Diversity, Equity, Inclusion (DEI) Column

Back to Fall 2023 Newsletter

Interview with Sage DeRosier and Liliana Ramos

Liliana:  Welcome! We appreciate you doing this interview. Would you please introduce yourself, tell us about your specialties, certifications, and training.

Sage:  My name is Sage DeRosier. I'm a trained holistic psychotherapist; I started practicing in 2008, became licensed in 2012, and in private practice since 2013.

I contribute in the world by loving people unconditionally while engaging in creative, experiential therapeutic relationships that help my clients heal from profound and overwhelming hurts and step into their innate power, potential, and wisdom. I help people move through developmental stages with increased youth and efficacy, learn skills , tools, and practices to more effectively navigate within our global milieu of intergenerationally-layered trauma compounded by curated ignorance and misinformation. I help people perceive the possibility of our species finally evolving beyond perpetual emotional retrogression toward creating systems, supports, and social structures that end unnecessary fear and instead nurture kindness, connection, inclusion and diversity.

My specialties include my niche area supporting gender expansive youth and their families, which is the intersection of three deep interests. Interest #1) Death and dying, bereavement, complex loss, grief work. Interest #2) Working with children, using play and art therapy. And Interest #3) Anything having to do with the full range of gender and sexual orientation identities as well as expansive relationship configurations. I was trained at the Process Therapy Institute as a process therapist. I also trained with the founder of Accelerated Resolution Therapy (ART), an incredibly effective trauma resolution modality. ART uses bilateral stimulation, sensory processing of the brain's playful and creative powers to decouple traumatic memories from hijacking the physical and emotional body. I'm trained in and I've trained other clinicians in clinical applications of polyvagal theory. Also, I'm also a graduate of the 50-plus hour San Francisco Sex Information Sex Education (SFSI) Training. I was also trained in and have a certificate in commercial mediation.

Liliana:  That is quite an accomplished list. What are the intricacies of doing therapy with transgender clients?

Sage:  Working with gender-expansive clients, including those who identify as transgender, gender fluid, non-binary, two-spirit, and so forth can be quite tender and complex. When a human being dares to enter into their individuation and authenticity-seeking process, sometimes they discover and learn things about themselves that flies in the face of often narrow, overly sheltered, ignorant, and or painfully rigid beliefs and childhood conditioning. I’ve come to realize that people are taught many narrow-minded beliefs, like there are only two genders — boy and girl — despite a blatant plethora of biological evidence worldwide that there are multiple genders, shared genders, changing genders among earth’s many living beings. When we enter introspection and authenticity-seeking and discover that the gender we've been brainwashed to perform is based on the genitals that define our sex, when we find our authentic identity doesn't match our conditioning, we face a primal fear. What if to belong, remain connected, safe, and supported, I must reject my authentic identity?

Many people historically have chosen to deny their authentic identity to conform and capitulate to social pressure to fit in, seem safe, and look normal. Unfortunately, that trade-off is not sustainable. Denying our authenticity is ultimately toxic, not only to relationships, but to the people who are (ironically) living in drag. By performing the role that has been projected onto them by everyone whose path they cross, nobody gets the benefits of their real, authentic, most empowered self. Refusing our authenticity results in resentment, depression, and anxiety. An inauthentic person does not have an actual connection with others. They perform for the illusion of safety; internally. they are disconnected. There are many people who live confused, perpetually asking, “why am I so depressed?” My answer: “because you've refused your authenticity, overlooking a core tenant of what it means to be fully human.”

In my practice with gender expansive people, it's my priority to meet each person where they are in their process: in pre-contemplation some haven't even thought about their gender. Maybe they're contemplating, exploring possibilities. Maybe they've started experimenting with identity shift. They might have already explored or tried coming out, or might be in physical, social, legal, or medical transition of some sort and navigating, gender identity shift in their meaningful relationships.  For example, with kids, many start with coming out to close friends at school because there's a closeness and it’s not as risky as starting with parents in some cases. Nobody makes this decision on a whim. It requires a new vocabulary, explaining stuff to people. It's really uncomfortable. It's potentially vulnerable. You expose yourself to harsh judgment, exclusion, the potential of violence.

