Embracing Cultural Context in Therapy | TheraWin Tales | Ep 1

[Music] [Applause] hi everyone and welcome to therawin Tales your One-Stop shop for exploring the beauty of culture and well-being I am sakshi Verma and we have weaved together heartwarming stories and expert advice to help you on your journey to well-being so today we have with us Geetanjali Vij who is a professional clinical therapist so Hi Geetanjali how are you doing today hi sakshi I'm doing well thank you for having me here thank you for joining us today and we're really excited to talk to you yes as am I it's a really important topic thank you so Geetanjali can you tell us about yourself your experiences your journey yeah absolutely uh so I am um a 1 Point 5 generation uh Punjabi American so for those who don't know that means that I uh immigrated myself but I was too small to remember anything from uh my homeland um and so I'm not first generation not second generation a 1.5 generation Punjabi American um I belong to a family that migrated um on a family basis not on a on a work basis uh and I think that's really important especially when we think about the Indian population um within California because when they immigrated makes a very big difference uh to different cultural contexts and and where they come from uh so I have been living in the Bay Area for many many years I am uh have always been committed to you know General Wellness mental health before we even truly started talking about it and had the context and so to that effect um have been for mental health for well-being and wellness um much longer than I've been in the mental health profession um because that's always something that that that was that big question mark and I always wanted to you know think about why and and what we do and and so so always an inquisitive child um I went to UC Davis uh for my undergraduate studies uh studied South Asian and Middle Eastern culture religious studies um have always kind of had that Curiosity um and wanted to think about how we function as a society um and so now I am in therapy and I I work with clients day in and day out um of various backgrounds uh throughout California thank you so much for Shar that I think you've had very you know great experience when it comes to a culturally competent mental health when we talk about so a Geetanjali what moved you to focus on immigrants and what do you see what are the struggles that moved you to focus on this era of mental health yeah absolutely I mean so I think it's important to recognize that um I I never made a conscious choice to focus on IM immigrant specifically um I think my aim in my work was always to provide culturally competent and uh accessible care whether it was any sort of roles I had before or my formal practice as a as a therapist and I focused or I'm able to work with the Immigrant population because I am the Immigrant population right uh my family immigrated in the 80s and 90s and um it's important to contextualize that because that was a time where you you know you wrote letters home you made calls on calling cards um very different than the access to you know being able to record a podcast across across the world at a moment's notice and so that framework meant that you held Community really closely together you leaned on each other much more and not just each other in terms of family and people of your culture um I had a very diverse background I'll give you an example of my parents my family in the 80s and 90s when you saw another person who looked remotely Brown remotely anything you gravitated towards them right so it didn't matter if they spoke the same language if they were Indian or you know Bangladeshi or Pakistani or Nepali you were just excited that it was someone they see or from the Homeland or South Asian there's different you know words use but now because there's so much variability and there's so much different there's all these subcommunities right um and so I do think that my philosophy in my clinical approach in my approach to my profession comes from that attitude of the collectivist um approach to Bringing communities together and making sure people feel supported yeah I think that's really important you know bringing everybody together and focusing on one thing that is really necessary that is mental health so Geetanjali when since you said that You' have migrated to us when you were I think two years old two or three yeah right so what changes do you see um in your whole journey right now when we talk about in 2024 how has mental health changed when we talk about it there and now especially in culturally context well I mean I can I can talk about this in you know for hours and hours this has been something that I've been uh touching on my entire career the reality is is the field of mental health and psychology has been evolving so much has been changing so much without even considering the cultural context right that when you add that factor and you add just as with everything else how globalized the world has become it's really important to recognize the ways both in which now therapy and the therapeutic field is inclusive to to people who either don't speak English or are not from Western cultures but also to recognize that there's a stigma right because there was a time where there was not an understanding towards someone who came from a different culture or someone who wasn't able to speak that language it was inaccessible and not just inaccessible it was something that was kept off limits right um the way you grieve right the way you heal that is all highly contextual it's highly um dependent on your family your ethnic background and if that didn't fit into the specific mold of what we used to know as therapy back in the day then that was considered as atypical and considered disordered right so ostracization was a big part of culture in general that has changed with globalization and so to that effect you know