Why do I ask you about your dreams?

An important aspect of psychoanalytic therapy is exploring your dreams - yes, those dreams, the ones you have in your sleep. They can be recurring dreams, pleasurable fantasies, or those dreaded “anxiety dreams”- but a lot of the time, dreams can just be a weird jumble of mundane, vague, random collection of images that are extremely difficult to recall in a linear fashion. I’m interested in all of them.

You can tell a lot about someone simply by asking how they relate to their dreaming life. Some people are totally excited to talk about their vivid, drawn out dreams that they can recall with such incredible amounts of detail. And then there are the people who don’t dream at all, or to put it more precisely, they forget their dreams. This is interesting on its own, to find out how someone thinks about their inner world, how comfortable they are with their unconscious.

Dreams were called by Freud the “royal road to the unconscious”, because of how useful they proved to be when the contents of a dream led to discoveries of a patient’s deeply repressed thoughts and wishes. Dreams are made up of different people, places and objects from different times in your life. In our dreams, we can experience feelings that our conscious selves would never allow us to feel. Sometimes these feelings are intense and they cause nightmares.

When we first start working together, I will ask you 1) how you feel about your dreams and 2) invite you to bring in any dreams you can remember. Keeping a journal is helpful, but not necessary. You can simply talk about a scene, an image, a feeling or just a word that you remembered upon waking. Dreams are anything but straightforward, so the telling of them will always be convoluted, pieced together and reconstructed in the present. You can never exactly say what the dream is - and so this frees the speaker up to retell it, to mull over the different elements, to explore it from different angles, and fill in the blanks. It is helpful to reflect on what you happened to be thinking about the day before the dream as a possible source of the dream’s contents. Did you have a stressful conversation with your parents? Were you thinking about a political situation you read about online, or were you upset with your partner?

I think the most useful part about recalling your dreams in therapy, is getting out of your usual patterns of talking about yourself, which comes from our egoic need to know everything we’re saying. Dreams introduce something different, an otherness that is also a part of you. Imagine describing a certain sensation, a room in your childhood home, a familiar activity with an unfamiliar person, a scene of violence or death. The dreams act as a useful prompt for speaking more of those strangely related thoughts that are hiding out in your mind. In therapy, the dreams are the raw material that get transformed and reconstructed into new ideas to work with.

We tend to take dreams for granted, dismissing them and forgetting them. We would rather go looking elsewhere for knowledge about ourselves, when our dreams are readily available to provide an intimate perspective on our troubles. They are a part of you always waiting to be discovered.

Are your parents’ desires for you overwhelming?

Have you lived your life trying to somewhat meet your parents’ demands while privately rebelling at the same time?

Are you unwilling to “cut off” your overly-intrusive parents and looking for a way to change your relationship without resorting to estrangement or superficial interactions?

Is your mother falling apart because you picked the wrong person to date, or you decided that having kids of your own is not for you?

Are you unclear about what your parents actually expect from you, yet you feel the pressure anyway as if you’re supposed to read their minds?

When your parents express feelings of sadness, loss, or disappointment, do you feel sad and guilty?

These are just a few examples of the sentiments I’ve encountered in my years working with young adults who are in a time of their lives where they are struggling to individuate and figure out how to live their life on their own terms.

I’ve noticed that Asian American children of immigrant parents are especially conflicted by the thought of going against their parents wishes for them. Immigrant parents tend to be anxious and oriented towards survival and security- after all, they had to start their lives from scratch as foreigners in a new country that is less than welcoming to newcomers. Many of them left situations of war and poverty in hopes of a better life, and for the next generation to succeed and have more than they did. The more they had to sacrifice and endure hardship, the more anxious and hypervigilant they and their parenting may become, and this sends a lot of mixed messages. It can feel too controlling, paranoid, and shaming/punishing, while at the same time interpreted as protective, motivation, and a cultural expression of parental love. I don’t think it’s one or the other. It’s all of above, and it’s downright confusing!

Constant dialogue and negotiation with one’s parents continue internally, including after moving out, having limited contact, or even after your parents have passed away. You may feel bothered by how much you think about what they think, that nagging voice in your head, how much they seem to speak through you, even though you’re desperate to get them out of your head!

Therapy can help sort out the jumble of voices, to find the similarities and differences, where the other stops and you begin. If this resonates with you, I hope you know you’re not alone, and that there are ways to relate to your parents differently as you grow into your own person, rooted in your culture and family, and yet finding your own version of success and happiness in life.

