Dear Patti, 

I’m Asian-American and my parents came to America from Hong Kong. Although I’m living on my own, I’m still extremely close to my mother. I’m very concerned about her, as it’s clear she has been severely depressed for a long time. She’s been to a doctor who has put her on medication and recommended a Chinese psychotherapist. My mother, however, refuses to go. Strangely enough, she’s willing to go to a Caucasian therapist because she somehow feels it will be more anonymous. Unfortunately, she’s very much ashamed of her situation. She has never been to counseling before and, were it not for her extreme condition, I don’t think she’d be willing to attend. If she has a negative experience, I doubt I could talk her into going to therapy a second time. I have some names of therapists that have been trained in cross-cultural therapy and plan on interviewing all of them. What exactly should I be looking for in a therapist for my mother?     

  — Maya

Dear Maya,   

While it’s mandatory that your mother see a psychotherapist highly trained in the treatment of depression, a professional that provides cross-cultural counseling should also be engaged in continuous training and education concerning your mother’s particular culture. Reading, classes, workshops, supervision and possibly even participating in intercultural activities and/or volunteer work are important in order to achieve professional competence in this area.

It’s the responsibility of cross-cultural psychotherapists to emotionally explore their own beliefs and prejudices. No one is culture-free, and cross-cultural counseling involves the norms and values of two cultures — that of the therapist and that of the patient. Psychotherapists need to be aware of any hidden assumptions they may be making that come from their own background. In order to be successful, therapists need self-awareness which acknowledges the values of their own culture; i.e., ethnocentrism, racism, sexism, homophobia, ageism and other prejudices. They need to be aware to the extent they have themselves internalized these norms. Otherwise, they might disregard aspects of their patients’ roots such as class, age, ethnicity, religion or gender. They may make the mistaken assumption that their patient is always the same as them and therapy might then be seriously compromised by countertransference issues of the therapists.

It’s important that a psychotherapist doesn’t automatically separate your mother and her psychological troubles from the personal culture she lives in and that she or he has an understanding of your mother’s behaviors and feelings. Your mother’s family, neighborhood, work, social networks and organizations, such as her place of worship or medical facilities, may have an impact on her when attending counseling.

It’s important that the therapist treating your mother ascertains the length of time she has been in this country, her degree of assimilation, her socio-economic background, family experiences and her educational level. Many questions need to be answered. How much of your mother’s personal identity is tied to her ethnicity? Is there preoccupation or denial of ethnic issues? Are there significant events that have happened in this area of her life which have impacted her? Is she isolated? During this time of life, what does she aspire? Does she have hope of reaching her goals? If not, what does your mother think the reason is?

Ethnic minorities frequently deal with the stress of acculturation and the continuous struggle to maintain dignity in the face of pervasive discrimination. Patients are often shaped by their encounters with the dominant culture. Racism, sexism and ageism are all realities and can seriously cause feelings of powerlessness, alienation, inferiority, subordination and deprivation. Feelings of grief, fear, anger and even rage may be present and need to be dealt with. If your mother is apathetic, angry or depressed, the counselor should look for psychodynamic causes but not overlook social reasons as well.

It’s also very important to be aware that clinical depression is twice as frequent among women as it is among men. Additionally, women from ethnic minorities are at particular risk because their life situations are often filled with experiences which can trigger depression.

Explain to your mother that it’s essential she feel comfortable and safe in therapy and that it’s perfectly fine and normal for her to personally interview a few therapists in order to find the correct counselor for herself.


Patti Carmalt-Vener, a faculty member with the Southern California Society for Intensive Short Term Psychotherapy, has been a psychotherapist in private practice for 23 years and has offices in Pasadena, Santa Monica and Canoga Park. Contact her at (626) 584-8582 or email pcarmalt@aol.com. Visit her website, patticarmalt-vener.com.