Rooted in Love: Noe Avila’s Mission to Heal Marginalized Communities

Transcript note: This transcript was generated from the episode audio and lightly formatted for readability. Speakers are host Jet Bunditwong and guest Noe Avila.

[00:18] Hi, and welcome to The Personal Side of Business podcast where every business has a story. Uh, today I'd like to welcome Noe Avila. He owns Noe Avila Therapy. It's a therapeutic office that offers mental health services for the community here in San Diego. Welcome. Thank you so much. So, tell us more about what it is you offer to the community, what you do. So, like I said, my name is Noe Avila. I'm a licensed marriage and family therapist. Um, I've been here in San Diego for the last 15 years. Uh, I guess I'll just say a little bit about my background. Started working uh, with Tides as my training and then after finishing my master's, I started working with the school district. Uh, and

[01:00] recognizing the need for community-based services, especially for mental health for, you know, minorities, people of color. So, after I started my uh, private practice, Noe Avila Therapy, my goal is continuing to work with, you know, families in need of mental health, provide services for individuals, couples, and again, primarily to families with children's disabilities is one of my focus and overall provide a safe place for the community to come in and learn about different types of uh, issues in mental health, depression, anxiety, um, family of origin issues, um, and the difficulties it is to access services for a lot of individuals that are minorities. Uh, mental health is still I feel very taboo in a lot of first-generation or uh, uh, families with people of color. Even for generational if they've been here for generations, mental health is very

[02:01] taboo. Um, depending on their access and uh, supports that they have in the community. So, something that I I provide is again, individual therapy for individuals. Um, and most of my clients that I do have are first-generation or people of color. I with that one, I do use modalities of Bowen family systems, which is family of origin work. I also uh, do a lot of attachment work. And attachment style therapy is recognizing how your family of origin impacts how you view the world and how you connect with others, especially in relationships. Um, in addition to that, I work with families with disabilities. Um, and mostly children on the spectrum. And that came about when I started my my career in mental health as an ABA therapist um, back in uh, Sacramento working for the Mind Institute of UC

[03:00] Davis and being able to work with these children on the spectrum and you go to the family's home. But a lot of these families again don't understand even what that type of support was. And being able to educate them on what autism looks like and what autism is and being able and then being in these individuals' homes, you become a fly on the wall. So, you see how this individual, this child is taking a lot of the resources, you know, unwillingly for the family system. You see how financially it impacts the family system. You see how, you know, the other siblings are starting some sort of resentment because this young child is not getting their meet needs met due to not being verbal or just having these big outbursts because they don't know how to how to manage their their um, emotions or because they're nonverbal, you know, this their emotions are their voice. Um, so when I was working with these families, a lot of Latino families

[04:00] again that didn't even speak English, um, they started asking me a lot about what is autism. So, providing these uh, workshops on what is autism, but then also talking seeing how the mom is depressed, seeing how the other siblings are having these, you know, behavior issues because their sense of resentment towards the parents and towards this child. So, seeing how, you know, this this child who is an isn't innocent child, right? Um, is is impacting the family system. Um, so through that, I decided to further my education and get my master's um, in marriage and family therapy um, with a focus of child work or child therapy um, and I moved back to San Diego, started working for Tides. Um, they the Tides uh, YMCA mental health services and right there I had this amazing supervisor called Bobby Paul and her modality was Bowen family systems. And with Bowen

[05:02] family systems, uh, they educate you on how to see the family as a as a system, but also recognize the multi-generational trauma or patterns that get passed on from each generation to each generation and being able to um, provide the family again, work with the family as a whole, not just the individual or not the individual child or another child that might be having behaviors issues, but recognizing that what is coming down the generational line and it's impacting the family system. If it's alcohol abuse, if it's of if it's um, physical abuse, if it's sexual abuse, how working as a family and especially working with the parents will in a way lessen the anxiety that's going on in the system and then you see an improvement with the children. Oh. And so when you're working with a family, um, do you does everyone get involved or do you work with cer- like certain members of

[06:01] family individually just to try to figure out how to kind of deal with everything that's that's happened? Yeah, so primarily, right? Like uh, the family will reach out and say, "My son or daughter, they're having these behavior issues and they and I want you to talk to them or see how what kind of supports you could provide for them." And when I have these young families or the identified client who is as a child, you know, I bring the parents in and I let and I let them know like, "I need to work with the whole family system because your child is just absorbing the anxiety that's going on. So, they might it's called the scapegoat, right? They might be the scapegoat and this child is a problem child how they're identified. But what I really need to work with is primarily the parents um, and what else is going on in the family system. So, what I do, I do I do bring in the family system for a couple sessions and then with that, I might see the child for it's an an individual session and see

[07:01] what they're going through. But primarily when I work with these children, when I was working at the school district, right? Uh, as the school-based therapist, my client would be the identified patient, which is, you know, the young client, but for sure I would always bring in the parents to understand what's going on with them and a little bit about the and do these genograms or called genograms where you understand three generations of the family system and from there kind of get a a picture of what's really impacting the system. Again, working with a lot of uh, with the Latinos, there's a lot of machismo that goes on and you know, uh, in a way women are secondary citizens in that world. So, being able to recognize how how cultures and family cultures impact the family system. Also, a big one is religion impacts the family system with working with a lot of minorities, especially with the Latino community. But recognizing, you know, what all factors are impacting these children and

[08:00] how why they're behaving this way. Uh, another big issue that I I see with um, first-generation clients is that the parents are not available. Right? They come to this country seeking a better life for their children, but what doesn't happen, especially in bigger cities, is that both parents are working two jobs. So, and this is where that attachment style comes that these children do not have secure attachment with the family systems even though the parents love them, even though the parents um, give them you know, shelter, food, and clothing, but most of these individuals or these family systems, um, the parents in are absent due to work. So, either one child, the oldest child has to take over um, and it's called perfect parentification and they start taking over the family system and take a parent role or another issue that happens with, you know, especially immigrant families is that if the child is born here in the United States, they have to take a parent role as well because then they