What is Psychoanalytic Therapy?

My training and way of working as a therapist is based on psychoanalysis, the original theory and technique that founded the art of therapeutic healing as we know it today. Its inventor, Sigmund Freud, made a lot of radical discoveries for his time based on his hours of listening to his patients describe their private lives. He discovered that each of us has an “unconscious”, an irrational force that plays an important driver of human thoughts and behaviors.

Psychoanalysis has endured over the past century as a rich, provocative field of study contributing to not only psychology but to sociology, philosophy, and cultural theory. The fact that psychoanalysis has historically centered the experiences of upperclass, heterosexual, white patients does not erase the importance and applicability of its ideas on a universal level. Contemporary clinicians of all colors, from all over the world, have expanded on certain aspects of his work, re-interpreted and re-translated his writing, and adapted psychoanalysis to suit the unique needs of different cultures, different kinds of illnesses, age groups, and socio economic classes.

What follows is a basic description of principles and values that all psychoanalytic practitioners can agree on:

Psychoanalysis invites us to consider that we are not fully in control of our minds, that we experience unresolved conflicts, ambivalences, and forbidden wishes and fantasies, all of which emerge from the lasting traces of past memories from when we were much younger. As subjects formed by language, our unconscious experiences are always mediated by the social discourses and cultural norms of the times we are living in. This is to say that an unconscious conflict will always reflect the time and place the patient is living in.

This anxiety-provoking material has been repressed in the unconscious, persistently finding means of expression through neurotic symptoms that cause psychic pain to the individual. And even as we defend, manage and suppress this pain, these very same defensive mechanisms can often lead to even more suffering. Therefore a constant balance is maintained between the expression and repression of impulses perceived as dangerous to the psyche.

What often prompts someone to seek professional help is a crisis that emerges when this balance gets disrupted in a major way. Perhaps increasing stress builds up to a sudden panic attack, or an impulsive and uncharacteristic action comes out of nowhere, or your dreams have turned into daily nightmares and the avoidance of sleep. These experiences may be scary and disturbing, but they provide an opportunity for insight and working through in therapy, like a light guiding you into a dark tunnel. You decide to put down your defensive tendencies in favor of knowing what it’s in that dark tunnel. This is deep, painful work. One’s suffering must be great enough to engage in a process as costly and rigorous as psychoanalytic treatment. The therapist’s office is the only place where we allow the painful material to surface for the purpose of healing and change.

We need to speak to another person in order to listen to what our unconscious is telling us. It is impossible to see our own blind spots, to know what is hiding from our awareness. The therapist, who may act as our mirror and interpreter, is intently listening to everything you say- and don’t say- about yourself. Rather than a set of techniques used, the psychoanalytic therapist has a certain way of being with your experience with an evenly suspended attention. There is but one rule to follow, which is that of “free association”- you must speak everything that comes to mind without judging what you will say, especially things you are afraid to talk about, or things you’ve never said to anyone else, or even silly and non-relevant thoughts. This simple rule is actually extremely difficult to follow! Similar to meditation’s command to focus on your breath, part of the work is continually having to notice our natural resistance to the process.

As you start to speak freely in therapy, you will feel the relief of being able to put vague, overwhelming bodily sensations into more sturdy thoughts and ideas, granting you some necessary distance as an observer of your experience. At times, a cathartic emotional release can feel liberating, yet this is not all that the work entails! By speaking your desires and what you really want out of life, you can redirect your mental efforts towards more fulfilling creative activities, discovered from having greater spaciousness and abundance of energy that has been freed up from inhibition.

Ultimately, psychoanalysis aims at restoring the aliveness and the possibility for satisfaction in your life, in both work and love. We never aim to get rid of the unconscious, for this is impossible. We learn to live with uncertainty, to be less afraid of our fantasies and strong emotions, and even start to enjoy the experience of not knowing. Psychoanalysis doesn’t promise enlightenment or everlasting happiness, but assures us that an ordinary life, with its expected ups and downs, is attainable.

The Wisdom of James Baldwin

Life is tragic simply because the Earth turns and the sun inexorably rises and sets, and one day, for each of us, the sun will go down for the last, last time. Perhaps the whole root of our trouble, the human trouble, is that we will sacrifice all the beauty of our lives, will imprison ourselves in totems, taboos, crosses, blood sacrifices, steeples, mosques, races, armies, flags, nations, in order to deny the fact of death, the only fact we have. It seems to me that one ought to rejoice in the fact of death- ought to decide, indeed, to earn one’s death by confronting with passion the conundrum of life. One is responsible for life: It is the small beacon in that terrifying darkness from which we come and to which we shall return.

