May 30th, 2023
A roundtable conversation on the many different approaches to developing an inclusive, anti-oppressive, and joyful practice.
May is Mental Health Awareness Month, a calendar observance first set in 1949 by the American community non-profit now known as Mental Health America. In its original form, the organization was called the National Association for Mental Health and was founded in 1909 by a man named Clifford Whittingham Beers—according to their website, it was his attempt to reform a broken system that he personally saw was full of institutionalized abuses against people in need of compassionate care.
Today MHA encourages people to spend May paying close attention to the way their own mental health, as well as the ways their environment and their communities contribute to and benefit from careful, sensitive, and inclusive care. This is a worthy aim, and within it comes questions that require their own attention: how do we define a term like mental health? What are the individual responsibilities to take care of ourselves, and how can that be possible in a world with so many systems that prevent us from living with safety, autonomy, and joy? What does it mean to locate mental health within a diagnostic or institutional framework, and how can that medical approach reckon with its own history of harming so many people with narrow-minded or oppressive definitions of “mental health” as a synonym for traditional or repressive values?
We’re looking at mental health through the lens of therapists in the Feeld community, to reveal the myriad ways we can define it for ourselves. The roundtable below features five people working in their own therapeutic practice:
- Sara Al-Khedairy, an associate therapist who specializes in consensual non-monogamy, neurodivergence, and racial trauma.
- Nikita Fernandes, a mental health and sex therapist focusing on culturally sensitive, poly & kink-friendly, and queer-affirming therapy.
- Adam Goldhopf, a registered psychotherapist who is building a client list around people exploring their own issues with masculinity, artistry and creativity, and grief and traumatic loss.
- Danielle Simpson-Baker, a registered marriage and family therapy intern and board certified sexologist who aims to provide sex therapy, coaching, and consulting.
- Joshua Terry, a therapist-in-training centering a practice around identity development and relationships.
Every one of these therapists has a unique idea of what is best for their practice, based on their own experiences and education. Many of them spoke about developing highly individualized approaches, which are just one kind out there—there are other angles that can be more general or even more specific,and we encourage you to continue reading and learning from a variety of sources if you are interested in finding more options for yourself. This is neither medical advice nor a how-to guide, but rather, a small group with their own opinions gathered out of a very large field.
Therapy itself is, much like the issues it was designed to treat, a construct made, unmade, and remade all over again by those who have the power to do so. The therapists featured spoke about how their own background influenced a multifaceted approach to therapy, one that isn’t restricted to limiting histories or previous definitions; the ways that people who choose therapy can best advocate for themselves throughout treatment; and how we might perhaps think of the ongoing work of taking care of ourselves not as what we’re trying to eliminate, but what our curiosity about our own interiority could prompt us to explore.
Your practice specifically mentions a need for providing inclusive and anti-oppressive frameworks. Can you tell us more about what kind of cultural, social, and political context you bring to work?
My practice is grounded in social justice and approaching healing through a decolonized lens. An important part of my work is striving to name and minimize the power hierarchy that exists between me and my clients. Societally, therapists are often placed on the “expert” pedestal, reinforcing the idea to clients that their therapist holds a superior wisdom, knowledge, and set of tools. In my practice, I defer to my clients as the expert in the room (or Zoom room), not only on their own lives, but also on their needs and the best strategies for their personal growth.
The primary approach I practice from is called narrative therapy, which is rooted in the idea that our lives are constructed by stories that create meaning and influence the ways in which we experience the world and see ourselves within it. It recognizes the centrality of culture in shaping our realities using the exploration of what’s called dominant narratives, aka broad social attitudes and beliefs, to contextualize our struggles and positionality. At the heart of my work with clients is this practice of deconstructing and co-constructing new meaning together to expand their lens about whatever is bringing them into therapy.