[09:01] have to be the translators for the parents. have to go to the doctor's appointments for these parents. And again, it's a lot of pressure for them to succeed and also, you know, be a play a big role in how the family functions. So, in all these impacts that individual. Uh, so there's a lot of challenges, a lot of first-generation and immigrant families face here in America and that's something that, you know, I really focus on helping the family system understand and the parents understand that, you know, you know, this this impacts your child and this is how, you know, we see a lot of rates in first-generation family systems that, you know, uh, in in in big cities that or even small cities. I grew up in a small little town in northern California that, you know, uh, friends or my friends or individuals join gangs or turn to drugs and alcohol at an earlier time because, you know, they have this sense of abandonment, you know, because

[10:00] unfortunately the parents are not there. Do Do Do kids in these families that are going through this pressure, are they aware of that there's this sort of underlying pressure for them to help the you know, the family get through everything or are they just like this is just my job? I I don't know any better. Yeah Yeah, you know, it's it's it's it's it's a it's becomes normalized, right? It just becomes a thing that that that they learn to do, right? They we learn to to we have to fill help our family system. We have to help our parents because we also know the struggle and we see the struggles and the hardships that they go through. You know, when I was young my mom would work sometimes 20 hours a day. She would go to her regular job and then she would go back to the tomato cannery um where she worked for many years and would do a double shifts just to again make more income for the for our family and you

[11:01] know, save money and to buy a bigger house. Our family was growing and you know, my dad as well, he would work uh from 8 hours to 14 hours a day sometimes um just to again to be to help us survive. You know, I was talking to one of my friends yesterday about the big blocks of cheese, the government cheese that you know, we would get, right? And I was like did you ever have the luxury of having those, right? And what we would do with them? Like you know, we split them up and put them on saltine crackers. And he's like that's really sad. I was like well, actually love them, right? You know, I I think the good thing about our community that everybody was on some kind of government assistance. So, you know, we didn't realize that we were financially struggling because our whole community was on the same page. So, for us again it's this normalization, but there is this big pressure that especially for the oldest children in the family system to be a role model.

[12:02] I I see this a lot with a lot of my clients that like are successful entrepreneurs, doctors, teachers, whatever, you know, that one of the biggest push is to go to college. It's to get a you know, um the reason our parents came here is to for us to have a better life. Um so, there is it's it is pressure, but it's it's it's not put in us. I think a lot of us take it on cuz this is our role and this is how we pay back our parents. All our All our degrees are not in our offices. They're they're showcased in my parents' living room. Yeah. And do you think that pressure uh to get those degrees and and and further give better lives to the families, is that is that pressure Are people aware of that? Uh No. You know, like what I'm saying like this is I think one of the not focused, but I now with me working

[13:02] with individuals, I'm getting a lot of referrals and and it's un and it's unspoken pressure, right? They don't recognize the impact that is having on their mental health. You know, even even when they're successful, they still carry a lot of the burden to not just be, you know, the perfect child, right? But also to now to be the role model for the rest of the siblings that you have to succeed. So, the you know, the oldest children in a lot of immigrant families, they hold a lot of anxiety. You know, they they they do have self-esteem issues. They have cuz they feel they have to be perfect. Right? So, and just depending on how that trickles down, um I work with a nonprofit called the California Justice Alliance and they do amazing work uh helping unaccompanied minors. I do the compassion fatigue training for the staff and you know, they're first uh uh first generation, you know, attorneys and still the

[14:01] um still the the pressure to succeed and make our parents proud and and be a good role model for the rest of the siblings and also being able to provide some financial support to these family systems, right? Even though they're out of it, it's still there's a huge uh obligation sense of obligation that it was never put on us, but it you know, this is part of our family system that we we know the struggles that our parents did. Again, my parents came here uh 14, 15 and they started working in in the agricultural fields up in the valley. And you know, my mom went to beauty school. That's what she wanted to do. That was her passion and she she did that. My dad went to uh uh community college and got some uh mechanical uh certifications and he worked at a oil refinery up in northern California and you know, they paid them well, but again still the sense for us to succeed or to go to college has

[15:01] always been input in in us. Um You know, they would they would let us they would take us to work in the in the agricultural fields uh harvesting tomatoes in the almond fields like you know, being like if you don't get your education, this is this is what your life is going to be. So, you know, there is a lot of pressures to be succeed and not and you know, give back to your parents what what they what they gifted us. And like that's why I said all my siblings' degrees, we don't have them on our home. The diplomas, all of the diplomas are BAs or masters that are just, you know, showcased in my parents' living room because that is the best thing that we could give them like thank you. That's That's great, right? I think a lot of the parents want to live vicariously through the kids, right? They're like this is an opportunity for us to Yeah. showcase. I I mean I I think about my mother's always super proud of my sister and I

[16:01] what we've accomplished in life and she's always bragging and then I always look at it as I was like what That wasn't that much. We just went to college, right? Yeah. But you look at the the fight that she, you know, someone going to another country, not English is not their first language and then achieving all that um and then like oh, they my kids get to they're they're doing more than I could ever dreamed of. Yeah. Was that part of your inspiration or your drive to do all this was you know, I want to make my parents proud, but I want to have have their journey not be all for not. You know, to to really go and and push even harder to try to get more things accomplished. Was that something that drove you? Of course. Of course, right? I think you know, with the new office that I just opened the mental health uh collective um the the Avila is my my my family's name

[17:01] and I highlighted that in my in that in that title cuz I that was my my you know, thank you to my parents. This is I wanted them to showcase that this is your legacy. Um and I just really wanted to let them know that because of you like I have chosen this career because to give back. My parents have always been great people about, you know, providing services to the community. All my siblings engage in social types work. One's a OBGYN nurse. My other siblings uh work uh work for, you know, the eligibility department providing working with families and and now they work for um the website Covered California help um helping it become easier for individuals to use, right? That are not computer literate, that that are not English speaking. But one of the Yes, I think our goals has always to be successful and show my parents that they their work is not in vain and to