-James Baldwin

Why do I focus on your family in therapy?

From the beginning, your childhood and family relationships will come into the picture as the foundation of who you are and how you experience the world.

Who we are is inextricable from our experiences being raised in a family, but because of how long ago these experiences took place, we are never fully aware of how these early years have shaped and organized our adult lives.

Here are the important ways that family shaped us in early childhood:

Family is where we learn how to love. The way our primary caretaking figure nurtured us from the moment we were born, making sure we were fed, clean and comforted, is our first model of love and care.  Using whatever means available, they provided a safe enough environment to allow us to become ourselves, exploring, playing, and finding the things that delight us.

 Family forms our first ideals and moral values

Our caretakers are also our first authority figures. We had our first encounters with limits and boundaries, hearing the crucial word “No”. The way they disciplined us, prohibited certain behaviors and thoughts while promoting others. Eventually, this function becomes internalized into our own consciences, which is often an “inner critic”, a voice that becomes our own distorted version of what we grew up hearing.

Family is our bridge to the outside world

Growing up, we start to engage with the“real world”, guided through our parents’ lessons they have learned themselves, whether through what they explicitly say, or by our keenly observing their actions (Children are very observant!). We learn how to get along with people, settle conflicts, follow rules, compete, and most importantly we learn about sexuality and gender difference.

In therapy, we can make connections between childhood memories and present-day conflicts. In fact, we are often jumping back and forth between past and present, weaving memory and fantasy together as if there were no concrete lines between the two. This can be especially important for working through trauma. But if we do the work to more fully remember what happened before, we can hope to make different choices for ourselves, without falling into a vicious cycle of repeating the the past.

So your parents don't believe in therapy...

“I think my mother has undiagnosed depression. I’m overwhelmed by her emotions”

“My father is an angry old man. We have to walk on eggshells around him and never know when he’s going to blow up”

“I wish my parent would go to therapy, but they don’t believe in it. They would never do it.”

When I hear some version of these statements from my clients, I sense the feeling of helplessness and despair from wanting a parent to heal from trauma, understand themselves better, be able to take difficult feedback, or at the very least learn to just listen.

If you are similar to my clients, you might start therapy not for yourself, but for someone else. By being in therapy, you can say to one or both of your parents, “Look, you’re the reason I am going to therapy…if I’m doing the work, why can’t you?”

Starting therapy this way would be a mistake. I see how frustrated you are, how your parents mental health impacts you, how desperate you are for them to change, so you can be released from the psychic burden of managing their destructive behavior and feelings. Sometimes, clients are seeking a therapist’s “expert” opinion on their parents condition, diagnoses, etc.

In my opinion, your parents are allowed to live their life however they see fit.

Culturally, your parents have probably thought therapy was only for people who were extremely ill, or that talking about your problems is shameful, useless, and a waste of time and money.  They’d prefer to brush things under the rug as they always have, one sacrifice among many they’ve had to make. They would never, ever, go to therapy. That very well may be the case.

Meanwhile, if you have grown up in the US, you have likely been learning that it’s good to express your feelings, to not bottle things in. You have learned about intergenerational trauma, attachment theory, internalized oppression, and the body-mind connection. You’re proud, rather than ashamed, to be in therapy.

Neither of you are right. It’s a difference, informed by your life experiences, upbringing, and surrounding influences. The fact that your parents don’t believe in therapy will not diminish your investment in it. This difference does not have to divide you, either.

So, instead of hoping that you can heal your parents, go to therapy to find out what’s there that can be just for you.

When Asian American Men Seek Therapy: The Invisible Struggle

“It was getting so bad I couldn’t hide it.”

When his friends and family members started noticing his unusual behavior and expressions, Ryan*, a Korean American man in his thirties, realized he needed to seek help for his feelings of depression in his late teens and twenties. He says his starting place was shame, an admission of defeat.

While research shows that individuals in the Asian American community suffer from high rates of mental illness, this is a population that has largely gone untreated. As an Asian American therapist in San Francisco, I have worked with too many clients who suffered in silence for years before they finally sought help for their struggles.

