Destigmatizing and Demystifying Health Disparities Impacting LGBTQ+ Communities of Color

8:35PM May 5, 2023

Speakers:

Desa Daniel

Keywords:

prep

feel

communities

conversation

counselors

providers

color

lgbtq

hiv

medical

counseling

folks

health disparities

thinking

stigma

person

people

patient

society

part

Hello and welcome to the thoughtful counselor, a podcast dedicated to bringing you innovative and evidence based counseling and mental health content designed to enhance your life. Whether you're a clinician, supervisor, educator, or a person wanting to learn more about the counseling process, we are here to demystify mental health through conversations with a wide range of counseling professional powerhouses. In each episode, you'll learn about current issues in the field, new science, and real life lessons learned from the therapy room. Thank you for joining us on our journey through the wide world of counseling. There's a lot to explore here. So sit back, take a deep breath. And let's get started.

Hi, everyone, this is Stacey Daniel, I am really, really excited to have you back on the thoughtful counselor podcast. And today I'm talking with Dr. James Garcia, who I have known since 2015, I believe, forever it feels like and one of the first people that I actually wrote an advocacy letter for so I don't know if you remember what he wrote that letter for division 45.

Oh, yeah, I do remember. Yeah, Pulse

nightclub shooting. So really just advocating having these conversations, but also bringing this conversation to all of our listeners and making sure they kind of know what's going on. So pause for a second Jays. Dr. Garcia, tell us who you are, where you are and what you're doing.

Thank you. Thank you, Dr. Daniel. And thank you for having me on your podcast. I'm assistant professor in the Department of Psychology at Cal State Fullerton. Broadly, my research is on health disparities, particularly with people of color and LGBTQ people of color.

Awesome. So I so as little backstory. A couple of years ago, I was taking quants, and I needed a data set. And James was awesome. And let me borrow data so that he had worked on about PrEP. And so that's actually my first exposure to it, of doing research and learning about it. I really like diving into a new research area that isn't actually hugely outside of black communities, but was outside of my kind of scope of research at the time. And then recently I was on tick tock which listeners know, I always am like I heard this on tick tock, and now I have to do a podcast about it. I'm like I have to talk about it. And the person on Tiktok was talking about how he just had like an ingrown hair on his leg and like went to the doctor to have it looked at. And it became a long drawn out conversation with the medical staff and the doctors and nurses about how he was on PrEP. And that being on PrEP meant that he was also HIV positive. And just having this fresh, frustrating conversation over and over again, how he's not HIV positive, and how being on PrEP does not actually mean that. And I was like Dr. Garcia is the perfect person to bring this conversation and talk to our mental health providers, but also folks who are working, especially with communities of color, but also queer LGBTQ communities all together, because we really need to have this conversation and know what prep is what happens and how we actually support our clients and advocate for them.

Yeah, you know, first off, you know, they saw I think, um, so I always get excited. Whenever I have conversations with you. I think we can have conversations for hours. But I'm really particularly excited that you ran with the the prep data set. So we need to chat about writing something up. But you know, I think the experience that you just described is all too common. For me, like as a Latino gay man. It happened exactly that way. I actually was interested in PrEP. PrEP stands for pre exposure prophylaxis, and to reduce my HIV risk. And I was wanting to go on PrEP. I had read a lot about it. I had done research about it. On my own. I went into my primary care doctor's office, and, you know, I approached the nursing staff. And I say, you know, I'd like to have a conversation with my primary care doctor about PrEP. And the nurse said, well, they only prescribe that to people that are HIV positive. And I stopped and I got offended. I'm like, Oh, I'm not. You're assuming that that I'm HIV. Be positive. Do you not know what's in prep? I literally have this confrontation with her. Right? I got my blood boiling, because here's a medical professional that should know what's in in these medications that they're prescribing. Right. And there's, you know, Don't come at me with there's no, not a lot of knowledge. Because there is an there has been, since about 2012, there's been a big adoption by the medical community of prep information. So I had to schooler, the nurse that was, you know, with my primary care doctor at that time, I won't prep was, and it was embarrassing. For me, it felt it felt weird, it felt like I'm telling you how to do your job. And it really didn't make me feel like I should go back to that doctor. And luckily, I got, you know, transferred to a specialist that you know, in an office that knew how to handle prep, prescribe it follow up and all that, which was really, I think, for me, enlightening to see. But while I was in that doctor's office, I was embarrassed. You know, they asked me questions about, you know, my sexual behaviors. And that's pretty typical. But in terms of, you know, assuming that was HIV positive, right, do you use intravenous drugs, all that stuff? So for me, it was, it was a little dehumanizing.

Yeah, as you're talking as well. So just thinking about all the stigma that comes with that, like, how brave and powerful it is to like, Hey, I'm sexually active, and I want to make sure I'm protecting myself. And then to have a medical professional, be like, you're obviously a hoe. Maybe we're just like, what's like, that's yeah, not actually this conversation. But then also have to, again, take your own, like medical future into your own hands and advocate for yourself and teach someone else that you can get what you need. And what a heavy lift that is for, like, the folks we work with every day who aren't going to, like their bloods gonna boil, but they're not going to say anything at all.

Mm hmm. That's exactly what I was thinking of. And this this stigma is, like, hard and true, right? Medical professionals are not immune to that to having that stigma. I would even say mental health professionals also are not immune from having you know, some of those. So those beliefs or stigmatizing beliefs about it. But certainly, like, if we, if I that am informed, and said something, you know, felt this way, I can only imagine how others who made me don't know about PrEP, or maybe don't react the way that I do, how their experience was, yeah, totally. And the whole, like, your whole, like, that's a real thing that providers, do. They they they are judgmental, some, not all, but some are judgmental.