I am Arab-American, a child of immigrants, polyamorous, partnered, neurodivergent, heteroflexible, a cisgender woman, and a first-generation college graduate. I am someone who is often white-perceived, and therefore someone who benefits from white privilege in certain spaces. I am someone who grew up in poverty but am now advancing in class status through education and employment. I am an older sister, a spiritual person, someone who experiences mental health challenges, and a person with chronic illness. I am an extrovert, a native English speaker, and a child of divorced parents. I am all of these things AND all of the experiences I’ve had over these 30 years of my life so far, all of which have shaped the lens through which I see and experience the world.
These identities I shared are a large part of the context and worldview I bring to my work. Because of the populations I work with, many of my clients often seek me out due to certain identities I hold, whether that’s being polyamorous, Middle Eastern, or being neurodivergent. I love having the opportunity to support those who I often call “my people”—those who I share in certain minoritized identities with, as I know finding affirming care for us can be challenging at times. Other clients seek me out due to feeling aligned with my approach to therapy, taking a social justice-oriented lens. I also recognize that I may not be everyone’s cup of tea, and that is more than okay. At the core, it’s about humans connecting with other humans—who are you wanting to have alongside you through this chapter of your healing journey?
My therapeutic practice is informed by my unique experiences as a brown, queer, Indian woman, and my knowledge of queer theory. Using a multicultural and emotionally focused therapy approach, I help clients unpack how systemic injustices affect their lives and see them at the intersection of all their identities. Additionally, I assist clients in building emotional intelligence to establish a deeper connection with their bodies.
As a curious individual, I immerse myself in cultural and social contexts as a person of color. My own identities are present when connecting with clients, fostering a sense of shared understanding. Knowledge of cultural, social, and political contexts helps provide clients with valuable insight into their behaviors. Drawing from my own experiences as a queer, neurodivergent, polyamorous person of color, I establish connections and empathy with these communities.
I always check in with my clients about their cultural and social backgrounds and how this has informed their sense of identity. I need to be aware of—so that I can avoid—missing the context of someone with a cultural background that differs from my own. As a white, straight, cis man working with a relational approach, I try to bring awareness to the ways systems of power may be present within my own psyche. I try not to go to a place of white shame, but accept that having been steeped in this colonialist, white supremacist, ableist, capitalist, patriarchal culture, microaggressions will inevitably emerge. I want to take responsibility for the ways I perpetuate these systems in the therapy room.
Psychotherapy has been one of many medical spaces that have historically ostracized and hurt folks with marginalized identities (e.g. the history of pathologizing trans folks’ experience of gender). “Inclusion” must be an active process where all identities are not only welcomed, but prized. I strive to create a safe space where clients can openly discuss their experiences with oppression and explore the ways in which these systems have influenced their lives.
I work a lot with folks who were raised male and identify as male, and whose mental well-being is challenged; I name that they have suffered harm by patriarchal expectations of masculinity. I share that healthy masculinity is beautiful and should be celebrated, but that under patriarchal norms, masculinity becomes restrictive in the demands for aggressive, dominant, and unemotional ways of being. Revealing the cultural, social, and political context in which they have been raised helps remove shame, while taking responsibility for ways that patriarchal masculinity may have worked through them to harm themselves and people around them.
As a therapist it’s my job to put my own views and values aside to best assist my client. Depending on the work setting—i.e., if I’m working at a therapy agency—therapists don’t always have the option of refusing to work with a certain client based on our own personal views, so that means we must approach each client with a non-judgemental and empathetic nature.
With that being said, that doesn’t mean it’s always easy to work with every client, and this is a big reason why a lot of therapists opt for private practice or solo work. They can have the luxury of referring out clients who may not be the best fit. In private practice, I feel freer to pull from my own contexts because there’s a higher chance that those clients have come to me because of those contexts in particular, but that’s not always the case.
As a black, plus-size, cishet, and former sex working therapist, my cultural, social and political contexts will absolutely not line up with each client—but depending on the work setting I’m in, that usually has little to do with what I bring to work. At the end of the day, my job is to support whichever client I’ve been matched with.
