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The Times spoke to several therapists, social workers, researchers and organizations serving Thai and Asian Americans to examine how treatment and recovery can be tailored toward their needs. These recommendations emerged: addressing a client’s practical needs, involving family and community in their care and practicing mindfulness in the context of community.

Addressing clients’ practical needs first

Gordon Hall, a professor emeritus of psychology at the University of Oregon, explained that Asian Americans have high dropout rates after going to therapy. Helping them solve practical problems can be a way to keep them engaged.

“[Some therapists] may spend the first three weeks on [a client’s] thoughts and feelings, and maybe that will eventually get to the person’s practical problems,” Hall said. “But for many Asian Americans, they may think: What do my thoughts and feelings have to do with this conflict I’m having with my mom, or this issue with my boss about asking for a raise?”

Natyra Na Takuathung, a case manager at Asian Pacific Counseling & Treatment Centers, works with psychiatric social worker Wanda Pathomrit to help clients, many of whom are Thai immigrants, apply for social benefits. Pathomrit meets with clients to understand their mental health anxieties, and Na Takuathung can help them apply for programs like CalFresh or CalWorks.

Pathomrit explained that she integrates case management into her therapy sessions because many clients with depression, trauma or avoidance behaviors may struggle to maintain relationships with case managers or follow through on referrals. Instead of separating the roles, she uses real-world situations — navigating the Department of Public Social Services or substance treatment centers — as opportunities to build coping skills, practice emotional regulation and foster self-compassion.

“By coaching in the moment, I help clients grow confidence and self-esteem while accessing services,” Pathomrit said. “For high-need, high-risk cases, this intensive approach is not ‘extra’ — it’s critical for progress.”

But some clients are hesitant to accept help, explained Na Takuathung, because they believe they will “burden” society by doing so.

“They had this idea that if they did not ask for public benefits, then they were ‘good immigrants,’” Na Takuathung said. “They would think it’s better that they struggled and made their own money, and even if it wasn’t enough, they would just struggle in silence.”

The choice is ultimately up to them, Na Takuathung said. But she explains how these programs can relieve some of their stress, reminding them that they do not have to feel guilty.

“You’ve been living in this country. You contributed to this country, too,” Na Takuathung said. “You deserve kindness.”

Involving family in care

In a study examining culturally competent treatments for Asian Americans, Hall and co-author Janie Hong explain that Western-based approaches tend to emphasize individualism and personal reflection.

“You go in, you have to talk about your problems, you have to verbalize what’s going on inside to a stranger within 50 minutes, and that healing happens through this vocalization of your internal experiences,” said Hong, a clinical associate professor at Stanford Medicine.

In contrast, many Asian communities are rooted in collectivist cultures, where identity and wellness are deeply intertwined with family and group harmony.

“If you’re in a community where everyone’s supposed to be taking care of you and you’re supposed to be taking care of them, if you have a problem, that implicates your whole group,” Hall said. “Approaches that are very focused on the individual … may deter Asian Americans from seeking treatment.”

As the chief clinical officer of Richmond Area Multi-Services, one of the country’s first agencies addressing Asian American and Pacific Islander communities’ needs for culturally competent services, Christina Shea has observed the value of involving family members in a person’s care.

“If you work with [a client] in the Western psychology, it helps because that’s one unit,” Shea said. “But if you work with, say, somebody from Southeast Asia [and] you work with one individual, that’s not enough. That’s not a unit, because that person is connected with the family.”

Phramaha Dusit Sawaengwong sees these dynamics frequently as a monk at Wat Thai of Los Angeles. He commonly observes conflict when immigrant parents’ high hopes and expectations clash with their children’s own career aspirations.

Language barriers can exacerbate the disagreement. A common Thai word used to describe suffering is hua òk ja tàek, which means that one’s chest (heart area) is about to shatter. But parents with limited English may have difficulty conveying this sentiment to their child.

“[They] want to say something, but [they] don’t know how to say it,” he said.

