Life

What Therapy Looks Like When It Acknowledges People Of Colour's Experiences

Racism, colonialism, and stigma are common issues.

“They wouldn’t understand what was going on.”

Growing up, Shangaari Kanesalinkam believed this about the white therapists that were available to her. Kanesalinkam feared that her identity a second-generation Tamil-Canadian whose parents who fled violence in Sri Lanka — would be misunderstood, ignored, or worse, attribute of all of the problems she wanted to talk about to her upbringing. It wasn’t until she started going to counselling as an adult that she realized therapy centred for people who look like her existed.

“For me, it was helpful that my counsellors knew the issues that happened in Sri Lanka, and how traumatic the events must have been,” she said, emphasizing that they allowed her to share her story without assigning negative tropes to her community.

Those who are people of colour may want to seek care that takes into account the role race and culture plays in their life. But this might be challenging to seek. Nearly three out of 10 Canadians who need mental health care aren’t getting enough support, according to the last Canadian Community Health Survey — from those numbers, sufficient counselling was the least likely aspect of mental health care to be adequately provided.

Indigenous, Black, and people of colour who are seeking mental health counselling might want to address culture and race with their therapist.
Indigenous, Black, and people of colour who are seeking mental health counselling might want to address culture and race with their therapist.

While the jury’s still out on exactly how effective culturally competent treatment is, it’s having a positive effect; Mental Health Commission of Canada found that several reviews report patient outcomes improving when they receive it. Along with the need for culturally competent therapy is counselling that addresses racial discrimination; a systemic review found that experiencing racism significantly worsened someone’s mental health.

A fair bit has been said about the difficulties faced by people of colour going to therapy or finding a therapist from the same cultural background. But once your appointment has been booked, how can you ensure your needs are met?

First: is your therapist right for you?

Before getting into therapy, it’s important to consider what you want to get out of it and the options that are available. Can you afford to see a therapist in the long run, or will you need to access short-term counselling or group therapy? Is it important that your therapist share the same identity as you?

Arij Elmi is a social worker and counsellor from Toronto. She understands why many people feel it’s important to see someone who is Black and Muslim like her if that’s how they identify, too.

Arij Elmi is a counsellor at Hard Feelings, a Toronto-based collective that provides low-cost mental health services.
Arij Elmi is a counsellor at Hard Feelings, a Toronto-based collective that provides low-cost mental health services.

“There’s a concern that if they don’t, they’re going to do double work,” she said. “Double work” is a term Elmi uses for when a client wants to explain how their pain is relational to their family and community, but simultaneously feels like they have to protect their culture from being maligned or misjudged.

“Therapy is supposed to be creating space for insights. It should never be a space where you feel like you’re expected to act or make changes in a certain way.”

Therapists of colour interviewed by HuffPost Canada pointed out that their profession isn’t without its limitations. Psychotherapy is based on a Western, European ideology, with majority white practitioners teaching the few therapists of colour who enter the field. As such, some say that even having a therapist of colour isn’t a guarantee for meaningful connection.

WATCH: Five signs it’s time to address your mental health. Story continues below.

One therapist shared her frustration when she had gone through a training session where she was the only person of colour in the room and the educator failed to bring up race. Another remembers feeling conflicted when a client cried in the waiting room, overjoyed to see that their therapist was trans and shared a cultural background. The therapist was happy their identity made the client feel safe, but cautioned them that shared identity didn’t mean they couldn’t make mistakes.

Whether or not your therapist has the same background, everyone HuffPost Canada spoke to recommended interviewing therapists during your consultations together. In order to make sure your mental health professional can provide the services you need, asking them directly what their values are or what experience they have working with those of your background can speak volumes as to how later sessions can go.

“Therapy is supposed to be creating space for insights. It should never be a space where you feel like you’re expected to act or make changes in a certain way.”

- Arij Elmi

Ultimately, a cookie-cutter approach won’t fit everyone. Many therapists HuffPost Canada spoke to said that any advice they give would be tailored to their client. They cautioned against therapeutic advice that painted any community with a wide stroke. Kanesalinkam, who is now a social work student, can attest to this; inspired by her own experiences, she’s begun research into how specifically Tamil-Canadian youth understand mental health.

With all this in mind, here are some issues that could come up for explorations in therapy for clients of colour.

Microaggressions

Microaggressions are defined as frequent, sometimes everyday indignities. From loaded questions about “Where are you really from?” to touching someone’s natural hair without permission, these small acts take a toll.

When Elmi’s clients want to talk about how racism affects them, they often bring up a single incident that happened in their day. It’s usually accompanied by a statement very familiar to Elmi: “I’m so tired.”

USA Today reports that in a study of people going to therapy for race-related trauma, 88 per cent referenced microaggressions.
USA Today reports that in a study of people going to therapy for race-related trauma, 88 per cent referenced microaggressions.

Being able to interpret that statement is important, Elmi says. She notes that in her practice, she acknowledges that the microaggression is one incident in a lifelong series. For her, it’s important to make sure the client knows that the heavy burden they’re feeling is valid.

Internalized racism

Internalized racism may lead someone to distance themselves from their culture, in fear of how they are perceived. Acting white” or “being too Indian” is a worry Nikita Sehgal hears from many South Asian clients at her practice, Soutien Counselling.