[18:03] continue hopefully making them proud and and showing them that, you know, because of you all like I continue to strive and I can want to strive to continue this legacy of hard work and hopefully, you know, they're they they're very proud of us, which I know they are. But again, this is why when I chose the name for this new office that that that I opened the in the Avila Mental Health Collective, it's not to to self-esteem myself and be like this is me, but is is to show and continue this legacy of my parents' work. Yeah, and um it was that coincidental that all your siblings and you went into sort of like service oriented fields trying to help people or did you guys have a discussion that this is what we all want to do is help other people? No, you know, I I was I I think this is part of a lot of individuals in in social work,

[19:00] right? A lot of individuals in social work are people of color because we know our struggles, right? I almost all my friends they're either teachers, they're psychologists, they are speech uh therapists as well. Um But all the community that I worked that I grew up with, you know, my friends, we all have some type of social work um influence because we understand the struggles that, you know, our families went through and the need for providing better supports for these communities and making it more accessible. Right? So, I you know, I I think for my family system it's something in not it wasn't ingrained in us, but it's something that again we saw our parents struggle. We saw our parents, you know, being uh can uh attacked because they're Latinos, right? They're Mexican and they work in the fields, right? And having to provide

[20:02] uh supports for them, right? My sisters had My older sister or both or you know, having to go and translate for them sometimes, right? When they were younger. So, I I think for us, it was just part of our family culture of giving back and supporting the community. But the other part of it is recognizing that the community that we come from, right? Being immigrants and first generation, that we want to give back to the community. I think like I said, talking I was just talking to my other another colleague and she's first generation as well and she's also she's a a social worker and we were talking about why we go into this field is to help people like us and help others, right? But we we know we know the struggles. We know how difficult it is and if we are able to make a difference, um that's amazing and this is our part of giving

[21:00] back again to our parents and giving back to the world and making everybody feel welcome and feel that they have some sort of support. Yeah, that's great. And do you feel like there's um big struggle or barrier for you to when you're trying to help especially the Latin community um sort get educated on what the needs that they have and you're trying to come in and help them is what is that conversation like? Can you explain it? Yes, there there there is again there's still like some resistance when uh you know, when I started working for the school district or especially with ABA, right? Um there were some families that especially when when it came to uh the the husbands, they and I would show up and be like, "My name is Noe. I'm going to be your child's you know, therapist." And it's like, you know, I was this big guy, right? I didn't have this many tattoos, but you know, they were like, "No, you're not going to be alone with my wife." Right? So, there

[22:01] were some family systems that that they didn't they I had to be I got turned back. But most of the time it is providing psychoeducation. Uh when I started working in the school district, uh of course the parents love their children. They love their children. So, whatever services they can get, they're going to come and most of the time when I would tell the parents, "You know, my name is Noe. I'm a therapist." And it's always like, "Well, they're not crazy." Right? Again, it's it's depending on your family of origin, your culture that how they see mental health that they see it's it's they're uneducated on how it really works. So, it's providing a lot of these uh psychoeducation of what therapy looks like and and and another layer of this is you know, there's other communities that have a negative relationship with social workers, you know, with schools due to systemic racism, right? So, it's it's just

[23:01] depending on what population you're working with that mental health is still very taboo and they're also scared of what might happen. You know, will CPS get involved? Um will the cops get involved? So, depending on there's a community that understands the benefits of mental health, but they also understand the negative consequences or natural consequences if something comes up like sexual abuse or trauma that other agencies have to get involved. So, depending on the history of that family culture or that culture, there might be resistant to seeking mental services for their children. Um specifically with the Latino community, first generation, um a lot of them is that there's nothing wrong with my child. You know, they're not crazy. And again, protecting the family system. Um and but most of the time when I tell my young clients and I I was like, "You're the hero of your family system." And this is

[24:00] I tell the parents and once I started providing psychoeducation on you know, the Bowen family system modality about like let's let's see what's going on the family system and they start seeing these changes with their children, um then they're more they become open. And something that I tell my clients especially my young clients or my clients that therapy is the first time and they could be 40 years old, right? They could be 16. I let them know you're the hero of your family system because once the family system starts recognizing that there is changes in the identified client was their child and then I mean they there's more buy-in. And then I'm able to talk to the parents and start asking about their family history and their trauma. Right? And then I like I said, I there's no judgment. I'm just going to paint you a picture of why that makes sense. Yeah. You know, we're not going to look at the choices that were made, but does doesn't this make sense why your child is

[25:00] behaving like this? And taking a lot of um responsibility off the parents in a way that it doesn't feel shameful for them. Um so, yeah, depending on the family culture, um when I was working in Wilson Middle School uh for the Somalian population again, the only person that could come would be the men. You know, and so the woman couldn't talk to me. So, that was that barrier. So, we would have to provide them a female therapist, but if I was the only one, I was like, "Well, this is your only choice you have." Um and just providing again uh what mental health is and how it's going to benefit their child. Now, do you feel like that's a when you got into being a therapist, um was this sales part ever in your mind? Like you were like or did you think, "I'm just going to go in there. Everyone's going to accept this. This is going to be great." Now you're like, "I

[26:01] have to convince people." Yeah. Yeah, of course, yeah. I I'm thinking wow, if I if there's a service that's going to be provided for their child, they're going to be like, "Yes, right? I I want this." Um but again, just the the naiveness of my experience as a first generation Mexican-American, right? I grew up in Northern California um where my grandma was 70 years old make you know, would come and make food for us. But my first client here um when I was talking about his grandma, I was like, "Well, tell me about your grandma." He's like, "Oh, she's she's in jail cuz she was selling meth." Right? And I was mind-blown. And cuz I had this picture of Coco, you know, the Coco the movie that grandma, that was my grandma. But his grandma was 53. Right? And his mom was 28 and he was 14. Right? So, it's a very this naiveness for me that I was blown away as yeah, they're not accepting

