Please mute yourself as you come in!

How to Find Affirming Care

for QTBIPOC Individuals

Presented by: Kulkiran Nakai, Psy.D., LP

​

at Integrative Empowerment Group, PLLC

Working community document...

Presentation Take-Aways...

1. Overview of what therapy is and how it works
2. Information for selecting the right type of therapy for you (credentials, treatment type)
3. Guidance on how to navigate the selection process (therapist directories, insurance, etc.)
4. Questions to ask yourself and potential therapists when seeking treatment
5. What to expect and to prepare for in therapy
6. How to tell if therapy is effective (or not)
7. Guidance on how to repair a rupture, change, or “break up” with a therapist
8. Information on self-care and resources for self-healing (community brainstorming)

Racist Roots and Mental Health Disparities

• History of Mental Health is Racist
• Medical Industrial Complex
• Using white definitions to explain and define problems of BIPOC
• Individualistic and Collectivistic

Therapy Shopping 101

What is individual outpatient psychotherapy?

• Voluntary (Informed Consent)
• Confidential (privacy is protected, with exceptions)
• Dedicated space to claim for a non-linear healing journey (with a guide)
• Vulnerable process with mysterious content
• Dynamic process of growth and self-discovery
• Understanding self and others
• New perspectives and deeper insights
• Skills and strategies for change
• Reduce symptoms and suffering
• Cope with challenges and complexities
• Improve overall quality of life

Informed Consent and Confidentiality

• Legal procedure (required by law and ethics)
• Client is aware of potential risks and costs involved in both agreeing to or refusing treatment
• Only valid if client is competent and consent is voluntary
• You are the agent of making an informed decision that you believe is in your own best interest (permission to consult before you decide)

Why do people go to therapy?

• Depression, anxiety, stress
• Trauma
• Grief
• Gender dysphoria
• Oppression (race-based, gender-based, sexuality-based, etc.)
• Identity (race-based, gender-based, sexuality-based, etc.)
• Attachment and/or relationships
• Early developmental experiences
• Support through life transitions
• Personality challenges
• Strategies and skills
• Self-exploration
• And more...

Therapist Credentials

• “Therapist”, “Counselor”, “Clinician”, “Practitioner”
• Advanced Degree (Masters or Doctorate) in Psychology (or related fields) from accredited institution:
• Psychiatrist (MD, DO): prescribe and manage meds but usually not therapy
• Doctorate Level Psychologist (Ph.D., Psy.D., EdD.): psychological testing, diagnosis, clinical therapy, meds vary by training and state
• Masters Level Therapist (MA, MS, LGPC, LCPC, MFT, LMFT): no meds or testing but offer therapy
• Social Worker (MSW, LCSW, LMSW, LSW): no meds or testing but offer therapy and case management
• Licensed (full or limited) and/or Receiving Supervision
• “LL” = Limited License
• “L” = Licensed
• Malpractice Insurance
• Continuing Education
• Price rates depend on credentialing - more expensive does not necessarily mean better quality!

Selecting Types of Therapy

• What would best serve my current needs:
• solving problems? changing behaviors? navigating change? working on relationships? understanding self better? healing trauma? treating a disorder/diagnosis?
• What would work best for meeting my needs:
• Structure? Organic?
• What best aligns with my own worldview?
• Focus on past or present, unconscious, cognitive, body-mind centered?
• What would challenge me the most?
• What sparks my curiosity?

Most common therapies for certain topics

• Cognitive Behavioral Therapy (CBT): understand and change thoughts and behaviors to change how they feel and act
• Effective for: mood disorders, anxiety, post-traumatic stress disorder (PTSD), disordered eating, low self-esteem, insomnia, chronic pain, and more
• Dialectical Behavioral Therapy (DBT): enhanced CBT with mindfulness
• Effective for: suicidal thoughts, borderline personality traits, disordered eating, PTSD
• Psychodynamic Therapy: look at unconscious to understand past experiences that impact current functioning and experiences (long-term)
• Effective for: depression, anxiety, personality disorders, childhood trauma
• Behavioral Therapy: focused, action-oriented approach
• Effective for: anxiety, phobias, substances, ADHD, OCD, other behavioral issues