Liliana: What should therapists be aware of when working with transgender clients who are neurodiverse?

Sage:  There’s a lot of overlap between gender expansiveness and neurodivergence. Neurodivergence is more common than most people think. Humans are adaptable and have a strong instinct to survive, so we're quite capable of masking and showing others what they demand to see. For most people, their only exposure to neurodivergence is extreme autism spectrum disorder (example behaviors include yelling/screaming, continuous stimming, primary communication is nonverbal and others) which can make some people panic. A lot of other neurodivergent presentation exists on the spectrum. Neurodivergence shows up quite differently from person to person. So, if I'm autistic, I won’t exactly match anybody else who's autistic. There might be some overlap, but the general public is not aware of this. And most of the historically well-known organizations that purport to deal with neurodivergence are about forcing behavioral conformance on people who are neurodivergent so they “fit” into neurotypical cookie-cutter patterns. To me, a lot of our social norms are overly simplified and don't account for or fully value the beautiful diversity of humanity. Essentially, neurodivergence is more common than people suspect. A lot of neurodivergent people have learned to mask, ignore their neurodivergent inclinations. Most my clients who identify as neurodivergent are on the autism spectrum or are diagnosed with ADD, or ADHD.

Neurodivergent folks may show up as a little different, quirky or more literal than average. Their relational skills may seem a bit different. There are some autistic folks who have learned how to “pass” as “normal” sort of like how some transgender people can “pass” as cis-gender. That's because they're putting an inordinate amount of energy into passing. I think of how ducks seem to glide smoothly on the water. But underneath, they’re paddling really fast. And we don't see the fast paddling of most neurodivergent folks. So, what happens after a while, is many get very tired, depressed, anxious. Some start developing maybe physical symptoms – they get sick. For a lot of people who are overworking to keep up with what is expected, at some point it catches up. For example, a person finds a place to work so they can be self-supporting. It's usually fine: “Somebody is working with my quirky self and they're able to get benefit out of my contribution. At some point, my manager takes another position or leaves the company and somebody else becomes my manager who didn’t hire me, doesn’t know me, and doesn't have a relationship with me. And they are really bothered by my quirkiness. My job gets much harder, or even threatened.”

With gender expansiveness and neurodivergence, anxiety and depression can sometimes enter the equation. Anxiety is our fancy word for afraid. And human-curated fear is, in my humble opinion, the core of what gets in the way of our species evolving. Fear has a very basic, quite useful purpose, which is help us survive imminent danger. My body is hardwired to rapidly pick up potential danger via neuroception, a subconscious system for detecting threat and safety. Being perceived as different coupled with a real fear of not being welcomed and included ups our odds for anxiety, sometimes enough anxiety to be diagnosable.

Depression is a type of “stuckness,” a lack of energy. If we look at polyvagal theory, our initial state from birth is dorsal vagal: rest and digest. Once we've rested and digested, then we can move up to our next level, which is sympathetic vagal:  excitement and/or fear. If I'm threatened, I get that jolt of energy to do something to survive. But, if cannot escape the threat, if I’m barely surviving, or if I'm still feeling threatened after my adrenaline has run out, I drop back down into dorsal vagal: into rest and digest. And it's a hard and difficult rest and digest, which takes much more time to get enough energy to come back up to sympathetic where I can try again. And so I can get stuck in a loop, unable to access the next level, ventral vagal: safe connection and creativity. That lower loop is the depressive loop. I have not enough energy to get unstuck from this loop of agitation and exhaustion. Depressed people don't feel alive and don't feel creative or connected. They ask: “What’s the point; why am I here?” When we're different, neurodivergent, or somehow not fitting into the narrow gender norms that have been imposed upon us, we experience disconnection, which can leave us anxious, depressed. So, there's a common root.

