Cambodian American Eden Teng was born in a refugee camp on the Thai-Cambodian border just a few years after the Cambodian genocide. She moved to the USA with her mother and aunt when she was 6 years old.
Teng credits much of her own resilience in moving to the U.S. to her exuberant mom, who wore whatever she wanted and wasn’t afraid to defy social norms — even when it was embarrassing for the teenage Teng.
But growing up, Teng also witnessed the negative impacts of historical, racial, and intergenerational trauma on her mother’s well-being. Teng often felt confused about how her mother’s emotions could spiral out of control for seemingly 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 hypertension, diabetes and kidney disease.)
It was this realization that drove Teng to become a therapist; In 2018, she started graduate studies in Seattle.
But when COVID-19 broke out and the Black Lives Matter movement took hold, and communities of color spoke more publicly about their struggles in the U.S., Teng says she began to feel differently about her education and the profession she would pursue. She began to notice how addressing certain issues, including race and immigration, had not been prioritized in her clinical training—even though she knew how important they were in shaping lives.
“I didn’t feel represented, and I felt like a lot of my family’s history just wasn’t taken into account,” she says, adding that she studied under teachers who were predominantly white. “I just felt silenced in my own history [and] my own experience in the work I did.”
Teng’s postgraduate program is not the only one of its kind. Therapy is an overwhelmingly white field in the US — 80% of psychologists, 63% of counselors and 59% of social workers are white, according to Data USA, a website that constructs visualizations of public federal data.
Many of the basic ideas, techniques, and schools of therapy were developed by white scholars or practitioners. As a result, the field has marginalized the experiences of people of color, therapists and patients say. Microaggressions are also widespread in psychological practice, the researchers note, and many immigrants report not seeking therapy because of language barriers, lack of insurance and high costs.
That’s why Teng wanted to take a new approach. For her, that meant joining a growing movement of other counselors hoping to transform the practice of therapy, make it more accessible and relevant to people of color, and — ultimately — help them find healing.
Accepting the practice of ‘decolonizing therapy’
Teng was initially inspired by people like Dr. Jennifer Mullan, who call this work “decolonizing therapy,” a process of addressing structural racism and other forms of oppression that prevent therapy from serving many marginalized communities.
“I think the best way to describe decolonized therapy is that it really creates a space to examine the external pressures, stressors, and layers of oppression that my clients have endured and survived,” says Teng.
He gives an example of microaggression in the workplace, i.e. a job interview. “There are opportunities that aren’t given to you because of your identity,” she says, “But if you look at it through the lens of self-esteem, it’s like, ‘There’s something wrong with you. You just need to think about yourself better, right? Like your we have to be more positive.”
But for people of color, that “more positive” frame doesn’t always work. It does not take into account racism, xenophobia and other forms of discrimination directed towards them. “The challenge,” Teng explains, “is to recognize that what you feel about yourself can also be internalized oppression.”
Teng’s practice of decolonizing therapy digs into family history, helping her clients of color better understand how their ancestors’ historical oppression affects them. She says this is true for people in her community, who experienced genocide when the Khmer Rouge regime killed an estimated 2.2 million people. “When we talk about Cambodian refugees and immigrants, there is a history here that is so horrific and rich and devastating.”
Teng finds that the children of Cambodian refugees who lived through the genocide can struggle with guilt. “Being first or second generation Cambodian Americans, there’s an experience that your parents have sacrificed or gone through so much,” she says. “They’ve experienced a tremendous loss. And having that sense of their victimhood, we feel like we have to hold onto that damage and that grief and that pain.”
Holding on to parenting pain leads into tricky territory, Teng says. “We also feel that we have to overcome it by being perfect or striving to be so successful that we become millionaires … instead of really being with the tenderness of sadness and the emotions that are held back and conveyed.”
Using culturally appropriate techniques
To address these issues, Teng has developed several approaches that differ from the way she was trained. First, Teng often brings family into his practice.
