Running Head: TIME TO TALK

Smita Kapoor
Clinical Project: Part II- Time to Talk
Dr. Kuhn
05/24/2016
Loma Linda University

Time to Talk
Time to Talk
In 2010, there were approximately 18.2 million Asians in the U.S. population
(U.S. Census Bureau), comprising 4.8 of the total American population. It is projected

that by 2050 there will be 40.6 million Asians in the U.S. population, or 9.2 % of the total
U.S. population (U. S. Census Bureau, 2012). Among subgroups of Asian Americans,
young Asian American women have emerged as the highest risk in terms of mental health
status. Specifically, South Asian American women have the second highest suicide rate
among the racial/ethnic groups in the U.S. for females 1824 years old and the incidence
of suicide among South Asian American women grew by almost 100 % between 2000
and 2009. Despite the substantial risk of depression and suicide among young South
Asian American women, current literature is limited in providing information about
mental health utilization patterns in this population.
Biology, Emotion, and Relationships interact within the larger social context to impact
Health and Well-being
Mental illness in the South Asian community is not openly discussed very often.
Although acceptance of mental illness has progressed significantly in Western cultures,
mental illness is stigmatized in the South Asian culture and their mindset. Many times
South Asian finds that the stigma comes from their family, who do not know how to
approach and deal with a situation like mental illness.
Mental illness should be treated as any other disease. Diagnosis and treatment for
mental illness should be as commonplace as getting a prescription for the flu. However,
the diagnosis of a mental illness is sometimes felt as a negative and shameful label for

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many South Asian parents. Along with this, they believe that illnesses like depression are
not real diseases but rather, a mindset. By insinuating that mental illness is a mindset,
many parents believe depression is just something to get over. Individuals with severe
mental illnesses are often ostracized in South Asian communities as they are considered
shameful failures. Below are some examples how mental health issues are handled in
south Asian community:
Ever since Devs mother told their family friends that was diagnosed with
ADHD, they noticed a change in their behavior. Mothers no longer wished to schedule
play dates with the sweet 8-year-old boy. They would make transparent excuses that sent
a clear message to his mother that they wanted to distance themselves from Dev. When
she asked one of her neighbors why this was happening, her neighbor said very matterof-factly, Im sorry Shubha but I just dont want Dev to be an influence on my little
Raj.
Aarohi called her mother and father one evening and divulged to them that her
doctor had diagnosed her with depression. He father reacted with anger. You wouldnt
be depressed if you just focused harder on your studies and had gotten into a better
college like your brother! Her mother followed up with, Just stop being so negative.
Be happy in life and this whole depression nonsense will go away. Its in your hands
Aarohi!
Neal had just moved to college three states away. His recurrent illnesses were
addressed by the college health center. After seeing numerous doctors, he was diagnosed
with bipolar disorder. As soon as he let his parents know, they demanded that he move
back home. Youre not going to be able to keep up with the difficult curriculum of

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college, his mother said, and we dont want you to get into any trouble. He didnt
understand. Well we know that people like that can get angry and do things to hurt
people. We just think we can protect you better at home.
Stigma is highly prevalent in South Asian culture against mental health issues.
The above four examples highlight just a few of the ways stigma present itself in the
community and in families. There are two types of stigma public stigma and self-stigma
and on both sides there are three specific exhibitions of negative attitudes toward
mental health.
Public stigma is how people view anyone with an emotional health issue whereas
self-stigma is how people with mental health issues view themselves because they are
part of a stigmatized group. Regardless of the source of the stigma, both groups express it
in three ways: through stereotypes, prejudice and discrimination.
Stereotypes are negative beliefs and attitudes towards a person because of their
membership in a particular group. Common stereotypes that result in public stigma
include believing that people with emotional health issues are dangerous (like what
Neals father was insinuating), that they are incompetent (as evidenced by Neals mother
who believed he could not keep up with college anymore) or that they are weak.
Similarly, self-stigma is perpetuated by stereotypes that people living with mental
illness believe about themselves. They may believe the message they are getting from
friends and family that they are a character flaw or that they are not competent enough to
live a full life with responsibilities.
Both public and self-stigma are also strengthened by prejudice, which are
thoughts or feelings that support the stereotype. Aarohis parents reacted to her diagnosis

