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Occupational Therapy

EMDR Therapy and AAPI Populations

It is Asian American and Pacific Islander (AAPI) Heritage Month, a time to recognize and celebrate Asian, Pacific Islander, and Native Hawaiian talents, diversity, and contributions. One month could never adequately address the impact and backgrounds of such a diverse group of people, so EMDR therapists with clients of AAPI heritage are urged to continue seeking information and attending cultural events to familiarize themselves with the unique aspects these clients might bring the therapy room. It is important to recognize and understand the ways in which AAPI people have been and are treated in the U.S., both positively and negatively, and to examine societal trends, hierarchies, privileges, and erasures during various times and places in U.S. history. It is also necessary to recognize the current need to have real conversations about race, culture, and intersectionality in all contexts where we live, play, and work. Although AAPI Heritage Month is a time to share, celebrate and honor people with AAPI and Native Hawaiian heritage, learning and engagement around culture, anti-racism, and social justice are best undertaken at all times of the year.

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“What is something you would like EMDR therapists to know about Asian American and Pacific Islander populations?”

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We asked EMDRIA members and EMDR therapists this question. Here are their answers.

“Be an ‘anthropologist’ when working with an Asian American and Pacific Islander client. Graduate school training in the U.S. primarily focused on defining what it means to be a human with mental health struggles from a western perspective which tends to have individualistic norms. Meanwhile, this group of people may be influenced by collectivist norms due to their cultural systems. In Phase 1, ask the client’s permission to do a genogram and be curious about their kinship systems, rules, and patterns. Trauma related to their family of origin may have different meanings, so be curious and be an anthropologist.”*** Sheba Shobashini Andrew, LCSW

“1. Asking for help may not be easy because of the need to appear that all is well. This may be influenced by the need to live up to society’s expectation of being the model minority and the cultural value of controlling one’s emotions and not disclosing/sharing one’s struggles with non-family members. So this essentially means that it takes a lot for AAPIs to seek therapy (especially older generations), and if they do, therapists should work on preventing premature termination/dropout. 2. Shame and the need to ‘save face’ can be another deterrent to seeking help. Experiences of being discriminated against or treated unjustly are more likely to conjure up shame rather than anger or the need to retaliate. This shame can be internalized and contribute to low self-esteem etc. They may struggle with feeling empowered to stand up against injustice. 3. Having to meet high family expectations is typical stress for many AAPI. Often parents depend on their children to succeed in order to reflect the family’s overall standing in society. There is a lot of pressure on AAPI to excel and financially support their parents. Parents may live vicariously through their children. AAPI parents compare their children’s academic and professional successes.” *** Dr. Joyce Baptist, LCMFT

“If I can only pick one of the most critical attributes of this population, transgenerational trauma and the transmission of the transgenerational trauma. Many Asian American descendents tried to ‘fit in’ by being model citizens and “not to make trouble.” In the meantime, the family rules such as obedience, and criticism as a way to show love, continue to pass on to the next generation without verbally communicating it. As a result, many therapists can’t understand why a client with high academic or career performance has mental health issues and low self-esteem. Because the family trauma often happened before the immigrant generation came to the U.S. (such as in Vietnam, Cambodia, Korea, etc.), the therapists often overlooked the transgenerational trauma the family tried to bury in the past. Many therapists are also confused about the client’s family rules that didn’t seem necessary or fit the mainstream culture.” *** Grace Chen, PhD, LMFT, EMDR Consultant-in-Training

The Asian American and Pacific Islander (AAPI) diaspora is extremely diverse and represented by many cultures, languages, and backgrounds. The AAPI population is not a monolith. Throughout the COVID-19 pandemic, many Asian Americans have increasingly pursued EMDR therapy to process racial trauma and the rise of experiences of anti-Asian hate. As a result, as EMDR therapists, we need to be ready and equipped to provide multicultural and culturally sensitive EMDR therapy services for clients.” *** Jaja Chen, LCSW-S, CDWF, EMDRIA Approved Consultant

“As a 51 y.o. Korean American who was adopted at age 4 by one caucasian parent and one Korean relative who felt the need to ‘white wash’ and enculturate me into white America. I don’t remember much of my Korean heritage and have been identified by others as Asian. This experience created a sort of cognitive dissonance internally, and I have struggled until recently to find my racial identity. I have recently reconnected with my Korean heritage, and my daughter, who is 31 years old and has lived in Korea for three years, has helped me embrace both cultures and to be proud of both cultures. I hope that I can inspire others to understand and learn to validate and accept that we don’t have to choose either culture as better or less than the other, as many of us have been taught, and we can embrace both cultures as unique and special and that they are not mutually exclusive.” *** Dr. Yun Gardner

