The Times spoke with several therapists, social workers, researchers and organizations serving Thais and Asian Americans to explore how treatment and recovery can be tailored to their needs. The following recommendations emerged: meeting the client's practical needs, involving family and community in the client's care, and practicing mindfulness in a community context.
Satisfying customers' practical needs first
Gordon Hall, professor emeritus of psychology at the University of Oregon, explained that Asian Americans often refuse treatment after attending therapy. Helping them solve practical problems can help keep them interested.
“[Some therapists] may spend the first three weeks on [a client’s] “Thoughts and feelings, and maybe it will eventually come down to the practical problems of a person,” Hall said. “But many Asian Americans might be thinking: What do my thoughts and feelings have to do with this conflict I'm having with my mom, or this problem with my boss about asking for a pay raise?”
It was the Road, the manager's business and Asia Pacific Counseling and Treatment Centersworks with psychiatric social worker Wanda Pathomrit to help clients, many of whom are Thai immigrants, apply for social benefits. Patomrit meets with clients to understand their mental health issues, and Na Takuatung can help them apply for programs such as CalFresh or CalWorks.
Patomrit explained that she integrates case management into her therapy sessions because many clients with depression, trauma, or avoidance behaviors may have difficulty maintaining relationships with case managers or following through on recommendations. Instead of dividing roles, she uses real-life situations—focusing on the Department of Human Services or drug treatment centers—as opportunities to develop coping skills, practice emotional regulation, and cultivate self-compassion.
“By providing coaching in the moment, I help clients gain confidence and self-esteem when accessing services,” Patomrit said. “For cases with urgent need and high risk, this intensive approach is not ‘superfluous’—it is critical to progress.”
But some clients are hesitant to accept help, Na Takuatung explained, because they believe that by doing so they are a “burden” to society.
“They had this idea that if they didn’t ask for public goods, then they were ‘good immigrants,’” Na Takuatung said. “They'll think it's better if they fight and earn their own money, and even if that's not enough, they'll just fight in silence.”
The choice is ultimately theirs, Na Takuatung said. But she explains how these programs can ease their stress by reminding them that they don't need to feel guilty.
“You lived in this country. You also contributed to this country,” Na Takuatung said. “You deserve kindness.”
Involving family in care
IN study Exploring culturally competent treatment for Asian Americans, Hall and co-author Janie Hong explain that Western approaches tend to emphasize individualism and personal reflection.
“You go in, you have to talk about your problems, you have to talk to a stranger for 50 minutes about what's going on inside, and that healing happens through voicing your inner experiences,” said Hong, an assistant clinical professor at Stanford Medicine.
In contrast, many Asian communities are rooted in collectivist cultures, where identity and well-being are deeply intertwined with family and group harmony.
“If you're in a community where everyone has to take care of you and you have to take care of them, then if you have a problem, it affects your entire group,” Hall said. “Person-centered approaches … may deter Asian Americans from seeking treatment.”
As chief clinical officer for Richmond Area Multi-Services, one of the first agencies in the country to meet the needs of Asian American and Pacific Islander communities for culturally competent services, Christina Shea saw the value of involving family members in a person's care.
“If you are working with [a client] in Western psychology, it helps because it’s one unit,” Shi said. — But if you're working with, say, someone from Southeast Asia, [and] you work with one person, that's not enough. This is not a unit because this person is connected to the family.”
Pramaha Dusit Sawaengwong observes this dynamic often as a monk in a monastery. A little Thai or Los Angeles. He commonly sees conflict when immigrant parents' high hopes and expectations clash with their children's career aspirations.
Phramaha Dusit Sawaengwong, monk and secretary, stands inside Wat Thai in Los Angeles.
(Juliana Yamada/Los Angeles Times)
Language barriers can exacerbate disagreements. A common Thai word used to describe suffering is hua òk ja tàek, which means the chest (heart area) is about to break. But parents with limited English proficiency may find it difficult to convey this feeling to their child.