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with anger and yelled at her because they thought she had created her negative situation
herself. Other common examples of prejudice associated with mental health stigma
include liking the person less, being afraid of them or not feeling as comfortable around
them. People living with mental illness or any emotional health issue tend to be
prejudiced to themselves often experiencing low self-esteem and believing they cant do
anything on their own.
Finally, both types of stigma are also fueled by discrimination. This is specific
behavior that is in response to stereotypes and prejudice. Friends and family may distance
themselves from people with emotional health issues, as mentioned in Devs case who
lost lots of play dates. They may not reach out to offer help, especially if they believe the
person created their own situation, as is the case in Aarohis example.
Living with emotional health issues, South Asians may stop pursuing activities,
interests or work, believing that they cannot handle it. They limit their exposure to people
worried about how others will react to them, stop going out and even reaching out to
friends and family.
The worst part about stigma is that often the effects of it, including social
isolation, lack of support and low self-esteem, are often worse than the actual emotional
health issue itself. Experiencing stigma while also living with emotional health issues can
also significantly impact the response rate to treatment and prognosis. In fact, many
South Asians living with emotional health issues, because they feel they cant talk about
it, often resort to substance abuse or suicide as a way to deal with the seemingly
impossible task of being accepted by their community.

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South Asians are a very community oriented group and just as we reach out to
someone who has lost a loved one or who just had surgery, South Asians need to break
the wall of stigma and reach out to those who are living with emotional health issues as
well. The support and community feeling that comes from that can act as a strong
protective and resilience factor, helping the person to recover and live healthier much
sooner.
Sadness is an emotion that we are hardwired to experience from birth. As humans,
it is an emotion that is necessary to have in order to communicate our current state and
needs. Seeing a loved one in pain, our best friend moving away, or watching a sad movie
all trigger the feeling of sadness.
While sadness is an emotion that lasts a few days at most, depression is a whole
body experience that lasts weeks, months or years. Often depression is considered a more
severe form of sadness. However, it is actually a more complex diagnosis and experience
that involves a compilation of many symptoms, one of which can include sadness. For
thousands of people, depression can become so overwhelming that it affects daily
routines and normal functioning.
Research has shown that South Asians express and experience depression
differently than other cultures. The most common symptoms that South Asians report
when they feel depressed are:

Headaches (including tension headaches)

Low mood
Loss of interest/boredom/apathy
Irritability
Fatigue and weakness
Dizziness
Gastrointestinal problems
Poor concentration

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Tearfulness
Anxiety
Wanting to be alone

Sometimes when we experience a trauma such as an accident, witnessing violence

or abuse, our minds protect ourselves by shutting off our emotions. The same way our
pain receptors shut off to manage intense pain, our mind suppresses strong, negative
emotions during times of crises to protect our well-being.
However, suppressing our emotions consciously and deliberately in times when
there is no trauma (e.g. death of a family member, loss of a job, argument with a spouse,
anxiety for a test, etc.) can lead to damaging effects on your mind and body. Emotion
suppression, which essentially is an avoidance of emotion, is a coping strategy that many
people employ mistakenly thinking it is healthy or the right thing to do. Common signs
that many South Asian use emotion suppression as a coping strategy include
* Distracting them as a way to keep them from reacting
* Avoiding talking about the situation because they dont want to feel negative emotion
* Avoiding places, people or objects that remind them of the negative emotions they dont
want to feel
* Using substances (such as alcohol) to numb the pain
South Asian culture, believe that emotion suppression is a particularly masculine
quality and that emotion expression qualifies you as weak. Unfortunately, no matter how

