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Self-care of the Clinician

As clinicians, we often find ourselves working with our clients to find more rest, more forgiveness, and more compassion in their lives. And often, we forget to find the same for our own. The world around us seems to be facing a darker time than we can remember: families are continuing to be separated at our nation’s borders, natural (and man-made) disasters continue to wreak havoc in various corners of our world, and fear seems to permeate our conversations. In this context where the threshold of fear continues to rise, our clinical work also gets impacted by individuals and families facing uncertainty and multiple stressors. It seems impossible and almost selfish to carve out space and time for our own selves.

It also doesn’t help that #selfcare has become a trendy word and has evolved in its meaning to something that requires economic privilege and resembles self-indulgence. It has come to signify a legitimate excuse to be couch potatoes and binge-watch mindless television in certain contexts, or eat junk food mindlessly for comfort. The irony is, this sort of #selfcare often leaves us less than rejuvenated and reenergized. It often leaves us numb and spent.

Self-care takes intentionality and discipline. It takes work to carve out time in our busy schedules to go exercise or eat a mindfully prepared meal. It takes some level of self-denial to refuse that extra episode on Netflix that will keep us up for another hour rather than getting some sleep. It takes energy to build and maintain a healthy community around us and to meet people whose conversations feed our souls. I know, because I am often guilty of neglecting these practices.

And yet, it is of utmost importance that we care for ourselves in this way to effectively support the burdens of our clients and to resist burning out. It is for the good of our own selves, but also for the good of our work and the good of our clients that we intentionally take time to practice
meaningful and effective self-care.

Please see the following resources on self-care:

Parenting as an Asian American Psychologist

By Chia-wen (Winnie) Hsieh, Psy.D.

I used to think my role as a graduate student was difficult and the jobs secured during my post graduate years were growth intending. Unbeknownst to my younger self, parenting is actually the most challenging career I have ever secured. This job is brimming with growth intending, there are not enough books that I can read to prepare me for the growth this job demanded me to have. Moments as a parent often forced me to reflect on who I am as a person and how I became the parent that I am today. Nowadays, I often think deeply on what it means to be an Asian-American woman, what cultural values that were imparted to me both implicitly and explicitly, and of these values, what I would like for my own children to learn or consider, and what values I would like to do away with.

To begin my deep thinking about parenting, one must briefly examine the history in order to go forward.  Both my partner and I are raised by strong women. Both our mothers are emotionally intense and adhere strongly to their traditional cultural roles and often used shaming as the ultimate parenting tool. While my mother’s passive-aggressive nature constantly engages in “cold war” with her children, my partner’s mother constantly uses anger to force her children into compliance. Growing up in a repressive environment, we both vowed to be a different type of parent than what we have experienced ourselves.  

Fast forward a few decades, in enters my children.  My first born is a free spirit. He can carry on a conversation with just about anyone, he is open to experiences, and he is the most fun-loving individual that I have ever encountered.  He loves daylight because he believes the sun powers him. On the other hand, he hates two things: eating and sleeping. He is emotionally intense and loves hard. This means that he is not shy to tell us what he thinks, and when he is upset, he is also not shy with his words and volume of his words. My youngest, at 15 months of age, is still pretty new to us. It remains to be seen how he will become, and I patiently read and re-read the events from each day as well as entering the next chapter of our journey together.  

As an individual, I am naturally more reflective and internalize way more of what is happening in the world around me. As a psychologist, I am apt to understand my clients better and to always listen with an empathetic ear.  As a parent, I read a lot. From my readings, I try to remember all the new and insightful information that initially catch my attention and gauge how I can apply what has been learned from my life experiences.  Knowing myself, I am definitely not a “tiger mom”, since I do not have the discipline to do so (blame it on the birth order, I am the youngest!). As a slightly more right-brain dominant person, I highly value creative expression. I have been told by those around me that I am “too soft”, “too lenient”, and allow my son to “says whatever he wants”.  When the house is becomes quiet at night, I would often lie awake asking the same questions: Am I a good enough parent? Have I done enough? Should I have reacted differently?