therapy is a field which I can't even say is the same now than it was a year or two ago right there is so much new research there is so much new technology new companies um such as this company that are trying their best to bring Equity to bring a voice to those who need the care right that all of that is changing the makeup of the of the field true yeah definitely it is changing you definitely right in this now when we talk about mental health and if we talk to our parents about mental they would say that it's a luxxury to you know have been thinking about it because when we talk about all these cultures all these say India somebody who has migrated to us from India they are so much uh more focused on Surviving there that they really don't think about their mental health that much so it takes a backstage um you know of their life and it's really great that now we're talking about it and the cultural context as well of it no absolutely there there is a concept called cultural humility right that is really important when practicing therapy with anyone right but it is something that you really have to build that muscle for when you're working with diverse populations right I cannot assume that by someone telling me the age the ethnic background the language spoken the city that someone comes from in India that I know their Journey that I know their experience that I know how their family or their society perceives mental health how they perceive mental health right the the country itself is so multifaceted that it's it's very counterintuitive from a therapeutic perspective to say hey here's a oniz fitsa right here's what's going to work for every immigrant from every country or every single person who comes from right in the context of providing Quality Care groundw work is extremely important right um that cultural humility piece walking into the conversation not allowing yourself to assume anything about the person right so I'm not assuming just because sakshi is from the Le that I know the type of socioeconomic status the type of familial background the type of social background that you come from right yeah we're not even talking about individual factors you know are you the oldest or the youngest or you're an only child you know have you had any adverse experiences have you had any trauma that is the real Crux of individual therapy right but before we even get there when we talk about the cultural context that cultural competency piece in really saying you don't know anything right so being a clean slate being able to have the person uh tell you what they want what they want from you and how they want it you know um we are we are here we are talking um in a conversational manner you're slipping in and out of Hindi and I'm and I'm slipping in and out of Hindi right um in a therapeutic space it's really important that I don't assume oh because this person is from here they will be more comfortable if I speak Hindi with them or because they are from uh Dilly then I'm going to assume that they carry the same values that someone I know from Dilly carries right so that bias is extremely important to keep in check and it's it's even more important when it comes to the context of someone who carries a background that identifies them by their name by their gender by all sorts of different things um before you know the their their immigration status right that defines you don't want to use that to assume anything about the person and you want to give them as open of a space and non-judgmental of a space as possible and so while that happens across the board for patients in therapy anyways it is much more acute and much more subtle when it comes to serving um any any diverse populations okay H yeah understood that is really informational I'm sure that I didn't know about it that one pocket doesn't definitely fit for all and we have to think broadly when we talk about people coming from different cultures right so gangel since you've talked to a lot of people like this what are the major struggles that they face um so the it really depends on which I think the biggest distinction I see is age right um is someone coming here as a parent in their retirement age and they're migrating on a visa on a family Visa basis right so they're coming here to be reunified with their family there's a question of of uh competency in English yeah right do they know English do they not know English that's the first piece of things outside of that you you can't assume that they don't know because often times people speak fluent English I mean we India is a country where you know uh even you know there's other countries where you go where the even the highest educated person is still going to be reluctant to speak English because they're going to say you speak our language right whereas with India it doesn't matter how educated what background someone's from there's a fundamental knowledge of basic English words please thank you yes okay right um and so to that effect everyone has a different comfortability with with English as a language um and again I can't assume that just because I speak the language someone speaks they're automatically going to prefer that and I realized earlier on my career in my in my um undergraduate experience that for myself I think when I think of work in English but when I think emotionally when I'm my internal my internal voice is in Punjabi right so so I get to make that distinction because that differentiation is not going to be the same for everyone right and so to that effect when you're talking to someone when you're taking in uh what they're sharing about them themselveses what their struggles have been you know where they are coming from being able to ask and and be very um flexible for for the person is really important language as as a uh not just as a linguistic barrier but as a comfort factor right is it enough for you just to have someone in front of you who has a