Most common therapies for certain topics

• Mindfulness: training mind to observe and be present
• Effective for: depression, anxiety, post-traumatic stress disorder (PTSD), disordered eating, low self-esteem, and more
• Exposure Therapy: CBT with experimentation of implementing new skills when exposed to triggers (preventing old responses)
• Effective for: obsessive-compulsive disorder, PTSD, phobias, complex anxiety
• Interpersonal Therapy (IPT): understanding issues about relationships
• Effective for: depression, unresolved grief, changes in social roles, conflicts or problems relating with others
• Humanistic: self-exploration of worldview and how to self-actualize
• Approaches: Existential therapy, Person-centered therapy, Gestalt therapy
• Effective for: self-esteem, coping, trauma, worthlessness/aimlessness
• Integrative Therapy: holistic (eclectic) combo for comprehensive and customized care

Therapist Specialties

• Family Therapy
• Couples Therapy
• Group Therapy (CGP)
• Psychodrama
• Sex Therapy (ASSECT)
• Kink Aware Practitioners (KAP)
• Polyamory Aware Practitioners
• Psychoanalysis
• EMDR
• Substance Use (CADC)
• Art Therapy
• And more...

How does therapy work?

• You cannot fail therapy!
• Therapy can fail you:
• client resistance to the work (impasse, psychological barrier, transference/countertransference)
• managing unrealistic expectations
• not practicing what is suggested
• poor fit in the therapeutic relationship
• therapist is “out of scope”
• different care is needed
• Balance of Science and Art

Navigating the Selection Process

Directory Search Online

• Do your research
• Read the bio
• Review the website
• Consider testimonials
• Make a list
• Call for a consultation
• Email questions
• Get support
• Complete the paperwork
• Meet and greet
• Trial and error

Email / Voicemail Template

• Introduce self:
• “Hi, my name is __, and I’m a student at UM”
• Referral source:
• “I was referred by __; I found you on ___”
• Potential match:
• “I noticed you work on __ and thought you might be able to help me.”
• Inquiry of accepting new clients:
• “I am wondering if you are accepting new clients”
• Topics addressed:
• “I’m seeking a new therapist to work on ___”
• Insurance/payment:
• “I plan to use insurance”
• “I prefer to pay out-of-pocket and am interested if you offer reduced fees”
• Availability:
• “I’m free to meet over the phone or virtually on ___”
• Salutations:
• “Thank you for considering. I look forward to hearing from you. Sincerely, ___”

“Safe-Search” Language for QTBIPOC Folx

• “Multicultural” or “Culturally Responsive”
• “Feminist”
• “Trauma-informed”
• “Humanistic” or “Existential”
• “LGBTQ+ Affirming”
• “Evidence-based”
• “Liberation”-focused or -based
• “Systemic” or “Structural”
• “Decolonizing practices”
• “Person-centered”
• “Integrative” or “Holistic”
• “Collaborative”, “Co-creative”, or “Collective”

Other Therapist Directory Resources for QTBIPOC Folx

• Latinx Therapy
• Asian, Pacific Islander, and South Asian American (APISAA) Therapist
• Black Emotional And Mental Health (BEAM) Virtual Therapist Network
• Boris Lawrence Henson Foundation Resource
• Black Mental Health Alliance
• Melanin & Mental Health
• Therapy for Black Girls
• Loveland Foundation
• Therapy for Black Men
• The National Queer and Trans Therapists of Color Network (NQTTCN)
• LGBTQ Psychotherapists of Color
• Ayana Therapy
• Therapy That Liberates

Digital Therapy

Is Virtual Therapy right for me?

• Do you enjoy and even prefer text-based, video, and/or phone communication?
• Are you without insurance and unable to afford traditional in-person therapy?
• Do you live in a rural area, or have limited access to transportation or services in your area?
• Do you struggle with social anxiety and feel more comfortable in your own space?
• Do you enjoy using technology?
• Do you prefer having the option to stay in daily contact with your therapist?