Yeah. And as you're talking, it's, it just reminds me of like so many parallels, and even, like, when I wanted to get off birth control, because I was having all of these medical problems, that same conversation, like, oh, like, you can't do this, this and this, because then you're going to be unsafe, or like, how are you going to make sure you don't get pregnant? Or like, how are you gonna make sure you right? And so, especially when I think about our LGBTQ communities, like the jump from, I want to protect myself to are you a drug user? Just seems like I bought like, I just like were in the survey, like, how, how is that the next logical step in our conversation without you even knowing anything about who I am? Or like, why I'm actually here?

Yeah, it's the power, I think of assumptions, right? It's the idea that I know from the epidemiological data or from medical training that IV drug users tend to have higher rates of HIV. And so I'm going to, you know, ask the question, just to see if, you know, it comes up positive for that as a screener, and then I'll make a decision there, but I'm, like, I've told you that I'm not HIV positive, you have my my recent HIV test. It hasn't even been like a day since you had it. So it was unnecessary. It and I think, you know, if we look back at it, I think we share that experience of, you know, providers, maybe not giving us that autonomy. And that's what it is at the core of this. It's like, Are you capable of this? Are you capable James, of making your own decisions without us helping you?

Yeah, I get even more frustrated because we're also like, heavily educated, right? Like we're not that every day. Like people all like, right, like we are the exception. And so even just that, like, you didn't read anything, like you haven't read anything on the chart to understand that I have several degrees. And so maybe also right, like, we encourage our students and as retraining future counselors and psychologists, making sure they're very aware of the context. And it's like, within three seconds in this medical room, you like threw the context out the window, and like you've decided, what's best for me?

Yeah. You know, it's interesting that you bring that up, because, you know, part of me was replaying that just now and I'm, and I'm thinking, was the provider uncomfortable talking about sex with me? Were they just like rushing through it? And really, their clinical decision making wasn't really there? Because they were anxious about the topic where they anxious because I identify as a gay man. How do they view gay men in society? You know, and some of the same kind of questions you can ask about your experience data, right? So I think it goes back to that, like, how are you, you know, perceived by these providers, is going to really dictate how they treat you in the settings. And unfortunately, for those of us who are from these marginalized, minoritized backgrounds and society that exists in society, we really are not treated well, within the healthcare system.

Yeah, I have to give a shout out to my colleague, Dr. Megan speciality, because she teaches human sexuality. And it's such a reminder to me as how it should actually be ingrained in counseling programs, like worldwide or even when I've taught psycho farm, right, like, we're talking about just basic level understanding of what our clients could be experiencing. And the full acknowledgement that our counselors and training are not getting any of that right baseline, and then even for you, right, the, the shame, and just the hurtfulness of being like, Oh, I can't come back to this doctor, I have to go somewhere else. And then just the time it takes to do that. But then also almost like, the blessing to like, have a referral, right, and realize that that's not happening to everyone. Yeah. And then for you like, just having to start that process over again, like, Oh, it didn't work with this person. And I have to explain the same thing again, with someone else.

Yeah, it could be. It was very draining for me at that time, because I'm like, here I am here. I was shamed for having done this. And here have to retell the story again. And yeah, no, I completely agree with you 100%. Like, you know, I'm very fortunate to be in a an HMO in a healthcare system that is integrated, and they have the quick referral time turnaround time and all that. But I can only imagine for those that may not have that type of insurance, or even access to insurance at all, to health insurance, that process becomes a lot more fragmented, and they get lost through the cracks. If folks, you know, may or may not know, prep, it wasn't covered before by insurance carriers. And they recently just made it a mandate Congress did and AOC was actually one of those critical pushers in Congress, Alexandria, Ocasio Cortez to make sure that they create subsidies to allow prep to be covered by insurance carriers. So it's a fragmented system that we exist in in terms of healthcare. And I can only imagine, you're not folks who don't have that experience. It's even more complicated.

Yeah, and even just the difference of like, recently becoming Dr. Daniel, and like, just the change in my health care and realized, like, actually don't have to think about it, I can just go like, I don't actually need to, like, do I have the money? Do I have the coverage, I can just go and so even that alone is also a lot of unlearning in communities of color, especially of like, now that you've entered a new space or now that you're Dr. Garcia, like you have the opportunity to do that. And so I'm wondering for you, like what are the parallels you see in your work with communities of color, and then for like LGBTQ bipoc communities?

You know, I thank you for this question. This is an awesome question. You know, I think I have very similar experiences as he just shared a feeling of you know, don't not having to worry, I just had an instance last week, where I had been having some chest pain And, and part of me had the mindset of like, okay, I'm a grad student, or even before that I'm a low income person, you know, I'm struggling, I don't, I shouldn't go to the doctor because I can't afford it. And slowly but surely I, I kind of overcame that because I realized, wait, I do have good health insurance, I should seek this, you know, preventative treatment to make sure that I'm okay. I think as I reflect on that, I think it's when people are feel are made to feel less than by society. That messes us up. That makes us feel like, we may not be worthy, we may not be able to succeed, we may not be able to access anything. And that's how I felt, you know, when I started having those chest pains, after working out and they worried me, I was like, Okay, should I should I go to the doctor? Now, this can wait, this can wait, this can wait. When society I think tells us this can wait because you don't make enough money, right? And we're made to feel less than in these low paying jobs as society, we're gonna jeopardize her health, we're gonna push it off. And certainly, that's been the experience of my family too. And so for me, it was over, like, really not overcoming but like reminding myself like, no, no, no, this this is that, that minority position, I think that I felt throughout my life, of minimizing the importance of of my health, minimizing that all the stuff that I go through in society impacts my body. It takes its toll. So for me, like living at that intersection as a gay Latino, I was like, yeah, it is, it is that minority position that's making me feel like I shouldn't go to the doctor. But no, I have to go, I gotta go. And I ultimately did. And so for me, I think in my work, I've seen a lot of those crossroads those intersections of identities, or the experiences that people have, because society ascribes to them, you know, minorities ation or feelings of inferiority. I think that is pretty across the board, though distinct, right? And I what I call flavor, meaning the different experiences and people of color and LGBTQ people of color, right, so heterosexual people of color, LGBTQ people of color, heterosexual cisgender. But that's one parallel that I've seen, right, I think for, for folks of color, right, that are maybe heterosexual cisgender, they may not have to contend with, you know, homophobia, biphobia, transphobia, their gender identity at all. It's kind of assumed by society, right? That that what how you look like externally reflects who you are internally, as you're, you know, assigned sex. But that might not be the case for folks who identify as LGBTQ. Both experience racism, from society at large in predominately white spaces and all these other things. But I think that is one of the main, I think, commonalities and parallels that I see between the struggles that people of color face and LGBTQ people of color face.