you know uh Indian looking face or an Indian name do they have to language you speak do they have to understand the cultural context you know all of these things are very intimate questions that everybody's going to answer differently uh the other piece of this is in terms of how you approach establishing care with this person Beyond language is also assess for you know what are their clinical needs mean someone who has spent a lifetime of ostracization by family because of a traumatic incident or because of a history of sexual assault is going to not want to be with an Indian clinician because it reminds them too much and it elicits shame or it makes them feel overwhelmed right right someone else might want an Indian clinician because it would provide a corrective experience someone could have immigrated here for a master's degree or an undergraduate degree or as a as a high school student and been bullied by someone who was you know of any ethnic background and that reminiscing of it you know I know people of color who have been bullied by people of color you know people from their own communities people who've been bullied by in in the racist context by by other white students and that is all going to play into if they can establish that comfort with you or not and so to not take it personally and give them what they need which sometimes means if they if you're not the right fit and they're not comfortable with you finding them the right fit um all of these are are barriers right that's true okay so Gangi since we're talking a lot about you know like culture and mental health so are there any practices that uh therapists follow that are coming from these cultures say India or Japan do you follow any um core practices from the taken from these cultures I think my um choice to go into therapy as a profession uh comes from a very very personal philosophy um I grew up in a joint family system South Asian joint family system so the collectivist mentality that Indian cultures or Eastern cultures uh encourage internalized the ability to think Beyond myself right the ability to think about the greater good the ability to think about a concept of SAA right which is as a sck concept um in being Punjabi and the way my family is we have both Hindu and sik and arguably Muslim you know um influences in terms of culture and values and so the idea of being in a collectivist family and this idea of SAA right of of and and there's not even a good translation of it but the idea that you you do good not because you're trying to you know do community service and and get brownie points for it or get get something in return but the fact that your moral duty as a human being is to be able to do some part of serving your community your you know and Sai is not just about community service or you know serving uh strangers or about you know doing sa meaning cleaning up your Gully right sa also means you know um taking care of your parents taking care of your grandparents right serving someone when they're so that kind of Selfless Love selfless act of kindness and Care is something that is very Eastern it is it is you know American culture is very individualistic unfortunately with the way that life is structured here you're very isolated you live independently you have your own space which is great for some but it's also extremely isolating and so in that way being able to come together you know that's why there's individual therap there's therapeutic groups there are you know different modalities of therapy that emphasize that as social beings we're not meant to be you know isolated and we're not meant to be um functioning as in a silo we're meant to be connected to others we're meant to give and take in that way and so if you think about it that way collectivist societies have the right idea because collectivist versus individualistic well collect actually goes more towards what is a healthy sustainable life and of course the reality is it has to be a balance of both right because sometimes if you go too far into the collectivist then you're not allowing the person to have their individual identity and so walking that path you can't go in either extreme right because there is a need to have community and there's also a need to have your individual identity and journey um there's and then another really important thing which as a trauma Survivor uh for myself a very very lifechanging concept despite these things that I shared is this Japanese concept called probably going to pronounce it wrong with a name like Geetanjali apologize in advance there's a concept called uh kintsugi and kintsugi is the literal translation in Japanese is join with gold okay and it's this this idea that this is artwork it's it's it's a it's artistic approach where when a ceramic dish or pot is broken right you don't discard it you don't throw it away yeah uh what they do in that is that they actually piece it together and they fill in the crevices with with a kind of a gold shimmery material right which fuses it together and holds it back together again um and that process of breaking something to fill in the crevices with with something beautiful and and and accenting it right to then make it whole again right for myself and my trauma journey and for my my patients as well is really transformative to think about how we hold ourselves and how we think of the concept of being hurt or broken yeah and how we come back from that right right finding strength in those really deep broken moments um is is part of the essence of therapeutic work right right yeah and changing that narrative and so that particular concept for me really allowed me to kind of unlock that grief of hey if something is happening with you or something this is a huge for people stigma right um as as you tell someone someone's thing at there therapist they say what's wrong with them right what's wrong with you oh Mom I'm depressed oh what's wrong with you you