Liliana:  Yes, that makes lots of sense. Thank you. Are there any other issues that are prevalent since we're talking about how they're all connected?

Sage: One of the most important issues in my opinion is the bane of most people's existence in the United States, which is insurance and affordable quality health care. Insurance often acts like an authoritarian gatekeeper. It prevents care that physicians and their patients agree upon. Insurance providers will lure us in with clever marketing schemes about building bridges and better health and better life and like a good neighbor and thrive and helping. Well, a good neighbor doesn't shut the door in your face when you need medical assistance. Functional medicine is actually much more competent, but insurance doesn't cover it, which is interesting. The things that are outside of the narrow business lines of western medicine don't get covered. So a lot of insurance companies deny care. They make it super difficult to get coverage for hormone therapy and gender-confirming surgeries. I worked with a client a while back who was the parent of the transgender youth who had passed the age of majority, and they got a big run-around with the insurance company about paying for gender-affirming care. The issue with insurance companies: who gets to decide what is necessary, what's a necessary procedure. How do we help the client get what they need to decrease their gender dysphoria?

When we tell an individual with neurodivergence that they need to figure their identity out quickly, it creates unnecessary pressure, anxiety. I imagine that a person who hears impatient demands from somebody else will feel jangled, perhaps frightened or overexcited and may not stop to say “let me think this through.” So, there's the pressures coming from a lot of people around us when we're just questioning what's going on with me? How come I'm having a harder time playing this gender role than my friends? How come I'm not able to look other people in the eyes and they're able to look me in the eyes? How come other people get sarcastic jokes and I don't quite get it? It gets complicated.

Liliana:  I'm wondering, what made you get into this work and decide to work with this community?

Sage:  At the end of my graduate studies, I had sort of an aha moment. I had to choose a niche, so I kept going back to my three interest areas. One, the working with children and youth by using play therapy, art therapy. Second, the death, dying, loss, bereavement, and grief work. Third, the non-traditional identities that involve gender, sexual orientation, and relationship configuration. I was not willing to let go of any of these three. So, I let them intersect. I wondered, what if there's a kid who's thinking, “I don't know if the gender that you've assigned me is true.” That sets off a whole pattern of loss for everyone around them, especially their family. So then, we're dealing with grief work, the death of hopes, fantasies. “My daughter's not going to get married and have babies because my daughter is now a son.” Or, my son's now my daughter... And what does non-binary mean? And who are they? And how's it going to look? So much grief comes out of that process of exploring identity. Then, the next question that a lot of parents ask is about sexual orientation. For example, “well, are you gay now? Because you were our son and you were dating girls… so if you still date girls, aren’t you a lesbian...?” So gender exploration can hook into sexual orientation. And there have been several clients who realized they're not really monogamous, that they're more polyamorous or want to be ethically non-monogamous.

Here's the overlap. Gender-expansive youth and their families, hit all three of my interest areas. That's what made me decide to work with this niche population.

Liliana:  That’s beautiful. Do therapists need special training to do gender affirming work with gender-expansive clients?

Sage:  Well, I think there are a lot of things that aren't necessarily taught in grad school. But I would say that no matter what your niche ends up being. I support the basics of what we're encouraged to do, which is having your own therapeutic supports, consulting regularly, continuing your education. There are a lot of LGBTIQ+ classes and program certifications available. There are quite a few competent teachers and opportunities for continuing education. I would encourage people who want to work with this niche community to be aware of peer consultation groups in their area and facilitate access; make sure you're affiliated with at least one regular consultation group to have a dynamic referral network. I'm part of the Gender Identity Awareness Network, G-I-A-N, a consulting group of colleagues who work with gender-expansive youth and their families. I'm aware of Mind the Gap, which is up in the East Bay. And there are organizations like WPATH for documenting standards. And every summer, there’s a continuing education weekend put on by Gender Spectrum, in the East Bay.