Online Support Groups

• Therapy for Black Girls
• Talkspace Support Group
• Sister Afya Online Sister Support Group
• Ethel’s Club
• UM’s SAPAC Wellness
• UM’s Gender Services Support Groups
• Firewood Collective
• Gender Spectrum
• IEG’s Group

Your Rights and Responsibilities

• Treated as competent
• Treated with dignity and respect
• Given informed consent
• Have knowledge and understanding about the risks, benefits, available alternatives to courses of treatment or medication
• Are free from abuse and neglect by the provider
• To not be recorded on audio/video or viewed through one-way mirror
• Confidentiality of private health information
• Access to your treatment record
• Experiencing treatment in a place that is clean and safe
• Civil rights are protected
• To be told about your treatment and progress
• Make your own choices about your treatment

Questions to Ask...

...Yourself Before Selecting a Therapist

• Goals/Purpose: Why do I want to go to therapy? What do I need / want? What do I hope to understand/learn? What am I willing to do?
• Funding: How can I realistically pay for therapy? Would it be better to use health insurance or work benefits? If I pay out-of-pocket, could my insurance company reimburse me, or could I search for therapists who offer sliding-scale or services at low cost?

How can I best invest in my care?

• In-Network through insurance
• Out-Of-Network (with or without insurance reimbursement benefits)
• Employee Assistance Programs
• Private pay
• Negotiate sliding scale fees
• Reduced-fee / Low-cost
• Scholarships (sponsors)
• Pro-bono (complimentary)

In-Network:

Out-Of-Network Reimbursement Benefits:

...Your Insurance Provider

• Is outpatient behavioral/mental health covered?
• Is telehealth covered?
• What is my co-payment?
• Is there a separate deductible for mental health?
• What is the usual and customary fee for a therapist?
• Which diagnoses do you cover?
• What type of sessions do you cover? For which CPT codes do you reimburse?
• Is there a pre-authorization needed for me to be seen by an outpatient individual therapist?
• What other services do you cover for mental/behavioral health?
• Is there a limit on how many sessions I have?
• Do you covers intensive outpatient or partial hospitalizations?
• Do you cover psychiatrists who provide medication?
• Do you cover medication at the pharmacy?
• What happens if coverage is denied?
• Can you show me a directory of therapists in-network?
• Can you tell me about my “Explanation of Benefits” (EOBs)?

… Your Therapist about Insurance

• Which insurance companies are you paneled with?
• What’s the process like after a session with you?
• Do you submit the bill to insurance?
• Do you collect payment from insurance?
• What’s my role/responsibility after submitting my insurance information to you?
• What happens to my therapy and fees if the insurance company denies payment?
• Will you help me with an appeal a denial of payment for services?
• If out-of-network with reimbursement benefits, will you provide an itemized bill for the receipts of payment so that I can submit with a claim form to my insurance for reimbursement?

...Yourself Before Selecting a Therapist

• Time: How far am I willing to travel? How often do I want to meet? How long do I want to be in therapy? Can I attend sessions consistently?
• Therapy Type: Do I want more/less structure/conversation? What would help me feel empowered and ready for healing/change? Would I want to include others in treatment and/or add alternative approaches to treatment?
• Therapist Type: What kind of person would I feel most comfortable being vulnerable with? What would help me feel seen and heard by them?

Resources for Funding Therapy

• The Boris Lawrence Henson Foundation
• The Loveland Foundation Therapy Fund
• The NQTTCN
• Inclusive Therapists
• Heal Haus
• Better Help

... Your Therapist

• What’s your availability during the week to meet? Are you available to meet __x a week/month? Do you offer teletherapy?
• What is your availability outside of session?
• What are your fees? Do you accept insurance or EAP / offer sliding scale / low-cost services?
• How long do you typically work with clients?
• What does a typical session look like? What is your style?
• What is your policy if I’m unable to attend session?
• What happens if you’re unable to attend session?
• What other services do you provide? What if I need something else? (e.g., couples therapy, group, meds, etc.)
• (If seeing therapist in a different state) How will our work together be affected after the pandemic?