Yeah, I was thinking a lot about, like, in your work, do you see maybe like an undoing or, like maybe a shift in hopefulness is that it can get better when folks have providers that have been helpful or have been supportive. And I say this because I like I had Dr. Goodman, who was a nurse practitioner, she was awesome. And I felt so supported by her that like, when I was looking for my new doctor in Denver, I was like, I need someone who like has it together and like, I need to not budge on that. And then now, I have Dr. Goodman, who's my allergist. So it's like, just by chance they have the same last name. Like she is the real MVP, like he is right. And so I'm also like, that has kind of changed the treatment. I thought I should get like, I didn't show up but I was like, oh, this person sucks, like figures, right? I was like, Oh, this person's not gonna work. Like, let me close out this appointment. And like maybe I can't find one right away but like I'm already looking for someone else, right? Like because I know that as a black woman or Like, as again, yeah, like you need a provider who's going to advocate for you.

Yeah. Yeah. You know, I think that that is an excellent point. I think that, for example, in that prep data set that that we have willingness to take PrEP, just attitudes and beliefs around taking PrEP and willingness of doing that, of taking PrEP, predicted lower stigma. So somebody who has more willingness to even explore what prep is, right, they're going to have less stigma, so I think, or they're going to be associated with less stigma. So I think that that's where it starts having a provider that is willing to explore things with you, and not just say, this is what you do. And that's it. Right? It's having a provider that you feel comfortable approaching with that, and then doing that with them becomes important. And I come back to this, it's that autonomy piece, like we all want to have a sense of, you know, we matter we what we do, affects our life. And so our decisions are important, us making decisions becomes important. Because that's how you get dignity. That's how you provide, not provide but allow the patient to have dignity, not even allow, I'm looking at my wording. And I'm even thinking about it make space for a patient to, to enjoy their dignity, I'm going to say, because we all have that dignity. And if we're given the right tools by healthcare professionals, and this has mental health providers included, we can we can really facilitate or help people feel like they have a choice in the things that they do in the medical care. And we can allow them to bask in that dignity, because I think that that's the most empowering thing. Like if I think back to my health care providers, the ones that I did with the best, were the ones that let me have that autonomy, Let them approach me with things that I was considering. Right. And we work together in partnership, which then made me feel like I was heard, made me feel like I mattered. And my health mattered. And they took me seriously.

Yeah, that actually leads me into my next question. And especially as you're talking, really thinking about, like, if I have the space to feel comfortable enough to tell you like, the reason I actually came right to like if I came for this one reason, but I now I'm comfortable enough to tell you like my symptoms are like if something's not going well, then the overall treatment is better, because there's just more information out there. And so, like, why is prep willingness and uptake so low? In our LGBTQ plus bipoc communities?

You know, there's a couple of factors here that we know from from the science. When prep first came out, when it was first introduced into the market, it was first advertised in predominantly white LGBTQ spaces. So for me growing up in LA, I saw it a lot heavily advertised in West Hollywood. So just over the hill, because I live on the other side of the hill. I live in North Hollywood, West Hollywood. And I saw gay white men. It was all gay white men on the flyers on you know, the bus stops in West Hollywood. When we went to the bars and the clubs in West Hollywood, you saw a gay man without a shirt with a prep pill. Right? Right. So I think it mattered who they had, representing a ripping in those in those ads. And it was not people like me, right, as a darker skinned Latino. I was not there. And it wasn't until community advocates pushed back and said, Wait, the people that you want to reach are not being reached here because of what this looks like. You know who it's who's on the ads. There was they were very vocal about that. And so things slowly started changing. So by slowly, I mean, so if it rolled out in 2012, by like 2014 15, you started to have some inclusion of more shades of color, different shades of color, folks that identify as LGBTQ, some Latinos or Latinx, identifying persons of black, African American, Asian, Asian American folks, on those flyers, on those ads, in the material in the clubs at the bars, all that. So if we think about it, if you're excluded from advertising like this, why am I going to take a pill if the pills not being marketed to me It's not really reflecting me in those ads. I felt exactly that same way. And so I was very skeptical. Back in the day about PrEP, I'm like, Well, it sounds like it's only a pill for white LGBTQ folks, or white gay men at least. So why would I? Why would I take that pill? Right? Because it was only being advertised to them. So that's one of the reasons another one, I think, is that prep stigma. So I remember going to these bars and clubs. So if hence, and if I didn't make it clear, I was a bar and club person, I went out clubbing like every every other day.

And educated doctor.