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highly it is valued, avoiding emotions never makes them go away and makes it more
difficult to manage a similar situation were it to happen in the future.
Siegel (2009) suggests that suppressing or avoiding our emotions in fact can make
them stronger. For example, if you are sad because a family member passed away but
want to avoid feeling the sadness, you may watch happy movies, try to keep your day as
normal as possible and may even talk to friends as if nothing happened. However, the
sadness is still present in your mind and a small hiccup in the day may cause you to
seemingly overreact to the situation. Even if the object of your emotion is different, this is
your bodys way of releasing the pent up emotions. Just as emotion suppression is your
bodys way of -protecting you during a trauma, emotion release in a non-traumatic
situation is your bodys way of protecting itself from further damage.
Effects of consistent emotion suppression include increased physical stress on our
body, including high blood pressure, increased incidence of diabetes and heart disease. In
addition, people who engage in emotion suppression regularly rare more likely to
experience stiff joints, bone weakness and more illnesses due to lowered immunity.
Siegel & Fosha (2009) suggests a connection between avoiding emotions and
poor memory as well as more misunderstandings in conversations with others. This is
because people who regularly suppress emotion are often less aware of the signals they
are sending to others and also less aware of the social cues present in daily conversation.
In addition, when one or both partners engage in regular emotion suppression,
communication skills often decline resulting in unhealthy relationship patterns and

Time to Talk
decreased satisfaction in the marriage. Men and women who avoid emotions, especially

negative ones, are more likely to experience high anxiety and depression in their lifetime.
Emotion and Recognition at Work
Fosha (2009) states that along with suffering, psychopathology brings an energy
crisis, where client knows what is wrong or what is going with him or her emotionally
and mentally. There is a decrease of the circle of life lived with enthusiasm, an exhaustion
of resourcefulness and a growing restriction of the inner and outer lives of individuals,
thats why a fundamental goal of the experiential therapies along with improving
symptoms while reliving suffering. I feel that experiential therapy with some
modification will work well with south Asian population. Because south Asians suppress
the emotions talking and helping them express the emotion will be beneficial with this
population.
According to Fosha (2005) emotions are equivalence excellence, vehicle of
change, when regulated and processed to completion; emotions bring healing and lasting
transformations. Thus talking and helping them express emotion is essential for South
Asian population wellbeing. Use of experiential therapies or the AEDP will make active
use of emotions to that end. Yet change, even healing change even though that is highly
desirable poses challenges.
Emotion is fundamentally linked with change (Damasio, 1999). Our
psychobiological response to conditions that violate expectations, emotions are the stuff
that tells us about us in relation to that change. They come on board to register that

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something has changed, for good or bad, and that it behooves us --if we're interested in
survival-- to attend to that change and deal with it (Fosha, 2009). Because of
unexpectedness, control and protection to fakery and voluntary control, emotions are
often experienced as foreign, as other, as external to the individual as "a clap of thunder
or a hit" (Winnicott, 1960, p. 141).
I really like the question asked in the book, how we contend with emotions in a
way that is progressive and transformance-informed rather than dread-driven and stopgap
in its action, how we make use of their transformational power and integrate their
potentially profound gifts into our repertoires of self and relationships?

Emotion and Recognition in Transformation & how AEDP can be Beneficial for South
Asian Population
Let me tell you a few scenes of stories, which explains not recognizing the
emotions: Seema feels too anxious to take her exams, her mind racing and her heart
beating too fast. Amar seems tired all the time, lying in bed and wishing he never had to
get up again. Kiran panics when she hears a car backfire, jumping up in her seat for some
reason we do not yet understand.
The body shows signs: something is not right, but we do not always have the
words to explain why. Be stronger, try harder, you dont need medicine for that. South
Asians know that there is a connection between minds and bodies, but they do not always
know what the connection is. Using experiential therapy and AEDP may help illuminate
the threads tying our emotional well-being to the rest of our lives.

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South Asians do not talk about emotional well-being. They hear ads for
antidepressants on TV, see rows of self-help books for anxiety, and laugh at jokes about
therapy. But in the South Asian community, too often they act like none of this applies.
This stigma hits them at every level personally, they may be too embarrassed or
ashamed to admit they are suffering emotionally. In their families, they may feel the need
to protect relatives honor, to be sure no one else knows about it. In our communities, we
do not always know where to turn to for help, who we can trust, if they will understand
what we have to say, in our own languages, within our cultural contexts.
From the very young age these thoughts are embedded which makes it hard to
change. Emotional Wellness means being attentive to your thoughts and feelings and
behaviors, both positive and negative. By choosing to live in a state of emotional
wellness, South Asians can learn how to recognize and express their emotions
appropriately, trust their own voice, and unlearn all the horrible messages they
absorbed for years. At first it may feel like learning Greek, and often it will be a wobbly,
difficult, stressful process. Two steps forward, four steps back. So difficult to master
when it doesnt come naturally. No matter; its been worthwhile. It may take many years,
but theyll finally learn their worth. Being emotionally well means living with peace of
mind, having an optimistic view of living (despite all that has happened) and the ability to
recognize and adjust to change positively.
Recognition as a process (Sander, 1995, 2002), allows us to connect (1) the basic
principles of organismic functioning (how we are wired) with (2) the emotion-based
transformational processes through which we move when we self right, heal, learn, and
grow. Providing psycho-education regarding emotions and recognition to south Asian