I am a Black, American, bisexual, and politically liberal/progressive man. My experiences growing up with little means, and raised by a Black mother with two older sisters, has largely shaped my socialization to the world. There’s truly a lot we can learn from Black women given the intersectionality of their identities. Because I have been fortunate enough to bear witness to their experiences, I use that to inform the work I do with clients from varying marginalized groups.
How did you come to the understanding that that context was crucial for your clients? Was it a personal experience, a professional encounter, an educational mentor, some combination of the above, or another influence entirely?
As someone who sits at the intersection of a number of minoritized identities myself, I have learned the significance of having a therapist who can fully see all parts of me and recognize how the unique combination of my identities and experiences make me (and my therapeutic needs) entirely unique. I’ve unfortunately had therapists try to use “cookie cutter” therapy approaches, in which I felt like my therapist was seeing me as just another therapy client. I’ve also been very fortunate to have other therapists who recognized and held space for all the unique parts of me and tailored our therapeutic work to supporting me and my needs.
At the heart of my work with clients is the awareness that each of us enters the room with a unique combination of identities, life experiences, worldviews, and cultural context. Seeing clients who hold varying racial or gender identifications, levels of physical and mental ability, sexual orientations, relational orientations, social class statuses, and so on requires me to be culturally humble, curious, and intentional in my practice.
Having moved to the US from India at the age of 19, I personally experienced the limitations of being put in a one-size-fits-all box by a white therapist, leaving me feeling unseen. As a therapist, I carry this valuable lesson with me, striving to truly understand clients through the lens of their intersecting identities. I recognize that what may work for a heterosexual white woman may not be effective for a pansexual white woman due to the contexts of queerness, privilege, and oppression. I prioritize treating the person rather than merely focusing on a diagnosis.
Therapeutic work on my own psyche led me to understand the importance of context in mental distress. I recognized the ways in which I felt worthless and the need for external validation through my work. In my healing journey came to the writing of bell hooks, and specifically her book The Will to Change. This book helped me realize that my experiences were not solely individual struggles, but were deeply influenced by societal and cultural factors. One quote in particular has always stuck with me: “In an anti-patriarchal culture males do not have to prove their value and worth. They know from birth that simply being gives them value, the right to be cherished and loved.”
I’ve seen firsthand how personal decisions without context can lead to stigma and/or diagnosis in the case of mental health; when it comes to working with clients, in order to understand their reality and worldviews, context is everything. What someone from a certain cultural or situational context would deem as neglectful or dysregulation, for others would be deemed survivalist or protectionist. Even in cases where a client will say or do something that I wouldn’t necessarily say or do, I always ask myself: “Given their reality, could I logically, reasonably, or rationally come to their conclusion?” Excluding cases of impulsivity, most people act or react in ways that they deem to be logical, reasonable, or rational. As a therapist it is my job to understand that before any real work can be done.
As a therapist, what makes you recommend Feeld to your clients? Do you find yourself recommending it outside of professional spaces (i.e. to your friends) and if so, what qualities do you find make it relevant to both your practice and your personal life?
A lot of my non-monogamous and kinky clients express challenges with navigating the dating scene, particularly difficulties with having to explain or justify their relationship orientation or sexual interests to others who might not understand or are judgmental. I love recommending Feeld as a resource for connecting with others who might share similar orientations and interests, especially in a setting that is more geared toward those who might fall outside of the heterosexual, monogamous, cisgender “norms.” It’s been a nice alternative to some of the other dating apps that seem to be more geared towards monogamous relationships.
In my own experience as a non-monogamous and kinky person, I remember feeling like I had no idea how to start connecting with other non-monogamous people. I’d heard about Feeld through a podcast in late 2020 and decided to check it out. I’ve been fortunate to develop many successful connections and relationships through my time on the app—it’s the only dating app I currently use!
Feeld is very relevant to me because it offers people a variety of identities to choose from. As a therapist, I specifically work with non-monogamous people, queer people, and people of color. An app like Feeld would allow my clients to meet partners and build community with other like-minded people.
I use Feeld myself, and have loved the way that I could authentically show up on the app. I recommend Feeld to my friends as well, especially my couple of friends who are newly opening up their relationship.