I strongly encourage all of us to be aware of any preconceived notions, biases. Notice if there's repulsion or you feel like pulling away, feel disgusted, or judgmental. Those things will be key in the self-selecting process. If I feel repulsed, disgusted, if I’m pulling away from somebody, I'm not going to be able to serve them. It takes a level of courage to look at the unpleasant stuff that's going on in one's organism in reaction to somebody else's organism and how they are showing up. In retrospect, I look back at when I was a youth and I experienced that ignorant reaction. To work effectively, I encourage nurturing unconditional love for each person striving to find their authentic self.

Liliana:  You did. Thank you. And what would the takeaway, if you want one thing for other therapists to remember about this whole article?

Sage:  If you're interested in working with people who identify as gender expansive or exploring their gender and/or people who identify as neurodivergent or are exploring whether they might be neurodivergent, it's important to ensure that you have supportive colleagues with whom you can consult. We're not supposed to do this alone. The reason we exist is relationship. I'm not an expert. I'm a person who wants to practice loving and supporting other people in learning how to love and support other people. So having consultation has been vital. Having resources who have experiences that are different than me, so that we can share them and enlighten each other. This is vital!

Liliana:  Thank you. I think that's a good point. Is there anything else that I should have asked that I didn't?

Sage: I think we covered a lot of the main stuff. One thing is, if you're reading this and you know somebody who is questioning their gender or wondering if they might be neurodivergent. check around your community for additional resources: a community center organization that is LGBTQ+ and other places to get more information, referrals, leverage support groups. There are so many aspects of society in this day and age that push us into loneliness and isolation, and we human beings do not thrive in isolation. Even though we have the internet, which is a great bridge for connections and information – it also spews tons of misleading information. Help clients by knowing quality resources, including low fee and sliding scale therapists. Many queer-identified and neurodivergent-identified people lack and need loving connections. I have found that in-person connections are often more nourishing to us than those that are electronically mediated. It's important to lean into the discomfort of getting some kind of proximity to others. So going to a community center for social events, or going to meet with a potential therapist, or even logging onto a teleconference gives us more of that warm connection and, in polyvagal theory terms, gives us access to the ventral, that good feeling of mutual connection, which is the baseline, the core of mental/emotional wellness. We must feel safe to have nourishing connection. For me, proximity, repetition, and play are vital to human wellness, thriving. If I'm just typing messages to somebody, I might have play and we might have repetition, but we don't really have proximity.

Liliana: Thank you so much for this valuable information. We appreciate your passion and expertise in this field. Thank you for all the people that you are helping in the gender expansive and neurodivergent communities.
 
Sage earned a master's degree in holistic counseling psychology from John F. Kennedy University. JFKU’s holistic studies program goes beyond the requirements for clinical psychology to include transpersonal psychology (spiritual focus) and somatic psychology (physical focus). Sage has been joyfully and successfully practicing holistic psychotherapy-for 15 years and finds the more inclusive model provides a solid foundation for effectively working with the human mind-body-spirit connection and empowering clients. More about Sage

 Back to Summer 2023 Newsletter

Interview with Leila Wooley, LPCC
by Liliana Ramos, LMFT, Director-at-Large

Leila Wooley is a Clinical Psychologist in Guatemala where she worked with teenagers and adults. After arriving in California, she pursued a Master’s program at Palo Alto University, focusing mostly on teenagers and adults during the licensing process. Now, as a Licensed Professional Clinical Counselor, she works with adults from 18 to 80 years old at Kaiser Permanente Psychiatry Department and at her private practice. While working towards her licensure, she had the opportunity to receive training on inherited family trauma from Mark Wolynn, an expert in this field. Today, she works from a client-centered, strength-based, somatic, and multicultural approach. As a Latina psychotherapist, she recognizes the value of cultural humility in her work, since this allows her to learn and understand her clients values and how they view themselves in the world.