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population by using ancient scripture which explains that in order to take care of body

mind need to be healthy. As Siegel explains, "emerges from patterns in the flow of energy
and information within the brain and between brains" (1999, p. 2). Emotion and
recognition are two mechanisms that bring information and energy into the system.
Accelerated experiential-dynamic psychotherapy (AEDP) is a form of
psychotherapy that focuses on healing-oriented techniques and aims to achieve a
transformation in client behavior by exploring the in-depth processing of difficult
emotional and relational experiences. This innovative method was developed by Dr.
Fosha and has roots in and resonances with many disciplines, amongst
them attachment theory, affective neuroscience, and body-focused approaches. Although
difficult and trying emotional experiences are often our least favorite parts of life, these
stumbling blocks can lead to a keener self of sense and instill confidence and courage in
an otherwise unstable foundation. But for many, these events can be experienced as
suffocating and even completely debilitating. Psychotherapy is the art of learning how to
deal with ones emotions, both good and bad.
Examples Of Clinical Interventions For AEDP, which can be used with South
Asian Population
1. Attachment: Establish Safety and Undo Aloneness
An AEDP therapy seeks to co-create a safe and secure base from which a clients painful and
previously overwhelming relational experiences can be explored and cognitively and
emotionally integrated into a coherent narrative. Guided by interventions that are affirming,
explicitly empathic, affect regulating, and emotionally engaged, facilitate and co-construct a
secure client therapist relationship from early on.

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Interventions include but are not limited to:

The use of we language: which can be very beneficial for South Asian population because
they like the stance when its done together.
Lets be with this. Can we be with this together?
Explicit acknowledgment:
Mmms, Wow, I get it.
Affirmation, Validation:
I see/admire you courage. This is so important.
Explicit relational interventions:
How do you experience me here, with you?
2. Experience: Facilitate and Process Emotional Experience

AEDP is fundamentally an experiential model of psychotherapy that fosters the provision and
facilitation of new healing experiences involving state transformations of both mind and body.
At the core of AEDP is a theoretical model of The Four States and Three State
Transformations outlining a process of therapeutic movement from Defense to Core Affect to
Transformational Affects to Core State. These phenomena and clinical proficiency in facilitating
the process of state transformation through stage-appropriate strategies of intervention,
including, but not limited to:
Moment-to-moment tracking of bodily-rooted emotional experience and interpersonal
relatedness:
Something shifted. And now, what do you notice as your voice softens? What is that like
for you to experience?

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Noticing and fostering glimmers of Transformance:

that sense of wanting, can we make space for that?
Dyadic regulation of affective states :
Therapist non-verbally slows breathing, and audibly exhales
Or says Slow down here... Take a breath. This is so big.
Somatic focusing:
What do you notice in your body when you tune inside?
Facilitating core affective experiences to completion, until
adaptive action tendencies are released:
Attention is given to sighs following expression of feelings and what comes next. Stay with
it...

Melting defenses:
Being with and empathizing so sad, tears in your eyes
Bypassing defenses:
Lets just set that criticism aside for now and tune into your feeling.
Restructuring:
Process of recognizing the defense, understanding its historical function and encouraging and
helping patient to choose different experience.
This intervention can help them feel/teach about their emotion in here and now what am I
feeling now?
3. Transformation and Integration: Affirm Transformation and Process Healing