know Dad I I feel anxious when you do this thing well what's wrong with you why can't you take it you know like there there's immediately this idea that if you're expressing a need that is different than normal that there's something wrong with you and so whether Western or Eastern cultures when you feel that pressure and you feel that shame being able to find a concept like this really helps you flip the narrative right be able to see yourself as something strong and resilient and a better version of yourself despite that break yeah right that's true and it's a beautiful concept right we see that if something I think it teaches us that when something is you know broken or if you're struggling with something it can always be fixed with how much care how much love you pour into yourself right and I think we should all see therapy or mental health as like this only it's about taking care of yourself it doesn't have to be that what's wrong with me every single time right yeah and and that's a that's a really really important thing to bring up um because it shifts the lens right you're 100% right that idea of if I go someone's going to think that there's something wrong with me or kind of admitting this is going to mean that I'm not just you know we we as South Asians culturally really Pride themsel they wear you know their their strengths and their weaknesses on their sleeve right so they really Pride themselves on resilience and you know hey I had a headache but I didn't take the medicine right I toughed it out um without realizing that the impact that that ultimately has on your system is probably more damage right so there is this this kind of denial or stigma whatever you want to call it but in that way what happens is the approach is then I am being diagnosed with this and it's it's like terminal diagnosis so so there's this idea that like if someone's telling me that there's something wrong with me right they're saying yeah right and it's either sane or insane insane and I and I can't accept that I'm insane right whereas the reality of talk therapy and the reality of mental health is we all have health we all have health problems problem we all have mental health we all have mental health problems right for some it's a small thing it's within their body's ability to maintain it like their immune system right they might get a cold it goes through the symptom but somebody who's immuno compromised or someone who you know is not able to process something the same way not going to recover and bounce back as quickly right and so we have a long way to go until we start seeing going to therapy as not as hey there's something wrong with me or that it's black and white but recognizing that as we move through life we have things that make us happy we have things that make us sad right the thing that will make your therapist the happiest is that they stop seeing you right just like your doctor your therapist does not want to hear from you they want to know that were able to help you you were able to build that resilience and you're able to move forward right so there's this idea of like you know the person's going to get me trapped in appointments and medications and this that and whatever right well that's Contra contraindicated to the goal that a therapist has the whole idea is that you don't need that hopefully at the end of the day you don't need me right yeah I think it's really important for us to see mental health as a spectrum rather than you know like just a two points that either you're sane or you're insane and as Indians we really fail to realize this and also come forward and express our vulnerabilities Gan what do you think why when we talk about people uh that are coming from these cultures they're very reluctant to share their vulnerability how I think it's a very very uh loaded question vulnerability is not seen as strength vulnerability as weakness right and across the board I think this is not specific to one Community or one both in Western and Eastern cultures arguably where you're taking more of a patri patriarchal approach which is quite common around the world right yeah um the the feminine the soft the emotional the vulnerable is not seen as strong it's seen as weak right yeah and until you acknowledge that you're not able to truly gauge in this space and or engage in any sort of care [Music] right and and and I think about my background and the people that I was raised by right my grandfather was born in 1940 okay he was the most vulnerable and open and S iens man I have met till date I have not met anyone born years after him in more Progressive more um educated more urban more worldly whatever you want to call it whatever people acate with with being feminist right he was a feminist he grew up in a small town arguably a village in Punjab right so there's this idea of dichotomies we set up right um strong versus weak Rich versus poor from being from the city versus being from the village you know being educated versus uneducated all of these things we set up schemas right so with gender the West has a very gender binary approach right that it's a b that's it right yeah but if you look at Indian literature Indian history Indian cultural mythology Indian even kind of the the ways that gods and uh historical figures are described right there's very little difference in how you know like like Krishan G is called sham Sund right a woman will also be called Sund right in in that case today I don't know about you but if I walk up to an Indian guy and I call him Sund he's going to say that was it's going to take offense to that right it's going to land it's not going to land in the way that you mean it right and that kind of like Boomerang effect of viewing the the South Asian the Hindu the Indian whatever you want to call it through a western lens and imposing a binary on it to things such as gender to gender roles to gender Norms right that is something that is the