Stigmas surrounding mental health exist in all groups and societies, but are particularly prevalent in the African-American community—making the concept of therapy or counseling a foreign one, at best. Some individuals simply don’t understand the practice, while others frown down upon it… leaving those in the community who struggle with emotional issues or mental illnesses wondering where to turn; what to do.

Fortunately, more and more people are warming up to the idea of therapy and finding refuge in it. This includes African-Americans, but it’s not to say that they don’t face certain adversities after they’ve taken that big step toward healing. Here are four common challenges African-Americans face and discuss in therapy:

1) The desire to be understood.

One major element and challenge in therapy for African-Americans is the desire to be understood, as explained by Mental Health Therapist Shemiah Derrick: “The therapy experience for African-Americans has been difficult due to stigmas and hesitancy towards buy-in related to mental illness. Like any other client, they want to feel understood, find someone who conceptually speaks their language, and understand their context without having to explain from A to Z. With the current political and social climate being so vulnerable, feeling respected, heard, and understood are more critical than ever for African-American clients in the therapeutic setting.” Derrick adds that as therapy continues to develop and evolve, she’s noticed a general increase in people reaching out for help—which has “translated into African-American clients as well as more minority professionals being available to serve them. Still lots to be done in the removal of stigma and the increase of acceptance and awareness, but small steps are counting for a lot,” she says.

2) The role of ethnic identity.

Another significant factor in counseling for African-Americans is the role of ethnic identity—the client’s as well as the therapist’s: “It is important to consider how a person’s ethnic identity influences their presenting concern,” Psychologist Qua Vaundra Perry explains. “Sometimes therapists can make extreme assumptions in one direction or the other. (E.g. all the problems are due to racism or the person hasn’t been impacted by racism at all). A simple way to address this area is to ask the client and empower him/her to share his/her perspective.” Piggybacking off of this, Perry says African-American clients often want an African-American therapist “because we want someone who can presumably understand our experience. Due to intraindividual differences, some clients may feel disappointed or misunderstood when their therapist has had a different black experience. I encourage African-American therapists to ask questions and clarify where needed. I have also inspired some people to be open to seeing a therapist of a different ethnicity as it can be an opportunity for mutual growth,” she says. Still, all that said, “the core features of therapy with African-Americans are the same, such as unconditional positive regard, genuineness, and respect,” she concludes.

3) The trouble with presumptions and perceptions.

Licensed Clinical Social Worker Donna Oriowo brings up another issue in counseling for many African-American men and women: troubling presumptions and perceptions. “One of the major concerns that tend to be a focus in therapy is intersectionality, or in other words, how race, sexuality, ethnicity, and all the other pieces that make us unique interact and intertwine with dominant culture—favoring white people over black people and men over women.” She ties this into another concern often discussed in therapy: “the idea of being black in what feels like white spaces.” She says that clients often talk about “how they feel they are perceived and get to move through the world based on presumptions about their blackness; with special focus on the stress in switching to be seen as non-threatening and knowledgeable about their jobs.”

4) The false pretense held by therapists.

And finally, one other common counseling challenge for African-Americans is overcoming the false pretense, held by therapists, that African-Americans all respond to therapy in the same way. “African-Americans are not all the same,” Licensed Professional Counselor Marquita Garret explains. “Many come from backgrounds where counseling and involving others is taboo. Ethiopians, Nigerians, West Indies, Ghanaian, Southern, Eastern, Midwest, West Coast, Suburban, Urban, rural, and low-income all have different experiences and make-up.” It’s important for counselors to understand this; and to more importantly understand that African-Americans aren’t all going to adhere to therapy in the same manner, she says.