Daniel Knoepflmacher, MD: Hello and welcome to On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. I'm your host, Dr. Daniel Knoepflmacher. In each episode, I'll be engaging in thought-provoking conversations with experts on mental health, neuroscience, and other important topics on the mind.

Today, we'll be talking about the importance of cultural sensitivity in mental healthcare. When doctors, patients, journalists, and politicians discuss the state of mental health in America, they often use the word crisis to describe the profound shortage of care available to those who need it most.

As with many inequities in our society, digging into the data shows that racial and ethnic minorities consistently receive lower quality care when compared to the white population as a whole. In the 2003 book, Unequal Treatment, published by The Institute of Medicine, a panel of experts documented how race and ethnicity are significant negative predictors of the quality of healthcare in America. Importantly, the authors showed that this is not just due to factors of economic inequality, in fact, the disparities in care occur even when patients from minoritized backgrounds have the same ability to pay for the equivalent level of care received by their white counterparts. Instead, the root of this problem with unequal care can be found in the clinical encounter itself, in the complexities of the interaction between the patient and their provider. Without necessarily knowing it, provider behaviors may turn away some of those who are historically underserved in our society from seeking the care they need.

What are the attitudes, expectations, and behaviors of clinicians that lead to these poorer outcomes for large sectors of our population? What can providers do to change these counterproductive cultural tendencies? And what can patients from minoritized backgrounds do to select the right provider? Today, we'll shed some light on the potentially uncomfortable but necessary discussions of race, culture, sexuality, gender and other identity factors that lead to culturally responsive mental healthcare. To provide some expertise on this topic, I'm grateful to have Dr. Stephanie Cherestal joining us on the podcast.

Dr. Cherestal is an Assistant Professor of Psychology and Clinical Psychiatry at Weill Cornell Medicine and serves as Director of Diversity, Equity and Inclusion for the Weill Cornell Medicine Department of Psychiatry, as well as Director of the Dialectical Behavioral Therapy Programs in New York Presbyterian's Westchester Behavioral Health Center. More importantly, Stephanie is a trusted colleague and friend who I've enjoyed collaborating with on several projects.

Dr. Cherestal, thank you for joining us today. I have so much I want to discuss with you. But before we jump in, I want to start by asking you a question I pose to every guest on this podcast. Can you tell us a little bit about your journey to becoming a psychologist?

Stephanie Cherestal, Ph.D: Thank you so much for inviting me to participate in this, Daniel. I'm really excited for the conversation that we're going to have today. Thinking about my own journey to becoming a psychologist, I thought a lot about this, you know, how I ended up here on this journey, what brought me to clinical psychology. And really at the beginning, I always knew that I wanted to provide therapy. From a very young age, I always knew that I wanted to become a therapist in some capacity, and perhaps that had something to do with growing up in a somewhat chaotic family and navigating conflict at a fairly young age. But you know, also really learning how to navigate conflicts from different perspectives within folks in my family, allowing different people to feel heard and understood. It was just always something that I did somewhat naturally. And so, that was always something that was in the back of my mind.

Now, it happened to be though that my own sort of serious thinking about this and what this could look like started with my own appreciation for my own mental health and sort of what that looked like as that got challenging for me at different points in my own life. My mother actually passed away when I was fairly young. I was 18 years old, and that really gave me firsthand knowledge as to what it really looks like to need mental health support and really what that looks like. And as I started I guess getting that support and receiving that support, that really firmed my knowledge that that was something that I wanted to do for other people as a career, like to be there for other people during tough times and even if you don't have necessarily a solution for what a person is going through. And you know, as a psychologist, I don't always have a solution for what people are going through to really be there to guide people through the tough moments in their lives. I really started thinking about myself along that journey as a function of those experiences.

Now that said, why I pursued psychology specifically rather than the other perhaps degrees that could allow someone to provide and practice therapy is maybe a longer conversation, right? Because I pursued a doctorate in clinical psychology, I could have pursued a career, a degree and social work, for example, and still provided therapy. And if we want to talk through the differences between those degrees and why I chose a doctorate in clinical psychology, we can. But that was just sort of my path, choosing to pursue a doctorate in clinical psychology. But that's sort of kind of why I found myself on this path.