[27:01] because they have for sure have trauma with CPS. You know, so that's you know, and but for me I was like, "Of course they're going to want the services and I'm relatable to the this this community because I'm Latino and I know Spanish." But that wasn't the case, right? You know, that was a big eye-opener or for me and I was in shock about like I'm working with a very different first generation here like in these big industrial cities, right? And I always think that's that's interesting that you describe it that way because I think in uh especially in the Latino community, speaking Spanish is opens a door, right? It starts to make everyone feel comfortable. Yeah. You already have that and you now you're dealing with this aspect of like, "Whoa, whoa, now we're going to these uh family norms that we're not comfortable with in our culture." And you're going to have trying to break that. Yeah. What were some of the things that you did early on in your career that allow

[28:00] allow you to get into that space a little bit easier. Were there things you were practicing go, "Okay, I'm going to try this. This worked. I'm going to keep doing this." Well, you know, I I I think that the thing that I I felt really connected and was really able to let the parents feel safe, is just connect with them. It's and connect with them being a parent and their love for their child. Right? Saying like, "Look, you you love your child, so this is why you want to explore this. And I want to support your child to get better. So, being able to connect with them in that in that way I was like, I know you love your child, so would you give me a chance to show you or provide you some education on how this would benefit." And also be very open to them about the the consequences of working with a therapist. Right? Being very clear that if there's sexual trauma, if there's physical abuse, even if there's elderly abuse or harm to self or others, I have to report this and CPS

[29:02] will probably get involved. There might be a police officer going to your house. And again, it's very intrusive. It's a very intrusive thing working with a clinician or social worker because here in the United States, of course, we have laws that we have to uh abide by and then that might have a negative impact on the family system. So, I think being very clear about you know, this is what it looks like and this is the pros and these are the the negatives uh if any of this comes up. About at the end of the day, it's just joining with a parent and saying if I know you love your child cuz you're here and I also know this is scary for you. And I would and can you trust me that if if something does come up, I will let you know first. I'm a very There's, you know, I'm a just a very direct therapist and and individual and I I want to be very transparent that if an issue did come up that I would have I would have to call CPS, I would let them know, but

[30:02] come in and sit with me while I do this call. It's going to be very uncomfortable, but I I I want them to trust me, right? I The main thing is building the sense of trust, positive or negative, that I I will show up for you and your family system as genuinely as I can to provide the best service and outcome for your family system. And you know, most of the parents know knowing that fear because there is that love for their child, they're open to it. And that's how that was my foot in the door that I with working with these family systems, um so there isn't that much resistance or fear. And like I said, I don't think it's resistance, I think it's just more fear of of their child being taken away cuz that's what, you know, they they know, right? It's It's all this psychoeducation. No, if CPS steps involved, the only reason they're going to take him up their severe negligence, severe child abuse, but if this is going on, you know, you'll

[31:01] get more supports actually. Um and being able to help them understand how to feel safe, I think was the biggest thing. Safety and and trusting me was the biggest thing that I wanted to do break through that barrier. Do you talk to both the child and the parent at the same time or is it a uh different conversations with them just to describe to the child this is what you can be you know, expecting to happen in the next steps or is it just a family sitting? You know, usually in the beginning, depending again of the age of the child, right? There I If they're older children, um I would say like 9 and 10, I bring the family in and both and let them know like, "Look, uh these are the the four things I have to report, sexual abuse, elderly abuse, uh physical abuse, and self-harm or others. And I literally ask them both like ask you know, I'm going to ask you

[32:00] questions and then I want you to answer these questions with a yes or no. If If your child tells me that he got high on Wednesday, it's something that I'm going to report to you, Mom or Dad, right? Or to you, you know, client." And the parents would be like, "Yes." And I would have to say, "Unfortunately, I can't." And they're like, "Well, why not?" Right? I was like, "Because um well, depending on also the age, right? Of of the child, there's restrictions. Um but I was like, "But because they're not in a harm to self or others. If they're having sex, Mom and Dad, is there something I I'm going to report to you?" And then I say they, you know, they say yes and then they say no. You know? But and then but then this is why I push also will put This is why it's important for us to engage in family therapy for you to be involved in this because I need you to know again, most of the time is if there's a child engaging in maladaptive behaviors, it there's something else going on in the home that's that is foreseen, not

[33:00] foreseen, or has encouraged this child to look for their needs outs outs outside of the family system. Um but this is how I really encourage the parents, if you really want to be in the known, then come in to family therapy with me and we could do a once a month, twice a month, depending on the severity, but I have a family that came a few weeks ago, um a new family that I started working with and everybody is they're they're thriving and it doesn't need that much. It's just psychoeducation and holding everybody responsible, even though my young clients, I think a lot of these young clients feel that they have a lot of privilege now that this iPhone is mine and you know, I think cuz of my ethnicity, like, "No, like, it's not." Like, you know, like I'm I don't coddle a lot of my even my young ones, right? It's important to put place responsibility and agency on yourself to empower them and to help the parents understand like, "Oh, are you sure you

[34:01] want to give your child an iPhone at 10? Because it opens this big window of of of it's mine." And again, I think one of the biggest issues with the younger generations that you know, it's it's it's our fault because we we wanted to give them more. You know, even with my with my family system, with my nieces, like they they're privileged. You know, they come from privilege now. We give We used to give them whatever they want and now there there's a sense of entitlement, right? So being able to recognize like you do come from privilege, but that can be taken away and this is a right. So helping the family that you know, helping restructure the family system in that way as well is very important. And but have especially have the young clients recognize that you do have agency and just cuz you're going to come and tell me that you want your phone back, doesn't mean I'm going to tell your mom or or parent to give you your phone back. I'll show you how to

[35:00] advocate for yourself, but at the end of the day, I don't get I don't get into what happens in the family structure. I don't I don't make the rules at your house and that's what I tell the parents as well. I'm I'm just going to coach you and provide you some insight and education on what modalities work and how to restructure the family system, but I'm not going to get in there and tell you how to raise your children cuz that's not my job. Yeah. Do you think the next generations of children growing up are going to be um and their families are going to be more understanding to this just because it's the norm of getting therapy and getting help inside of family is starting to to change like over time. Do you think it's going to those children are going to have um better understanding and be more open to it and their families um against what is happening now that