“This may mean bringing parents into meetings so we can hear their point of view,” she says. “When we’re in that space, there’s a lot of opportunity to shed light on the impact of being a child of immigrants. And through that lens—being someone like a first-generation immigrant—we can talk about the harm that’s very much connected to the harm that the parents suffered.”
Teng supports children and parents in openly discussing experiences such as racism and genocide in a safe and valuable environment. He says that many who survived the genocide had to repress their feelings. “And so, when you have the experience of suppressing those [painful] emotions, you also suppress joy and connection, belonging.”
Allowing her clients and their parents to experience the full range of emotions can be healing, she says. “[They] it can enable positive attachments and meaningful relationships.”
Teng also works against the stereotype of the detached therapist as expert. 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 really be with what’s hurting, we know we’re in this together,” she says. “I am part of this shared healing journey with my clients.”
Increasing acceptance of the role of historical trauma
Like Tengo, Ramona Beltran became interested in decolonizing therapy because of the problems she encountered in her community of origin. She identifies as Xicana of Yaqui and Mexican descent and is a professor of social work at the University of Denver.
When she was early in her career, several members of her family passed away before they reached the age of 60, and she wondered about the connections between her community’s history of trauma and their health.
When Beltran began her doctoral studies in historical trauma 20 years ago, she was not taken seriously at first, she says—such as when she gave some presentations on the theoretical framework of historical trauma and healing. “I remember this [presentation] where they gave me feedback, and several people said, ‘This is political. It is ideological. It does not count as research. There is nothing empirical about this. This is not like a real academic paper.'”
Now, Beltran says things have changed, “I teach a whole class on historical trauma and healing, and it’s always one of the classes that fills up right away,” she says. – And that, in my opinion, is progress.
When she was working on her master’s in social work, she says, she noticed that all the evidence-based practice styles she learned in graduate school weren’t enough.
“They were like these mainstream approaches to therapy that came from primarily white, primarily middle-class families,” Beltran remembers. “Maybe they will be translated into Spanish, but what I’ve seen is that these practices don’t really generate a lot of healing.”
Now that he teaches, Beltran emphasizes that decolonization can take many 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 sensitive therapy: building authentic relationships, ensuring community representation, and reconnecting with one’s cultural background. Like Tengo, Beltran is particularly interested in working with clients to help them see their culture as a form of intergenerational strength rather than suffering.
The growing need for culturally sensitive therapy
While therapists like Beltran and Teng are committed to making therapy more inclusive, communities of color continue to struggle with access to therapists. Teng has a lot of people who she just can’t help. “I only have a permit to see people in my area, and there are so many interested. And it breaks my heart every time I’m not able to provide support.”
He notes that this is particularly common for clients who live in areas with few available clinicians. “I recently had one from Kansas who said, ‘We don’t have any Khmer therapists anywhere in the state.’ But, unfortunately, I am unable to provide that service.”
Teng knows what it’s like when you don’t have access to therapy. “Until recently, I didn’t have my own therapist who practiced like I did,” she says.
But recently there have been some moves in the right direction, says Teng. Organizations like Inclusive Therapists have created the BIPOC Therapy Fund to provide financial assistance for at least four initial sessions for people of color. The Asian Mental Health Collective has also created the Lotus Therapy Fund to provide financial support to Asian therapy seekers for eight sessions.
And the largest professional organization of psychologists in the USA is also promising changes. Last year, the American Psychological Association issued a formal apology for its role in what it called “the promotion, perpetuation, and failure to challenge racism, racial discrimination, and human hierarchy in the United States.”
The APA has pledged 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 implement these three goals.
Teng says she hopes to see more funding dedicated to helping people of color gain access to therapy that respects their history and experiences.
“There’s no way we can just say we’re going to look at this through a cultural lens without actually looking at it through a historical, intergenerational lens,” she says. “And so, it has to be comprehensive and interconnected to really honor the human being that’s in front of you.”