“As a Certified EMDR Therapist, an Asian American, and a Filipina in heart and mind, we are a culture that values and regards faith and God as a strong and stable resource within our lives.  Bringing the elements of God and Jesus in resourcing can be a powerful element of healing.” *** Doreen de Leon Hills, LPC, EMDRIA Certified Therapist and Founder, Executive Director for Healing Trauma and Attachment

“Shame: In some Asian and other collective cultures, shame plays an essential role in childrearing and parenting. Getting ashamed is often how we learn that our behaviors or emotions are not acceptable. Unfortunately, many of us internalize and over-generalize the shame and grow up to live with our worst enemy in our heads that attacks who we are as humans. The shame from reflections on our decisions on the family and communities often becomes the inhibitor when we try to pursue autonomy. So, learn about how shame affects your AAPI clients, understand the strong internal shackle we have lived with, and help us feel accepted unconditionally.” *** Kyungah Kim, LPC in Colorado

“Thank you for celebrating Asian American and Pacific Islander Heritage Month. I’m a Filipino immigrant who works with Asian American and Pacific Islander populations. Here’s something I find helpful when working with Filipino or Filipino-Americans in particular: It’s helpful and essential to incorporate culture and history when providing therapy. Doing a genogram is a valuable tool for understanding the family dynamics. Filipinos are a collectivist-centered community, hence a lot of comparisons between relatives. It’s also helpful to incorporate values such as ‘pakikisama,’ which means ‘getting along with others’ and entails the value of group harmony. There’s a stigma that one is either weak, crazy, or spiritually lacking if one needs mental health counseling. Seeking help for mental health is often the last option on one’s list, and quick fixes are often expected. Hence, EMDR therapy is an effective approach to meeting their mental health needs. Go with it.” *** Kelly Koken, LMFT

“Something I would like EMDR therapists to be mindful about regarding Asian American and Pacific Islander populations is the level of hate crimes and anti-Asian sentiment that has unfolded in the past couple of years since the pandemic began. I am an Asian American EMDR therapist located in San Francisco, California. I was shocked when our police department released preliminary figures showing a 567 percent increase in reported hate crimes against Asian Americans and Pacific Islanders during 2021. Fortunately, I have not had any direct personal experience of this, but this number for my community deeply saddens me. While the number of serious COVID cases has decreased, I think it is important for EMDR therapists to remember that some of the discrimination and hatred toward Asian communities has continued. I would encourage and invite EMDR therapists to explore this with clients of Asian descent since we will all have different experiences and levels to the extent of how it impacts us personally.” *** Christine Mark-Griffin, LCSW

“Keep an open mind and be conscious. Filipino and Filipino-American family systems and cultures can vary greatly in terms of dynamics and values, even though they can seem the same.  Be aware that ‘positive’ norms in American culture (i.e., independence & separation from family) though not present in Filipino culture (values interdependence) does not mean individuals are unable to develop, succeed and grow in healthy ways.” *** Lisa Miranda, LMFT

“When working with Asian American and Pacific Islander populations, recognize that there are a lot of different cultures. Often, family plays a big factor with some of our clients, and it is very complicated. Checking in with the client regarding their relationships with their family is crucial. There could be stresses related to acculturation and familial expectations. Explore what being Asian means to them. There are adopted Asian children who do not identify as Asian because they are adopted by families that are not Asian. These are all factors that can be processed with EMDR.” ***  D. Joyce Mojica, PsyD, CADC, EMDRIA Approved Consultant

“I am an Indian, residing in Singapore and practicing mainly with the population in South East Asia. Traumas here are more of developmental nature, ongoing relational ones as compared to single incident traumas. The population here finds it hard to articulate their feelings. We are generally not out loud, and there is a cultural tendency to keep a facade that hinders processing. It is also observed that shame and repression are evident in almost every client. So they need a lot of support in that regard. Therapist’s use of Self during processing enables simultaneous attachment repairs, which is very prevalent here and forms the basis of case conceptualization. *** Navroop Sood

“As an Indian-American who frequently utilizes EMDR with children of immigrants from the South Asian diaspora, I believe that it’s imperative for EMDR therapists to recognize the role that intergenerational trauma plays in clients’ present day struggles. In many South Asian cultures, multiple generations of family members live together to support one another and maintain community.  A majority of the South Asian children of immigrants I see in my private practice witnessed their parents grapple emotionally and financially with rebuilding their lives abroad without having their extended family’s support. Observing their parents’ struggles and how they responded to stress shaped my clients’ present-day core beliefs related to responsibility, self-worth, and belonging. For example, some of my clients took on the expectation of helping their families financially and emotionally at a young age because their families immigrated with little or no resources. They learned that caretaking equals connection and that their needs may not be as important as their family’s needs. Now in adulthood, they struggle with setting boundaries and shifting away from this caretaking role relationally. In addition, we have to consider how the European colonization of South Asian countries, like India, was traumatic for previous generations. Imperialism led to the suppression of South Asian culture and the oppression of South Asian people. When British colonizers left India in 1947, they established a Partition, which divided the country. This led to social and religious upheaval, extreme violence, and one of the largest migrations in human history. Communities that had co-existed for thousands of years were displaced and at war with one another, and they experienced trauma and loss on a massive scale. These traumatic experiences affected how previous generations navigated the world and parented within their families, and often, their unresolved trauma was passed down intergenerationally. Exploring these past-present connections during EMDR history taking and reprocessing helps clinicians to understand better why the client is having difficulties in the present through the lens of their intergenerational and cultural experiences.” *** Nidhi Tewari, LCSW