[36:00] you're dealing with? No, already again I already, you know, here in the United States in the last few decades, mental health is uh is has been highlighted and has been instilled in a lot of these younger generations. Right? Uh and so they're open to mental health. You know, it's it's not a bad thing to go see a therapist, right? There's there's no shame with that. Um the the negative part of this is that these younger generations do have this lingo of uh what anxiety is and like and depression and, you know, I need a mental health day. So being able to kind of swing back and be like, "Yeah, this is hindering you, but it's it's not considered trauma." Right? So I you know, the good thing that now in I there is a lot of dialogue and the schema of shame um is not so profound in in the younger generations. I think they're very open to therapy

[37:00] um and what mental health looks like, but I think it still needs these restructuring of what I call not weaponizing your trauma, right? Like if you didn't get what you wanted that morning, doesn't mean that now you you need a mental health day, right? It's like it's what it's They need to learn these coping skills to be able to also continue uh managing their own selves in this world and uh I don't have I don't work with that that really young population, but I have a lot of my friends that have companies and, you know, they find it a struggle with working with these the younger generations that they everything for them is very traumatic and they and and they they use the word trauma now for for to to kind of describe what is happening describe what is what is happening to him and it's like, "No, that is not

[38:01] trauma. That was just unfortunate." Or, you know, and I I think being able to come back and be like, "Look, like, yes, um like the words that I I don't have my clients use anymore is depression. I'm I'm feeling depressed today." And I was like, "Well, tell me about that." And I was like, "No, I think you're just feeling sad or you're grieving about this and this is what clinical depression looks like. I think words do have power. Um and but, you know, I hear very young clients coming in and saying like, "No, I I'm I'm I have anxiety." Right? And they might have distress in their life, right? Um but it's it's not to the level of like uh you have anxiety because then some of these children do take that label and that's how they view the world for them now. That I'm an anxious person and I can't function. So I think there has to be some reformulating of how mental health is is presented to especially younger

[39:01] children. And when I will do work with families, I let them know like, "Don't, you know, really try to keep away saying like, 'Oh, she's anxious' or 'My child is depressed.' You could use the, you know, 'Do you feel sad today?' and understand why they're feeling sad." Right? There is levels that there is children that are extremely depressed, extremely anxious due to traumas in their life that are very severe, but I think being able to really again provide these younger generations with uh accurate depictions of what anxiety looks like and and and depression looks like. But again, right now we're also living in a world that there is like eco-anxiety going on, right? Global anxiety that it's impact adults. Uh so, you know, for sure mental health is is pretty acceptable now in our culture, the American culture. Um and uh but when I do the genograms with my

[40:00] clients and I we talk about the you know, if if you're in your 40s and I have a client or 35 and I have a client and I ask them about their grandparents if ever talked about depression or anxiety, they're like, "No, that wasn't that was never any type of discussion or or verbage that was used in the family system." You know, a lot of my clients again that are 40 and above, now their parents are are are using "Yes, I I might have anxiety or I was depressed." You know, I worked uh and it's funny because I when I worked with the family systems and again even with clients I have a client that's 35 and she brought in her mom in to do some family of origin work and you know, it was great. The mom was really accepting and I asked the mom after I heard her story, I was like, "And you never suffered from depression?" And she was in denial like, "No." And I was like, "Okay, right? Like, you know, this was a big trauma in

[41:00] your life and you didn't get out of bed for some days apparently, but you don't think you were depressed, huh?" She's like, "No, I was just tired." I was like, "Okay, right? But, you're not going to argue with them, but like, you know, I you know, I think now she's open to seeing it cuz my client tells me, you know, she even got on antidepressants. But, um again, this this sense of denial that we we don't get depressed, you know, it just doesn't happen. Especially in you know, with older generation in the Latino world, right? That men do not get depressed. But, I when I was working at Kaiser as a patient advocate in the first housing crash, there was a plethora of Latino middle-aged men that tried to commit suicide because they couldn't uh support their families. So, it brought them a sense of shame and failure. Um and then even after they uh attempted uh suicide, uh there was more shame. So, again, now

[42:00] they were open to to getting mental health services and and again, just providing psychoeducation about what trauma looks like and and without judgment, but doesn't this make sense? You know, you lost your home and again, you lost the American dream and you know, a lot of these people were bamboozled into these great, you know, schemes of you will get you a house and you get a great mortgage and then boom, you know, they were paying triple and double. So, Do you if in your ideal world, what would be if someone's not able to get to a therapist for some reason and or uh get help, what's what are some gauges in your ideal world where someone could tell, "I I am hitting some anxiety. I do have depression." And sort of these elements where they're thinking, "Oh, no, that's just a bad day." Yeah. Well, you know, I I guess the biggest criteria is how it

[43:00] how it is impacting three areas of your life, right? How is it impacting your social life? How is it impacting your personal life and your work life? You know, with children, uh their their work life is school. So, if you see a big decline in your child's academic functioning, uh if you're seeing the the different stuff with these young generations is it doesn't look like my generation, right? Like, you know, now sending a kid outside is punishment. So, before it was like, "Are they withdrawing?" And now these kids withdraw cuz they use they have technology and you know, gaming is huge and they use their phones to communicate with with So, you know, for where these young ones it's it's very different. Um but again, if it's impacting your social life, if with anxiety, if if you can manage at work, if things seem overwhelmed, um and again, if you're isolating uh with anxiety, if you're irritable and you're lashing out, that's a big indicator.