“This is so difficult [to deal with] because your entire life, you may have been shamed for being a certain way,” she said. “I think a lot of people feel that they live double lives. They’re a certain way with their parents, but they’re a lot different with their friends. You always have to watch yourself for who could potentially shame you, so you’re always on.”

Nikita Sengal noticed that mental health issues may look different between her male and female South Asian clients because of their family roles. 
Nikita Sengal noticed that mental health issues may look different between her male and female South Asian clients because of their family roles. 

She says that instead of picking a side in their turmoil, a therapist’s approach for internalized racism should explore the emotion that the client’s beliefs evoke and how they react to the emotion.

“Am I feeling ashamed for who I am? And if I’m feeling ashamed about this part of my identity, do I feel that I have to police myself around my friends, or my family?” are some of the questions she says clients can examine.

Stigma

Some of the Chinese-Canadian clients who see qualifying psychotherapist Levana Lam have told her they wanted her services because of their shared background, believing she would understand the way they talk around their issues.

“There’s this kind of evasion,” Lam notes. “Even if someone’s depressed, you would never say that they’re depressed. They vaguely imply that they’re going through things and never address it. If you say it, it becomes real.”

Clients who have internalized stigma may appreciate hearing their mental health struggles named for what they are, in relation to their daily lives and inner thoughts.
Clients who have internalized stigma may appreciate hearing their mental health struggles named for what they are, in relation to their daily lives and inner thoughts.

She often finds that it’s helpful for her to debunk two stigmatized acts for her clients: the first is seeking support for something they can’t deal by themselves, assuring them that counselling doesn’t make them incompetent. The second is to help clients understand that mental illness has an impact on one’s abilities.

“They’re not just being lazy, they’re not just overreacting or being sensitive,” Lam says, as examples of misconceptions she’ll try to unpack about the effects of mental illness.

Colonialism

Settler-colonialism and its effects takes centre stage in Nicole Penak’s practice. An Indigenous therapist and social work professor, Penak notes that the root of her clients’ struggles is dealing with the fallout of colonialism in Canada.

“Not to sound hyperbolic, but it’s apocalyptic,” Penak said, going on to list a number of issues her Indigenous clients may be affected by, such as the the genocide on Indigenous women, girls, trans, and Two-Spirit individuals (MMIW>T), environmental crises, and the ongoing “scooping” of Indigenous children. “Those I work with are folks whose relationships have been ravaged by the way we organize society … colonialism isn’t just a sense of loss, it’s a real loss and grief.”

She recommends that if colonialism is something you’re hoping to address with your therapist, make sure whoever you’re seeing is aware that colonialism isn’t just something to theorize about, but a process that is ongoing even in your conversations.

For professor and therapist Nicole Penak, therapy as a framework itself needs to be assessed before a client wants to talk about colonialism's affect on their lives.
For professor and therapist Nicole Penak, therapy as a framework itself needs to be assessed before a client wants to talk about colonialism's affect on their lives.

“Our offices are not a sanctuary from capitalism, neoliberalism, or colonialism. They’re actually an expression of it,” she said. Penak explains that these ideologies have shaped it so that seeking mental health support is seen as an individual getting fixed in order to function in society, instead of acknowledging societal problems.

As Penak sees it, her role as a therapist for those managing colonial trauma is to be a temporary, formal support in lieu of those relationships one should have with their community.

“What is the remedy to [colonialism]? Is it coping as an individual? Or is it trying to restore some of those relationships that were severed?” she asks. “Community needs you as much as you need community.”

Group therapy can be healing

If exploring these issues isn’t accessible in an individual therapy session, you may find it beneficial to attend a group program.

It’s what inspired Alexa Joy, the 26-year-old founder of Black Space Winnipeg (BSW). She had heard from many Black people in the city that the connection between racism and mental stability within communities of colour was being missed in professional settings.

“Learning how to work through profiling, carding, all these issues that really affect your community aren’t addressed … there’s no focus on the institutional factors that contribute to your mental health,” Joy said about her city’s counselling services.

BSW started the group therapy program, Project Heal, as a way to address that gap for Winnipeg’s Black community.

In the program, she notes that it’s been particularly helpful for facilitators and participants to outright name acts of racism as what they are. Joy noticed that when someone would share a story, it would often follow with another attendee affirming that experience and then add how they’ve gone through the same thing.

Sessions for participants from Black Space Winnipeg's Project Heal explored fitness, health, police brutality, music, and art.
Sessions for participants from Black Space Winnipeg's Project Heal explored fitness, health, police brutality, music, and art.

Alternatively, participants also found they gained insight by sharing how they came from different walks of life. Some were newcomers, others were born in the city. Some came from Africa, others from the Caribbean. When the topic of colourism came up, how a participant related to it depended on their skin shade.

What kept many coming was the validation they felt from coming into a space that they could trust to share their truth with.

“One of our participants said, ‘We came in as strangers and left as family,’” Joy recalls. “I think that’s invaluable.”

Taking care of your mental health is critical — but there’s still a stigma about seeking therapy to manage your own wellbeing. In our series, “This Could Help,” we’ll explore how to get started with therapy and fit it in to your life and your budget. We’ll answer the questions you’ve been wondering, and show you the ways therapy can benefit you and the people you love. Whether you’re struggling or just want to make sure you’re on the right track, support is available, and it really can help.