It gave me life, it gave me life. It gave me character, as my sister says. When I when I would go to to these bars and clubs, right? Gay men would literally shame people for taking PrEP, calling them Truvada horse. So the brand name is Truvada. And so they would shame the gay man that took this medication to you know, to reduce the risk of, of he contracting HIV, shame them. And, of course, nobody likes to be shamed. Nobody likes to, you know, feel like what you're doing is wrong. And so that didn't help right when people call you a Truvada or they're assuming that you're sexually promiscuous, that, you know, your deviance, and your sexual behavior, all that right, all those beliefs around that. And so that's I think another reason I think, particularly for communities of color where sex sometimes is or is not openly discussed, mostly not openly discussed, like I remember having a night even having a sex talk with my mom. It wasn't until after when I started prep that I told her about it. And she said, Well, are you being a whole? No, lover proud mom, I was like, Oh my gosh, like, like, slow down, slow down, slow down, put the brakes. It's not that. And I told her, you know, just like you would take medication for heart disease to prevent a heart attack, I'm doing the same to prevent getting HIV. And for me, it's about empowering myself, right? I make decisions, I can make decisions, and I'm capable enough to make decisions. And this is what Bill does for me. And so I there is some literature out there that talks or that finds that these, you know, stigmatizing beliefs are related to attitudes related to sexuality, in communities of color, in LGBTQ people of color communities as well. The family environment, right? If it's not supportive of decisions like this around sex, there's gonna be more shame. And so somebody is, like an LGBTQ person of color might not want to take PrEP if their family is like, well, there you go up there being a hoe? Like, is that why you want to do it? Because you want to maintain your whole ways? Right, that's, you know, it's it's funny, and, and it's also pretty disheartening, right? If the family does have those beliefs, because it really impairs I think, people from benefiting from the amazing benefits, I think that that prep does have in terms of reducing risk for HIV.

Yeah, as you're talking, it's just so many things just coming up for me, but I keep going back to the the heavy burden and lift on communities of color to have to change the feeling change the dialogue. Like really changed the discourse, and especially like, as you're talking, it's like, I see these ads, and like, no one on these ads look like me. I mean, like, no one in my community looks like me, that I know is taking PrEP, because of just the shame that comes with like actually taking it right. So it's like, not only do I see people on like TV, or like in these bars who may look like me, but then like, none of my close friends are talking about it because they're worried that we're gonna shame each other. But then also write like, our generation of, like the RE parenting of our parents of like, No, this is what practice is like, this is why I'm keeping myself safe. And like also having to deal with some of the stigma and like misinformation our parents have, and like help them be re educated. And suddenly you're making a choice to Protect your health and protect your partner's health, while also making the choice to be like a medical representative for community, your family that like the bar, because you also

feel stretched out and all these directions, right? And that's exactly sometimes how it how it feels. And it can, it can be stressful to a lot of burden. But I think it's, it's, it's not just LGBTQ people of color, but also women of color, that are also disproportionately affected by HIV, black women, Latina, Latina women, as well. So yeah, it's like being stretched out to the brim in all directions.

Yeah, and I just think of just, like, the mental somersaults that you have to do every single day, to be like, I want to be free. And I want to talk about my sexuality. And I want to talk about my life, and I want to make sure my friends are being safe. But then also just the continuous caution of like, you never know, how even the people closest to us are going to react. Even in the pursuit of like, making sure that your community remains safe. And like, especially right now, right? In pandemic times, with COVID of like, I want to make sure everyone around me is okay. But like, the shame and stigma makes it incredibly difficult, because I have decided if I have the mental capacity to have this conversation today.

Yeah, yeah. Yeah, it is. It is, I think, as you put it, like if I choose to have the mental capacity, because that's also a decision you can have, I think what what really, for me, like drives me to stay in the fight, I think, in this fight of being stretched out and all these different angles, is, I think, ultimately, this is the beginning of what what change is gonna look like, right? People are going to be uncomfortable. People are going to ask a lot of questions, people are going to assume a lot of things. And I think I'm, I've gotten used to being like the first as as bad as that sounds, I think, because I, I usually characterize like this, I'm like the burnt Dorthea I'm like that first one that you cook, and you're like, do I have the flame just right? And so I'm like, okay, Berthier, here we come. And so I think I all my life, I've I've kind of been like that. And so for me, it feels like, this is just another one of those things that i i will be a Berthier for and that's okay, because I think people are catching on to prep. Right? We now see, and this is fascinating for me to see this in my lifetime. Like for real, it's really, it's really cool. We have ads that include trans women, black trans women, I was watching pose and during in between the commercial break stage showed black trans women, Latina X trans women, advertising for PrEP. I never thought like I didn't think we're gonna get to that right now. And so, for me to see that for me to experience that I'm like, wow, I think things are going to so are slowly opening up, we now have an injectable prep that we can take if we want it's on a daily pill, but a monthly injection, the effectiveness is roughly about the same, maybe slightly lower for the injectable prep. But it still is another tool in that tool belt to protect against HIV risk. But all these advancements I think, are going to make it easier for people to grasp that prep. Works. Prep is safe. Prep, shouldn't be stigmatized.

Yeah, I also think and I've actually seen commercials as well, and, and like I've had enough exposure to actually know what it is. So that that enough is to realize just the significance of what's happening. But I think even right, like younger generations are really requiring more of us and like want more information, period. Like they just want the information so they can make a decision. And that's so far, and like from maybe like what our parents experienced. And so I'm wondering like, as things are changing so fast, and we see things kind of evolving so quickly, like what should counselors know about health disparities and our prep to inform their clinical practice with communities of color or LGBTQ plus bipoc communities?