Since parents often visit him at the temple for counseling help, he advises them to let their child absorb all the different opportunities available to them and to let them bloom.

“Don’t expect … just let them learn,” Sawaengwong said.

Support can extend beyond family.

Danielle Ung, a counseling and health psychology assistant professor at Bastyr University, is examining the mental health toll on Southeast Asian students during and after the COVID-19 pandemic. She works with patients to identify communities where they can receive support, viewing community as “concentric circles that surround that person.”

“Community can mean friends, extended families, adopted families, even the community which you live in,” Ung said.

Pam Evagee and Ta Sanalak are volunteer teachers at Wat Thai temple who coordinate Thai-language lessons and cultural programs to foster communication and understanding between family members. They ask parents to understand how living in the U.S. can influence their child’s beliefs while explaining to the student the importance of learning traditional customs because of where their parents grew up.

“We understand the parent because we are Thai, and we understand the kid because we’ve lived here [in the U.S.] for quite some time,” Sanalak said.

Families can also support each other at Wat Thai.

Some kids may be the only Thai student at their school, explained Evagee. At the temple, they can form friendships with other Thai students who understand their challenges. And many parents will cook meals together at the temple for their children while sharing advice on handling conflicts within families.

Mindfulness is a core tenet of Buddhism. According to the Pew Research Center, 90% of adults in Thailand identify as Buddhist, and many Thai Americans continue to practice the religion.

According to Hall, many Western therapies incorporate mindfulness, but the focus remains on the individual, whereas Eastern-based mindfulness practices account for the self within a community.

“There’s what’s called loving kindness meditation, where you focus on someone who’s done something for you,” Hall said. “You might meditate on your mother to the extent that she’s taken care of you, the gratitude you have for [her] and what you [owe] her.”

Buddhist monk Phiphop Phuphong frequently employs this approach when visiting people who are ill or hospitalized.

A diabetic man who had his leg amputated expressed deep grief over the loss and shame at “becoming a burden,” feeling dependent on his mother and sister. Phuphong guided him through mindfulness exercises to help him find peace with his new reality while encouraging him to stay strong for his mother’s and sister’s sake.

“Your body is your present,” Phuphong said through an interpreter. “Bring your mind back to your home.”

Health policies and training have come a long way

The Los Angeles County Department of Mental Health has services to reach underserved communities. It supports cultural competency through translation and interpreting services, culturally and linguistically inclusive services and bilingual bonuses for employees. But language is just the start.

“We’re trying to cover all of our bases, but I do think there’s still a lot of work to be done,” said Dr. Lisa Wong, who heads the department. “And I don’t think we’re going to make a huge amount of progress until we bring a more diverse workforce into mental health.”

Wong added that it is difficult to recruit clinical professionals from diverse ethnic backgrounds because many new immigrants and their children choose higher-earning professions rather than mental health fields.

In addition, much of the training and education for practitioners are still based on Western concepts of mental health and recovery. Many evidence-based models were developed from research on predominantly Eurocentric populations, explained Carl Highshaw, executive director of the National Assn. of Social Workers’ California chapter.

“While these models have value, they often fail to capture the realities of immigrant and collectivist cultures,” Highshaw said. “We need to adapt and co-create interventions that honor cultural traditions, family systems and community networks.”

Hong appreciates that many therapists are now acknowledging clients’ cultural context. Equally important, she said, is finding methods that do not stereotype.

“Not all Asian Americans are going to respond to a problem-solving approach, and not all Asian Americans are collectivist or interdependent,” Hall added. “[Some] may really want the mainstream cognitive behavioral approach. They want to talk about their thoughts and feelings, and that may actually help them.”

Approaches that have worked for the Thai community and for Asian Americans can work for other communities too, Hall said.

For Highshaw, cultural competence is “not optional,” especially in a diverse state like California.

“Moving beyond a one-size-fits-all approach,” he said. “Ensuring that interventions reflect the lived experiences, values and strengths of the communities we serve … is an ethical responsibility.”

Interpreter Supakit Art Pattarateranon contributed to this report.