your therapists and see if you feel there is a fit. You’re allowed to trust your gut and instincts about the fit (but be sure that you’re listening to your gut about the fit with the person, and not the anxiety around trying therapy for the first time or talking to a new person in general. Your body could also be feeling hesitation not around the therapist in particular, but in the ask of you to be authentic and vulnerable in therapy. Trust your gut. And if you truly can’t figure out which it is, maybe try three sessions and then make up your mind).
It is normal to fear letting your therapist down. It is normal to want your therapist to like you and find you special. It is normal to feel a connection with your therapist. It is also normal to develop romantic feelings for your therapist. It is normal to question whether your therapist cares about you at all or whether you are just a random client for them. As someone who has been in therapy for many years and who works with many therapists at my workplace (I work at a mental health facility) and who has many case management clients, I wanted to share that therapists are regular humans with their biases and judgments but also that just because someone is getting paid for a job does not mean that they are leaving their emotions at the door. I see so many therapists who do genuinely care about their clients and think about them and worry about them outside of therapy in their own time. I see therapists thinking of and looking up ways to help clients in unique ways because of their care for their clients. Therapists also do develop fondness and irritation over clients- because again, they are human. But as someone with clients (though I am not a mental health provider), I know that even when I am overwhelmed and annoyed by certain clients, I still adore my clients over all, and wish the best for them.
Race and sexuality and gender (and other marginalized identities you might belong in) matter. Which of your identities matter to you more is based on who you are and what you are seeking at the particular time. We don’t live in a world where it’s very feasible for multiply marginalized folks to find therapists with similar overlapping identities- which is not ideal. So we often have to choose which identities we don’t feel well-equipped at this time to explain to someone who may have possible blinders around that identity of ours. It’s useful to ask yourself whether you’re in a space to handle microaggressions around a particular identity that the therapist may not share. For me, being misgendered (someone using the wrong pronouns for me) is annoying but doesn’t trigger me or deeply hurt me. However, someone calling my culture “uncivilized” or saying “third world country” is deeply hurtful in a way that I could not tolerate in a therapy setting. For me, as I was working more towards navigating my sexual identity more, it helped to have therapy in a queer affirming environment. At this particular time, explaining queerness and my Muslim identity feels much easier to me than explaining being a desi immigrant, and my need is of a therapist who is a person of color with trauma training, who is also queer affirming. And I recognize that my needs might shift over time, and that’s okay. I don’t need to stick to the same therapist forever.
Having a desi therapist is sometimes daunting when it comes to talking about things that are shamed in desi culture (similar for whatever poc culture you’re from, I think). It is hard for me to talk about sex or trauma or non-monogamy with my therapist because she is a Pakistani Muslim immigrant. As desis, we’re often culturally taught not to talk about these topics, and that pressure to hide those components from other desis is even stronger. I think what helps if you feel anxious talking about a particular topic with a therapist, is to tell them you’re feeling anxious around the topic and interview them about their comfort level and experience with those topics. However, sometimes, when beginning therapy for the first time, it might feel much easier going to a non-desi therapist, and I totally validate that decision. The last time I had a white therapist, during the first session, I told her I wasn’t sure I could trust her to understand my cultural experiences due to her whiteness and that made me nervous about starting therapy with her. She totally validated my concerns, and we worked together to figure out how we could collaborate on this journey best and in what ways could I inform her that her statements felt that they were coming from a place of whiteness rather than understanding of what I was saying. The thing to remember here is that therapists are not perfect! They are fallible, they have their own judgments and biases that pop up in how they might question your sharing or where they might push you, and you have the right to push back because it is their job to serve you and hold space for your identities in a nonjudgmental way. Sometimes, it’s worth working with a therapist to establish an understanding of your needs, and other times, if you feel that a therapist doesn’t get it, it’s okay to either choose to not talk about that certain topic with the therapist or to get a different therapist overall. I know for me, I was really worried about talking about non-monogamy with a therapist of mine because I feared her pushing back with questions that were rooted in me lacking commitment or some other ignorant reason. My therapist turned out to be super affirming, however, because that identity of mine is not a huge one for me to figure out in therapy, if I didn’t enjoy how she pushed back, I was prepared to not bring up the subject with her since I didn’t have much interest in teaching my therapist about how to becoming affirming towards non-monogamy- it just wasn’t that important for me. The point here is to choose what you want to discuss with your therapist, and figure out which topics are negotiable for you and which topics are things you need your therapist to have a better understanding over.
Sometimes, especially if we have very complex lives with multiple marginalized identities, it’s a natural tendency to just share everything all at once while being checked out/dissociated/numbed so you don’t have to relive your experiences. It is important to remember that your therapist is not entitled to your entire life story. You also don’t have to force yourself to share more than what you are ready for. You can also share all the intense things in your life with your therapist if that is helpful for you to have someone listen. But sometimes, we force ourselves to share more than we are ready for and then leave ourselves triggered. Somehow, it is not on the forefront of my mind that I am an immigrant all the time and the pains of that journey are not floating on the surface always. And sharing details for me often gets me lost in the past where I have to work to get back to my regular day, so I have to ask myself what I am willing to share with my therapist at what time and what purpose is that sharing going to have. Therapy is not meant to be a quick and easy fix- because we are not broken people. We are complex humans doing really difficult work around emotions. "Slow and deep" is often a phrase I keep reminding myself to remember around therapy work. As much as I have the tendency to rush through things in life at a faster pace than everyone else, therapy, of all things, is not a competition of best mental health or a race to get to "fixed."
Note: This blog post can also be found on Pseudo Polymathic Princess, posted April 4, 2019