But I guess the last thing about that that I want to say is that, in pursuing maintaining my own mental health, I realized how few people around me were discussing this, the importance of pursuing mental health, specifically as a black woman, right? Growing up in the '90s in Queens, there weren't a lot of people talking about mental health and mental health treatment and going to therapy. And so as I was really coming into my understanding of what it means to struggle with your mental health and really need mental health support and really thinking about pursuing this as a career, I also always had in the back of my mind that I wanted to do something to really destigmatize this topic in certain communities, and at least the community in which I grew up in. And it's been nice to see the conversation around that start to change, at least somewhat, in the last few years.

Daniel Knoepflmacher, MD: I love hearing that. The fact of who you are, what your experiences were growing up in your family, it makes so much sense knowing you and seeing the work that you do. Like, it's one story that has this wonderful ending because we are very fortunate to have you doing this work. I want to switch gears and talk about this topic, which actually relates to some of what you were just saying. Talking about who you are and why you do this work is especially pertinent for our discussion today because it touches on the importance of identity. So, you've done a lot of great work in our department helping clinicians, and that includes psychiatrists, psychologists, social workers, nurses, learn about culturally responsive mental healthcare. Can you provide some background on why these efforts are so important for helping the diverse population that we serve as providers here in New York City?

Stephanie Cherestal, Ph.D: Yeah, absolutely. It goes without saying, but I should really stress that the New York City area is one that is incredibly diverse and is growing increasingly so every day, right? So in terms of folks presenting with various racial or ethnic identities or religious affiliations, sexual and gender identities, there is such diversity within the New York City area. However, what we know is that the mental health field itself in terms of providers doesn't always reflect that same diversity.

So for example, speaking, as myself as a psychologist, as of 2018, the United States psychology workforce is composed of 86% of providers who identify as whites. And so, we know just hearing that and in a nutshell, that the psychology workforce in and of itself does not represent the diversity that exists within the New York City area. And so, we know that that cultural mismatch is very likely occurring in sort of therapeutic spaces, whether we're thinking about psychologists or working with a psychiatrist, working with a mental health provider. So since we know that that mismatch exists, how can we help folks learn strategies and techniques and things to avoid in terms of providing culturally responsive healthcare, in terms of really being able to work effectively with people who are culturally different than themselves? It's incredibly important as we're also thinking about the psychology and the mental health workforce changing overall.

And I do firmly believe that we're going to see a lot more diversity in terms of mental health providers at some point, hopefully in the near future. In the meantime, we really do need to train the folks who are providing that mental healthcare as it stands right now to be able to work effectively with people who are culturally different from them, because that is something that they're doing, and we really want to be able to optimize that work and get patients the most appropriate form of care. And really, that involves providing them with culturally responsive care.

Daniel Knoepflmacher, MD: That makes so much sense. So, we're dealing with the reality of now in this approach. I was just at a conference, and actually you were there as well, where there was some discussion of cultural competence in one of the talks. And you just used the word culturally responsive. There's a lot of different terms around the word cultural or culturally that are used in this context, and I just wanted to make sure we can understand the vocabulary correctly. So, can you explain what you mean by culturally sensitive or culturally responsive versus culturally competent?

Stephanie Cherestal, Ph.D: In the field of mental health, psychiatry, psychology, but just thinking about this across the board, what has commonly been the goal is developing cultural competence, right? And using that term, folks have really thought, "How can I develop cultural competence?" So, cultural competence has been defined in a number of different ways. But the way in which I've come to understand this term through research is that this really refers to the ability to engage knowledgeably with people across various different cultures.