first hurdle um for someone themselves to approach therapy for someone to go up to a family member and say hey I'm not not feeling good about this I I want to talk about this or I need support with this um and certainly something that is unlearning those things is a big part of what my work with with uh clients is from the get-go uh do we see any differences in the way that a woman approaches therapy and a man you know comes forward and says that yeah we need therapy and typically if you talk about mental health in both of these you know genders or other genders how do they differ so I I I don't think it's fair to speak to everyone's narrative and make a blant statement but I will share my my journey and my experience okay okay I as I mention there there is a cultural Concept in anthropology where you know when when someone immigrates what they take with them you know sometimes they grow with their home country but especially for older folks and when times where there was such a divide and the country the world was not as globalized um there's this way in which you kind of freeze the home culture the home community in a way of preserving your history right you you kind of still think that the town you left the city you left the house you left you know when you leave your home right when you leave your home and you go on vacation you're thinking about how everything is set up because it's a sense of familiarity it's a sense of comfort right and then when you come back sometimes you know students leave for college and then their parents change their rooms to a gym right that hurts why because that comfort that loss is there so for my for for myself um as a woman in in a family where you know there there was a lot of uh patriarchal Norms a lot of um cultural perspectives that didn't change with the times because of when my family immigrated that you did have to push up against them I was the oldest of three girls right um the first thing is you would go to any G or Mand and some you would come up to one of my parents and say you have three daughters you should try for a son right or a then then they tell us right like hey pray that you have a brother right so so there it wasn't ever something that is overtly said but it comes out in these ways in in in different ways I you know I have to hand it to my parents be being the parents of three daughters being who they were the context and the background that they came from there has been no one who has been more empowering and has done more work than I have seen my my my parents do you know when someone came up to them and made a comment of that nature they didn't Flinch I didn't even see them have one moment of like yeah that person's right never right and that really empowered me as a woman to not just express myself but to be able to do so unapologetically hyper masculinity and patriarchy is arguably more dangerous for Indian men than it is for Indian women right because you know Indian women that struggle is identified right if I'm crying no one's telling me be a man don't cry right it is equally confusing to be a South Asian man as it is a South Asian woman because in both cases your gender identity is a box it's fixed right you are you are you know female you are supposed to have long hair you're supposed to know how to cook you're supposed to do XYZ you're male you're supposed to you're not you know the Masha i I cannot say enough about the Masha the movie okay the Masha movie is a great example of how patriarchical systems of how uh societal norms and expectations put equal amounts of pressure the person who was more Disturbed the person who was more uncomfortable in their skin in that movie was the male protagonist right right because they wanted to be artistic they didn't want to have to worry about being educated and being the bread winner and all of that so when I say I take a feminist approach to my my therapeutic care that's not saying I take a feminist approach only for those who identify as feminine but that I take an approach to identifying gender Norms across the board gender binaries are all things that hinder your ability to be yourself regardless of of what that identity is in the in the cultural context as it exists today yeah right it's it's a really great topic to talk about that how feminism right we are not just doing that for ourselves right we're doing that for our coming generation for our coming boys for our coming girls as well and it's a important topic that you put forward that how um mental health is and maintaining that masculine image of yourself is actually harming themselves right so I REM I get reminded of this one thing right we all say that our mothers have a lot of friends you know as women we have but I just can't stop thinking about that how many friends my dad has like that you know that who he can approach and share that hey I'm dealing with this thing and will you back up me uh if I go for support yeah and this is and and this comes up you know very very clearly when you think of the social context right whether it's siblings or friends unfortunately this is a a phenomena that I've seen both professionally and just in my experience with this community there are in the South Asian Community specifically there are so many instances where a man's best friend if not only female friend is their partner right and there's you know again back to my Bollywood Roots like there's the right yes you want friendship yes you want vulnerability yes you want Mutual care in a relationship right but everyone is it's not one-sized fits all right um for some people yeah their partner may be their best friend and and their and their partner and that's totally okay right every everyone has a different cup of tea but the leaning on the female partner and the female partner kind of carrying the emotional weight in the relationship is something that is a lot higher a lot more common in South Asian younger South Asian