... Your Therapist

• How do you think you’ll be able to help me?
• How will you customize my treatment plan?
• How will I know that treatment is working?
• What would you need from me in order for therapy to be effective?
• How will I know that I no longer need therapy?
• What percentage of your clients identify like me?
• How would you describe your understanding of and experience working with clients who identify like me?
• Why do you do this work? How do you work towards staying relevant in the field?
• Could you describe your own experiences with therapy and/or your healing journey?

... Your Therapist

• What was your graduate education/training like with understanding and working with different cultures? How have you continued your training?
• What is your/your practice’s position on the mental health impact of navigating multiple systems of oppression?
• How do you plan to use an intersectional lens in my treatment?
• How do you work with race-based/gender-based/ sexuality-based trauma?
• How do you/does your practice work on decolonizing therapy?
• How do you address issues related to societal oppression, like racism and transphobia, in therapy?

... Your Therapist

• What’s the best way to share feedback about my experiences with what you’re recommending?
• How do you address misunderstandings and/or therapeutic ruptures between us?
• How should I approach any problems in therapy or our relationship with you?
• What’s the best way for me to bring up any experiences of microaggressions or oppression by you?
• Have you done your own anti-racism/gender-/ sexuality-based work? How would you assess your own biases against QTBIPOC?

What to expect in therapy

Preparing for your First Therapy Session:

• How long have I been experiencing this problem/issue?
• What have I tried to cope with it already? What worked/didn’t work?
• What do I think the cause could be?
• How often do I suffer from this?
• What was my life like before this problem/issue was present?
• Why do I want/need to see a therapist right now?
• What do I need my therapist to know about me?
• How can I evaluate my first impression of them?
• What are barriers to treatment that would make it hard for me?
• What can I do before and after this session to take care of myself?

What to Expect in the First Few Sessions:

• Anxiety and fear is normative
• Paperwork and logistics
• Interview to gather history
• Rapport building
• Data collection (observation of lived experience)
• Establish treatment goals/plan
• Start where you are (don’t force it!)
• Co-guide pace, contents, and style
• Sometimes it gets worse before it gets better
• Check for unrealistic expectations
• Ask all the questions

What to Expect Throughout Therapy

• Everyone is different!
• Not one size fits all
• You do not have to be “perfect” client
• Dynamic process that evolves
• Won’t always feel good but should always feel safe
• Check-in and celebrate progress/developmental milestones
• Feedback to customize your care
• Reevaluate therapy (goals, needs, approach, technique, provider, service) for goodness-of-fit as you go

Normative Therapy Experiences

• Awkwardness and silences
• Transference and countertransference
• Therapeutic ruptures and repairs
• Implicit biases
• Misattunement
• Errors in scheduling or billing/payment
• Forgetfulness / tardiness
• Dance of good feels and bad feels
• Working outside competency, but with supports
• Small-town vibes and/or multiple relationships / conflicts of interest
• Bartering (if not contraindicated and not exploitative)

Client Tips for Effective Psychotherapy

• Attend appointments
• Set-up reminders
• Get logistics and business out of the way
• Be your most authentic self (don’t perform)
• Start where you are
• Don’t force anything
• Schedule at a good time
• Budget accordingly
• Communicate: social support / journaling
• Set boundaries around therapy (vulnerability)
• Practice checking-in with progress (celebrate)
• Be transparent about your experience (feedback)
• Pursue creative outlets to aid healing
• Let the therapist be the keeper of the clock
• Manage expectations of self and therapist
• Show up, be present (that’s hard enough)
• Prioritize self-care and r e s t (integration)

Loving-Kindness Meditation to Help Therapy Work!

May I have a desire and courage to participate

May I actively engage in treatment

May I commit to timely attendance

May I commit to funding my care

May I follow-through with treatment suggestions

May I honor and express my needs and feelings

May I be honest about my experiences

May I trust the process

May I believe in myself and my treatment team

May I respect my healing journey

Green Flags and Red Flags:

Repair the Rupture or Break Up?