As a therapist-in-training I recommend Feeld to clients who are looking to explore a new aspect of their personal and sexual identities. Because the app is so inclusive with gender, gender expression, sexual orientation, relationship orientations, I recommend Feeld as a way to explore their new identity at their own pace. Even if the client is just making a profile and selecting their preferred sexual-orientation, relationship-orientation or gender identity marker, Feeld offers a relatively safe place to do so with mostly like-minded people. This can be therapeutic for many clients I see to slowly immerse themselves into a new(er) community that doesn’t make them feel isolated.
What do you believe are some of the most common misconceptions about therapy? Where do you think they come from?
Where to begin!? There are so many misconceptions out there around therapy.
I’ll caveat to say the ones I’ll choose to include here are influenced by my own worldview and positionality, but I highly recommend you take some time to do some more research on your own to see what others perceive to be the biggest misconceptions.
Some of the biggest misconceptions I’ve seen most in my own practice are those pertaining to expectations—both from clients and society itself. The first that comes to mind is around the expectation of how long therapy will “take”. Many people come to therapy to work on a specific issue or challenge and perceive that this can and should be addressed within a specific timeframe—one that is usually far too short. While the length of time someone spends in therapy will vary depending on the person and their individual goals, whether that be better managing anxiety, exploring a diagnosis, or processing trauma, the process is not going to look one way or take the same amount of time for everyone.
It also depends on the therapist’s approach to therapy. This misconception is often attached to another: Therapists are “experts” who can “fix” people. We’re humans too and cannot fix people. Instead, we are here to support people through their own individual journey and to provide the care necessary for the individual to heal.
Unsurprisingly, that misconception is also often attached to another: that healing is about taking away a problem. One of my mentors often says: “healing isn’t about the absence of something, it’s about the addition of something new.” Perceiving ourselves as flawed and broken people needing to be “fixed” is a pretty disempowering view, don’t you think? What if instead, we were able to view our challenges as something to be curious about and explore rather than try to eliminate? It might sound counterintuitive, but speaking from my own clinical and personal experience, I’ve seen this approach allow for so much more compassion, and long-term impact.
Where do these misconceptions come from? I feel inclined to say capitalism and white supremacy. Both of these oppressive dominant systems communicate that we must be efficient, that our primary purpose is to produce, and that we must prioritize addressing and fixing any barriers that interfere with our ability to produce. Because therapy is so closely linked to the medical field and the medicalized model of care (don’t get me started on this soapbox…), there is often this view that therapy is a highly clear-cut, scientifically-backed approach to care. Our field is absolutely grounded in science, but it is the furthest thing from clear-cut. Therapy as an art runs counter to these dominant narratives because it requires holding space for uncertainty, curiosity, and openness. I think there is a lot more “humanness” in therapy than people are comfortable acknowledging.
Therapy, including sex therapy, is often misunderstood as a quick fix. Building trust and safety, like any relationship, takes time. Rushing the process and expecting immediate results is going to be disappointing. Healing requires dedication and effort. I remind my clients that therapy is just the beginning, with 10% of the work happening in sessions and 90% outside of therapy. This misconception stems from a capitalist society that promotes guilt around rest and pressures quick bounce-backs. True healing cannot be rushed or commodified. Embracing the journey means recognizing that healing takes time and hard work. Prioritizing self-care and allowing space for growth and transformation is essential.
I think in a capitalist society there is always hope and desire for quick and easy change. But the process of sustained growth and healing at the foundational level takes a lot of effort and time, and is not always linear.
The biggest misconception that comes to mind is that therapy is only for those who need it, or those who are “crazy.” Yes, there are some people who are dealing with extreme clinical issues, but that doesn’t mean that these are the only people who can benefit from therapy. The mental health industry basically emerged as a way to treat the most extreme psychiatric cases, so in a lot of ways, it is rooted in the idea that therapy is only for extreme cases.