Now, cultural competence though, when we think about it in this way, it almost suggests that once we reach a level of mastery, then we're done, right? "I'm culturally competent, I've learned, I can engage knowledgeably with people across cultures, I don't have any more learning to do." And because we know that that is unrealistic, that as much as we as mental health providers want and need to be doing ongoing research to increase our knowledge and understanding of what it looks like to be able to engage knowledgeably with people across different cultures, there is no end goal necessarily that we can say that we've reached and, you know, we've reached this point of cultural competence and we're done and we no longer have learning to do. And so because of that, a number of people in the field are suggesting the importance of moving away from this idea or really this term, and moving towards the pursuit of providing culturally responsive care or practicing cultural sensitivity or cultural humility.

So, cultural sensitivity or cultural humility means acknowledging that one does not and will never know everything about another person's experiences and how their cultural identity has shaped their experiences. But rather, that we are willing to learn from our patients or our clients about what their experiences are, how those experiences have looked for them and how it's shaped their experiences in the world while doing our own self-directed learning. So moving in the direction of describing this process as developing cultural humility or sensitivity, it really indicates that this is a lifelong learning process rather than one that we can kind of check off a box and say we're competent, and then move on to see another area of competence that we're we're trying to develop. It's a lifelong learning process.

Daniel Knoepflmacher, MD: So, process versus task, you know, it's, "Check, I'm competent. Now, I don't have to keep working at it." But with this kind of diversity, we always have to keep working.

Stephanie Cherestal, Ph.D: Exactly. And always remain aware of our own areas of bias, that's a major part of practicing, and delivering care from a lens of cultural humility or cultural sensitivity. It's really engaging in an ongoing practice of self-awareness because we, as mental health providers, are not distinct from human beings across this world. We have bias. And so, practicing cultural sensitivity and cultural humility recognizes the importance of really deliberately engaging in a practice of self-reflection, so that we are aware of our areas of bias so that they are not inadvertently playing out in our clinical encounters with the patients with whom we're working with, or at least we are interrupting the possibility of doing so because we're aware of them.

Daniel Knoepflmacher, MD: Thinking about this, being aware of ourselves, but that humility is such an important part of it. And I'm wondering, in offering culturally responsive care, how does that relate to patient-centered care, which is another word that we hear a lot about centering our care on the needs of the patient?

Stephanie Cherestal, Ph.D: Right. So when we think about patient-centered care, we're really thinking about really treating a patient's specific health needs and desired health outcomes, and using that as how we drive all of our decisions and, from the point of assessment and diagnosis and treatments of a client, really what our plan of approach is and really putting the patient and their needs and their goals at the center of that. And really thinking about cultural responsive care, that goes hand in hand with providing optimal patient-centered care, right? Thinking about not only, say, the symptoms that a patient is coming in describing, whether it's depression or anxiety, or difficulties with anger. Not only necessarily just thinking about those symptoms as we think about tailoring a treatment plan to help the patient, we also need to be thinking about all areas of their identity and how that plays into their presenting symptoms or they're presenting challenges because we can't look at these symptoms in a vacuum and still provide adequate patient-centered care.

So, it's really looking at all of these factors as well as the difficulties that that patient is struggling with and what their goals are for whatever treatment they're coming to you for, whether it's psychiatric care or psychological care, and really putting a huge focus on that patient's identity and how it's related to, again, their symptoms as well as their goals.

Daniel Knoepflmacher, MD: So, allowing the patient to really feel heard and seen by the provider. Hopefully creating, as a result, a really strong therapeutic alliance. I wonder about the opposite though. Can you give me some examples of what patients face when they see a provider who may not be consciously taking in issues related to race, culture, sexuality, gender or the patient's identity?

Stephanie Cherestal, Ph.D: Sure thing. I think the first thing I think about when I think about this question is that what happens very often is that the provider isn't bringing these issues up at all in sort of a therapeutic space. So, I'm obviously recognizing that folks might be listening to this podcast who do less therapy and maybe do more straightforward sort of medication management.