Yeah, that's, that's a really ambitious question. I think, you know, in terms of health disparities, I think if we go back to the definition of health disparities, whether it be the CDC, Paula Braverman or any other health equity scholar The field, these are things in society that are avoidable, but that exacerbate physical health burden for particular marginalized groups and minoritized groups. Right? These are things that get in the way and cause these differences in health and they're avoidable. So we need to understand that health disparities are real error and are avoidable. How are they avoidable? This, I think, becomes important for counselors to know, at the not only interpersonal level, right, because you're working one on one with folks to work with their stress, maybe experiences of racism, maybe medical racism, right, or unfair treatment because of the race, ethnicity and medical systems or, you know, LGBTQ, you know, related stress of existing is that in medical systems, so that's one way I think of counselors integrating some of the the factors that typically drive health disparities. So what might that look like? There are specific protocols now that are published on addressing you know, anti gay rhetoric? So, pro TaskUs, has published extensively on gay affirmative therapy, and what are the components of gay affirmative therapy? We have folks, we're looking at racism as a traumatic stressor. So how do we develop individual therapy group based therapy to to help reduce the anxiety, and the trauma symptoms, and depression that comes with experiencing that in society? So I think that's the main takeaway, I think that counselors should know that these health disparities can be addressed one on one in session, right. And so it takes a little bit of expansion. And not only that, but training, right. In doing some of these protocols, and, and helping patients that are diverse, in terms of prep, I think that counselors I think, are in a very unique position to address health disparities, right? We have training and as a mental health professional, we have training in psychotherapy and specific modalities of support. But I think what training programs may need to consider is adding classes on how to consult. And I say this, because we all do it, you will consult some time in your career, whether it be you know, when you're out in practicum, or even out on the field, you'll consult with either another mental health professional, maybe a social worker, or a medical provider in the hospital. So it becomes incumbent for the next generation to feel very empowered to know how to consult. So I would say counselors in these counseling programs, I think it begins there to advocate for a consultation course. At my previous university, when I was teaching doctoral students, I actually taught the consultation course, they found it so helpful. They actually had a training experience where they had a fictional patient with physician assistants, students, and athletic training students. And so they conceptualize what care would look like and how you would maintain continuity of care. With all three professions, something to that effect, I think becomes important for counselors to advocate during the program. And then after their program. I think if you have patients who asked about this medication, find out about it, right? The CDC website has a lot of good information. hiv.org has a lot of good information, they can provide you, those sites can provide you with some basic understanding. YouTube is also a good one, right? But go to, you know, certified links like the CDC, YouTube page, all the these other you know, medically established organizations, the medically verifiable organizations so that you can get accurate information about PrEP, because there are some side effects for particular people. And so it becomes important for folks to know about the decisions that they need to make. And I'm not asking counselors to step outside of their scope of practice, right? I think it becomes important for us as health practitioners, because that's what we are we are we are healthcare, psychology and in counseling is healthcare. For us to have a basic understanding of this, right, I'm not asking folks to provide to prescribe medication, just to have an understanding of what prep is. So that, you know, we don't put our foot in our mouth like that nurse did, assuming that I was HIV positive or that somebody else was a should be positive. Right so that we have some understanding of that.

Yeah, I think it's so important that you touched on scope of practice, because often, because of how the United States is, it's this conversation of like, mental health is just mental. Like, it's not like for whatever it has health in it. But it's for whatever reason, we keep thinking, it's not health care. And so often, like when I'm talking to students, they're like, oh, you know, I don't want to step out on my scope of practice. And it was like, in your intake, and your triage, and your mini mental examination, you actually should be having a conversation with clients about medication, like, we're most likely to see our clients more than their primary health care providers. And so just a simple conversation on, like, how's it going on this medication? Or if you're having any side effects, can help the client realize that they need to make another appointment? Or they may need to change something rather than them just like not taking it? Because it doesn't make them feel great, right? So it's like, how do we help them do that? It's knowing enough to Google, right? Like, you're gonna, you're not gonna know everything, you're gonna have to look some of these things up, but being comfortable with what you don't know, to still have a conversation with your client.

Right. And I think that that's, you know, that's exactly the point. Right? Knowing enough so that if there are any opportunities for providing information on where they can get more information about it, to pursue that, right, because it's about providing those tools so that they can make an autonomous decision, like a decision that's informed by their autonomy. And I think that that's, that's where we exist, right? We are the folks who do see the patients more than the providers. And I often tell students, you know, you don't have to ask them specifically, you know, the names of medications, if they don't remember them, but do they take an antidepressant? And you can even keep it as broad as that same thing here, if a person, you know, says that they had an HIV scare, and that causes them anxiety, that's related to the clinical question, right? So they had an anxiety? Why did they have anxiety because they thought they were gonna get HIV, how they thought about PrEP. It's as easy as connecting that.

Yeah, and I and I also, just as you're talking, really think about how powerful it is for us to help our clients just get the information, like, just enough to say like, Hey, you're not alone in this, like, what have you thought about PrEP? And then like, hear some information, do your own research, come back, and we'll have a conversation about it. And so it makes them feel a little less alone in that process? And maybe they come back and they're like, oh, you know, like, I think people use pepper hose. And I just don't want to do that yet. And you're like, Okay, that's fine. Like, just tuck it away. And like, if you feel like it's something you want to revisit, we can revisit it, right? Like, our goal is not to convince people, that's not our goal. Our goal is to support them in their journey to making decisions that really support them and their identities and like their friends and family so they can live whole semi happy lives.

Yeah, no, I completely, wholeheartedly agree with that. Like, that's what we're in this, you know, profession for, right, we got to, we got to provide that information, I think to to the benefit of the patient.

Yeah, yeah. Yeah. And so as you're, I'm gonna backtrack just a little bit. So something that came up for me when you're talking just about, and I was thinking a lot about kind of historical trauma. And I always struggle, you can tell me how you feel about this. But I always struggle with the idea of historical trauma, because I'm just like, anyone who's Brown, like, anyone, like all of our parents went through some stuff, like subs, you know, I mean, like, so the idea that, like, I already know, I'm starting off at a disadvantage to some of my white colleagues, like, especially some of my white women or white men, colleagues, right. And so realizing that that is part of my journey. It doesn't define me, but it's the acknowledge that blood pressure runs in my family, high blood pressure, because of probably historical trauma and federal slavery depends on how far we're going back. Right. And so, I'm also thinking like, when our providers are scared or nervous, right, like to have these conversations because of their own stigma are their own beliefs. Then how has that been transferred to us? Whether we know it or not?