How to tell if Therapy is Working:

• You feel heard and seen
• You like your therapist
• You keep coming to session
• You feel hopeful and empowered about the work
• You are more aware of your triggers
• You are more present and grounded
• You are better at naming your feelings
• You are better at catching and choosing thought patterns
• You don’t react as strongly to painful experiences
• Your set boundaries and stick to them
• You respect and accept yourself
• You are more curious and compassionate
• You are less attached to unnecessary suffering
• You spend more time focused on your values and wellbeing
• Life feels more fulfilling and satisfying

How to tell When to End Therapy (“termination”):

• Treatment goals accomplished
• Stable, regulated (not in crisis)
• Impasse (psychological barrier; mismatch)
• Plateau (integration phase?)
• Logistical challenges (scheduling conflicts, financial hardship)
• Quick fix (problem solved)
• Over-dependency (codependency)
• Boundary violations
• “Vote with their feet” (ghosting / cut and run)
• Resistance (roll with it)
• Therapist needs to terminate...

Therapists might Need to End Therapy if:

• Client care:
• Client no longer needs assistance
• Client not likely to benefit from the service
• Harm is being caused by continuing services
• Personal factors (e.g., intern rotations, retirement, grief/life, job change, case load, etc.)
• Interpersonal dynamic (strong and unmanaged countertransference; safety factors)

What an “Ideal” Termination Session might look like:

• Evaluate work experienced
• Celebrate challenges overcame and progress accomplished
• Explore what worked and what didn’t work
• Process experience of attachment and separation (beginnings and endings)
• Identify new goals / refine values and needs
• Discuss experience of the therapeutic relationship (what you liked and didn’t like)
• What to carry with you (across lifetime and/or to next phase of treatment)
• Express gratitude, affirmations, loving-kindness
• “Termination gift” (cards, notes, crafts)
• Professional relationship maintains itself (boundaries)

Vibe Check: Green Flags

• Warm, empathic, attentive, engaged, listens
• Nonjudgmental, curious, authentic, humble
• Feel connected, hopeful, empowered, safe
• Feel challenged, held, supported
• Inspires trust and confidence in you
• Maintains integrity and confidentiality
• Respects your boundaries
• Responds to feedback with humility and accountability
• Commits to personal and professional growth

Vibe Check: Green Flags

• Coordinates the best-line of treatment
• Collaborates with you to develop a (realistic and flexible) plan
• Explains approaches and interventions
• Facilitates the change process and healing journey at your own pace and on your own terms
• Licensed and/or receives supervision
• Works within scope of practice (or has supports when in training/learning)

Vibe Check: Red Flags

• Being judgmental or critical of your choices or lifestyle
• Pushes their own agenda/values
• Becoming reactive or defensive when receiving feedback (gaslighting)
• Insensitive or dismissive of your culture/beliefs
• Unchecked countertransference
• Unchecked microaggressions
• Overt discrimination and/or bias treatment
• Accessing your social media
• Giving medical or legal advice
• Overly friendly / flirtatious

Vibe Check: Red Flags

(Deal Breakers - Potential Ethical Violations)

• Violating confidentiality
• Not providing informed consent
• Working outside of their competency (scope of practice) without supports
• Manipulating insurance (fraud)
• Sexual relationships
• Client abandonment
• Exploitation (profit, fame)
• Coercion
• Abuse / neglect

File a Complaint Here

Navigating the Process of Confronting a Therapist:

• How long have you been with this therapist?
• Is this an isolated incident?
• Do you trust them enough (feel safe with them enough) to be honest about your observations/experiences in therapy?
• Receive support by talking it out with trusted loved ones (or anonymously online)
• Outline main points or write a letter without sending
• Practice using “I-statements” when expressing a need, feeling, concern, boundary or request
• Refrain from avoiding/ghosting, if possible
• Trust that your therapist can handle the conversation / decision, and will respect it

Examples for how to Repair a Rupture with your Therapist:

“I want to address what happened last session. What you said felt racially insensitive to me, and I feel hurt that you broke my trust. I can’t see us moving forward in a meaningful way until we can talk about it openly.”

“I’m not feeling very heard right now. Can you confirm your understanding of my perspective..?”

“I don’t think I’m getting my point across, let me try again.”

Examples for how to ask to Change your therapist/therapy:

“I’m realizing that my treatment needs have evolved from learning better coping skills to wanting to go deeper into my traumas. I want to explore different options but I also want to keep seeing you. Can you help me with my next steps?”

