Cultural Competence in Mental Health

“Why do I always feel guilty or ashamed for no reason?”

“Why don’t I like confrontation and arguments?”

“Why do I keep pushing myself so hard at school or work, even when I feel miserable inside?”

“Why is it so hard for me to talk about my feelings or what I’m going through with my family?”

“Why do I always feel like I'm not doing enough, no matter what I achieve?”

“Why do I brush off my successes or think I don’t really deserve them?”

“Why am I freaked out by the idea of messing up or failing?”

“Why do I feel bad for wanting to do what I love instead of what seems more respectable or secure?”

“Why do I feel like I’ve to keep proving myself to everyone, including me?”

These are the kind of questions that burrow themselves into my coming-of-age story – questions that revolve around feelings of guilt and inadequacy, and fear of failure.

These questions lingered and fermented in my thoughts – well into my early adulthood – until I brushed them away, telling myself “Enough with the insecurities and pity party.” For a moment, it gave me a sense of relief – I didn’t have to face them. But they’d return and burrow deeper into my thoughts, starting an endless cycle all over again.

It reminded me of something Dr. Martin Luther King Jr once said, that “There is something of a civil war going on within all of our lives.”

I am Vietnamese. My parents sought refuge and settled in the US. I am Vietnamese American – born, raised, and nurtured in the US. I belong to an umbrella term, Asian Americans and Pacific Islanders (AAPI), that consists of multitudes of descendants or immigrants from East and Southeast Asia.

In recent years, I’ve noticed people from diverse walks of life being more openly comfortable talking about mental health.

From my family and friends.

From athletes – Michael Phelps, Serena Williams, Dak Prescott, Simone Biles, Aly Raisman, Kevin Love, DeMar DeRozan.

From celebrities – Selena Gomez, Demi Lovato, Lady Gaga, Elliot Page, Kristen Bell, Chrissy Teigen, Ryan Reynolds, Kendrick Lamar.

And from AAPI athletes and celebrities – Naomi Osaka, Jeremy Lin, Chloe Kim, Suni Lee, Nora Lum (Awkwafina), Olivia Munn, Brenda Song, Ken Jeong, Constance Wu, Steven Yuen.

Even with much recent progress, we live in a place and time in which mental health stigma still prevails. I believe a critical way to combat this is to continue embracing open conversations, which will help lessen the “suck it up” mentality – internalizing emotions and feelings – and encourage individuals to seek help.

In AAPIs, mental health often remains a complex and not widely discussed issue due largely to cultural values, family expectations, and the immigrant experience tied to intergenerational trauma. (1,2)

The American Psychological Association defines intergenerational trauma as “the transmission of trauma or its legacy, in the form of a psychological consequence of an injury or attack, poverty, and so forth, from the generation experiencing the trauma to subsequent generations.”(3)

Intergenerational trauma includes the psychological impacts of war or displacement. For instance, children of refugees may experience anxiety and stress related to their parents' experiences, even if they did not directly experience those events themselves. It might seem as though they, too, have been affected by this past trauma.

Throughout my life, I would get snippets from my parents and grandparents and read narratives from others about their experiences.

Flying bullets, airplanes, blood, cries, dynamite, ships, boats, ocean, home, death, hunger, thirst, fear, capture, torture, encampment, prisoner, chains, shackles. These words, by themselves, are just nouns and adjectives. But connect them together and what you have are harrowing and traumatic stories of the refugee experience. For my parents, this was their emotional and psychological reality. Though I only heard and know of their experiences, it’s enough to leave a lasting imprint on me.

Research indicated that the trauma experienced by previous generations is passed on to future generations through epigenetics. Epigenetics are heritable changes in our genes brought upon by emotional and psychological events from the environment.(4)

Intergenerational trauma may stop individuals from seeking help. It’s made tougher by the unique cultural and familial dynamics, such as a strong focus on family honor, the need to ‘save face’, and pressures – both said and unsaid - to assimilate and strive.

Also, societal pressures from the ‘model minority myth’ paints AAPIs as universally successful and hard-working, which sets up unrealistic expectations. It means the struggles of some individuals are ignored and silences them from talking about mental health.

In coaching, it’s important to acknowledge and recognize that the emotions you observe, or sense could be deeply rooted and inherited from past generations. I believe that coaches should take the time needed to build a relationship based on trust, offering individuals a safe, non-judgmental space to express themselves.

To help address mental health in AAPIs, especially when dealing with intergenerational trauma, we need to develop cultural competence – or become ‘culturally savvy’. This means being aware of how culture shapes the way an individual thinks and behaves.5 Gaining cultural competence is an added skill that needs ongoing commitment in coaching individuals from diverse backgrounds. By appreciating and valuing the unique stories and backgrounds that everyone brings, and by adjusting our coaching approach as needed, we can encourage more open conversations about mental health and continue breaking down barriers that stop individuals from seeking support.


1.       Wang JT (2023). Permissionto Come Home: Reclaiming Mental Health as Asian Americans. Balance.

2.       Lee SJ and Yoon L (2024). WhereI Belong: Healing Trauma and Embracing Asian American Identity.TarcherPerigree.

3.       American PsychologicalAssociation. Accessed April 2024)

4.       Yehuda R and Lehrner A.Intergenerational transmission of trauma effects: putative role of epigeneticmechanisms. World Psychiatry. 2018;17:243–257. (Link)

5.       Chao M, Okazaki S, Hong,Y. The quest for multicultural competence: Challenges and lessons learned fromclinical and organizational research. Social & Personality PsychologyCompass. 2011;5:263-274. (Link)


Paul Cao is currently enrolled in the Nickerson Institute's Integrative Mental Health Coaching Program. Paul received his BS (Biology) from University of Houston and PhD (Cancer Biology) from Wake Forest University School of Medicine. He currently works in medical communications to create materials designed to bring awareness of research on new medical treatments for various health conditions. Outside of work, Paul enjoys community volunteering and, as a former Big Brothers Big Sisters, mentoring. He is also aspiring to become a mental health life coach - in large part due to his own mental health journey - and is aiming to help men on their own journey as well.

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