[44:00] But, with depression again, depression is a big one if now going to work is difficult and you're calling in sick a lot, if you know, even getting out of bed is hard, you know, um you're not engaging in regular hygiene, um brushing your teeth, getting ready, you know, um and also social isolation is huge. Change in appetite is a big indicator for both. Um so, the the those are what then in in the mental health world is like they're hitting these criterias. Mhm. Right? So, each each diagnosis of anxiety has a different criteria that that that they hit. But, you know, there was also these labels or diagnosis of like dysthymia that you just see the world as gray. You know, you you're not really really over animated when something good happens and you're just also not really sad if something doesn't happen. Yeah. Right? So, being able to distinguish and

[45:01] uh how it how this is impacting you. For me, diagnosis's aren't that big uh that I focus on. I of course I focus on those they're all for medical reasons. For me, I just looked at the symptomatology that they're presenting. And being able to focus on that. The what kind of symptoms is an individual presenting and a lot of the times a lot of individuals are just experiencing senses of stages of grief. If they lost a relationship, if they lost a job. Um but then also that has uh stages of denial, bargaining, you know, in this bargaining stage is, "Did I do enough?" Um there's a stage of anger towards somebody else, the world, you know, um and for sure there's that sense of sadness which could lead to depression when you go through these three stages. So, providing, recognizing uh for me is what symptom is my client presenting with and really not putting a

[46:02] label, but being saying like, "Oh, you are sad." Or, you know, coming to say to a client like, "Look, actually for me now you are heading to these symptoms of depression and like you you're meeting the the criteria for clinical depression." Um and being able to provide them that information. And do you think that's even harder for uh a minor let's say minority male who grows up in a in a family that doesn't talk about their feelings, like there's all these layers, right? I I'm just thinking in terms of you know, it if you were to look probably start to you know, generalizing here, but if you start to look into a lot of different cultures, sharing this side of you is not that's not accepted for a lot, you know, and I think um it's got to that that's probably a whole another pressure that someone's dealing with, right? I'm deal I'm dealing with these things that are not normal to me right now. And then I

[47:03] can't talk to my dad because he's going to just tell me to go outside and do something and my mother doesn't want to deal with it. Like, what when you're dealing with families like that, do you do you start to see all these different layers when you're when you're talking to them? Of course, you know, that that's something uh I have a lot of in the last few years I have had a lot of Latino uh young females come as as clients and I tell them like your parents are going to hate me, right? Because it's about putting boundaries and and saying no. Um but with a lot of my first generation males, right? Person of color, uh it it is not emphasized to share your feelings, right? Or and even in the American culture, boys don't cry, right? You know, in my culture is if you really want to cry, we'll give you a reason to cry, right? And it was it there wasn't a lot of statements as I love you or tell

[48:03] me how you really feel, right? It was just like, "You get in trouble or something happens and you just shut up, right? Like, why are you crying?" And then you you know, a lot of sometimes I feel that the parents reference their lives, right? Because you don't know what we've been through, so this is nothing, right? There's no sense of empathy or maybe because again, it's generational thing, it's it's cultural thing. No one was able to express a feeling uh and uh feelings are connections. So, you know, and when you have connections, that's called empathy. You I mean, you might I might not align with your thought, but I for sure could align with if you're feeling frustrated or sad, right? I know what that feeling is. So, it uh and a lot of cultures use acts of service to show their love. Right? We don't say I love you, but my dad would for sure, you know, be like, "Well, let me help you do this, right?" Or let me give you this. My mom's acts

[49:02] of service to is like every time we get we go home, it's like, "Let me make you what you want. What do you want to eat, right?" That's or you know, when she stays at my house, uh she'll stay, "Okay, well, I'm going to clean your house." I was like, "No, Mom, I want you rest." But, for her it's this sense of like act of service. This is how I show you love. I'm not going to tell you, um but I will show you. Uh so, like something with my dad that I started doing a few years ago just to test this hypothesis, I started saying, "Hey, okay, Dad, I love you." And he's like, "Okay." Right? Kind of brushed it off, right? And then, you know, I was like, "Okay, Dad, I love you." And then he's all like, "All right, well, have a good weekend." Right? Like he can't he can't do it. finally it finally I was like, "Tell me." He's all like, "What?" I was like, "Tell me you love me, Dad." He's all like, "Why do you need to know that if you know I do?" I was like, "Because I still want to hear it." And he's all like, "Why?" Right? "Call me I'll call you later." Right? And then you know, there was and then you know, he started doing like, "Yeah, I do love you." Right? He's still not

[50:01] that way, right? But I know if he's pushed to shove, he will say I love Um but yeah, of course, depending on your family of culture, you know, it's acts of service that express love, not the word I love you. But it's important. Because I think there's for a you know, you're talking about your father, to have a male who's probably gone through decades Oh, for sure. his upbringing not having that and then to be like, "Oh, yeah, I'm going to try to switch this on in like a like a day." It's really tough, right? And I I I just think of, you know, being of uh of Asian background, especially Thai, I think of all the um just uh the Asian friends I have and that's like that's another that's in the culture, too. Like you start to go deep into it, you're like, "No, we didn't hug." You know, Asian cultures don't hug. They don't It was it's just like, "Great, good job. Keep doing the next thing." Right? So, I

[51:00] always it's it's interesting you tell me this from the Latino culture cuz I always saw Latino culture as being really touchy-feely, hug and stuff. But but now you start to peel back layers, there's there's it you're going through the same thing. I think it's almost every ethnic background. Yeah. Yeah, no, I you know, in in the in the Latino culture, yes, my mom was very loving and kissy, right? But my dad was not, right? Like He's he's doing better now, but I think we're the ones also being more vulnerable and and really pushing to this and um with my siblings, uh we we do say to each other that we love each other uh even when we're mad. Um uh uh but yeah, like in the Latino culture, it's a very warm and enmeshed culture, right? Um but then again, the reason that again, it's so enmeshed is because of survival mode, especially when they come to the United States.