Leila works with older adults from a cultural lens, which requires her to be more curious about where the client is coming from and how they perceive this stage of their life. In addition, she looks at their health, finances, support network, and activities. She also explores how they perceive all the losses that they have experienced in their life. Are they starting to lose many of their friends or how are their roles or what are the contributing factors to their health and independence? She believes that by finding out all of these areas in their life, she is honoring where her older adult clients are at this point of their life.

Since she is a Latina and many of her clients are Latinos, she finds that Latinos may have a higher resilience due to the fact that in the Latino culture, families take care of each other. The older adults are being taken care of, as well as having the responsibility of helping with the care of the children and doing household chores. This keeps the older adult active and gives them a purpose. In addition, they have their religious faith which helps them find meaning in their life experiences. She understands that there are various other cultures that take care of their elderly family members.

Another lens is grief. She feels that when she works with grief, finding meaning in the hardest situations is essential. Like Viktor Frankl wrote in his book Man’s Search for Meaning, having a purpose makes it easier for a person to tackle life’s hardships. For Leila, her personal grief helped her as she trained at Pathways Health and Hospice in Sunnyvale. She herself was grieving when she moved to the United States. She felt depressed and anxious as she recognized that she was grieving for the country AND FAMILY that she left behind. Leila said: “I think that working with grief is beautiful. People come at the most vulnerable time and can do the deepest work. They shift. Grief gives us the sense of connection. Realizing that we will always grieve but the intensity will change with time.” She teaches her clients how to live with their grief, by understanding it and allowing themselves the time they need to grieve.

Leila finds that older adults have grief in their lives because of the cumulative losses that they have experienced throughout their life. She said that it starts even with the loss of their role, or perhaps they are no longer working or part of a community. Moreover, they might have become the caregiver of their spouse or partner or lost their independence because now people have to take care of them. Slowly, things they used to do are being taken away. Many of these losses might be occurring at the same time. Leila describes the experience like a lasagna made of layers and layers of losses. She suggests it is helpful to do a life review timeline to see the things that have happened in their life. In addition, she found that the pandemic was a wake-up call. She recounts the beginning of the pandemic where older adults had to learn how to use Zoom in order to attend grief groups. It was their only way to connect because they couldn’t leave their homes and connect with their loved ones and community. Plus, their families would not visit because they were scared of getting them sick. It magnified their entire experience of loss and isolation.

I wondered what made her decide to work with older adults and their grief. Leila narrated how her family is Jewish and living in Guatemala. Guatemala was one of the places where they could go to during WWII. One thing she observed about Holocaust survivors is that they do not speak about grief. In her family, when someone dies, they don’t talk about it. People have this expectation of ‘I should be done with this.’  For Leila, as she started doing her own work, she realized that there are a lot of rituals in Judaism when someone dies. So she found that learning more about rituals helped her clients identify their own or even create new ones to honor their loved ones.

She added that older adults who remain engaged and connected physically and mentally are mentoring us on how to grow old with grace. We can see how parents and grandparents model how we can have meaning in our lives as older adults. By watching this unfold, it is not as scary for the younger generations. Leila finds that working with older adults gives us a good sense of what resilience looks like.

Since people are living longer these days, it helps if individuals initiate conversations with the older adults in their families. A conversation about what they want when they die or how they want to be taken care off when they can no longer stay in their home. Leila says that in the Latino culture, people in their 40’s and 50’s say that their parents’ health is declining and they do not want to move out of their homes.  Adults struggle to approach their elder parents, as they are not ready or equipped to have those conversations, so it is causing distress in the younger generation.  Older adults who are financially stable think that their independent living is the last thing that they are going to take away from them. Especially with older adults where their children are spread out, it means leaving their home and moving to another state or possibly another country. So, having these conversations with older adults is crucial, asking ‘what would give you peace if you were able to choose how to live and die.' Most older adults avoid talking to their adult children about these topics. Adult children may not want to think about it or know how to start these conversations. So it’s good to have clinicians help the older adults or their children begin these conversations.