I like to think of it like an auto shop. Sometimes there’s been a car crash and there’s a lot to fix on the car. Sometimes the car just needs an oil change or tune up. Therapy can be just as helpful for a little maintenance as it can be going for more intensive or long-term therapy.
I think some of the most common misconceptions about therapy is that it’s only for white people, and/or there’s something inherently flawed about the person that can never be changed. These two things are the farthest thing from the truth: therapy is for anyone, regardless of their background, seeking to understand themselves better. That need for new understanding can come from a traumatic experience, grief, separation, starting or ending relationships, life transitions…and the list goes on. There is a therapist out there that can meet you where you are and help you get to where you want to be.
I think these misconceptions largely come from the historical and educational teachings of and within the field of psychology. With limited perspectives coming from those outside of dominant culture, it’s not hard to see why marginalized groups would think therapy doesn’t work for them. It is incumbent upon the field of psychology and mental health to broaden its scope of research to include more marginalized groups in both theory and practice.
How can people best advocate for themselves in a therapeutic setting? How can they find therapists that are best suited for their specific needs?
It is important to first acknowledge that self-advocacy is hard and can be uncomfortable. Before anything else, it requires us to believe that we deserve to have our needs met and to be heard. To help with that process, beginning to identify what those needs may be, whether jotting them down on paper or a note in your phone, is a helpful first step prior to meeting with a therapist. When meeting with potential therapists, come with a list of questions to explore what is most important for you based off the prior list. This could include asking about the potential therapist’s lived identities or experiences, sharing about what you’ve appreciated or not liked in previous therapy, or asking the potential therapist about their experience working with similar identities/issues that you are hoping to address. As you are going through the process of finding a therapist and engaging in therapy, remember that you are the expert on yourself, and no therapist knows what’s better for you than you do. This includes using and trusting your own voice, giving feedback to your therapist about your experience of therapy, the relationship between the two of you, and strategies/techniques that are working or not working in therapy for you.
In addition to those general tips, using specific therapist directories and filters to find therapists who hold certain identities or areas of specialty is often beneficial for those seeking therapy. This is often the route I take for myself when looking for a therapist and is the one I recommend to friends and family as well. Here are some of my favorite therapist directories that cater to minoritized populations:
- Open Path Collective
- Inclusive Therapists
- Ayana Therapy
- Therapy for Black Girls
- National Queer and Trans Therapists of Color Network
People can advocate for themselves in a therapeutic setting by being curious and asking the therapist their questions while sharing concerns. Therapy is a great space to learn boundary building. To find therapists best suited to their specific needs, I would recommend using Google to find certain sites that house options of therapists who work with marginalized identity folk such as Manhattan Alternative in NYC. Other options include Psychology Today, Queer Healers and South Asian Therapist.
I remember when I first sought therapy: I went with the first therapist who I found on the internet. It wasn’t until I started with another therapist that I realized that she wasn’t at all a good fit for me. I actually realized I felt incredibly judged by her. Some of that had to do with her lack of understanding of my Jewish cultural background, and ways of relating to my parents. Therapists have a responsibility to check their biases and do their own personal work to bring to consciousness the systems of power which are living in their unconscious so that they do not harm their clients. As a client, my suggestion is to make consultation appointments with multiple therapists, and assess who feels like the best fit.
Clients can advocate for themselves by doing their research before working with a potential therapist, and booking consultations to ensure it’ll be a good fit. The best thing to do is to have a general idea of what you’re wanting to work on therapy, look for therapists who have experience in that, and then talk to that therapist before booking with them to get any questions answered. If you feel a therapist isn’t a good fit, no matter how long you've been seeing them, kindly let them know and find another.
What kind of responsibility does a therapist have to their client at this moment in time?
With the current social and political upheaval stripping basic individual rights for folks with marginalized identities, the role of advocacy is more important than ever. As we are in a time where institutions are actively suppressing even basic medical rights, I believe therapist’s bear a heightened responsibility to be relentless advocates for their clients' identities and needs. This could look like providing education to clients, being intentional to explore what safety means to your client and fostering it in your space together, or connecting clients with resources and supports aligned with particular identities they might hold. On a broader level, counselor advocacy could look like supporting legislative efforts that support human rights, engaging in training to learn more about supporting minority identity groups, and initiating conversations about social justice and identity with their colleagues.