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In both theory and practice, AEDP is a synthetic, integrative model of change for the better.
AEDPs this technique will seek to facilitate positive transformation and to process emotional
experiences to completion as indicated by 1) the release of adaptive action tendencies in the
wake of deep emotional experiencing2) a clients integration of these actions with coherent
cognitions about her/his current state and autobiographical narrative. Moreover, the process of
transformation of the self in the context of a healing relationship is, in itself, a positive affective
change process. Interventions include:
Meta-therapeutic processing of the experience of transformation of the Self:
As you sense this strength, what do you feel in your body? I notice your spine straighten,
are you aware of that? Whats that like?
Meta-therapeutic processing of the experience of receiving help (feeling seen, understood, and
helped by another):
How has it been to have this experience with me? Can you say more about awesome or
good. What in your body gives you that experience?
Meta-therapeutic processing of the experience of transformation as an experiential
phenomenon:
Notice the difference of when we started this session and now. What do you see? feel?
sense?
Facilitating, affirming and processing the experience of healing affects:
Lets be with these feelings for you, so movingso much youve been through. Such a deep
relief to feel the difference now.
Demonstrating emotional competency as the recipient of deep love and gratitude.
I feel your gratitude, and want you to know you are so welcome

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Being with mourning the self:

Stay with this feeling. Are you feeling from the experience of your younger self or for that
self? Yes lets make more space to grieve the loss of so many years
Recognizing the tremulous affects distinctly from anxiety and helping the patient to be with the
fear of whats new and unknown.
On the brink of something new Yeah, just breath into this Whats happening? I want
you to keep me with you, for us to navigate this together. In what way overwhelming?
Feeling something youve never known before. Makes sense youd feel uncertain, nervous.
Showing receptivity to gratitude, love, feeling moved.
I am so touched by you right now. So moved. I love you! This feels so important to
my heart.
Deepening the experience by staying with it:
Is there more? How does safety feel in your body? And if safety feels important, what is
important like?
Working with the experience of recognition:
How do you feel as I see this in you?
This intervention particularly be very helpful when using it with the old Hindu saying about,
healthy body without healthy mind can be dangerous and harming to healthy body.
4. Work with core state, its truth sense and the coherent, cohesive autobiographical
narrative.
This AEDP technique facilitates clients co-engendering of secure attachment and the positive
valuation of the self. As the transformational processes integrate, the patient

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puts things in place and weaves their autobiographical narrative through a clear knowing of
themselves. Interventions shows how to help clients to draw together themes of how their life
was then and how their experience is now, to recognize and draw upon their capacity to utilize
their resources and how they can make sense and meaning of their lives.
Interventions include:
Reflection:
What is the experience of having come through all of this to being here now with me?
As you see yourself now, having moved through this process, what do you see about
yourself.?
How would you welcome that very young part of you into this life that is now here for you?
Intervention listed above can be very valuable when working with South Asian
population regarding mental health stigma because this approach is nonpathologizing. When
working with this population it is very important to keep the respect of the cultural value in
mind. Despite these alarming facts, there seems to be an insurmountable barrier that continues
to dissuade South Asian Americans from getting the help they need, when they need it. The root
cause for this barrier is still blurry. However, immigration to the United Statesa foreign
country and culturemay elucidate a more concrete reason for this barrier, as cultural
adaptation brings with it its own set of stress and anxiety. This population is also known to place
their cultural norm of using alternative and holistic treatments before resorting to western
treatments, so using holistic approach in therapy can be very helpful. Inevitably, there is an
urgent need to develop and implement culturally and linguistically appropriate interventions to
evaluate and address these disparities, which I feel that AEDP techniques can help bridge that
gap.

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This model exactly explains how it can be used with South Asian population.

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Reference:

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Diaspora (Qualitative Studies in Psychology). New York, NYU Press
Fosha D., Siegel D. J., Solomon D & M. F. (2009) The Healing Power of Emotion:
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Jacobsen K.A., and Kumar P., (2004): South Asians in the Diaspora (Studies in the
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Khandelwal M., (2002): Becoming American, Being Indian: An Immigrant Community
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Kreps, G.L. & Sparks, L. Meeting the health literacy needs of immigrant populations.
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NAMI (2009) Multicultural Action Center Fact Sheet: Mental Health Issues among
Asian American and Pacific Islander Communities.
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Americans Traverse a Transnational World. New Brunswick, NJ, Rutgers University
Press

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Rangaswamy P., (2000): Namaste America: Indian Immigrants in an American
Metropolis. State College, PA, Pennsylvania State University Press
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Princeton, NJ, Princeton University Press

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