couples and older South Asian couples for that matter too um than it is in other across other communities and a big part of that is you know well hey I I who do I reach out to get my needs met well as a as a as a young Indian boy have a good relationship with my mom afraid of my dad I don't really have any other you know I don't have a sister I don't have any other influences I've been told to stay away from girls because God forbid I'd be walking home from school with a girl next to me and someone's gonna say something's happening there right so the idea of like community and perception is really toxic right um so then finally you get married and it's like all right hey you're my person here you go right yeah yeah right right and it I feel it really takes a huge tool on a woman right when they're in a relationship with they're married and especially in South Asian because all the responsibility is like yours you know you have to take care of your own mental health your partner's mental health your in-law's mental health and everything everybody is coming up say our example of our mothers right everybody is it's normalized yeah it's normalized it's like it's normalized yeah whenever something happens you always run to your mom and I think that shouldn't be just her task to do right we should have other uh significant people in our life and we should reach out to more people for that sake yeah there's a there's a visual um resource it's I don't want to call it a comic strip it's like it's told a narrative form with with um illustrations it's excellent um very easy to to consume as a piece instead of you know heavy clinical language there's this um piece that's called the mental load right so if you Google the mental load I don't know who it's by you might have to insert their name here um but it is a very very digestible very very clear look at the concept the exact concept as you're naming right what happens when the expectation and that weight is is disproportionate in in that in that um dynamic as a husband and a wife grew up in a home where my my Nani was the first person in her bloodline to hold a job outside of this outside of the home right she was a a full-time mom and a full-time teacher right she retired as a principal um after that my mom and my dad completely full-time you know making ands meet here as immigrants and whatever needed to be done they did it together right my dad we were three sisters so there was not this gendered concept of this is a western thing it's American thing I don't know if this is other uh in other places but like taking the trash out was seen as like a masculine like the brother's task right and my sister was taking the trash out once and someone said wow like you're the man of the house you're taking the trash out and we realized that because grew up as three girls and our dad said I'm gonna do this I'm not going to do this that we never we never inherited we never in gested that right so didn't see changing a tire or cleaning the car or grabbing a hammer and fixing the fence as oh I won't do that my brother will do that or my dad will do that and that is that's not just a South Asian thing that's cross the board right the division of labor in that way and that is it's every single family every single couple is kind of coming up against that differently um you know my my my own partner right I enjoy cooking right I cook I play Holy in the kitchen as my partner likes to say and he does the dishes right he does the cleaning Happ he does the dishes he is more you know they say like oh women are more clean women keep the house cleaner than men right in my experience that's not the case now when someone comes over when someone sees things they might comment on it right but there's no concept here of this is masculine task versus a feminine task and that is culturally there yes but it comes down to a very intim at the end of the day it comes down to a choice right it to an understanding and that is something that we have to make um you know we have to make that make that change for lack of better words on a Case basis yeah right so I think we're having a very you know deep loaded conversation about mental healthier so just Tove gone G exactly yeah so just to bring back the track and make it a bit lighter have you experienced any you know cultural works that people talk about mental health something funny cultural Qui probably my favorite thing about working with people who are culturally more theyy or culturally more Indian you know regardless of when they've come or have not come from from uh India is they are able to laugh at themselves a lot more easily right there is a much bigger role that humor plays right like how are you feeling well I'm not feeling good am I if I was feeling good why would I be here right or you know being able to say like yeah like I did that thing because you know that's just me right so there's a little bit more honesty and vulnerability through human that comes up um when you have folks who are culturally not as westernized their way that they think about themselves the family that they are in the culture and the community that they are in when it's less Western there's more of an ability to speak candidly and laugh and connect about your circumstances and that vulnerability is is a very um important and and utilizable Tool in therapy so I think that's what a quality that indans have they have a thing about lightening every situation be it you know whatever it ends that it is yeah okay so it's it's really great talking to you Geetanjali and we really um we learned a lot about mental health about culture about gender and we gained a lot of knowledge a lot of um confidence in the the context that we are talking about so thank you so much for being with us here today thank you yeah no absolutely the pleasure is mine is continue to do the great work that you're doing and and continue to have these conversations thank you