“When I meet a client whose threads of heritage are drawn from a part of the world that is less familiar to me, I spend time outside of session expanding my awareness of historical and geographic contexts. A history of colonization is likely to have rendered linguistic and cultural capital invisible but can easily become valuable resources (in and out of session) for the client now. Similarly, an awareness of the ancestors who lived in high desert climates or fiery summers can give the client and me a new way of reflecting on the strengths of ancestors alongside inherited traumas. I learn to respect the client and their culture through understanding adaptive and maladaptive behaviors within the larger context.

In an interdisciplinary team meeting some years back, a speech and language pathologist colleague was perplexed by a child’s family who claimed only to speak English but had been overheard speaking in their heritage language in the waiting room on more than one occasion. My colleague had confronted the family resulting in an impasse, and he now felt anger toward what he saw as ‘lying behavior.’ For those who come from nations that have been colonized and were speaking your heritage language has been banned in schools, this can be a self-protective learned behavior. To pretend only to speak English in the presence of any authority figure was a form of navigational capital that had helped this family to survive. The historical context and the family’s immigration narrative provided a new lens for the whole team to approach this family with respect for their lived experiences, rather than judgment.” *** Rajani Ventrakaman Levis, MFT, PPS, CTTS, EMDRIA Approved Consultant and Certified EMDR Therapist

“If you’re aware of #SorryWrongAsian, we invite you to follow that thread into EMDR therapy, when appropriate. Many clients of Asian heritage report being mistaken for a different person of Asian descent, which can be a formative and often disempowering experience. Clients may identify with cognitions such as “I’m invisible,” “I am disposable/replaceable,” “I don’t matter,” “I don’t belong,” and “I am not worthy” because they feel dehumanized and devalued. It is important to recognize these as oppressive cognitions (Levis & Siniego, 2016) that are being societally reinforced. It is essential that we acknowledge the historical factors as well as the sociopolitical and other contextual forces at play while clearly naming the micro and macro aggressions experienced by the client. Bearing witness to the client’s unique experiences in such a nuanced manner could also provide a window to unique resiliencies and community cultural wealth resources (Levis, 2016). By specifically calling out the societally reinforced oppressive cognitions and not treating them simply as negative cognitions, therapists become active agents of social change. This also ensures that we do not perpetuate the idea that the client is somehow responsible for the trauma they are experiencing.” ***Rajani Venkatraman Levis, MFT & Laura Siniego, MFT, EMDRIA Approved Consultants and Certified EMDR Therapists

“Pacific Islanders (PI) are Micronesia, Polynesia, and Melanesia indigenous peoples. European colonization has directly impacted many pacific islanders, resulting in the loss of language, land, culture, and traditions. A significant gap exists in mental health services within PI communities due to a lack of access to care, language barriers, stigma, and available resources, leaving our communities underserved. Common PI cultural values include respect, family, relationships, and spirituality. As a proud Chamorro, I hope to continue to educate others on the mental health needs of Pacific Islanders by providing representation in a field where we are the underrepresented minority.” *** Christina Watts-Figueroa, LMFT-S, LPC, RPT-S, EMDR AC, EMDR Certified Therapist

“As a Filipino American psychotherapist, EMDR has been effective in my personal healing journey, and it’s also my most utilized intervention for my AAPI clients. Like most Asian Americans, Filipinos often do not have the language to talk about their emotions and mental health. Instead, we rely on body cues to describe how we are feeling. Emotions are expressed through somatic symptoms, such as stomachaches, headaches, or other physical pains. Using EMDR to focus on the sensations in our bodies without needing to explain them in words makes this intervention helpful in uncovering and processing deeply rooted trauma that we wouldn’t have otherwise reached with only using traditional talk therapy.” *** Maria Grace Wolk, LMFT, EMDRIA Certified Therapist