Sometimes, older adults are worried about what death looks like. To complicate things, they might be taking care of their adult children. This brings an extraordinary amount of anxiety and fear. What will happen to their adult children? Or perhaps how will the money be split? Or they worry about their adult children NOT honoring their wishes. Some of them lost their partners and are looking forward to when they can join them in death. We have to remember that these individuals are complex. There will be many situations which will be a first for them. Furthermore, everything in the house brings them memories and the world is changing.  

Leila finds that providing therapy to older adults is a rich experience. She encourages clinicians who want to work with grief to do their own work in therapy regarding aging and grief. As a therapist, one can start thinking about one’s family and how one will cope when that happens.  For Leila, it was natural to process death during therapy. Making sure therapists get the support they need, because it is heavy work, is an important aspect of this enterprise.  

In summary, just like with any population, there are commonalities. There are certain themes to work on and explore like death, grief, and aging. It is one of the age groups for whom going back to values, background, and culture will guide a lot of the work we do because that is very ingrained in their stage of life. It is mostly working with what they have rather than teaching them new things. It is very hopeful to work with people who have gotten to this stage of life and have so many experiences. For many older adults, there are so many things they are proud of and find meaningful. Talking about their grief, meaning of life, and normalizing their feelings is healing for this population. Likewise, it becomes meaningful for the therapist.

Leila Wooley currently works at Kaiser Permanente’s Psychiatry Department offering therapy to adult clients.  She also has a private practice where she works with adult clients.  She is originally from Guatemala City where she practiced as a clinical psychologist working with teenagers and adults.  When she moved to the Bay Area in 2010, she decided to pursue her master’s in professional clinical counseling. While working towards her licensure, she had the opportunity to work in hospice, substance abuse, and community health working with the Latino and LGBTQ community.  As a psychotherapist, she works from a client-centered, strength-based, somatic, and multicultural approach.  As a Latina, she recognizes the value of cultural humility in her work. Since this allows her to learn and understand her client’s values and how they view themselves in the world.

References

Devine, M. & Nepo, M. (2017). It’s ok that you’re not ok: Meeting grief and loss in a culture that doesn’t understand.  Sounds True Publishing

Frankl, V. (2006). Man’s Search for Meaning. Beacon Press

James, J. W. & Friedman, R. (2009). The Grief Recovery Handbook (20th edition). William Morrow Publishing

Back to Summer 2023 Newsletter

Fall 2022 Newsletter

I interviewed Dr. Sherry Wang, an associate professor of Counseling Psychology at Santa Clara University and a licensed counseling psychologist, who identifies as an Asian American cisgender woman and a feminist multicultural psychologist. 

As an anti-racist educator, Dr. Wang’s research is focused on working with and advocating for the voices and experiences of those who have been historically under represented and underserved; for the most part Black, Indigenous, and People of Color (BIPOC) as well as sexual and gender diverse communities. Her research focuses on the need to address systems to improve the quality of life for the mental health and well-being of individuals when dealing with societal oppressions such as racism, sexism, and heterosexism. She trains clinicians in the field and consults with companies regarding anti-Asian racism and issues pertaining to diversity-equity and inclusion. She educates lawyers to be more trauma-informed, and facilitates spaces to talk about difficult topics such as race, power, privilege, and oppression.  She has given talks at corporations regarding race, privilege, quality of life, and burnout and her private practice focuses on people of Color and women. So far, she is primarily working with Asian American women so that her practice can be accessible