However, for a therapist to be the best advocate they can be, it’s equally important we prioritize our own self-care and wellness. Therapists cannot “pour from an empty cup” and owe it to themselves and their clients to take care of themselves so they can show up fully. I know this is something I often struggle with, feeling as though there are only so many hours in a day and that my attention is being pulled a million different ways. I’ve really been working to cultivate intentional time for myself, whether that’s the ritual of making my tea in the morning, moving my body, or carving out time to spend with friends or my partner. To get on the capitalism soapbox again for a moment, taking care of ourselves is truly a radical act of rebellion against capitalism. Capitalism does not inherently benefit from our choosing ourselves, and yet, this choosing ourselves is essential to our survival. To learn more about this form of resistance, I encourage you to check out the works of Angela Davis, Audre Lorde, and Tricia Hersey as a starting point.
Right now, as a therapist, one of the key responsibilities is to constantly remind our clients of their humanity and help them cultivate grace and kindness towards themselves. The pandemic has deeply affected everyone's lives, and it's easy to forget just how challenging the past few years have been when we're too hard on ourselves. It's crucial to provide a gentle and understanding space, allowing clients to acknowledge their struggles and embrace self-compassion. We're all navigating uncharted territory, and it's important to recognize the weight of these collective experiences. By offering support and reminding clients of their resilience, we can help them find strength and healing during these difficult times.
Given where we are socially and politically as a nation, we can see there has been an increase in isolation and loneliness, especially after the Covid-19 pandemic. What I see many people coming to therapy for now is a way to get connected or regain connection with themselves and those around them. People are searching for space to work through their issues in a non-judgmental environment; it is the responsibility of the therapist to hold that space.
- Sara Al-Khedairy (she/her) is an associate therapist practicing in San Diego who specializes in working with consensual non-monogamy, neurodivergence, and racial trauma. Her approach to therapy is oriented in social justice, identity exploration, and decolonization. Sara is also a current doctoral student pursuing a degree in counselor education and supervision.
- Nikita Fernandes (she/her) is a Mental Health and Sex Therapist in NYC, specializing in culturally sensitive, poly & kink-friendly, and queer-affirming therapy. She holds a Master's in Mental Health Counseling and a dual degree in LGBTQ+ Health, Education, and Social Services from New York University. Nikita identifies as a queer South Asian woman. With a personal understanding of navigating kink/sex-positive environments, Nikita supports clients in building sexual self-esteem, embracing liberation, and processing sexual trauma.
- Adam Goldhopf (he/him) is a Registered Psychotherapist (Qualifying) and filmmaker working in Toronto. He has completed a Master’s in Counselling Psychology from the University of Toronto’s Ontario Institute for Studies for Studies in Education. He works with couples and individuals and has a special interest in working with folks around issues relating to their masculinity, artists and artistic practices, and grief and traumatic loss. To read more about Adam's therapy visit his website here.
- Danielle Simpson-Baker is a Registered Marriage & Family Therapy Intern in Florida and a Board Certified Sexologist with the American Board of Sexology. Danielle earned her master’s in Marriage & Family Therapy in 2021 and is currently working toward a dual certificate in sex therapy and education. She also runs a sex-positive Instagram page (@thesexpottherapist) that has amassed more than 24,000 followers since its inception in 2019; with that following, Danielle started a virtual sexual wellness clinic called Sex(pot) Therapy, LLC. Danielle hopes to provide sex therapy, coaching, and consulting, as well as a host of sexual wellness products for every person’s needs.
- Joshua Terry is a Chicago-based therapist-in-training with a focus on identity development and relationships. His approach to therapy is showing up with authenticity and encouraging others to do the same.His goal is to meet clients where they are and forge a path forward through collaboration, empathy, and helping people write the stories of their lives.