[52:00] Right? It's it's a lot of I think immigrants have to unite and to survive for the first few decades or years. Um and this is why we're so close, but then also there's a lot of unhealthy boundaries that are being crossed in these systems. Do you think some of that for especially that uh crossover generation from other countries, they have to build this sort of fortress around them in order to make to make it through? Does that make sense what I'm saying? Like they have to be so strong to be like, "I'm bringing family to to the United States of America that I can't let anything break me because my family depends on it." Of course. Again again, that pressure to survive, right? And and I I think it just becomes this time that well, you don't have time to sit down and focus on your sadness and I think that's why there's, you know,

[53:00] big high rates of alcoholism with immigrants or first generation. Right? Cuz there's no time to sit down and think, "Oh, I feel sad today." You just have to get off work and you go to sleep. You know, a lot of the families here, what I've found different from where I grew up, right? In my my parents also worked, you know, my dad would leave at 8:00 and maybe come home at 7:00 when when we were very young, that's when he was working in the agricultural fields. And um so you just they work all day, they and they you get fed and then you go to sleep and you have to work the next day. Right? And that's and right here in this in San Diego because it is such a touristy industry industry, right? You know, you have a mom working in the hotel or both parents working in the hotels or food industry. Um so yeah, they work double shifts. And or they work one works in the morning um and the other one works at

[54:00] night. So, again, now the other parent is responsible for their children. So, when do you really have time to sit down and sit with your feelings? Cuz you don't. And I'm sure that pressure just keeps building, right? Like over Of course. about knowing just years and years of "Oh, I can't let my kids down. I can't let my family down." And I think the Latino culture um the the male is just like a workhorse, right? Like you just keep working. Yeah. Keep working. That's that's the best way to take care of my family. Yeah. And um and I, you know, seeing that in so many different cultures, I I wonder I I from what, you know, from what I've heard from you, the US is making that change. But I now start to wonder if other countries are going that way. Do you know anything about that side of things? Well, you know, like in Mexico, I think mental health is also becoming very um available. But before for what I know in Mexico is that again,

[55:02] there mental health wasn't uh a service for you know, maybe poor people, right? It was it's it's a very social class society. So, it was, you know, only the the rich could afford uh psychologist, right? Or a therapist. Um I still don't know that much about how it is in other countries, especially in Mexico, but you know, even a few decades ago, like mental health is now becoming more pronounced and accepted, right? But I still don't think the accessibility for services that are free or um reasonable um sustainable for a family that is not really wealthy or middle class, they have. a uh sort of a government financial things all mixed in to try to offer that service. Yeah. Yeah. Yeah, and uh

[56:00] do you think right now with everything that's going on in our United States climate, are families becoming more apprehensive to want to let you come in and say, "Hey, you can we might have to get other agencies involved in it." Is it is it tougher right now? No, well, in what sense? Well, just like they're worried if if someone from the government's going to come involved in in, you know, the um in our families and start to get information. Uh-huh. You know, of course, depending on the population that you work with, right? With with these families that are undocumented. Right? Of course, there's this big fear that that uh CPS will come in or something happens and then they get deported, right? But this is another reason why a lot of individual family systems or communities don't reach out to for mental health or any other services because of the fear of this will

[57:00] highlight our family system due to if the parents are undocumented and the the consequences are severe. So, I do I I do think now with this climate, there's a lot of communities that are fearful of of of services, of reaching out for services. Which is another added stress on Yes. Yeah. Yeah, but then again, I think there's also a lot of family systems, right? Or communities due to our social pressures, political pressures that they're feeling that they're more prone to to go and seek some type of mental health support system. Yeah, that's great. Yeah. And I I you know, I think this is still why for my passion is to continue to provide free workshops, free mental services to just the community at large just in our country, everybody's suffering from some type of mental health issue, primarily anxiety. Right? Social anxiety. Since the

[58:00] pandemic, social anxiety has has risen. And since the since the pandemic, also depression has risen, right? For people staying home, right? From working from home, it's a luxury, but you know, I tell my clients like, yeah, it's a luxury, but it's not a luxury anymore, right? It's it's it was convenient, but that convenience also takes you away from social outings. And now you're just at home and you're not really seeing people and you could get DoorDash delivered and now you're isolated. Right? And now you can you're watching TV, blah blah blah, or you're on social media all these times. So, again, it's it's this ebb and flow and uh but the good thing is that mental health services and awareness is is more available and accepted now. And it's it's and people are are seeing the impact of it. Yeah. And it's interesting you you bring up like technology, how it affects you. And I think in a good way

[59:00] like the telehealth side of things has allowed people to Yeah. it enter that world without being, "Oh, I Maybe I didn't I didn't want to go into someone's office." But it allows you to have that conversation. Yeah, I think the telehealth um boom since, you know, of course, the pandemic has really opened up services widely for everyone. Right? This is why, you know, you have these big agencies I work for uh uh I'm on panels on Spring Health and you know, it's a big agencies that have collective therapists and you provide in um in-person supports or you also provide telehealth. Um due to me having my private practice, uh depending on on the family support, right? I had a I had a I have a I'm working with a family that they have three kids and you know, going to my office is also financially burdening. They have to get a babysitter and so now it's like, you live by my house, how how comfortable do you is there space that I could just go to your

[1:00:01] house? Right? And I still do families family support there. So, you know, having my private practice has really helped me um broaden my services and what I could do to help families and provide less stressors. You know, therapy should not be a stressor. Um I had I I have I'm working with a a mom uh with three children, right? And she got there late and she felt really she was like, I'm so sorry and I could tell she was flustered and she's coming in because she has she has anxiety. And I was like, look, this is your time, right? Like you know, this is your time. You if you come here 15 minutes late or if you text me um that you can't make it today because you're just burned out, I get it. Right? Like or we could talk if you would like me to do a home visit once in a while. But again, mental health should not be so stressful for individuals. Um

[1:01:00] and you know, of course, you know, there's a lot of insurance now that provide mental services. There's a lot of EAP programs that provide services um that people can really look for. Um so, there's a big push for mental services here in the United States um that are available to everyone. Um but again, there's now there's this big fear with medical being taken away. I work with uh a population over 55 that medical provides their services through telehealth. And that's one of their biggest fears and what do you tell these individuals? Right? And this is why then I was like, for me, if I have a client and some type of payment doesn't happen, be like, well, I'm going to I'm not going to abandon you. You know, I the universe is great. It always gives it back. So, for me, abandonment is not not abandonment or termination to to any kind of payment is not an option that's going to happen with my clients.