But just thinking about this in therapy, very often providers aren't bringing these subjects up at all, and probably for different reasons; lack of a perceived ability to navigate these topics or these issues of identity effectively. Whether it is due to other reasons, oftentimes these issues are not brought up at all. How does this issue that you had sort of with your family, how does your culture relate to how this all played out for you? These things are oftentimes not brought up at all. And what we know though is that not broaching these subjects in treatment, it communicates something, right? It communicates that perhaps there's a lack of comfort from the provider to bring these subjects up. And so, that then communicates to the patient that this isn't safe for them to bring up in this space. And so, not bringing these issues up at all is a real concern.

Now, sometimes when these issues are brought up, providers are not consciously taking in differences in terms of race and culture and identity into account and actually maybe dismissing the importance of those aspects of their identity. So, you know, for example, if I am working with someone who is in training in some regard and they receive some sort of performance evaluation and they look at their performance evaluation and their scores and their marks compared to, say, one of their peers and colleagues and thinks that there's some unfairness in terms of how it played out. And I, as a provider, sort of dismissed the possibility that bias could have played a role in that. Let's say that that's something that my client is struggling with. But me as a provider, ask questions like, "Well, is there other possibilities for what could have happened?" Or "I really doubt that that was in any way related to bias." I'm pretty sure your supervisor is using, you know, standardized measures and bias had nothing to do with this. If providers are actively dismissing the importance of identity in these clinical encounters in a therapeutic space, we know that that can be incredibly invalidating to the patient that you're working with can be incredibly damaging to rapport and can really get in the way of your client getting their needs met in this therapeutic space. And it can really impair the ability of your client to really learn ways to manage how it is that they're feeling around the situation as effectively as they otherwise can. So, I think about this in a couple of different ways, not bringing this up all together, and also dismissing the importance of identity as it relates to some of your client's concerns.

Daniel Knoepflmacher, MD: So really, to be a culturally responsive provider, you have to really engage in this two-part process. You commit to your own self-evaluation, think about the influences you have from your background. Also, make a dedicated effort to really appreciate the specific cultural context and the dynamics of the individual who's seeking your help. I wonder, is there a guide, a specific approach that you can recommend for helping clinicians think about what cultural influences are impacting the relationship between the provider and the individual?

Stephanie Cherestal, Ph.D: So first, it's hard to choose just one strategy or framework to help us kind of think about all areas of one's cultural identity because there are many aspects of one's cultural identity, whether we are readily thinking of them or not. But if I could think of one in particular that I've recently come across that I utilize very, very often in my own practice, it's really what is referred to as the ADDRESSING framework that was developed by Dr. Pamela Hayes. And so, the ADDRESSING model is, well, ADDRESSING is an acronym, and I can talk through what the acronym stands for in a second, but the ADDRESSING model is a framework that really helps and aids in the recognition and understanding of all of the complexities of one's individual cultural identity. Like I said, it has many, many, many different aspects to it. The ADDRESSING model stands for encourages us to reflect on starting with the A and addressing age, developmental disabilities, acquired disabilities, religion, ethnicity, sexual orientation, socioeconomic status, indigenous group membership, nationality and gender, right? All of those different areas really constitutes and contributes to one's cultural identity.

And so, using that acronym and, you know, in psychology, we happen to love acronyms, but this one I find to be particularly helpful in terms of helping folks. And when I say folks, I'm thinking about providers as they think about their own cultural identity, as well as all aspects of the cultural identity of the client that they're working with. And when we're doing our own reflection of our own cultural identity and using the addressing framework, what it helps us to understand is our own relative areas of privilege, right?

So specifically speaking, as a black woman, I don't oftentimes walk through this world thinking of myself as privilege in many regards. But then, when I reflect and I really specifically use Pamela Hayes's ADDRESSING model, I recognize the areas of positions of power and the areas of privilege that I actually do hold, right? Not experiencing myself as having any developmental or acquired disabilities, for example, that's a privilege. Identifying myself as a cisgender, heterosexual female, right? Those are areas of privilege.

And so, the ADDRESSING model helps us almost take ourselves out of what we think of our own identities and really think deliberately about all areas of our cultural identity, the certain positions of power that we hold and how that relates to our clients. And so, we want to engage in a similar process as it relates to our clients. When I'm working with a client, I want to use the ADDRESSING model to fully understand their cultural identity and really think about the differences in terms of the positions of power they hold as opposed to the positions of power that I hold and how they might play out in the therapy room.

