Dr. Denise Nguyen Interview: Advice and Experience from a Marriage and Family Therapist

I was born and raised in Southern California all of my life. I’m a 2^nd generation Vietnamese American. My undergrad was through UCI and then received my Masters and Doctorate through Argosy University in Counseling Psychology (MA and EDDCP programs at the time allowed me to work full-time and pursue my internships). I’m currently licensed as a Marriage and Family Therapist (LMFT). I originally went into the mental health profession because I was so fascinated by the stories I’ve heard about my parents’ and relatives’ experiences as refugees during the Vietnam War. I couldn’t understand how they went through such  horrible ordeals (losing children, rape, leaving family members behind to escape, seeing death/persecution, etc.), but came out with such resiliency. However, the more I dug in, the more I saw how depression can be masked in many ways. I learned the stigma that “mental health” held in Vietnamese culture and wanted to find ways to help fix that with other families. In fact, my dissertation thesis was about “The Effect of Social Stigma on 2^nd generation Vietnamese Americans: Influencing Attitudes toward seeking Mental Help”

A defining moment for me that solidified being in this profession is when my husband (then boyfriend) when through his own hospitalization and continuing to manage as a couple. Seeing it very close and upfront brings a new type of awareness and empathy that I can always channel from, when I’m working with other families.

This sounds so much like one of my favorite quotes by Charles Swindoll: “Words can never adequately convey the incredible impact of our attitudes toward life. The longer I live the more convinced I become that life is 10 percent what happens to us and 90 percent how we respond to it.” This is something as a Supervisor, I try to impart onto my staff. Additionally, this is something I try to help all of the clients and families we work with to learn and find some acceptance with situations that arise in their lives as well. There are so many things in life that will be out of our control, but the one thing we do have control over is how we can approach the situation; whether it be in our attitudes towards it, or how we choose to cope with the situation. I’ve worked with children, teenagers, young adults, adults, older adults. I’m blessed to be back in a program (Wraparound) that works to “wrap” the entire family system, so no one person is singled out as “the problem”. Everyone in the family (that agrees to participate) has their own goals that are collaboratively working towards their family vision. So we are able to bring this philosophy to everyone in the child’s “team” essentially!

I might be repeating myself in the previous answer, but I worked in many programs either as a County employee, non-profits, or County contracted mental health programs. Each prior program I’ve worked in, I would just interact with the client themselves or with client and a family member through conjoint therapy. With Wraparound, I love being able to work with the entire family system as our goal is to strengthen the youth & families’ bonds with their surrounding community, in addition to supporting them with their individual goals. We understand that it’s impossible to have the energy to care about your own mental health needs when you might not even know if you’ll be able to pay for your rent for the next month. Our program is able to receive funding to assist with basic needs/safety needs first in order to stabilize the family, and additionally work on acknowledging their mental health needs as well. Pretty much going into Maslow’s Hierarchy of Needs and working to build a solid foundation before delving deeper into other interpersonal goals. Our program is all about celebrating the small milestones, so every time anyone in the family is able to meet a goal: we celebrate as a team! We work mainly with low SES families but we also work with very well-to-do families, as we help normalize their situations and build familial bonds to work towards their success.

I’ve worked with children as young as 1.5 years old and up to 21 years old. It really varies with each family that comes into the program, but the nice thing is that the referral has to come through their Therapist, Social Worker or Probation Officer. With that being said, the referral usually comes with a good amount of background information (depending on how long they’ve been opened with one of the 3 referral sources). We have a “no secrets” policy (while also still being mandated reporters) in that we’re open about what the referral say, but we also want to hear in the family’s words about their story…and why they are in the situation they are currently in to be accepting of our services.