“I am grateful for what I have learned throughout my time with you. I no longer feel the need for therapy as often. What does the process look like to wind-down? What happens if I need therapy again? Do you offer maintenance sessions?”

Examples for how to “Break Up” with your therapist:

“I’d like to cancel my next appointment and all future appointments. Please have your billers contact me with any remaining balance. Thank you.”

“Based on some of my experiences so far, I’m not really feeling like this is the best match for me, and I don’t yet feel comfortable to talk about it.”

“I need support in finding another therapist, but I also still need a space to learn new skills/vent right now. Would you still be able to meet with me while helping me find a new therapist?”

Self-Healing Resources:

Community Brainstorming

Resources for an Emergency or Crisis

• National Suicide Prevention Hotline (800-273-8255)
• The Trevor Project (866-488-7386)
• The Gay, Lesbian, Bisexual and Transgender National Hotline (888-843-4564)
• Trans Lifeline (877-565-8860)
• Crisis Text Line (text “HOME” to 741-741)
• National Sexual Assault Telephone Hotline (800-656-4673)

• National Alliance on Mental Illness (800-950-6264; text “NAMI” to 741-741)
• National Domestic Violence Hotline (800-799-7233)
• National Substance Abuse Number (900-662-4357)
• National Drug Hotline (844-289-0879)
• National Eating Disorders Association (800-931-2237)

Resources and Hotlines

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Instagram Pages to Follow for QTBIPOC Mental Health

• The National Queer & Trans Therapists of Color Network (NQTTCN)
• Inclusive Therapists
• Fearless Femme 100
• Decolonizing Therapy
• The Nap Ministry
• Rest for Resistance (@qtpocmentalhealth)
• Asian Mental Health Collective
• Indigenous Circle of Wellness

• Therapy for Black Girls
• Brown Girl Therapy
• The Wellness Therapist
• Latinx Therapy
• The Loveland Foundation
• Melanin and Mental Health
• Black Emotional and Mental Health Collective

Instagram Pages to Follow for QTBIPOC Mental Health

• Rachel Cargle
• Nedra Tawwab, Therapist
• Vienna Pharaon (@mindfulmft)
• Sarah Crosby (@themindgeek)
• Ayyson Dinneen (@nontesfromyourtherapist)
• Alishia McCullough (@blackandembodied)
• Jamie Castillo (@findyourshinetherapy)
• Ash Inspires
• Minaa B (@minaa_b)

• Lauren Fogel Mersey (@drlaurenfogelmersy)
• Ericka Gail (@mentalhealthfemme)
• Camesha Jones (@sistaafya)
• Jenny Wang
• Gabes Torres
• Nicola Pierre-Smith (@melanatedwomenshealth)
• Dr. Norton (@drnortontherapy)
• Melisa Lopez (@counseling4allseasons)

Therapy and Mental Health Podcasts

• Latinx Therapy
• Therapy For Black Girls
• Between Sessions
• Brown Girl Self-Care
• Balanced Black Girl
• Where Should We Begin with Esther Perel
• Self Care IRL with Ty Alexander
• Mad Chat
• Other People’s Problems
• The Mental Illness Happy Hour
• Unlocking Us with Brene Brown

• The Lavendaire Lifestyle
• Celeste The Therapist
• The Hardcore Self Help Podcast
• Terrible, Thanks For Asking
• The One You Feed
• Not Another Anxiety Show
• Stories of Stigma
• Tara Brach

Reclaiming your Roots:

Use of Cultural Practices for Healing

• Ancestral healing
• Community
• Dance
• Music
• Food

Sleep Hygiene

• Environmental conditions
• Routines and rituals

Breathing

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Mindfulness

• Mind is the sky, thoughts and feelings are clouds rolling by
• Thoughts and feelings are leaves going down a stream

Grounding

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Emotions

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Thoughts

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Journaling Prompts

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Quarantine Coping

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Uncertainty

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Loneliness

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Coping with Self-Harm

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Suicidal Ideation Urges

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Coping Statements

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Affirmations

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Mood Boosters

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Thank You! :)

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