Eliza McBride, MS, NCC
A Few Therapy FAQs for Fil-Ams
Updated: Sep 13, 2021
As a Filipina-American therapist, I come across a lot of questions from other FilAms about therapy. Here are a few that I wanted to take the time to answer this week.
[Note: I'll be using the term FilAm as a shortened version of Filipino-American, Filipina-American or Filipinx-American.]
What is therapy?
Therapy is a confidential space where people (usually referred to as clients or patients) can talk about mental health issues with a professional. Topics may include processing anxiety related to work and school, feelings of sadness and depression, or family dynamics that are causing distress.
Therapy includes working with a trained and certified clinician who completed a graduate degree in a mental health-related field (i.e. psychology, counseling, marriage and family therapy, clinical social work, etc.), a national and/or state licensing exam, and several hundred/thousands of hours of supervised clinical work. Some medical doctors or nurse practitioners who specialize in psychiatry can also provide therapy. Therapists and counselors complete continuing education trainings to keep their credentials active and may specialize in things like trauma, addiction, eating disorders, grief and loss. Usually clients and clinicians are matched depending on what clients need help with at the time of service.
I know FilAms can be skeptical about going to therapy or counseling, but think of it as similar to going to the hospital if we need medical attention. If we notice that we’re not feeling physically well and home remedies haven’t worked, we usually check in with a medical professional to help us figure out additional steps for recovery. The same thing applies to when we’re not feeling mentally or emotionally well – it helps to talk to a trained professional so we can learn new insights and come up with strategies to help us feel better.
If therapy is just talking, why can’t I just talk to a family member or friend and call it good?
While talking is a part of therapy, there are also many different components that are necessary to make therapy work. The first is confidentiality – therapists are ethically and legally bound to keep client information private. The only exceptions are related to mandatory reporting, like if someone from a vulnerable group is being abused (i.e. kids, elderly, or people with disabilities), or if a client or patient is at serious risk of harming themselves or someone else. Other than mandatory reports, everything processed in sessions are between the client and therapist.
Why is this important? Because it means that if you talk to your therapist about personal struggles, then it likely won’t spread to your mom, Lola, Lolo, Tita Barbie or Uncle Boy. Family and community are huge components of FilAm identity (for better or for worse), and while involvement from family can be helpful, it may also be harmful – especially if the sources of distress stem from cultural community and family-of-origin. It helps to talk to a therapist who is a third-party person, with no personal history with you, and is ethically bound to keep conversations private.
Another important thing to remember is that therapy isn’t “just talking” – therapists often ask clients what their goals are for therapy, and then use their clinical training to create treatment plans to help clients work towards those goals. An example can be learning coping skills to help decrease panic attacks from 5 times a day to just 2 times a day, to eventually none. Or helping someone process grief related to a recent loss of a loved one – giving them space to talk about their feelings and creating self-care plans so that the sadness and depression feels manageable. Other goals can include simply having a safe space to reflect on topics like managing anxiety around religious identity or cultural identity, or identifying patterns in beliefs and behaviors that clients hope to change.
Once again, talking to a family member or friend can be helpful at times, and I always recommend having a support network. However, if we need a confidential space and help from a trained professional, therapy and counseling are necessary.
My Lola says that time heals all wounds. Do I need therapy if I can just wait something out?
Lolas (grandmas) are full of wisdom, and I appreciate the things they do to help their loved ones. Yes, time does help with healing – and sometimes we need extra assistance. One of my favorite analogies is healing a wound with dirt in it – we can try to ignore the dirt and just let the wound heal naturally, but if we don’t clean the wound it will get infected and take longer to heal. Think of therapy as the cleansing agent for the emotional wounds we’re walking around with. Cleaning a wound can hurt like hell, and it’s understandable that most of us would want to avoid it. However, when we give ourselves the opportunity to go through the “cleaning” process, we begin to realize that we don’t need to postpone our healing or walk around in pain.
Sometimes we postpone our healing and walk around in pain for centuries – this is generational trauma, often caused by colonization, war, impoverishment, abuse, internalized oppression and self-loathing. All of these things show up in FilAm history and culture and impact how we view ourselves and navigate the world around us. We are taught to keep trauma secret and hope that it will disappear, not knowing that trauma thrives in secrecy. Healing requires openly identifying, acknowledging and processing what has happened to us as individuals, family units, and cultural communities.
There is a powerful quote by Maya Angelou where she said that “there’s no greater agony than bearing an untold story inside you.” In therapy we get to share our stories and hopefully move towards feeling like we have a firmer grasp of our own narrative, growth and healing.
Can I pay you in lumpia and ube ice-cream? Why is therapy so expensive?
This is really tempting, but unfortunately, I can’t accept food as payment at this time (I’m also not able to accept expensive gifts on ethical grounds.) I know finances can be a barrier to getting mental health services, but there are options for low-cost or free therapy – usually at clinics or non-profits where graduate students are completing practicum or internship, or at agencies and providers that take insurance. The caveat with these options is that the waitlist may be long, and it may be challenging to find a culturally-responsive therapist. Additionally, processing with insurance often requires a diagnosis code that will stay on your medical record (some people are okay with this, others are not. It just depends on what you want.)
A lot of practitioners in private practice, like myself, charge at rates to reflect the amount of experience and specialized training we have, and in accordance with cost-of-living for our geographic area of practice. Private practitioners can also provide a superbill or receipt that clients can process with their insurance companies – as mentioned above, this would require a diagnosis code on record with insurance, and there may be conditions for how many sessions insurance will cover. Like many therapists, I offer something called “sliding scale” where I reserve a number of spots for clients who need a discounted amount for a certain number of sessions. I also encourage people to consider every-other-week or monthly sessions if they feel this works for them, and if clinically appropriate.
Therapy is a health-related expense, but because there’s so much shame and stigma around seeking mental health services, we’re not quite at a point socially where it’s seen as vital or worth the cost – even though research has shown that therapy can be life-saving, or at the very least, improve quality of life. Hopefully we can move towards a space where we all realize that mental healthcare is essential, and more resources are made available to make it more accessible.