In Wraparound, we develop a Plan of Care within the first 30 days, where we ask each family member about Needs that they want to work on. Need statements are the “hole-in-the-heart” needs and when the team is able to build trust and rapport with the families, they usually are able to share their Need…which in turn comes with the families’ story. We don’t have set timelines (we’re open as long as their case with the referral source is open), we don’t have a policy of missing appointments that causes them to be dismissed from the program… it’s really a “whatever it takes” model. We’re a neutral party as well, so we don’t make recommendations to the Psychiatrist, we don’t make recommendations for their court cases, etc. Once the family begins to see that our program is different from a traditional mental health program, they start to open up a lot. Our meetings can be held at parks, in their homes, at a bowling alley, in their therapist’s office, etc. I also think because each team comes with a 1) Case Manager, 2) Parent Partner (aka mentor), and 3) Youth Partner (mentor), that everyone in the family feels there is a representative for their voice.

Unfortunately, so many of the youth we work with have contemplated suicide, have expressed suicidal ideations and/or have attempted suicide. There is a pattern of feeling lonely, not accepted/loved, and not understood (by their peers, parents, people in their lives). With every Plan of Care developed, there is a Safety Plan component built in as well. As a Supervisor, I have to assess each referred youth and the youngest case I have is an 8 year old that started cutting (which was only discovered because she posted it on social media).

I’ve worked with adults before and right now in my program, we work with the youths’ parents as well. Working with adults in my past programs on an individual basis, I found it harder to gather information (as they have to give me consent about who I can talk to) to develop a better sense of the client. It also really depended on their developmental age and emotional development, as some adults can very well present like a teenager or younger in how they perceive the world. With trauma, people can get stuck in the developmental age when their trauma occurred, so I find myself using similar techniques I’ve used with the adults I’ve worked with and have shared those same techniques to my current staff when working with their youths (e.g., relaxation techniques, grounding strategies, coping skills/tools). Adults respond well to positive praise and incentives as much as the younger ones too!

I’ve always let clients know that they don’t have to share anything that they’re not ready to share, typically when I’m doing the initial Intake assessment…as it does ask delve into questions about trauma, family history, etc. I’ve certainly had youths tell me very little at times and I let them know that it’s okay. Since my role as a Supervisor doesn’t allow me to be part of the main team that sees the family on a weekly basis, I really try to go out to as many meetings as a I can during the initial phase so the youths and families know my face and can get a sense of my personality. I think that really helps with inserting myself in the very beginning and doing fun activities with the family before I go into “assessing mode”.

Since I dealt mainly with the elderly population when I was a Social Worker, a lot of the issues I encountered were both related to their psychology but it went hand-in-hand with dealing with aging, health issues, lack of independence, seeing their peers die and losing their social networks, and feeling either helpless or useless within their own family networks…all of which influenced the levels of depression, anxiety, etc. that could have been existing many prior years before. I’ve always seen that social work and psychology should go hand-in-hand, because we do not exist independently in our own bubbles. Our families, friends, community, and world events play a part in our lives (for good or bad) and understanding that social connectedness sometimes puts the pressure off the feeling of, “How come I can’t get better?”

I’m starting to see more portrayals in movies and TV about mental illness but as someone very invested working with not only the Asian Pacific Islander populations (e.g., seeing more people of color and their families deal with mental illnesses), but the underserved populations as a whole…there is so much more to what’s shown on TV that doesn’t accurately capture what these families go through each day.

It is a mix of mentoring staff that are working with the youths and families, and still having the ability to interact with the youths and families myself. I’ve been in this field for 10+ years now and am able to be like an “anchor” for my teams in times of high crisis, or to be on the sidelines to hear about all of the successes they’ve been able to celebrate together with their youths & families. I always tell my staff that it can be a thankless job at times, so you have to be able to really find meaning in the daily work that you do…to bring that passion forward each day. But I still get to be a part of those family meetings, I can jump in and fill any role for my teams when needed, and be a part of those celebrations as well.

Although you might feel like you cannot go on living anymore, you’ve somehow either searched or reach out to find these words right now… that life is hard, but you are not alone. If you don’t have anyone that you can share this feeling with, do not lose hope because there is someone out there that wants to help you. Search for a therapist and tell them what you’re feeling, and you will have someone to help you bring back hope in your life.