Daniel Knoepflmacher, MD: So, all of this intersectionality that each of us holds with our different identities makes each of us culturally distinct. I want to turn to questions of inequity and specifically discuss the impact of racism and the marginalization of black people in our society. There's a growing body of research that has repeatedly demonstrated the negative neurobiological impacts of ongoing socioeconomic inequalities, systemic injustice, and police brutality that's faced by the black community. At the same time, there's also a growing movement in mental healthcare to take into account the impact of trauma on an individual psychology. So, I'm wondering if you could speak to the specific impact of racial trauma and how that's experienced by many black Americans.

Stephanie Cherestal, Ph.D: Sure thing. And first, I appreciate you deliberately using the phrase racial trauma. And I say that because that's not a term that shows up right now in the DSM. The most recent iteration of the Diagnostic and Statistical Manual, which for those who are unaware of what this is, this is a real tool that mental health providers use to provide diagnoses of mental health concerns like post-traumatic stress disorder.

Now, there are though a number of people in the field who are specifically looking at the presentation of racial trauma or what is sometimes referred to in the literature as race-based traumatic stress and really looking at that to better understand the symptoms that can develop that very often reflect the symptoms of post-traumatic stress disorder that occurs in response to a racist event. And now, a racist event can be something that you directly have experience, say, a traumatic police encounter that a black person might experience having gotten pulled over by the police or having a loved one being arrested for something that they didn't do, things that have directly happened to you.

In addition to rather things that you have witnessed on the media or through the media that whether we're talking about your own direct experiences versus the experiences that you have had vicariously that, again, you have experienced through the media, these can lead to a certain set of emotional difficulties that we need to look at. So, this can be represented by feelings of depression or sadness or elevated anger, low self-esteem, intrusive symptoms, what we call intrusive symptoms, so having things like flashbacks or nightmares about the experience; hypervigilance constantly being on edge or looking over your shoulder for the next event that might happen to you; physical symptoms like racing heart rates or sweating in response to memories of that traumatic event or being in situations that remind you of that traumatic event; avoiding situations that remind you of that traumatic event, that all of these things can develop in response to racist events.

And so, it is important for us to understand that racial trauma exists, that it has an impact on minorities, generally speaking, and these are the people that are coming into us for treatment, especially black individuals. And we've seen so much of this, especially over the last couple of years since the murder of George Floyd.

Daniel Knoepflmacher, MD: Absolutely. And I'm wondering with so much in the media and I've certainly seen it in work that I've done, so then what is the best way to address racial trauma in psychotherapy?

Stephanie Cherestal, Ph.D: There's a lot of different treatment strategies that providers can think of. The first thing that I want to say is that we want to do assessment the same way that if a client comes to us and says, you know, "I think that I have post-traumatic stress disorder," we would do a thorough diagnostic assessment and maybe use perhaps standardized measures to better understand those symptoms. We want to do that same assessment and really deliberately ask questions around whether clients have experienced racist events and the impact that those events have had on their mental health symptoms or their psychological functioning.

And so, what does that assessment look like or what can it look like? We want to specifically ask these questions. We want to specifically ask things like, "Have you ever experienced racist incidents that you would describe as traumatic?" Or "Have you ever had unpleasant experiences because of your racial background? How has your racial background influenced your life or educational experiences?" We want to deliberately be asking these questions. Now for clients who are presenting with whether it's depression or anxiety or symptoms that look similar to post-traumatic stress disorder in response to a racist event, what can we do in addition to assessment in terms of treatment?

Particularly one resource that I've come across somewhat recently that really lays out a lot of different strategies from a cognitive behavioral perspective. And I say that as someone who practices a lot of cognitive behavioral therapy in my own practice. And I also want to give credit to where it's due. I've learned so much from this particular resource. And so, this is an article titled and I encourage anyone to look into this article if you are interested in understanding more about how to treat this presentation, an Evidence-Based Approach for Treating Stress and Trauma Due to Racism. And this is a resource published by Monica Williams and colleagues fairly recently in 2022. And it outlines a number of different strategies and techniques. And so, I'll just try to briefly summarize some of them.