According to a 2011 study from the National Institute for Mental Health, Asian Americans are less likely to reach out for help with emotional difficulties than white, Latino, and Black ethnic groups. In fact, only 17% of all Asian Americans have sought professional help, and only 6% sought this help from a mental health provider.

It became my mission to find out why. To this end, I’ve conducted a series of interviews with Asian American men in order to understand why this trend exists.

“My family was split, and you couldn’t reach out [for help] in my community. There were so many hot topics you couldn’t talk about. You don’t want to show your cards.”

Ryan tried to keep his suffering to himself. He said he would seclude himself alone for days, unreachable by any mode of communication. He found himself sending bizarre, cryptic emails to friends, and engaging in risky behavior like talking to random strangers in the middle of the night. Still he could not bring himself to open up about his suffering with friends or family and things grew worse, not better. Eventually he decided it was time to talk to a counselor.

Ryan’s story is common. Seeking therapy is generally not the first consideration and often the last ditch effort. Many of my clients grow up believing “Asians don’t go to therapy unless there’s something wrong with you” or that Asian men are not interested in their emotional life. They speak about the avoidance in their families of origin when it came to verbalizing thoughts and feelings, where the option of going to therapy was never even brought up.

The stigma of mental illness in Asian cultures can make it unsafe to express feelings of overwhelm and vulnerability, let alone talking openly about your symptoms of depression. For men adhering to traditional masculine gender roles, it often means that you keep your pain silent. I’ve heard many guys describe how they tend to bottle it up, hoping it will just go away. One wants to do whatever they can to “save face,” which means to avoid mention of any issue that could potential bring shame and humiliation to themselves, their family, and the greater community.

Unfortunately, these efforts to hide are precisely what can cause psychological symptoms and maladaptive behaviors to emerge.

For Mark, a Korean American who grew up in the Midwest, the emotional struggle was visceral.

“I would have pretty bad panic attacks and was having a really hard time falling asleep…I was in a ‘rabbit hole’.” He tells me of his difficult time working for an advertising company.

He was wearing himself thin, spending hours overtime into the night, and dreading going to work. The stress started to become unmanageable.

Mark, who is now in therapy, said he didn’t know what it meant to be depressed when he was growing up. But as he looks back on his childhood, all the signs were there. “I feel like a lot of things I’m experiencing, if I had voiced them then, I might have found different coping mechanisms.”

Because of the popular stereotype around being “model-minorities,” Asian Americans are under immense pressure to exemplify what it means to succeed in America, and are, in turn, denied lives that also include temporary setbacks or failure — lives that are also frustrating, conflicted, historically influenced, and subject to the pains of loss and death like any other person.

The lack of nuanced portrayals of Asian American perspectives in the media contributes to a belief that Asians are not complex people, although there have been major signs of progress with the emergence of television shows like “Fresh off the Boat,” “Dr. Ken,” and “Master of None”. When an Emmy-award winning episode of “Master of None” showed us two Asian American men exploring their relationship to their immigrant parents, it captured an experience that many have often felt alone in. More importantly, it made it okay to talk about, sometimes for the first time.

Mark* says being in therapy has greatly helped relieve his stress and anxiety. When I asked him about the shame factor, his answer surprised me.

“I don’t hesitate to say that I go to therapy. I’m not ashamed at all.”

Share your story, get in touch: nicole@nicolehsiang.com

All names and identifying information have been changed

What Happens to You When You Don’t Want to Suffer?

“You can hold yourself back from the sufferings of the world, this is something you are free to do and is in accord with your own nature, but perhaps precisely this holding back is the only suffering you might be able to avoid.” -Franz Kafka

It’s curious that most humans do everything they can to avoid suffering- it’s only natural, right? Yet the results of these actions can lead to graver discontent and even deadly consequences.

Consider everything you’re not doing when you attempt to not suffer:

You’re not asking that person out.

You’re not asking your boss for a raise.

You’re not sharing your art or writing.

You’re not speaking your mind in school or at work.

You’re not standing up for what you believe in.

You’re not calling your friend to hang out.

You’re not leaving your house.

Take Franz Kafka’s simple words seriously, and you may see how the avoidance of suffering leads to an un-lived life.

The Shadow Side to Being an Asian American Over-Achiever

Andy* a 34 year old Taiwanese American living in San Francisco, could easily be seen as a person who has “made it”. A UX designer at a prominent company, he spent 7 years steadily climbing the career ladder, receiving much praise and acknowledgement for his artistic talents and focused work ethic.