“[They] I want to say something, but [they] I don’t know how to say this,” he said.
Since parents often visit him at the temple for counseling, he advises them to allow their child to absorb all the opportunities available to him and allow him to blossom.
“Don’t wait… just let them learn,” Sawaengwong said.
Support can extend beyond the family.
Daniel Ung, assistant professor of psychology and health psychology at Bastir University, is studying the mental health impacts of Southeast Asian students during and after the COVID-19 pandemic. She works with patients to identify communities where they can get support, viewing the community as “concentric circles surrounding that person.”
“Community can mean friends, extended families, stepfamilies and even the community you live in,” Ung said.
Pam Evaji and Ta Sanalak are volunteer teachers at Wat Thai who coordinate Thai language lessons and cultural programs to promote communication and understanding among family members. They ask parents to understand how living in the U.S. might influence their child's beliefs, while teaching students the importance of learning traditional customs based on where their parents grew up.
“We understand the parents because we are Thai, and we understand the child because we have lived here. [in the U.S.] for quite some time,” Sanalak said.
Families can also support each other at Wat Thai.
“Some children may be the only Thai students in their school,” Evaji explained. At the temple, they can make friends with other Thai students who understand their problems. Many parents cook together at the temple for their children and share tips for resolving conflicts within the family.
Mindfulness is a core principle of Buddhism. According to the Pew Research Center, 90% of adults in Thailand identify as Buddhist, and many Thai Americans continue to practice the religion.
Many Western therapies include mindfulness, but the focus remains on the individual, while Eastern mindfulness practices consider the individual within a community, Hall said.
“There’s something called loving-kindness meditation, where you focus on someone who has done something for you,” Hall said. “You can meditate on your mother to the extent that she cares for you, the gratitude that you feel for her. [her] and what are you [owe] her.”
Buddhist monk Phiphop Phufong often uses this approach when visiting sick or hospitalized people.
A diabetic man who had his leg amputated expressed deep grief at his loss and shame at having “become a burden”, feeling dependent on his mother and sister. Phufong led him through mindfulness exercises to help him find peace with his new reality while encouraging him to stay strong for his mother and sister.
“Your body is your gift,” Phufong said through a translator. “Bring your mind back to your home.”
Health policy and education have come a long way
Los Angeles County Department of Mental Health has services to reach underserved communities. It supports cultural competency through translation and interpretation services, culturally and linguistically inclusive services, and bilingual employee benefits. But language is just the beginning.
“We're trying to cover all our bases, but I think there's still a lot of work to be done,” said Dr. Lisa Wong, who heads the department. “And I don’t think we’ll make much progress until we attract a more diverse mental health workforce.”
Wong added that it is difficult to recruit clinical professionals from different ethnic groups because many new immigrants and their children choose higher-paying professions rather than mental health fields.
Additionally, much of the training and education of practitioners is still based on Western concepts of mental health and recovery. Many evidence-based models were developed from studies of predominantly Eurocentric populations, explained Carl Highshaw, executive director of the National Association. California Division of Social Workers.
“While these models have value, they often do not reflect the realities of immigrant and collectivist cultures,” Highshaw said. “We need to adapt and co-create interventions that honor cultural traditions, family systems and community networks.”
Hong appreciates that many therapists now recognize clients' cultural contexts. It's equally important, she says, to find methods that don't rely on stereotypes.
“Not all Asian Americans have a reactive problem-solving approach, and not all Asian Americans are collectivist or interdependent,” Hall added. “[Some] one might actually want to use a conventional cognitive-behavioral approach. They want to talk about their thoughts and feelings, and this can really help them.”
Approaches that have worked for the Thai community and Asian Americans can work for other communities, Hall said.
For Highshaw, cultural competency “is not optional,” especially in a state as diverse as California.
“We’re going beyond a one-size-fits-all approach,” he said. “Ensuring that interventions reflect the lived experiences, values, and strengths of the communities we serve…is an ethical responsibility.”
Translator Supakit Art Pattaratheranon contributed to this report.
