Is The Self-Care Boom Leaving Behind Those Who Need Therapy Most?
Ever heard of "YAVIS"? It stands for "Young, Attractive, Verbal, Intelligent, and Successful." No, it’s not a new dating term - YAVIS is an old acronym coined in the 60’s describing the apparently “ideal” therapy client preferred by mental health professionals due to inherent biases. A good 60 years on, with the self-care industry now worth a whopping $450 billion, how prevalent is it still today?
The self-care market has exploded by a spectacular 4400 percent in the past six years, driven in part by famous figures like Dwayne ‘The Rock’ Johnson, Michelle Obama, and most recently Prince Harry, increasingly speaking out on their mental health battles. In fact, Prince Harry’s advocacy of his therapy has even resulted in critics arguing he has perhaps had too much!
While the normalisation of seeking therapy and self-care is undoubtedly a net positive, it risks overlooking the countless barriers that still exist blocking those who need it most from accessing it - and even with access, the challenges faced by those on the edge of a normative identity.
Jumping over hurdles
Coming from an Asian culture where mental health is taboo, I’m very open about being in therapy in the hopes that it encourages others to seek help. It took a couple of painful years before finding a phenomenal therapist that understood alternative relationship structures and non-normative sexual preferences, which I only discovered by stumbling across PinkTherapy.com, an independent therapy organisation working with gender and sexual diversity.
I consider myself immensely lucky in that the care I need is not a racial or cultural-related trauma, as I wouldn’t even know where to begin with finding the right help. More importantly - I’m lucky in being able to afford private care.
Comedian JennyBSide explains that despite having been in therapy for a while, she is still struggling to get an NHS referral for help with adult ADHD. “My initial therapy was given as I was suffering from anxiety and depression and it had got to a point where it was serious to my life,” she says. “This elevated my need to immediate so I received a counsellor within six weeks. I didn't mention any trans stuff until we were halfway through.”
Her trans status has not been broached in the referral process for help with ADHD, she does not want to have to mention gender dysphoria - purely just to bump herself up the queue to be seen - despite having been told by the NHS in May 2021 they were currently only just seeing referrals from July 2018.
Neurodivergent speaker and comedian Luke Poulton’s search for a therapist who understood autism took years. “At university, I first had therapy with a therapist that didn’t understand autism and thought the reason for my depression was my parent’s divorce - even though I was 21 at this point and my parents got divorced when I was 13 - and are still friends! For me, it took a long time to find a therapist that had experience with disabled people. A lot of therapists just don’t have the experience, and some people are treated differently by some therapists.”
Structural stumbling blocks
So why is it so difficult to find therapists with the right experience?
Psychotherapists Mamood Ahmad and Shahajra Jamal are co-founders of The Anti-Discrimination Foundation (tadf.co.uk), which runs diversity anti-discrimination training programmes for helping professionals, including therapists and institutes who help people with their mental health.
Ahmad says “The pressures in the NHS - and most likely funding - can cause long wait times. It's easy to assume that it’s due to a lack of therapists, but in reality, a lot of therapists are in the NHS mental health system because of the type of therapy they are trained in. For example, Cognitive Behavioural Therapy (CBT) is much more prevalent than humanistic therapies.”
Ahmad, who pointed me towards the acronym “YAVIS”, highlights that of course, YAVIS isn’t what therapists strive for. Therapists are trained to be aware of biases and assumptions so YAVIS provides a guideline to be aware of when they practice.
Despite this, a lack of diverse thinking in the industry may begin from early study of counselling. Jamal explains that “therapy is a very middle class taught subject, with the biggest historical theorists being white European middle class older men. So obviously the subject invites a certain type of trainee student from a particular economic background - as it’s an expensive course and degree.”
Ahmad points out the fact that therapy was mainly developed by these privileged identities with a Eurocentric focus “then has a knock-on effect for people accessing therapy and their experience within it. For example, diversity studies are specialisms and typically with not enough depth within core training,” he explains.
It’s no surprise then that a review of the UK’s Mental Health Act in 2018 found “profound inequalities” in mental health treatment, with Black British people four times more likely to be sectioned than white people and more likely to be given psychoactive medication instead of talking therapy. And while shocking, perhaps this explains why there are nearly 300 disorders listed in the main mental health professional handbook Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - but not one of them recognises the impact of extreme racism.
The good news is there are signs of change. Ahmad tells me that the social justice events of the past year, such as the Black Lives Matter movement triggered by George Floyd’s death, and the wider awareness of lack of diversity, have led to many of the voluntary governing bodies setting up an Equality, Diversity, and Inclusion task force to look at resolving these issues.
Lived experience
But in the meantime, does this mean those of us with identities outside of a white, cisgender straight or non-disabled-bodied framework just need to hope we stumble upon a therapist who has lived through the experiences we face, in order to understand our challenges?
Jamal believes that “street smarts, common sense and complexities that arise in people’s lives” can help therapists “tune into others’ pain. Wisdom and academia can also give these values to a person - but I’m not sure if a felt experience sometimes is the same as a studied experience. How can you know better than someone who has experienced racism when you never have? That lived experience can be shared with you but only people who have lived life being ‘othered’ feel it in their being,” she argues.
Ahmad also agrees that for therapists, “lived experience plus skill is usually better”, but he points out that “with lived experience, you need to have done your own work so you don’t over-identify with clients’ own processes. It’s hard to be absolute.”
Jamal is keen to encourage a more diverse range of therapists to enter the space. “The therapy world is one that always tries its best to expand their knowledge in present times,” she shares. “The more students we have coming in from all backgrounds no matter what race, sexuality or religion, the more we change a system to make it better for all.”
The road ahead
It gives me hope that Ahmad, Jamal, and others fighting for inclusive mental health care speak positively of their experiences working in the space.
“As a brown woman, I’m aware that some people may skip past my profile because they may believe I won’t possibly be able to speak English well, I may be uptight, religious, or any other stereotypes about South Asian people,” Jamal says. “But the majority of the time I have felt accepted well by my peers and my clients.”
Ahmad describes how in the therapy world, “I am a rarity as a man and even more of rarity being of South Asian heritage, so it’s nice to be able to hold that and help improve the profession. We want to help individuals and institutions as they address these gaps in provision.”
Marcus Tiersson, founder of the Don't Suffer In Silence mental health awareness campaign shares that he has never had any negative responses to being a black mental health activist. Tiersson works hard to encourage people to get help for their mental health but believes real change won’t happen without help from the government. “Having ‘Mental Health Awareness Week is pointless to me - it doesn’t help people. Posting a quote on your socials for a week is not stopping people from committing suicide,” he explains. “The government has to put more money into helping provide more counselling and train doctors more about mental health - it’s not just giving out tablets - and teaching school pupils about mental health issues and looking after their mental wellbeing.”
However, he also argues that “We cannot always rely on the government to help us - sometimes we need to help ourselves by taking care of our minds. It starts with ourselves. We need to not be ashamed about having any mental illness.”
While privacy is of course paramount, sharing experiences can certainly be helpful for those seeking care especially if people feel tentative, or due to stigma. Ahmad believes that a good first step for people with non-normative identities struggling to find care is to ask questions to others they know have had experience with therapy, use specialised therapist directories, and use voluntary governing bodies like the UKCP as a source for signposting assistance.
Only by working together, sharing our experiences, and encouraging change can we break down the barriers to truly inclusive mental health care.
Fiction and Poetry
Written by Ginnia Cheng
Ginnia Cheng is an East Asian writer and comedian who was recently part of a BBC Writersroom programme to help the BBC produce more diverse content. She is a diversity & inclusion advocate and writes about how to make the world more inclusive.