Why Asian Americans Struggle to Start Therapy — and How to Move Forward

As a first-generation Taiwanese American, I know firsthand that the cultural gifts Asian Americans inherit can sometimes become cultural burdens. Certain internalized beliefs about emotions, relationships, and mental health can quietly shape our wellbeing in ways that are worth naming when we're ready to unpack them.

The Asian diaspora in the United States is vast and varied, and no single experience speaks for all of us. Even so, there are patterns common to many Eastern cultures that are worth exploring together, for both our individual healing and our collective understanding.

You might have been raised in an Asian household where emotions were quieted and feelings like anger or sadness weren’t recognized or processed. Perhaps you felt the pressures of adult-related responsibility from a young age, and see how it connects to present-day anxieties about not doing enough. Or maybe you wish your own parents would consider trying therapy for their mental health, and can sense the real sociocultural barriers to them ever considering it.

These situations reflect several common patterns among Asian Americans: barriers to emotional expression, the complexities of parent relationships, and mental health stigmas. If you relate to any of these challenges, the following sections are worth exploring and might point you in the right direction for improving your own mental health and well-being.

How emotional suppression affects Asian American mental health

Asian cultures make up more than half the global population, but many members share similar beliefs such as filial piety and respect for authority, collectivism and interdependence, and emotional regulation or restraint.(1) Beliefs around emotions often include value for duty, honor, and deference to others as a virtue. These cultural frameworks are gifts, and reflect widespread philosophies such as Confucianism, Taoism, Hinduism, and Buddhism.

But ultimately, inherited belief systems that emphasize controlling our emotions can lead to discomfort with strong emotions like anger, fear, shame.(2) Research has shown that in many Asian American families, habits of emotional suppression contribute to individuals developing mental health challenges.(3) Common family patterns include avoidance of discussing emotional pain or resolving conflict, withdrawing from others when upset, pretending to be calm to keep the peace, or avoiding conversations around depression or anxiety.

Emotional suppression can even lead to somatizing mental health problems, where the suppressed mental and emotional strain on our bodies leads to developing physical, bodily pains.(4) You may have known family members who often complain of stomach aches, headaches, or fatigue, and might have been concerned that there was an underlying problem. Sometimes there is, and uncovering it is essential to finding the right treatment and recovery.

Compassion is critical in understanding the source of these patterns of emotional suppression that may be deeply internalized. Asian Americans of all generations have been impacted by immigration and acculturation stress, which both can have profound, lasting impacts on how families emotionally survive and cope with daily life.(5) But the risks to our health that stem from ingrained ways of navigating our emotional world are worth facing directly.

Family roles, self-sacrifice, and the weight of cultural expectations

Asian American clients that I’ve worked with in therapy have often spoken of specific familial patterns that they felt frustrated or blocked by in navigating their adult lives. These have ranged from the emotional strain of being the primary caregiver for elderly parents, feeling the weight of family responsibilities from a young age, navigating expectations as an eldest child, or struggling to distance themselves from the emotional needs of others.(6,7,8) There was a running theme among these stories that ties back to cultural values: namely, living lives of self-sacrifice.(9)

You may be personally familiar with how family and cultural dynamics have informed an inner sense of lacking emotional attunement from loved ones, feeling “too much” for having emotional needs, or having chronic anxiety from nagging fears of inadequacy. These are each difficult and painful challenges that affect our individual mental health, even if they originated in our relationships.

But the challenge that comes with facing these systemic burdens can be both daunting and deeply meaningful. Whether we have developed ways of coping like people-pleasing, perfectionism, or intense discipline, we have come through incredibly complex relational and emotional challenges with our sense of self and what we deserve still intact. This is the inner spark that we can fan into a stronger flame to guide us on a path toward better mental and emotional health.

Mental health stigma in Asian American communities

Self-compassion with our own struggles and receiving empathy from loved ones can be difficult when mental health stigma weighs on us. Among Asian Americans, there are often instilled values for saving face (East Asian cultures) and protecting izzat (a South Asian virtue), in order to protect family reputation and communal dignity. It’s easy to see how caution around self-expression would make it easy to downplay internal distress like mental health issues or emotional suffering.

Research has confirmed that Asian Americans continue to have low rates of seeking help for mental health difficulties, including through therapy.(10) This reflects the caution around mental health disclosure that extends to professional support. Some would understandably wonder, “If my own parents don’t think my depression is real, why would I want to be interviewed by a professional who is a stranger and doesn’t even know who I am?”

Therapy can be an essential resource

In my therapy practice, I’ve met with numerous Asian American clients who are trying therapy for the first time. I marvel at their courage and determination to prioritize their own mental and emotional well-being, particularly given all the cultural beliefs they might be confronting in order to do so. In all their unique stories, it was clear that they were tired of trying to push through on their own, and their sense of self wouldn’t allow them to suppress their struggles any longer.

