Wathma Dissanayake: A Sri Lankan's Journey into Clinical Psychology

Wathma Dissanayake (she/her) is a Doctoral student working towards her Clinical Psychology Doctorate (PsyD) at the California School of Professional Psychology. She sat down with RC Sadoff to discuss her personal and professional experiences as a Sri Lankan mental health clinician, including the challenges she has overcome and sources of inspiration she found along the way.

Please tell us a little about your background.

I started off doing pre-med, meaning I wanted to go into the medical field, which is very common in Asians. If you grew up in an Asian household, you’re either a doctor or a lawyer or an engineer, nothing less – I think that’s an expectation that our parents set for us. So I initially started going into pre-med, and then I took a couple of criminal justice classes, and I fell in love with that, so I changed my whole undergrad degree to criminal justice. While I was doing criminal justice, I took a few psychology classes, and I fell in love with psychology. So I have my undergrad degree in criminology and criminal justice with a minor in psychology.

It sounds like you’ve found an incredible place in between the doctor/lawyer/engineer categories. How did that come about and how does it feel?

So in the beginning, it was hard for me. When you’re 19, when you’re 20, you don’t know what you’re doing with your life, and all you have is your parents telling you, “oh, you should be this, you should be that.” Because that’s just expectations from our culture. Like if I wanted to go to art school to become an artist or a musician or something like that, that would be a beautiful thing, but that’s considered more like, not a job in our culture. I’m not trying to bash any culture, but that’s looked at like it’s not enough. You can’t feed yourself with something like that. That’s how my culture views it, in the Asian culture. So I honestly was lost in my 20s. That’s why I was a pre-med thinking, “Oh, maybe I’ll figure this out, I’ll figure this out...”

“I came to the US in 2014, then I went back home to Sri Lanka, and then I came back here. It’s hard being an international student, especially if you’re Brown in this country in a White-male-dominated field. It’s not easy being away from home, from your culture, from your friends, from your family, your support system, trying to acculture to this country, to this culture – it’s a huge culture shock.”

In my head, it wasn’t even about ethnicity, like how many kids of my color go into this field, which is really few; and I was surprised myself to discover that not a lot of Sri Lankan clinical psychologists are known or seen. In Sri Lanka right now, we don’t have any licensed clinical psychologists. We have people who call themselves psychologists (master’s level), but nobody who is licensed in my country. One of my friends, she is a licensed clinical psychologist, and I think she’s one of the very few from my country right now – but she doesn’t work there, she works here, because psychology is not established in my country, like it is not recognized yet.

It took me a long time. Even in my 25 years, even when I was doing my master’s, it took me a long time to actually find my passion. I wouldn’t say my culture necessarily pushed me – I would say that I pushed myself when I realized that this is what I love to do. And I did. It was a lot of self-reflection, looking into myself, seeing what I wanted to do, and Google searching programs in different colleges. A lot of things that I had to do on my own weren’t easy. It’s going to be hard the first few years until you figure out what you like and what you don’t like. My advice is to just go for it, just try it out. There’s nothing wrong with trying out something new. And if you don’t like it, you don’t like it. You don’t have to stick to it.

“The most difficult thing for me was getting used to the norms here, the culture in America, because unlike some of the Asians who were born here and raised here, I had to learn from zero. I don’t know the health system here because my country’s health system is different. I have a few international friends and we’re all navigating the system together. We don’t understand certain decisions that US doctors make because we don’t make those decisions in our country – we don’t have inpatient hospitals in our country, those things don’t exist, so it was a new field for us.”

That’s great advice, especially for people in their 20s. Given how much of a process this self-exploration has been, was there ever a moment where you thought, “I found it! This is it!”

I think I had that last year, that was in my first year – I’m now in my second year of my doctorate – when we were put into clinical settings. Before I started my doctorate, I worked as a therapist in an inpatient hospital with kids. This is a clinical setting with children on 5150 [involuntary hold], so they only stay for like seven days’ intensive, and then we sent them out somewhere else. When I worked there, I loved it. And my supervisor was like, “it’s very rare that people like to work in inpatient because you get all these kids with their manic episodes, dysregulation, and broken homes, and it’s really hard.” It’s chaos, I’d say, in an inpatient hospital, and it’s hard seeing little kids in places like that. But I loved it. There were so many days I was sitting in my car, and I was like, “oh, this is this is what I want to do! Oh, I love it. I love it.” I think this was early last year before I started my doctorate. Once I started that, I did another practicum site here in California at an inpatient hospital. I like working with the kids, and that’s when I realized, “this is what I want to intern in, this is what I want to specialize in. I want to specialize in children.” That’s my lightbulb moment.