Dr. Wang often gets asked how can clinicians include social justice and advocacy into their clinical work? She said we already do it when our goals are to improve our clients’ lives.  On the topic of privilege and power, which have become "ugly" words for some, she says, “The truth is that power and privilege are not bad words. Everyone has power and privilege of some type. The question is what do we do with power and privilege in terms of sharing it with people whose voices cannot carry. Social justice and advocacy work begins with being able to recognize where we have power and privilege; being grateful for that power and privilege, and being aware of those who don’t have it and our role in that.”  She clarifies how a person can feel conflicted with having privilege and power, but what matters is how we deal with our internal conflict. She gives the example of a therapist who might decline to work with someone who is gay because of concerns surrounding competency. While that may be acceptable once or twice, if the therapist continuously says no without seeking further training, then the clinician needs to ask why they are choosing not to see clients in this demographic and why they are not seeking training to develop the competence to work with them. How are they using their power and privilege affecting their decisions to choose some clients and not others? Where are their blind spots? How are they improving themselves so that they can serve those clients that may need our field the most?

One power-sharing example from Dr. Wang’s lived experience is using her platform to speak up on anti-blackness and the need to dismantle anti-Black racism. She is aware that when she speaks up about this topic, the issue is taken much more seriously than if a Black person were to talk about anti-blackness. In this case, Dr. Wang has much more privilege and power to have her words be taken seriously.  Similarly, it would be so much more powerful for someone who is a man to speak up on issues of sexism and misogyny so that it is clear that sexism isn’t simply a “women’s problem.”  “It is so crucial for White clinicians to be able to name racism; for male clinicians to recognize the sexism within the therapeutic context, and to convey to clients that they are able to understand what it is like to have power and to use the power for those who do not.”  Dr. Wang conceptualizes this as a way of sharing power and privilege; and is similar to when a therapist writes a letter for a client to get access to hormone therapy or surgery.  As providers, it is not only our knowledge, but also our awareness that contributes to whether people are willing to sit with us to share their vulnerable, intimate information.  

Moreover, Dr. Wang reminds us how we all carry privilege and marginalization.  For example, a Latinx woman might be marginalized as a woman, but have privilege because of her education and lighter skin color. Or a man might have more privilege than a woman, but be marginalized in his experiences as a Person of Color. By speaking up with each other and for each other, we can advocate for all of us so that those who are marginalized never have to do the lonely work of having to speak for themselves. She goes on to offer that there is beauty in the community using their power to prevent suffering and helping each other with our needs since we are all marginalized in some way.  This is in line with Greene-Moton and Minkler (2019) calling readers to action in their paper on cultural humility by stating that inequitable power, privilege, and injustice affect the well-being of people. Thus, Dr. Wang says, “We can be more effective partners across a wide range of barriers and divides if we work collectively toward racial, social, and health equity. And the more just and habitable society and the planet will be, on which our work and our future depend.”

As we have all experienced in our field, we take one multicultural course and the message is we can work with anyone. This is not quite true. However, to say that we are not competent to work with a certain group of people is also an excuse. Dr. Wang states, “There are two extremes: one is someone who thinks that they’re competent when they’re not; and the other is when we keep referring clients out because we choose to lack the competence in serving select members of our society.”  Dr. Wang would like to challenge therapists to ask themselves why they keep referring clients of a certain demographic or identity background. We might not have competence, but we need to gain competence.  She goes on to say that “Our personal development is our professional development.”  When working with marginalized groups, “It is a duty for us to learn, as opposed to ‘it’s just something I don’t ever have to deal with’”.  According to Dr. Wang, we grow by challenging our assumptions, ourselves, and worldview. We also need to “challenge ourselves so we are doing more than surviving.” Thus, part of social justice and advocacy is also about having compassion for ourselves so that we can set a bar for ourselves and our clients to thrive, not just survive.

When asked what topics are close to her heart when it comes to social justice, Dr. Wang talked about how current events are important because they are what our clients need and address current social needs.  She talked about how everything is interrelated. Indeed, if people care about racial justice, then they care about climate change because of its disproportionate impact on People of Color and those who are at the lowest rungs of the socio-economic level.