The first thing you want to do after assessment is also provide psychoeducation, provide education around the nature of racism and how it can relate to mental health challenges to really validate for your clients that what they're experiencing makes sense, and this is something that we have seen before.

We also want to, and I use that word validate, we want to validate our client's experiences. As a cognitive behavioral therapist when our clients express certain thoughts that might be leading to painful emotions and unhelpful behaviors, an important strategy as trying to practice something that we call cognitive restructuring or helping the client generate a different set of thoughts or a different perspective, a more helpful or balanced perspective in that situation so that they feel differently.

But when we think about, and I'll use the example that I referred to previously, say, a client that is struggling due to beliefs at an evaluation that they experienced at work was unfavorable or poor perhaps because of bias; bias from, say, their supervisor. We want to be careful as therapists to not try to challenge or work with that client to challenge that thought or belief, but we really want to validate that that's that client's experience and that client has that experience for a reason. We want to try to practice reframing thoughts that relate to internalized racism. So if that client then goes on to say, "And that means that I am incompetent," or "That means that I am not capable of doing X, Y, Z," or "That means I'm not smart enough," that's when we want to really slow down and try to help reframe that thought. But we certainly don't want to challenge that client's experience that something happened to them, something that feels real to them.

You also want to consider other things like leading skills building in terms of practicing communication skills for when they face racism or racist events in the future. You want to reward clients' engagement in racial or ethnic identity affirming practices. So, what do clients or what can our clients do to increase their sense of pride in their race or their ethnic identity? We want to perhaps target the avoidance that they might be engaging in because of the experiences that they've had and really think about how can we deliberately, but in a way that feels safe for that client, reduce some of that avoidance.

So, there's a number of things that we can think about as it relates to different cognitive techniques or behavioral techniques for folks who are presenting with racial stress and trauma that I really encourage folks to look into. And I really encourage folks to look into that resource by Monica Williams and colleagues.

Daniel Knoepflmacher, MD: I think we can post a link to that so that people who are listening can look at it directly. I'm curious, outside of the actual treatment room, where does advocacy play a role in creating positive change? And can you give some specific steps that individual people within a behavioral health organization could take to create positive change?

Stephanie Cherestal, Ph.D: Oh, absolutely. I think that advocacy is really important as it relates to mental health providers who are doing this work. If we care about this, what can we be thinking about in terms of advocacy to try to change, even in small ways, what is sort of playing out in terms of inequities? And so, whether that means engaging in, say, letter writing or being very deliberate in terms of what we're doing in terms of our voting, to really think about how can we really start to shape this world in a way that really addresses inequities that exist, I think it's important for providers to think about their role in that. And I think about this also from the perspective of what can we do to advocate for increased funding for mental healthcare, generally speaking, and also what does that look like in terms of really advocating for increased funding specifically to help underrepresented folks in medicine think about pursuing careers in mental health, right? Because very often, clients come to therapy wanting to work with someone who maybe has had similar experiences or in some way reflects their own identity. And I think there's a lot that we can think about that needs to be done from a sort of a political perspective to really think about what funding is provided to make that more of a possibility to increase the ability for people who are underrepresented in medicine really think about pursuing, say, a career in mental health so that we can address that mismatch that I was referring to earlier. Those are just some things that I think about in terms of advocacy that we could be doing.

Daniel Knoepflmacher, MD: So, helping to recruit a more diverse workforce of the future and that would help destigmatize hopefully mental healthcare for many people in communities who don't see themselves represented in the people that are there to treat mental illness. I want to switch gears. We're nearing the end, but I want to ask in case there are people listening who are not providers but are seeking mental healthcare. What advice do you have for those listeners who might be looking for a culturally sensitive clinician?