Yeah, that I think I see it all the time, I think it's it is transferred to us. Their nonverbals tell us their body posture, their tone of voice. When I, when I was doing a postdoc at one of the local medical rehab hospitals in Pomona, I was training some of the medical residents who by the way, do use Google. So even as medical residents, why use Google? You're supposed to know

everything. Yeah, right. Agree, right? Every

I, so I was training, you know, working with them and training them on their communication with patients. And you can tell when some when some of them were uncomfortable with some of the topics, their body posture, tone, how fast they were going, or slow, they were going really changed. And we feel it like I felt it in the room. I'm like, I'm not even the patient. But I feel like this change. And that's when the person checked out. That's when the patient checked out. Because they clearly see the person uncomfortable. And they're like, No, this person doesn't get it. And imagine having that time and time and time again, kind of like allostatic load that wearing and tearing of the body results. So I totally think that it affects us, it takes its toll chips away. And I think all aspects of our health not just physically like our heart, like for me with my heart scare. But mentally as well.

Yeah, and also just how much it like stacks up over time. It's, we had orientation a couple of weeks back in. One of our students had a reaction to something. So let's say we're talking about about multiculturalism. So obviously, there's always like suggesting xiety They're also like first day orientations, I think that adds to it. But after I was telling on the students, I and something that I've actually Dr. Rafe McCullough taught me was kind of the these like, the sentence stems. And I have used it so much this week of just when you feel the energy of the room shift or something happens. I was like, I'm having a reaction. Is anyone else feeling the same thing, right? Like, it's okay, just to point out that something's not okay. And like to keep yourself, like derail the trade, so that you don't end up re stigmatizing the people you're working with, or making the conversation worse, or having them leave and never come back. Because you are too prideful and your degree or like in the work you're doing to admit that you just don't know enough. Like, that's the whole point of the work we do and working in health disparities is, we're never gonna know everything. That's why we keep doing research and keep learning and keep discovering so that we can make things better for everyone.

And to humble yourself.

I know Yeah, like I'm telling,

ya know,

I said something bad.

It's calling up the the elephant in the room or whatever animal in the room, right, or whatever object in the room if you want to, if you don't want me to reference animals, whatever thing that's happening in the room, it's that taking away the power of what was there and checking in. And that's exactly what I would do with the patient. So you have this medical resident interacting this way, right? So I'm like, Hey, patient x x. Are you feeling about this? You know, there's a lot of information. And, you know, sometimes they would say, Ah, I don't really care about it. So I'm like, Okay, well, let's chat a little bit more about it. How about we go out to the courtyard, right away from this medical resident who may have made them checkout, right. And this is where I think then consultation comes in. Right? patient tells me this is how I felt this I reacted. And I consult with the medical residents. So how do you think they went? And they give me their assessment or impression? And I'm like, Well, you know, I think that that you did this well, and this well, and there's some areas here that I think that you can improve on. That I think is a beautiful skill. I think I've told folks this before. I don't think I've told you this, but I think that health care providers, mental health care providers are going to be the ones that change healthcare. Yeah. We're gonna be the ones that bring back humanity into like, care with humans. It's not just about the plumbing We're not just all plumbing, we have a brain. And for better or for worse, we have emotions, right to share. And so it's not just the plumbing here that we're fixing. It's also our reactions to what's going on with the plumbing. And I think that in my field, as a clinical health psychologist, I've seen some clinical health psychologists be part of like, for example, chief medical officers at VA systems. I'm like, that is where healthcare is going. We're bringing back the human in, you know, helping to healthcare.

Yeah. Yeah. So we were highlighting a lot just over, like, how do we work with communities of color? How do we have these conversations? But also right, like, how do we move away from talking at folks and actually, like having a holistic conversation with them about their health? So they're, they understand what we're saying, but they're also bought into the process, because this is, this process is theirs? And for you kind of like shifting a little bit back to the work you're doing? What are your thoughts on why LGBTQ scholars publishing work on communities of color, or bipoc LGBTQ plus communities?

This is always a very interesting question. Whenever I do run into it, I think that, you know, there have been some great contributions by white LGBT, Q scholars. So let's get get that clear. I think that where I find as a, as the G part of LGBTQ and you know, Latino, not white, I, what I run into is that oftentimes, when I read these articles, the lead author is a white scholar, a white LGBTQ scholar, that then is having potentially maybe one or two scholars of color that are LGBTQ after. So to me that reads, I'm benefiting from the labor of LGBTQ people of color. And some scholarship has been White's white LGBTQ scholars publishing on the experiences of LGBTQ people of color. For me, that doesn't sit well. Right. Here we have somebody who may or may not be part of, you know, the problem, trying to encapsulate our experiences as LGBTQ people of color. Mind you, not all LGBTQ people of color are going to know everybody's experiences. That's, that's I don't claim to do that. What I am saying is make space for LGBTQ people of color scholars to be first author to lead these projects to publish these, these findings in scientific journals to review the science and editorial boards of these high impact journals. So that we have that opportunity to lead this particular movement. Right. Just like with, you know, the gay liberation movement, the LGBTQ movement, right. Everybody has had a role. But there were those that really had a big role. Sylvia Rivera, right. Who threw a heel out into the crowd at Stonewall. So it often goes unnoticed, and and I think on unchallenged, when some of us have been in these events that have had high impact in the field or just out in the community. And instead, credit is given elsewhere. So it didn't sit well with me when that happens, as a as a gay, Latino, in this scholarship. And so those are kind of my initial thoughts. I think that we also should start diversifying, whether it be the counseling pipeline, the training pipeline, or the psychology pipeline or the medicine pipeline, by deliberately given these opportunities, presenting research publishing research that's led by and for LGBTQ people of color.