But shortly after he became promoted to a senior position, he realized that he was completely miserable.

Amazed, I asked him, “How did this happen?”

Andy took me back to his childhood. As a teenager, Andy hardly had any spare time for a social life because he was too busy with school and extracurricular activities. His parents, who were worried when they saw too many B’s on his report card, put him through hours of after school Kumon tutoring, SAT prep courses that started in the sixth grade, violin lessons, Mandarin lessons, and sports. He was given math textbooks to read over the summer. He became a hardworking perfectionist, conditioned to strive for the best.

Andy’s story is common for today’s young people in an increasingly competitive society. We see a lot of concern in the media about whether we are putting our youth through too much stress in school without enough consideration for their emotional wellbeing. Parents are encouraged to look for warning signs of excessive anxiety in their children, and many schools incorporate “socio-emotional learning” within their curriculum.

But if you ask an Asian American family, you might hear that it’s entirely appropriate and necessary to push our kids to excel and reach high goals with a hearty dose of "tough love. On the recent hit show “Glee”, there was a memorable episode called “Asian F,” where Asian American character Mike Chang is scolded by his father for getting an A- on a chemistry exam.

That’s right, an A- is equivalent to an Asian F.

Despite the exaggeration, the story resonated with many former Asian kids. They remember what it was like to be reminded of their immigrant parents’ struggle and sacrifice, so that they could have a better life. Even if they didn’t receive the messages overtly, immigrant children are likely to feel that their family’s future weighs on their shoulders. Being smart, hardworking, and studious is the only way to a bright and secure future.

As a result, Asian American college enrollment and academic achievement has surpassed that of any other race including whites, demonstrating the immense value of this type of parenting. The media has highlighted the phenomenon of Asian American success as either a sign of great accomplishment, or a threat to American security.

But lately, people have started to pay attention to its emotional cost. Research shows high instances of depression and suicide among Asian American high school and college students, a fact often masked by their achievements. A recent study at Cornell University found that among 21 on-campus suicides between 1996–2006, 13 were Asian American. A task-force and outreach center was created at the school specifically to address the needs of their Asian American students.

In 2002, San Francisco’s Lowell High School lost 16-year old Thomas Hoo , described as a “seemingly untroubled” teen, whose hidden depression led to his suicide. Lowell High School is the most competitive public high school in San Francisco that selects its students based on merit and academic performance. Their student body is predominantly Asian American. More recently, Palo Alto experienced a spike in suicides among upper-middle class high school youth, many of them Asian.

Being good at school doesn’t mean you’re good at life, and we often overlook this fact. Asian American students frequently fall under the radar when screening for mental health issues in schools.

Andy said that he never questioned what it was that he wanted for himself. In complying with his parents’ demands, Andy developed the strengths he needed to meet similar high standards in college and graduate school, although always driven by a perpetual feeling of inadequacy.

It wasn’t until he started his career when his mental strategies started to fail him.

“When you’re in school, there’s a sense that you’re stressed out now, but at least there’s an end in sight. But when you apply that same mentality to work, you realize there is no end. The way that you’ve always done things, it’s not sustainable. You look into the future and think, ‘Am I going to do this until I retire?” And that’s when the hopelessness sets in.”

Like Thomas Hoo’s story, Andy’s perfectionist battle with himself went unnoticed. Feeling disconnected from his colleagues, he became irritable, resentful, and even developed serious physical symptoms, including tendonitis from computer-related repetitive stress.

One day, he finally decided he had to do something about it.

“I realized that all of the rewards in the world won’t make me feel good about the work I was doing.

“I had this feeling that I’m missing out on a whole world of emotions that I don’t know how to express,” Andy explained. He decided to begin personal therapy and career coaching to think about what it would mean to live and work for himself and not others.

His journey to find himself began, and he now works in a different field.

Beneath the image of the hardworking, successful Asian American, people like Andy have complex and nuanced desires and feelings that are a part of what makes them human. A lifetime of avoiding failure and disappointment can prevent one from ever sharing who they are inside- and as we’ve seen, the consequences can be deadly.

The truth is, if we don’t allow ourselves to make mistakes and disappoint others, we won’t be able to ever know who we are beyond what people expect us to be. And that is never a sustainable way to live.

Perhaps a better way to thank our parents for all that they’ve done for us, is to show them that we’re not afraid of failing. Every once in a while, that is.

*Name has been changed to protect confidentiality