Stephanie Cherestal, Ph.D: My advice would be this, do some research, right? And don't be afraid to do that research. Many times when we're looking for a provider, we're looking through different resources. For example, Psychology Today is a very commonly used resource to try to look for a therapist. And we can look through providers' bios or biographies as they really describe not only themselves, but their areas of expertise, the client populations that they've worked with and what treatments that they've provided. There's so much background that's out there. Keeping an eye out for what trainings they've undergone to improve their cultural sensitivity, their ability to work with various populations, to really do that research and use that to guide who you reach out to and try to set up an appointment with.

But that said, it's one thing to sort of do that research ahead of time, but it's also really important when you're finally, say, sitting down or across from a provider for the first time to ask them those questions deliberately. And you would be surprised by how often patients are nervous to do that or afraid to ask their therapists about their qualifications or what experiences they've had working with different groups. But I really encourage clients to really think about doing that. Don't be worried about the provider's feelings or hurting the provider's feelings or putting them on the spot. Your mental healthcare is a priority here. And so, we really want to encourage folks to ask those questions during even a first therapy visit. "What your experiences have been working with someone who looks like me or had these experiences or inhabits this sort of identity?" I encourage people to ask those questions. And then, I also encourage people to think about, I'm reluctant to use this phrase, but almost shopping for a therapist. If you meet with a therapist for the first time and it doesn't feel like a good fit, again, prioritize your own mental health as opposed to the feelings of that provider. If it doesn't feel like a good fit for you, there is a strong encouragement to keep looking because a good provider is out there and you deserve to find that good fit, even if that means that that first fit is not the first person that you found.

Daniel Knoepflmacher, MD: That's really helpful advice. And hopefully, with more and more clinicians, you know, learning how to be culturally sensitive in their care, that you won't have to shop around as much in the future. And then, also, we'll get a more diverse workforce, which still needs to learn how to be culturally humble and responsive as you pointed out, no matter what background you're from.

I'm going to ask you to answer a question which I ask everybody who's a guest on this podcast, and I hope it can be a piece of helpful advice for those who are listening. So, specifically, Stephanie Cherestal, what is the most important thing you do to help maintain your own mental health?

Stephanie Cherestal, Ph.D: Oh, my gosh. The most important thing is, if I could only say one thing, I don't know what I would say, so maybe I will cheat and say a couple of things. The first thing is I go to therapy myself. I go to therapy myself, and I'm a strong advocate for doing that. And if you have the need to, I strongly encourage it. But if I just think about what I do on top of that, I am physically active. I am an avid runner and that's something that I do very regularly to maintain my own mental health. And I'm actually training for my first half marathon in another month. So, I love it and that really is something that is just sort of at the forefront of what I do to maintain my mental health.

In addition to that, I mean, I stay socially connected. I am incredibly close with my loved ones, my family, my friends. And especially when I'm having a hard time, what's really important in terms of maintaining my mental health is remaining connected to the people that I care about. So, I know I cheated. That's not the most important thing, but things.

Daniel Knoepflmacher, MD: Hey, they're all super important. There's no cheating in this question. So, thank you so much, Dr. Stephanie Cherestal. I really am so grateful to have you speaking about cultural sensitivity, bringing some clarity to this really crucial piece of effective mental healthcare in our diverse society. And I think it's often overlooked. The efforts that you make here, not just because you're a great clinician, but also because you're an educator of others, including me, really can help create more and more culturally sensitive care that's going to help the diverse communities that we all serve here in New York City as mental health providers. So, thank you, Dr. Cherestal. It was just an absolute pleasure having you here today.

Stephanie Cherestal, Ph.D: It was a pleasure being here. Thank you.

Daniel Knoepflmacher, MD: And thank you to all who listen to this episode of On the Mind, the official podcast of the Weill Cornell Medicine Department of Psychiatry. Our podcast is available on all major audio streaming platforms, which includes Spotify, Apple Podcasts, and iHeartRadio. If you like what you heard today, please give us a rating and subscribe so you can stay up-to-date with all of our latest episodes.

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