[1:02:01] Once again, another stressor. Yeah, yeah, yeah. Try to get help, but I'm stressed out about this. I'll be able to pay. Yeah. Um so, yeah, I feel like you have so much information and um as we wrap up, I could you tell about the business side of it briefly? Like how what are some of the things that if someone were to um want to get into your field, what what are things how should they start? What are things to look for that help them grow? Well, again, I think in my field, you know, we have the education part, but I think as understanding the business is huge, right? Like I when I started working with you and you know, I tell people you turn my you turn my life upside down in a way that I just never knew that this was possible because my parents don't there was no education on what business is even even in my master's program. Nobody talks about business,

[1:03:00] right? So, being in as I still step into my next stage of of being a business owner, being a private practice owner, right? There's still that I I need to know. Like you you have helped me and the San Diego small business um Imperial County um initiative has really provided me a lot of supports on education and I know you guys provide a plethora of free trainings um and that's something that I want to do this year. Um but again, before it was like, oh, there is small business loans you could do or hey, this is what a business plan looks like and you know, once again, being I was what, 43 at the time. I'm 40 I'm going to be 46 now. You know, that's something that was never part of my family culture about business. It's nothing that I was taught in school. So, being able to have like your services and and mentors um to help specially people of color

[1:04:00] um learn about what a tax ID looks like and different types of of businesses. What's the difference between an LLC and an S corp, right? This is how my my accountant has educated me, right? Um and marketing, how that looks like, right? Um and you know, hey, it's not that hard to get a commercial lease, right? Like when my incident happened that I had to leave abruptly from my old space, I I was extremely I was I had anxiety attacks. I was having anxiety because I was thinking, man, they're going to ask all this money and I don't know until you're like, no, no, it's not that hard, right? Like look at this. And uh so, it it is very challenging, right? And it it but it's it's not challenging. Let me let me reframe that. It's scary. It's fear-based, right? But like I said, working with you and you helping me understand and providing me education about look, it's actually not that hard, but

[1:05:01] because I you know, I wasn't raised like that. That was never present in school um and again, not having the time to learn about, you know, how to run a business, um it is challenging. Um but step by step, I'm learning what to do and you know, there's still some hiccups and there's still some, you know, maybe bad contracts that like I was like, oh, I got duped in that one, right? Um but uh being able to start learning, but also having accessibility to it is also really huge. And I I think that's what people don't realize that enough. Yeah. That for especially first generation um immigrant American families that come over for you to start a business, it's I feel like it's going from like riding a bike to driving a bus. Yeah. Yeah. Yeah. You're like, oh, there what are the steps in between? And your parents

[1:06:00] like, I I don't know. Like I we've just been literally working from 9:00 to 8:00 every single day just trying to get money. I agree with you, right? When I think when I met with you, I was in my little like, you know, dinghy and then like you're and then you're like, yeah, take this route and now I'm like, I'm in the rapids, right? I see them coming and all of a sudden it starts happening and you're like, okay, you know, I'm sorry I didn't warn you that. Yeah. No, but again, like but it it's it was exciting, right? And and um but then at the end of the day, it's it's so beneficial, right? Like again, I'm where my office is now, it's this grade three office suite with a conference room um and I I wouldn't have never thought that I would be in this space a year and a half ago, right? You know, like and it is amazing. So, again, thank you very much. You know, I'm I'm I'm very grateful for you um and for your mentorship. And the unique thing is that we have only met a couple times, but you know, even those couple of times,

[1:07:01] you have propelled me in opening these doors that I I wasn't even aware of. Yeah. I think a lot of times businesses um that are in your position end up being so scared and fearful like you're saying that it's just like you just need to to have that push. Yeah. I think that's what happened with you. Um you I first I'm talking to you, I can tell that you had the knowledge, you're super capable, but it was just like this like, uh don't worry. Like other people have done this. You'll be fine if you just kind of take a couple steps forward and start to see the other side of the door and how that's going to all work out. And I think um but I always think that's comes with a lot of the the lack of experience in the business world, right? It's the same thing the way I look at the way I dealt with first business until now is completely different, but I needed to make those mistakes.

[1:08:00] But you're doing it real time. You're like, I'm I don't get to whatever I make now, this is what happens in business, you know. No, like it's saying like, yeah, there's many times that like I, you know, if that metaphor like I fallen into the water, but you know, the good thing is is like, you know, you I have my safety supports and you know, have my mentors that like You know how to swim. You know how to swim. Yeah, yeah, right? And get back on and you know, and I think that's also the best part of this journey, right? Like I said, being where I am now compared literally to where I was 2 years ago, I I it was a vision that I had, but I just didn't recognize I was going to be like propelled so quickly uh to it. And again, it was scary. It still is in a way, right? Cuz now I have there's more things I have to really learn if I want to take employees on and you know, taxes and blah marketing, right? Um but I'm really excited. I'm really excited and you know, I that that is one of the other areas of

[1:09:02] workshops that I want to do for is mostly again for um clinicians to be like, look, it's it's it's hard work, right? It's hard work. Having your business is hard work cuz you know, sometimes you are working 16 hours a day, but it's yours. So, there's a difference, right? Like you know, now I'm very I'm very I am very uh time means a lot. You know, I'm if I go to your party on a Saturday, that means I really like you cuz in my head I was like, I just lost this much money. So time and is is very valuable to me, right? And and how I look at business and time is and being intentional with my time is how I take care of myself and my value systems have really changed. Being a business owner and having that education of what it takes a business to run.

[1:10:00] Right? And of course in the first four years is a lot of work, but you know, thanks to my culture, my family culture like, you know, we're hard workers, right? Like so and again seeing how this makes my parents happy and is also worth worth the while, right? Being able to be the first business owner in my family system is also great. But you know, all my family siblings are also extremely career orientated and successful in their in their professions. You know, so it's just been a great experience overall. That's great. That's a way to end this. I love it. If I know if anyone wants to get in touch with you, where they can they find you? Yes, they could find me at my website at NoeAvilaTherapy.com. I think that's the best one. They could also reach me at Noe@NoeAvilaTherapy.com as well. And

[1:11:01] those are the best places. They could look me up at Psychology Today and just look up NoeAvilaTherapy is another form that they could contact me as well. All right. Well, thank you so much for being guest on the podcast and hope that listeners out there enjoy and it was great knowledge today and we look forward to having you on the next episode. Thank you. Thank you so Thank you.