One day, an argument broke up in my house. My partner angrily yelled at our son while he yelled back in frustration. I stood by the sink, not sure what I should do as I often do when conflicts arise in my life; I just froze. After my partner’s anger subsided, I asked my son to have some quiet time to cool down and I confronted my partner about his level of anger which was met with the usual “I do this because you don’t discipline him”. I attempted to educate him about developmental stages and psychological perspective of why our son did what he did, which as you can imagine, was met with immense resistance ladled with more anger (I can see you guys reading this and thinking that I am intellectualizing the whole thing, and yes, I was!  This is an excellent time to refresh myself on defense mechanisms we all came to know so well from our training). Needless to say, the rest of the night went by in an eerily quiet manner. As I counted sheep to try to go to sleep that night, I had an epiphany (an a-ha moment, if you would). I was reacting to my partner’s parenting as how I have reacted to my mother’s anger (silence and retreat) while my partner was merely repeating the history of how he was parented (anger expression). A few days later, we sat down to talk about this and I offered my thoughts while he shared with me the challenges he faced as a parent. We had a breakthrough.

Is my home a perfect home from this point on?  Of course not. We still have our moments, but we continue to move forward with constant reflections and discussions. We are learning together, and we are growing together.

I am a better person because of my children.  I am a better psychologist because of my children.  My current role as a parent and a psychologist afforded me the ability to psychoanalyze every situation faster, dispel any irrational thinking quicker, and dissolve my defense within minutes.  I am confronting my cultural values with curiosity and with respect, and I gently let go of what does not work for me. I will continue to encourage free speech at home but I will also continue to emphasize the importance of respect and compliance (to certain degree).  

My journey has just begun.

Chia-wen (Winnie) Hsieh, Psy.D. is currently a full time mother of two loving boys. She also works in her “spare time” as a full time Program Director at Pacific Clinics in California and a part-time private practitioner. Winnie was the inaugural DoP chair and a long time AAPA supporter.

Locating our traditions

(A long-ish rant-esque entry from one your Korean-American colleagues)
By Wonyoung L. Cho

When I am working with first- and second-generation immigrant families, there are these nebulous concepts of “cultural traditions” and “how things were back home” often used to describe the cultural and generational gaps within the family. These concepts also emerge when I am working with individuals who straddle multiple cultural contexts. These individuals are often 1.5 and second-generation hyphenated-Americans (i.e. Korean-Americans, Vietnamese-Americans, Mexican-Americans to name a few) who are working through their identity and relational issues. I refer to these concepts as nebulous because the meanings that are conjured up by these words are subjective and contextual, connected deeply to a specific time and place in socio-political histories. Yet, we often use these words as though it means something objective and constant, disconnected and dislocated from our sociopolitical and cultural locations. And I think this linguistic practice locks us into deeply problematic dynamics in our work.

Let me try to explain what I mean with a story.
In my previous life as a young working professional in a different field, I had female co-workers who were also Korean-American like me. I spent my early- and mid-twenties with them, and we worked hard and played hard together. Our after-work conversations over dinner and drinks often involved complaining about work and commiserating on the complexities of life as Korean-American young women–especially in trying to figure out how to balance being “good daughters” to our parents while enjoying the independent and individualistic culture of the mainstream US. In these conversations, my co-workers spoke about the patriarchal gender dynamics in their families, of sons being valued over daughters, and curfews for the daughters that were different than the sons–perhaps family and gender dynamics that are stereotypical of an Asian American narrative. My co-workers often attributed these patriarchal values to being Korean, and blamed the “traditional Korean” ways of their parents.

If I had been a therapist then and was tasked to support the work of my co-workers’ family dynamics and identity as Korean-American daughters, I might find myself problematizing the Korean culture and having to split their identities. Perhaps I might work to “free” my hypothetical clients by suggesting that they give up their “cultural traditions” and embrace assimilation to become more “American.” Perhaps I might be inclined to problematize the parents and their “Korean” ways, identify Korean culture as oppressive, and encourage my co-workers to “differentiate” and detach from their “toxic” families. Perhaps these may serve as solutions for my hypothetical clients. But perhaps it may also invite further complications–of deeper conflicts within the Asian American identity, and having to split and choose a side.