A foundational piece to social justice is cultural humility, says Dr. Wang.  “Multicultural competency has the components of knowledge, awareness, and skills.” She describes the three components as follows:  knowledge about other groups; awareness of self; and skills in applying it to the client.  Dr. Wang states, “The piece that is missing is the process piece, which is cultural humility; knowing what you don’t know and how you approach that.”  We approach it from a place of humility because we will never understand the client’s “lived” experience.  To explain further, Dr. Wang gives the example of what happened at her first clinical encounter in graduate school when working in the correctional community. The client was an older, homeless, married, African-American man who identified as being Christian. He took one look at her and questioned her credibility and legitimacy to be able to understand any part of his life experiences. The advice she received from a supervisor, was to give herself the permission not to be defensive.  Instead of, “But I’m not what you think I am…” she was encouraged to think about the root of the pain and to focus instead on: “What can I do to earn your trust?” This is an example of cultural humility, which is part of practicing social justice. It is about validating other people’s worldview. Dr. Wang advises, “Even when your client may have more power and privilege than you, we, as clinicians will always have more power. Which is why it is crucial for us to help someone feel heard and validated in their worldview.” How do we do this? We can start by validating our client's appropriate distrust of us. We can recognize our need to have to earn our client’s trust, and to also share parts of our vulnerability—all of this being a part of our striving for social justice.  This is all the more crucial, according to Dr. Wang, if we look like the people who have harmed them or their ancestors. She mentioned the Tuskegee syphilis study that is still taught in counseling psychology classes as an unethical study conducted on African-Americans. With this in mind, it makes it our responsibility to gain our client's trust since we have the power and the privilege in the room even when we are feeling small.

When I asked Dr. Wang, how can social justice and cultural humility help the client in the therapy room, she spoke about how, when we listen to the client and understand their “lived” experience, it may be the one time the client feels heard, validated, and accepted.  As a feminist multi-cultural psychologist, she believes in appropriately sharing those aspects of her “lived” experiences to be able to bond with a client and grow in their journey together.

Finally, Dr. Wang wanted to leave the SCV-CAMFT community with two things. One piece is knowing how much power we hold as experts in the room. “We are experts, so what we say holds a lot.”  She reminds us to be mindful of our defensiveness: “It’s like being a parent. How do we hold our client gently and with compassion and with a sensitivity even when they are trying to rile us up …. We have the power to do harm. So how can we harness that power in ways that we can do a lot of good?”  The second piece is cultural humility: “I feel that it (power and privilege) is connected.” Similar to Dr. Wang’s message, Greene-Moton and Minkler (2019) describes cultural competence as striving to know more about communities and cultural humility as a mental health professional recognizing their own biases, stereotypes, and beliefs (pg. 4). Noting that everyone has some type of bias. So it is up to us clinicians to become culturally competent, notice, and work on our own biases to practice cultural humility with our clients. Cultural humility is a lifelong commitment and a gift of power and privilege that we can offer our clients and our communities.

References:

Greene-Moton, E. and Minkler, M. (2019). Cultural Competence or Cultural Humility? Moving Beyond the Debate. Health Promotion Practice. 21(1): 142-145. doi. 10.1177/1524839919884912

Shaw, S. (2016, Dec). Practicing Cultural Humility. Counseling Today. https://ct.counseling.org/2016/12/practicing-cultural-humility/

Sherry C. Wang is a licensed counseling psychologist practicing in Santa Clara. She is also an anti-racist educator, mental health media contributor, consultant, and professor at Santa Clara University’s Counseling Psychology Department. Her research is rooted in advocating for the voices of underrepresented groups (e.g., People of Color, immigrants, refugees, LGBTQ populations). At the national level, she co-chairs the Asian American Psychological Association’s (AAPA) Division on Women (DOW). She previously chaired the American Psychological Association (APA) Committee on Ethnic Minority Affairs and was also a member of APA's Committee on Psychology and AIDS, which has since been expanded and renamed as a committee on health disparities. Since the start of COVID-19, she has been featured, cited, and interviewed in the media on the topic of anti-Asian racism, xenophobia, and cross-racial coalition-building. She lives with her husband, her dog, and their twin girls.

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