Art therapist Owen Karcher specializes in helping LGBT survivors of domestic and sexual violence.
Owen Karcher remembers going into the emergency room with a broken ankle.
The injury was painful enough. But the stressful situation went from bad to worse when a hospital staff member asked an insensitive question about Karcher’s gender.
“I’m not sure what you are — are you male or female?’” Karcher recalls being asked. “And I’m just there really needing my ankle to be fixed.”
It’s likely the staffer didn’t mean to offend, but for people like Karcher, a transgender man, interactions like that are all too common. A national survey found that 50% of transgender people reported having to teach a medical provider about proper care for trans health. For many transgender people, it’s an uncomfortable conversation. But for individuals recovering from trauma, dealing with an uneducated provider can be a major setback to recovery.
“Imagine somebody who is experiencing an intense amount of trauma, anxiety and oppression walking into a space and being treated poorly and being asked accusatory questions,” Karcher says. “They might not have the capacity or the willingness or the strength to sit with those questions and answer them.”
Karcher is an art therapist in Madison who specializes in helping LGBT survivors of domestic and sexual violence. There’s been a recent push to take trauma into account when providing care and services to people. But Karcher says that often these providers fail to recognize culture and identity when helping individuals recovering from trauma.
“It’s important to understand, contextually, what people are walking [into therapy] with,” he says. “When you don’t show that you’re welcome and inclusive of LGBTQ folks, you run the risk of the assumption of the opposite.”
When meeting with new clients, he takes care to start by using reflective, nongendered language. His intake forms have blank spaces for both a client’s preferred name and their legal name, and he asks what pronouns a person prefers. It’s a helpful educational tool for cisgender clients, too, but it’s a real benefit to transgender individuals — many of whom are accustomed to discrimination.
“There’s almost some relief, some relaxation in body posture,” Karcher says. “People thank me for asking those questions.”
It seems a logical approach to counseling, but this emphasis on culturally informed therapy has been surprisingly slow to catch on in the mental health community, Karcher says. Last year, he gave the first local presentation explaining best practices for treating the LGBT community at the Conference on Child Sexual Abuse in Madison.
“The person asking for proposals thought it was really exciting,” he says. “They haven’t had this topic before.”
Some local mental health professionals are stepping up efforts to better understand the unique ways that trauma can affect other marginalized groups.
Fabiola Hamdan, a Dane County social worker, says Madison is “a long ways behind” when it comes to serving the mental health needs of the area’s Latinos, Hmong, African Americans and other groups. But recognizing the conflicts and history associated with each culture is essential to providing proper mental health care.
Hamdan, along with Celia Huerta, a Spanish-English bilingual therapist with the Rainbow Project in Madison, has for the past two years given presentations on working effectively with Latino families and survivors of trauma.
Huerta says she’s seen a recent increase in the number of workshops that focus on serving minority populations — a push she says represents an important step forward for mental health care.
There’s a shortage of bilingual therapists in Dane County. Interpreters are available, but most Latinos feel more comfortable with a native speaker, Huerta says. Understanding a client’s cultural background helps providers pick up on subtle signs and behaviors that might not be obvious to non-Spanish speakers.
“It’s kind of shocking, but one out of two Latinos are dropping out of mental health services,” Huerta says. “Here in Dane County, it’s attributed mainly to differences in culture.”
Hamdan echoed that concern: “I hear from a lot of agencies that Latinos are dropping out [from treatment] and underutilizing services — probably because they don’t feel comfortable and they don’t feel like they’re being understood.”
Many Latinos find that the dominant culture in the U.S. is formal, impersonal and “institution-oriented,” Huerta says. Latinos generally respond better to a more “person-oriented” approach and appreciate it when a therapist takes time to chat at the beginning of an appointment, adds Huerta. Issues like immigration, deportation, employment and family dynamics are also important to approach through a culturally competent lens.
LASUP, a Latin American support group, includes between 40 and 50 social service agencies that meet monthly to discuss community concerns and share information among providers. But more effort is needed, Huerta says.
“Agencies could benefit from doing more outreach, hiring more minority service providers, offering incentives and looking for people outside the community,” she says. “It will take more work, but I think it can be done.”