I have to say, my definition of “traditional” gender dynamics of South Korea was (and is) different. Due to my unusual and somewhat nerdy interest in Korean history, I knew that the Korean peninsula had queens reigning over it as early as the seventh century (e.g. Shilla dynasty), and Korea was not always patriarchal in the way they organized society (e.g. Goryeo dynasty). My parents also did not reflect these patriarchal norms. My parents moved to the US in the early 90’s, after having been through a cultural shift propelled by the slogan “잘 키운 딸 하나 열 아들 안부럽다 (a well-raised daughter is better than ten sons)” in mid-80’s South Korea. This slogan is perhaps a manifestation of what we in the US name feminism in the cultural history of South Korea; and if we are going to call this movement a kind of feminism, then my parents were feminists. They believed in providing equal education and access for their daughters–and they fought for my education and access on my behalf when I was younger. Granted, their idea of equality and equity between the sexes and genders differ from the current trends of feminism, but my parents were intentional and careful in the way they loved and supported their daughters.

What I’m trying to illustrate here is that patriarchal gender dynamics is not innate and traditional to being Korean or to being Asian. And this is just an example. There are many other social customs and relational norms that we have come to name as “traditional” to being Asian or to whatever country or culture of our heritage. But if we reach back into the cultural and historical narratives of our homelands, they too have complex stories that illustrate the ebbs and flows of different values and customs, different social values and relational ethics.

We need to be careful of what we mean when we refer to traditions and what we attribute to our heritage cultures. It is a misnomer to name problematic family dynamics and relational patterns to a culture without locating its socio-political and cultural history. It may lead us to villainize our ancestors and our parents. It may tempt us to deny or dissociate from our histories and our roots. Furthermore, it creates a narrative that requires us hyphenated-Americans to have to split our identities and think in binary frameworks (e.g. American and not-American, Korean and not-Korean). Ultimately, it may lead our clinical practice to also perpetuate some of these problematic thinking in our clients.

I’m sharing these reflections with you because I want to be accountable. Locating our traditions in their complex and nuanced socio-political histories goes against our knee-jerk impulses to categorize and simplify. It requires more work, effort, and time. It requires emotional labor to a certain degree, and I am often lazy. But I want to think complexly when I’m working with my clients, and I don’t want to participate in perpetuating problematic narratives of what it means to be a hyphenated-American.

Let us be careful when we name things as practitioners, scholars, and researchers, especially when we are going to link them to a certain culture. Let us make sure we are locating ourselves, our work, and our traditions to the rich, complex, and nuanced socio-political and cultural histories.

Wonyoung L. Cho, LMFT, is a marriage and family therapist and a clinical supervisor currently based in San Diego, California. She will be graduating with a PhD in Education in May 2019, and headed to Portland, OR in the fall to start as a tenure-track assistant professor in the Marriage, Couples, and Family Therapy (MCFT) program in Lewis and Clark Graduate School of Education and Counseling.

Divion on Practice Updates

By Ulash Thakore-Dunlap and Thuy Truong

Thank you to all our members for your ongoing support! We are grateful to have you be a part of this momentum and are appreciative of your contributions and feedback. As our division continues to grow, we are excited to share some updates regarding our upcoming projects to support the needs of our members and the AAPI community. We hope that you continue on this journey with us as we embark on these projects.

The DoP Website and Blog

The DoP website, https://aapadop.wordpress.com/, is a platform through which we hope to connect researchers and practitioners to promote mental health wellness for the AAPI community. Please visit to learn more about the executive committee, DoP’s goals and mission, and resources. Additionally, the blog section offers articles and postings on clinical practices, struggles within the AAPI community, and clinician perspectives. We are always looking for writers to capture new ideas and talent, so if you are able to provide an entry, please contact our communications officer, WonYoung Cho at wonyoung.lmft@gmail.com . Also, don’t forget to check out our Facebook page at https://www.facebook.com/DivisionOnPractice2016/.