Yeah. Yeah, I love this question, because it actually makes me think of someone who's actually in the counseling profession who identifies as a white queer man. And like, as you're talking as thinking about two things, one of how powerful mentorship is, if you're actually mentoring, and I wish I can remember the author in the name of this paper I read off to find it and send it to you, but this person talks about how some mentors aren't collectors. Of like bipoc folks So play, that person collects, like bipoc students, but like, they don't actually excel in these ways, because they're just like gathering them. Yeah. And like benefit, like, as you're saying benefiting off that labor. But then I also think on the other side of it, like, when we have white scholars doing all of this fantastic work. And as researchers, we know, research is really hard. And it's not like it's not a cakewalk, right. Like we're all putting a lot of blood, sweat and tears into this work. Yeah, we are. I'm also just very frustrated with our profession that folks are writing diversity articles are LGBTQ books of like how to do this work. And then they're terrible in real life. Like, you're not living your research agenda in your everyday. Yes, like the kids in. I also think about how, like, yes, we shouldn't have idols, we shouldn't put people on pedestals, because we're all people and we all make mistakes. And we're not all supposed to be friends. But in your pursuit of supporting these communities, and like making sure that everyone knows about the power of these communities, don't also then further the health disparities of those communities, and you're like, outside academics,

you know, and and I think that that's, that's the important point here, right? So I think to not do that, I think requires a lot of introspection, I think of like looking inward and saying, Am I is this consistent? Is this one I'm working on? Consistent with who I am? And not to say that it's not for those folks, what I'm trying to get at is, if there's consistency in what I published, what I do, how I, you know, navigate my research career, and that's in line with who I am as a person, right? It's not going to create or have this image of tension, if I, you know, if I'm being consistent, like, I'm not going to be a horrible person, if I know and care about the communities that I'm working with, right, because I'm part of those communities. And that's I think the key piece that perhaps some folks that do publish this work that are white LGBTQ scholars don't have that insider's perspective, right, of what it means to live, breathe, exist in these communities. And it isn't necessary. But I think that the disconnect then becomes, if they're maybe not consistent in their non research life with that, that's where I think they go into problems.

Yeah, it's it really just highlights for me. How, like, Dr. Joseph white, his black psychologist talked about, like the three questions of identity and i Yes, I'm pretty sure you and I have talked about the three questions identity because I'm like, whenever they says, Doctor an identity crisis, like after bringing out courses, we're just like, you know, I'm an assistant professor. So it's been coming up a lot lately, but that's fine. Um, but it's like, who am I? Am I who I say I am. Am I all that I can be, which is actually originally from phenom. And so this reminder that, like you, academia isn't everything you are, your research is not everything you are. But if you're actively telling us every day that you are invested in these communities, and you are doing this work to better those communities. And then we find out that you're like, secretly telling people that like, if you take PrEP, you're a hoe, like

what is happening, and then disconnect.

It's like as your research colleague, I'm like, Ah, in 2023, Dr. Daniels taking it upon herself to let you know that you got to do something different. Because newer generations deserve something way better than we're giving them. Yeah. Yep. So we're getting towards the end and I love to ask this final question to everyone. And I like to keep it open because you know me so I just want your like, first thing that comes to mind. So what is one piece of advice you would give current students students at any level interested in doing similar work as you?

I think that have a lot of thoughts on this. So I might, I might say more than one but the one that comes up for me, you know, given my recent heart scare, take care of yourself. It can be as easy as remembering to take care of your hygiene. bathe yourself, you know, brush your teeth, shave, get a haircut. I think that that's the first thing that comes to mind for me, but I have other thoughts and I want to share them. If I can. Yeah, tell us I'm like, I think it's important because I looking back, had I had someone tell me some of these things while going into this field, I would have started actively incorporating them, rather than like haphazardly finding, though. And for me, it was a stumbling block, going into the field of psychology in terms of going into my Ph. D program, and all that that's along along the way, that's where I really, I think honed in on some of these things. So like the taking care of yourself part is important, I think, I think you mentioned that this already. But don't let your work be the only thing that defines you. You have other identities, you have other relationships, you have other connections in this world, ground yourself in those and lean into those connections, when something is going on. And for emotional support, or for tangential support, like a tangible support when you need them. I think that this has been, I think, one that that I think I've done with DISA and others other folks that we know, like Robert Don, and other colleagues that we have in common but building a professional network, building a personal professional network, who in your, you know, cohort or in your association does work that's similar to yours, seek them out, approach them for potentially, you know, getting in starting a mentorship relationship with them, you can check in with them, if they do provide that chicken with them on something that that happens. I think that that's part of having that vast collection or web of mentors and mentorship networks. And I think that this is something that I think has allowed me to do the work that I keep doing, because I have folks like this, and Roberto and timee that not only do they, you know, approach me with with things that like, oh, how do I negotiate salary for permission. But other things like, you know, I've been having a hard time dealing with this, this comment that this one person said, maybe on a listserv, a professional list or at a conference, or I'm having a hard time, you know, working with this person. And so we both lean in into that professional network relationship. I think that no, knowing when to walk away from conversations and discussions is important, especially with people who might adamantly oppose things like health disparities, or who might oppose that racism exists, right? And I'm talking about folks that use colorblind ideology, I don't see color. People that say all lives matter, that kind of stuff, right? Because they may not get it. And so reminding yourself, hey, I'm, it's not my responsibility to change anyone. And I have the freedom and autonomy to do what I want, including walking away from here. Yeah, and I choose to do that from my heart. That that, I think, is a good lesson that I've learned while doing this work. And then last but not least, I think that we all have tools that have helped us exist on our own, you will not be here, I would not be here this if we didn't lean in on to some of those skills, some of those social relationships that have helped guide us in into who we are now. And so whether it be like networks, organizations, family members, friends, patients that maybe we connect with, right? I think drawing from these personal experiences to help us navigate these professional spaces that were a part of, oftentimes, and this you can tell me if you've experienced this or not, oftentimes, I think we're told professionally, whether it be as therapists, counselors or psychologists and training that we should leave the personal out of it. Yes, right. To hang the personal at the door and I'm like, No, I disagree. We bring in our personal, personal stuff, whether it be racial, ethnic identity, be LGBTQ identity and what it means to us, right, we cannot simply hang that at the door. That's like literally wanting to dismiss a person's like lived existence. And it's very invalidating, so lean in to some of the rich, I think resources that you may have drawn from identifying as a black African American woman, with your friendship groups or family members, right? Same with me with my Latino family members, and drawing from the closeness of the relationships, and developing close relationships, meaningful relationships with people who know what it means to exist as Latino, and the racism that accompanies that. Because we don't leave our identities at the door. So don't leave earlier than is up the door.