Each of us will have our own unique needs that therapy can help to address, but there are some common themes that underlie the valuable work I’ve done with Asian American clients. For personal health, these include:

• Cultivating emotional awareness, processing, and articulation/expression
• Allowing feelings to come out vulnerably in safe conversation
• Connecting physical symptoms to mental or emotional stress and developing tools for releasing stress
• Building mindful awareness of how stress builds up and practicing routines to metabolize it

When relationship challenges are at the forefront of your mind, therapy can help to improve circumstances by way of:

• Strengthening emotional, psychological or physical boundaries with family members
• Carving out time and space in your busy schedule for rest
• Refining communication skills to navigate tensions with aging parents
• Unpacking the false guilt or shame that may have been imposed by others

None of these are simple challenges to tackle or easy skills to learn, but as my clients have shared, the processes are deeply worthwhile. Matching with a therapist whose approach is a good fit for you can be the first step toward addressing these goals in a meaningful way

Treatment strategies to explore

There are many therapy modalities that you can explore that might work best for you, depending on your goals, temperament, and personal preferences. But across specific modalities there are personal growth strategies that many of us will find helpful to learn.

For emotional health, many therapists incorporate evidence-backed exercises like using language to “name and tame” mental and emotional distress. This strategy takes advantage of neurobiology research to proactively soothe our overtaxed nervous systems through the use of expressive language.(11) While verbal processing and sometimes “venting” are natural instincts, approaching complex or overwhelming inner states with thoughtful language is actually a mindfulness skill. Some of us were not taught specific emotional processing skills as children, and learning strategies for self-expression now can reap enormous benefits.

Mindfulness is also helpful for safeguarding our psychological health caused by culturally-related pressures.(12) In Acceptance and Commitment Therapy (ACT), there is a useful concept called “self-as-context” which reminds us to view all thoughts as clouds moving across the sky of our minds - whether stormy and troubled, or serene and lighthearted. This is a simple way to relate more mindfully with our thoughts, and steady practice can help improve our sense of inner grounded-ness.

When our therapy goals are focused on relationship conflict or stress, communication skills become invaluable tools. One skill that is both critical for our mental health and often more difficult for Asian American clients, is practicing respectful assertiveness with parents. Many of us might relate to the frustration of having our honest, direct thoughts interpreted as disrespect by older adults. Studies have shown that generational differences including those caused by acculturation to Western norms frequently drive disconnect between Asian American family members.(13)

To know that we are maintaining respectful yet assertive communication, oftentimes we need to hone our self-regulation skills. Emotional regulation includes strategies for de-escalating yourself and tense interactions so that disagreement can be more productive. Sometimes this involves somatic practices like deep breathing, slowing down your speech, or using silence before responding.

A second element of assertive and effective communication with parents relies on pursuing common ground. This can involve explaining your individual needs within the context of familial and broader values like upward mobility and achieving good fortune. Or it can mean preventing defensiveness in others through non-aggressive language such as “I” statements, and direct validation of the sacrifices made by family.

You’re not alone as you build these kinds of mental health and family relationship skills; a skilled and attuned therapist can provide support and a safe space for strengthening such habits over time.

What to look for in a therapist

Many criteria for good therapist fit will apply to everyone regardless of cultural background. But for Asian Americans, cultural sensitivity can be critical. You can look for a therapist who is both well-trained in evidence-based therapeutic approaches, and also humble in how they approach your unique story.

A culturally sensitive therapist will not make assumptions that they know what your life or history has been like, particularly if they themselves are Asian American. They will lead with curiosity as they continue to understand your story more deeply, and adapt to your comfortability in how soon you want to be vulnerable.

Sometimes, practical needs include receiving psychoeducation around how the therapy process often works and what types of interactions you might expect to have. All your questions should be welcomed at any point in treatment, because your understanding of where the process is headed provides safety and grounds expectations for the outcome.

You might prefer shorter-term therapy, or be open to ongoing sessions as your goals develop. Either way, the right therapist for you will have both the clinical approach and empathic perspective that makes your care a worthwhile investment. If you feel more comfortable working with an Asian or Asian American therapist, Alma’s network of licensed professionals has a wide network available.

Taking the next steps

If you have been considering starting therapy and also resonate with any of the Asian American cultural themes described here, know that you deserve support for the mental and emotional burdens you’ve been carrying. Reaching out to a therapist to explore their fit for your needs is a courageous step, and may bear unexpected fruit as you enter into a new type of supportive relationship.

Regardless of the specific treatment goals and therapeutic methods a therapist will use, it’s important that the process go at your pace. A culturally sensitive, emotionally attuned therapist will invite you to share what feels comfortable and let them earn your trust in your own time.

As Asian Americans, we carry the weight of our histories and the wisdom of our cultures simultaneously. Choosing therapy isn’t a rejection of where we come from; instead, it’s an act of honoring ourselves fully, so that we can also show up more wholly for the people and communities we love.

The path toward stronger mental and emotional health isn’t linear, and for many of us it begins with a quiet but significant act: deciding that our inner life matters. Whatever cultural inheritances you carry, the gifts and the burdens alike, you’re worthy of a space where this can all be held with care.