“As an Asian EMDR therapist working with the API population, I often remind myself to listen to my clients’ cultural experiences very carefully and not assume that I know it all. Every Asian heritage is different from one another in its own unique way. Chinese Americans might have a different experience growing up in the U.S. than Vietnamese Americans, and so an immigrant’s experience can look very different from a second-generation Asian American’s experience. Being able to embrace more than one culture is a gift, and EMDR therapy can help individuals fine-tune their path beautifully. *** Sherry Yam, LCSW, EMDRIA Trained EMDR Therapist

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Resources:

Archer, D. (2020, Fall). Racial trauma, neurons, and EMDR: The path towards antiracist psychotherapy. Go With That Magazine. Open access:www.emdria.org/wp-content/uploads/2021/05/GWT.2020.Vol_.25.Issue_.3.RacialTrauma.ALL_.pdf

Archer, D. (2021). Anti-Racist Psychotherapy: Confronting Systemic Racism and Healing Racial Trauma. Montreal, QC: Each One Teach One Publications.

Ashley, W., & Lipscomb, A. (2020, Fall). Addressing racialized trauma utilizing EMDR and antiracist psychotherapy practices. Go With That Magazine. Open access: www.emdria.org/wp-content/uploads/2021/05/GWT.2020.Vol_.25.Issue_.3.RacialTrauma.ALL_.pdf

EMDRIA. (n.d.). Antiracism Resources. www.emdria.org/publications-resources/practice-resources/antiracism-resources/

Federal Asian Pacific American Council. AANHPI Resource Center. https://fapac.org/AAPI-Resources

Hernandez, C. (2020, Fall). SPACEHOGS make a difference. Go With That Magazine. Open access: www.emdria.org/wp-content/uploads/2021/05/GWT.2020.Vol_.25.Issue_.3.RacialTrauma.ALL_.pdf

Levis, R. V. (2017). Placing Culture at the Heart of EMDR Therapy. In Nickerson, M. I. (Ed.), Cultural Competence and Healing Culturally-Based Trauma with EMDR Therapy: Innovative Strategies and Protocols (pp. 97-112). New York, NY: Springer Publishing Co.

Levis, R. V., & Siniego, L. B. (2017). An Integrative Framework for EMDR Therapy as an Anti-Oppression Endeavor. In Nickerson, M. I. (Ed.), Cultural Competence and Healing Culturally Based Trauma with EMDR Therapy: Innovative Strategies and Protocols (pp. 79-96). New York, NY: Springer Publishing Co.

The Library of Congress. Asian Pacific American Heritage Month. https://asianpacificheritage.gov/

Nickerson, M. I. (2017). Cultural Competence and Healing Culturally Based Trauma with EMDR Therapy: Innovative Strategies and Protocols. New York, NY: Springer Publishing Co.

Orelus, P. W. (2012). Being black and brown in the 21st century: Challenges and pedagogical possibilities. Sage Open 2(4), Open access: https://doi.org/10.1177%2F2158244012464979 

Smith, L., Proctor, G., & Akondo, D. (2021). Confronting racism in counselling and therapy training – Three experiences of a seminar on racism and whiteness. Psychotherapy and Politics International, 19(2), e1579. Open access: https://doi.org/10.1002/ppi.1579

Torchinsky, R. (2022, May 2). The story behind Asian Pacific American heritage, and why it’s celebrated in May. NPR. https://www.npr.org/2022/05/02/1095812576/aapi-asian-pacific-heritage-month-origin-may-why

Urdaneta, V. (2020, Fall). Engage in the conversation of race and racism with “Hot chocolate and cheese:” An idea you can implement. Go With That Magazine. Open access: www.emdria.org/wp-content/uploads/2021/05/GWT.2020.Vol_.25.Issue_.3.RacialTrauma.ALL_.pdf

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EMDRIA Race, Culture, and Ethnicity OnDemand Education Opportunities:

Archer, D. (2020). Racial Trauma, Neurons, and EMDR: The Path Towards an Anti-Racist Psychotherapy. [EMDRIA Conference session]. EMDRIA OnDemand. www.emdria.org/course/racial-trauma-neurons-and-emdr-the-path-towards-an-anti-racist-psychotherapy/

Archer, D., Ashley, W., Chaffers, Q., & Hernandez, R. (2020). The Elephant in the Room: Systemic Racism and Psychotherapy. [EMDRIA Conference session, panel discussion]. EMDRIA OnDemand. www.emdria.org/course/the-elephant-in-the-room-systemic-racism-and-psychotherapy/

Hernandez, R. (2020). EMDR Diversity & The Spectrum of Trauma Prevention. [EMDRIA Conference session]. EMDRIA OnDemand. www.emdria.org/course/emdr-diversity-the-spectrum-of-trauma-prevention/

Nickerson, M. (2020). Social Trauma and Adversity: Restoring Connectedness and Resilience. EMDRIA OnDemand. www.emdria.org/course/social-trauma-and-adversity-restoring-connectedness-and-resilience/

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