by Nicole E. Cabrera Salazar, Ph.D.
As a woman of color, it took me years to overcome the negative stigma our society has around counseling. I wish I could say it had occurred to me to seek help during times of extreme stress in undergrad, but it wasn’t until I was on the brink of a breakup that I thought to visit my university’s counseling center. The fact that I was motivated to start therapy for the sake of someone else rather than for my own self-care is something many women of color can relate to. It’s that same survival mode — we sometimes have no choice but to employ — that ends up taking a huge toll on our mental health.
If you’re anything like me, you might be thinking that everyone has stress and there’s no need to bring a medical professional into it. Or you might worry that if you have to talk to a counselor, what does that say about your own strength?
I want to reassure you that, just as you wouldn’t feel shame about going to the doctor for a checkup or the flu, there’s no need to question yourself about therapy; it’s something that everyone can benefit from.
Because there are many misconceptions about the therapy process, I’ll guide you through what it’s been like for me.
Types of Therapy
There are many different types of therapy, including individual, group and couples counseling. Individual therapy involves a one-on-one relationship with a counselor who works with you on the areas on which you want to focus. Sessions are usually 50 minutes, and you can talk about behaviors you want to change, current stressful situations, or even past events you want to overcome or understand better. It can be scary to divulge personal details to a total stranger, but you have the power to set the pace and can share more as you develop trust with your therapist.
Group counseling is usually centered around a specific topic that everyone in the group can relate to, such as graduate school, interracial relationships or LGBT+ issues. Sessions are usually around 90 minutes, where members of the group check-in about what’s going on in their lives. The benefit of group counseling is being surrounded by people who can empathize with your situation. I’ve found that by having compassion for those around you, you learn to have more compassion for yourself. It’s okay to find this kind of counseling too personal at first; it took 3 years of individual therapy for me to warm up to the idea of joining a support group, but I’m really glad I did. To protect everyone’s privacy, most groups discourage having friendships with members outside of the group; this may make it easier for members to share personal information.
Couples counseling involves a couple meeting with a counselor together, either as a preventative measure (i.e., pre-marital counseling) or to resolve current problems in the relationship. A couples therapist is a neutral party who does not side with either partner; instead, they are there to teach tools for communication, such as how to fight fairly. They can also point out issues you may not be aware of so you can solve them together. In my experience, couples counseling has been very effective and has made my relationship with my husband stronger. Couples sessions are usually either 50 minutes or 90 minutes, depending on the therapist’s preference or method.
The Therapy Process
It’s important to understand therapy as a process, rather than an instant cure for all our problems.
Having a longer timeframe in mind will help curb initial frustrations and set you up for success. The first step is finding the right therapist for your needs, which involves identifying 2 or 3 people within your insurance network (if you have it) and setting up a phone call with each. Some therapists specialize in trauma, depression and anxiety, family counseling, or personality and mood disorders. If you have a specific need in mind, be sure to ask if the therapist is experienced in that area.
The single most important question to ask about is your therapist’s identity.
Women of color have everyday experiences that others cannot relate to, and it can be exhausting to explain and justify those experiences to an outsider.
I accomplished a lot with a white woman therapist for several years, but switching to a woman of color made a huge difference in terms of being able to discuss my racialized and gendered experience. You may want to seek out a therapist with a disability, someone who identifies as LGBTQ+, or who is fluent in Spanish or Creole. It all depends on what would make you feel most comfortable and acknowledged.
Some therapists spend the majority of your session simply listening and asking few questions, while others engage more actively and can even assign “homework” to practice positive behavior. Some therapists may have a religious lens to their practice, while others may be completely secular. Because therapy is a long-term process, it’s important to find someone whose methods match your preferences.
Cost is also important to discuss during the initial phone call. Most insurance plans cover mental health, so if you find someone in your network you may pay as little as $20 for each session. However, some therapists do not take insurance, or you might not be insured; in this case, fees can range anywhere between $50 and $200 per session. If the financial burden is too much, you can ask if they provide a “sliding scale” fee, which is based on how much you can afford. Typically you would meet once a week, but scaling back to bi-weekly sessions could help lessen the financial strain. If you’re a student, chances are your university offers many types of free counseling, making a set number of sessions available to you per year. After your free sessions are over, you may be able to transition to your therapist’s private practice if they have one; if they don’t, you can ask them to recommend one or more therapists who might be a good fit.
Once you find someone you can connect with, you can make your first appointment. When you arrive, they’ll usually ask you to complete a form of detailed questions about your personal history, family of origin, experience with drugs and alcohol, and more. These questions are important because they can inform your behaviors in ways you may not realize, but that your therapist can help you connect. The first few sessions will be spent talking about your personal history and what brought you to therapy. After that, you can choose what specific issue you want to discuss, and you can also set the pace. You have the right to decide what topics are off-limits, and you have the right to stop and seek a new therapist if you feel they are not a good match.
I struggled with depression and anxiety for a long time, but I was scared to try medication because of the negative stigma in the Latinx community. My therapist had been asking me to consider it for years, but my parents initially disapproved and did not understand why I needed it. I finally agreed to try anti-anxiety medication in a moment of crisis, and although it took weeks to see improvement I am grateful I made that decision.
Anxiety and depression are very common but poorly understood and have many negative misconceptions, especially within communities of color. High-stress situations can trigger chemical imbalances in the brain that cause psychological and physiological changes in mood, appetite and libido as well other factors; medication can correct the brain’s chemistry to a functional level. I was afraid taking medication would change my personality, but instead it lifted the cloud hanging over me and made me feel more like myself.
While medication may be necessary to treat the symptoms of depression and anxiety, they can only go so far on their own. Individual therapy is usually recommended in tandem to treat the root cause, and having a team working with you is tremendously helpful. Because therapists cannot prescribe medication, they will usually refer a psychiatrist — or a general practitioner if medication is urgently needed. During a major depressive episode two years ago, my doctor, therapist and psychiatrist worked together to give me the care I needed.
Now that you have a better idea of what therapy is about, I hope you’ll consider trying it – even if you think you don’t need it. Most people only seek therapy in a moment of crisis, but the best time is actually when things are relatively okay. That way, your support system will already be in place when something really stressful or significant happens.
As women of color, we deserve the best care for our mental and emotional health. Our survival – and more importantly, our happiness – depends on it.
Copyright © 2017 by The SeRCH Foundation
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