It really reminds me of I was on like a rant last quarter with some of my students. And I told them, like you are the intervention, like you're actually the intervention. And it's just like, there's all of these statistics, right? That clients symptomology is vastly reduced just by going to counseling. And it doesn't matter, like what your theoretical framework is, all of these things, right? And so you really highlight, like, if you're stripping your identity and stripping who you are, to be this robot, that it's like, you're who you are, is actually the intervention in that the connection clients need to do the work.

Yeah, that therapeutic bond. That's what it comes down to. And oftentimes, for those of us who do come in with, you know, rich identities, very complex, interconnected social identities, I have been marginalized by society, oftentimes, and I was told this, you know, keep it professional. I was told the sign, I think I shared with you that my face is too expressive. That mine

is like, just steeped in white supremacy, like the idea of what and so the fact that your face is just like, what does that even mean? Like, you're just supposed to, like, get Botox and not smile, like I don't?

Yeah, I remember making a comment. Like, I think I'm too young for Botox. I was just a sassy back. I was like, to my supervisor at the time, I'm like, That's offensive, like, my eyebrows are expressive, because I have an expressive face. Effectively, Latinos are expressive. I use my hands a lot in therapy, do you want me to not be who I am. And it got my blood boiling. But that phrase of, you know, keeping it professional has been really ingrained in some of these clinical programs. And again, that has been rooted in that white supremacy, wanting to whitewash the profession.

Yeah, and more and more our clients look like you and I, than anything else. So like, it's not doing anyone any favors. So something else you talked you talked about, and I thought about it in terms of like, I believe, Dr. Helen Neville, or other people have talked about radical breast, like, making sure you're resting. And as you're talking, I just came up, I was thinking, don't lose your community while advocating for your community. Like, don't lose sight of why you're doing that work. And it means making sure that you're still connected to your own friends and family to them, the meaning behind the push, or the hustle or whatever you want to call it, because this work is not easy. And so I think it would add that like, this is long term work, you need to be in it for the long term. And part of that is going to the doctor, advocating for yourself getting what you need. So you're you're around long enough to actually see the impact you're making.

Yep, yep. So what good is all this if you might not see all this in your lifetime, which for me, has been the most humbling lesson to learn and all this like I can overwork myself. And if I do that, I won't be, you know, along for the ride to see that change.

Yeah, but also, like, how humbling Empower enough to give yourself that space of listen to your needs.

I think that that's, that's the key here is like to not avoid what we need. I think that that's important. I think, like I know, for too long, I avoided all that. Because I had to take care of everybody else. I did. I did. I did. I had to make sure that my family was was fine and you know, both extended immediate, and that my job was in a different state I was still kind of related to the or not related I was relegated this task of like, you're so really you're no, you're part of the provider of this house, even though you live, you know, 1500 miles away. And and I think that that's again, that humbling piece of like, you gotta take care of yourself, you got to listen to what you need. Because if you don't, you're run yourself to the ground. And you won't be here.

Yeah. Yeah, I just feel like it came full circle of when you're like talking about being the first right like this this burrito of like, like you have to make sure you're recovering or else like you. You're just not there for the good stuff. So like you did all the bad stuff. And then you miss all the good stuff. Yeah, yeah. You miss all the clubbing and drinking and partying.

One not now it's now it's going out to two restaurants and catching the occasional drag brunch in West Hollywood.

After 25

Oh my gosh, yeah, that was this was life in my 30s Isn't life at 35.

Thank you so much. It's almost it's always always always such a privilege and pleasure to talk to you and like have these really personal but complex conversations and really dive into the work that you're doing and how we are making the profession better. And we are really empowering the next generation of students to do similar work. As we wrap up, what should we expect next from you? What are you doing next? What should we look out for?

Oh, my gosh, I that's that's a good question. I'm doing so much. If you couldn't gather that by my bio, you know, that's going to be listed. I think what's really exciting for me is a book that I'm a book proposal that I'm working on for Cambridge University Press. And I haven't really made this public or anything, but here's to help some manifesting that it does get approved. And they pick it up. But a couple of us a couple of us LGBTQ people of color across the country scholars, community activists, and other folks in policy are submitting a proposal on strategies for LGBTQ people of color activism, community led efforts that highlight some of these activism, health activism for LGBTQ people of color. And what providers and educators and other community activists can can kind of gather from some of these efforts. So we're thinking of compiling this as an edited book. And that's what I'm really excited about. So hopefully, that comes into fruition. And so this is my first step, really saying it out loud, outside of the group that I'm in, but I, I'm feeling optimistic about it. And if it doesn't get picked up, that's okay. I have a million in one of the things to entertain me. Yeah,

I'm just gonna say that it will get picked up and then we'll expect to have you back and we'll talk about your book, and all of the wonderful things we learned from it. Thank you so very much. It's I just like I'm just so excited about this episode and spending this time with you. Everyone, this is a thoughtful counselor podcast, please please please look in the show notes. Read more about Dr. James Garcia. And we are super excited to have you today. And even we're excited to see you next week. Bye. Bye.

Thanks again for tuning into the thoughtful counselor today. We hope you enjoyed the show. This podcast is made possible through our partnership with concept, Palo Alto University's Division of Continuing and Professional Studies. Learn more about the thoughtful counselor and some of the other amazing continuing education offerings provided by concept at Palo Alto you.edu forward slash concept. As always, if you are a fan of the show, we would love to hear your feedback and review on Apple podcasts or wherever you subscribe