The Clinical Referral Board

We are currently developing a clinical referral board with AAPA. The clinical referral board will provide a list of current DoP members who are licensed practitioners. We hope that the clinical referral board will provide an avenue for AAPI clients to connect with a clinician whom meets their cultural and clinical needs. Please come back to our site in the future for more updates.

Other Exciting Projects in the Pipeline

We are excited about other projects in the pipeline including webinars for our members on topics related to clinical practices and needs of our AAPI community. If you have any suggestions for the webinars, please contact our Chair-Elect, Dr. Meiyang Kadaba at meiyang.liu@gmail.com. Additionally, we will be looking for ways for members to connect locally to build a stronger, more cohesive community.

Together, we hope to create connections to support our AAPI practitioners, so in turn we can support our community. If you have any questions, want to be a member, or volunteer, please feel free to contact either Ulash Thakore-Dunlap, ulashmind@gmail.com or Thuy Truong, truong.psyd@gmail.com .

 

DoP Executive Committee members:

Chair: Ulash Thakore-Dunlap | Co-Chair: Thuy Truong | Chair-elect: Meiyang Kabada | Membership: Joanna Maung | Treasurer: Judy Huang | Secretary/Historian: Susan Han | Communications: WonYoung Cho | Student Representative: Keziah Lyu

by Sally Chung

Being Generation 1.5, I always wrestled with my cultural identity. Raised in America, I am not “Asian” enough. Raised in Hawaii and being Chinese, I am also not “American” enough. I always felt a little behind, a little out of place. Even after making cultural identity the focus of my dissertation, it is still a process that moves at its own pace. Sometimes in sudden, hammering surges. Other times, the barest whispers barely caught on the edge of my consciousness.

Fast forward to a few years ago, I started a private practice after completing my residency. I learned I needed a niche to make me more marketable. Being trained as a general practitioner, I had no niche and couldn’t think of one. I didn’t have anything that would make me stand out in the sea of therapists in the Seattle area.

Except I did.

In 2018, 2/3 of my intakes identified as people of color, couples of color, or mixed race couples. For many of them, my ethnicity was a factor in them choosing me. They wanted someone who could understand their experiences, cultural values, and family dynamics. They wanted to be seen. They wanted someone who would get it. Some shared feelings of relief at finding a practitioner of color and their relief struck me hard. It was poignant, weighty, and bittersweet.

They were relieved to find someone who looked like them and could relate to them. They were relieved because Asian American therapists are kind of like unicorns, especially at the doctoral level. According to APA in 2016, AAPI-identified psychologists comprised about 4% of all psychologists (n = 3,576) and that is a 92% increase from 2007. That does not even factor in age, acculturation/generational status, or specific ethnicity. As a whole, people of color do not have as many options for non-white practitioners; that same APA report found that only 16% of psychologists identify as an ethnic/racial minority. (source)

It turns out my niche found me.

And it turns out that working with people of color, particularly young professionals working hard to adult effectively and figure out who they are, is something that is deeply fulfilling to me. I resonate intimately with their struggle. We have so much to offer as API psychologists by embracing our cultural identity as a core part of our professional identity. I love that I am using my research to guide people as they navigate the intricate and never-ending process of becoming. My experiences give me just enough wisdom to retrace my steps to walk with them on their road. I love sitting with them in a space that is filled with questions, connections, and compassion. My heart soars with each insight made and each relationship repaired. My heart breaks with their grief when interventions go wrong- or right. I love feeling that each session heals a bit more of the little girl part of me that needed to know that the struggle will get easier and that I’m all the more whole because of it. I needed her to know that we made it. Because we made it.

Sally Chung, Psy.D. is a licensed clinical psychologist who has a private practice in Seattle, WA. Her way-too-long dissertation was a cultural identity exploration workshop for Asian Americans.