I’m also surprised and very happy to hear that you like working with people in inpatient settings. Given that they are presumably at the lowest point of their lives, and that’s part of your daily life, how do you protect yourself?

It’s interesting that you asked that. So you know how they teach you in the books, “do this, this, this, these are the ethics, this is this is how you talk to children, this is what you do to protect yourselves.” So when we started working inpatient, they gave us the training first about how to defend ourselves, or how to make sure the patient is safe and how we can protect the patient when they try to harm themselves. We learn all of that, everything textbook, everything nice. But once you walk into inpatient, that’s just out the window, like those things don’t work. Once they start coming at you or attacking you, I’m not going to remember how to take down a person in my head like step by step, your brain doesn’t start working! It’s a bit chaotic.

I’ve had incidents where kids have thrown things, have grabbed me, have attacked me. Something that happened this week: one of the kids that I was working with threatened to harm me and kill me – we call it homicidal behavior – and they said they want to do unspeakable things to me. Hearing that, that’s when I realized, “oh, I think I’m okay because I have my training.” That’s the moment I realized that, because once that child told me all of that, I wasn’t fazed at all. Nothing.

It didn’t hurt me because my heart ached for that kid. Because as she was continuously telling me her homicidal thoughts, she started crying, and that’s when I realized that she doesn’t mean what she says. It’s just a lot of hurt, anger, and pain that’s coming from her. And she just doesn’t know how else to say it other than in a very assertive, aggressive way. That hurt me. After the whole incident, when I was going home, it made me realize that I wasn’t fazed by that, I wasn’t fazed at all. Because when I told my friends, they were like, “are you okay? That must be really hard.” But in my head, I’m like, “no, that wasn’t that hard.” I didn’t feel anything because in my head I knew that kid didn’t mean that, the kid didn’t mean to harm me or anything. I think I’m just still in the first few stepping stones, I still have a long way to go. But I’m getting there. It’s been okay so far.

“It’s going to be a bit hard when you’re in college, and doing practicums, and working in the field, and being Asian, and listening to things that sometimes White people have to tell you. It’s going to be a bit hard but trust me – there are people who hear it and not everybody is the same. Everybody has different experiences.”

I can’t imagine how that felt. It does sound like you’ve found a field where you have a superpower – like how many people are strong enough to do that? So, in addition to protecting yourself physically, how are you protecting yourself emotionally and mentally?

That is something that we emphasize in our field. Maybe it’s the program that I’m doing, but self-care is something that we emphasize a lot for clinical psychology students, because I have to be in a good state to take care of somebody else, right? If I am not in a good place, in a good state, how can I provide advice or services for somebody who’s in a low state when I am myself not in a good state? So something that we emphasize in our program and in my training is self-care.

It’s hard, some days are really hard. Some days, I just sit in my car and cry, because some days listening to stories of the kids is really, really hard, and it also makes me realize how privileged I am to have grown up in a background where I had two supportive parents and a supportive community of people. It just makes me realize how privileged I am. It also makes me realize that not everybody is as privileged as I am – not everybody had the resources, not everybody comes from the same socioeconomic status as me. And that breaks my heart a bit. When I used to work in Georgia in inpatient before I started my doctorate, I cried every single day because it was just hard. It took a huge mental toll on me.

So self-care for me mostly consists of watching TV, like true crime documentaries. Some people are like, “how is that self-care?” That’s self-care for me! Or cooking, spending time with my friends, or just sleeping. It’s not big things, but those keep my mind off a lot of things that I’m dealing with every day. Some days I just let myself cry. Some days I just need a good cry, and that’s okay.

“It took me a while to realize that I did go through microaggressions, I did go through racism, I just didn’t realize it at that time. It took me a long time after working in this field. I see now how certain people were micro-aggressive to me, some people were racist to me. And it’s hard, it takes a huge toll on you. But there are good people out there – I have amazing friends who have been there with me throughout it all.”

That is so important. I’ve heard that you excrete different hormones from your tear ducts if you’re crying because you’re sad, so I think of it as: if I’m sad, I just need to cry and flush those hormones.

That is something I tell my kids: if you’re feeling that feeling, just feel it, we’re not trying to correct those feelings. If they’re feeling sad, I’m like, “I’m not going to make you happy. Feel sad, sit with that sadness, sit with it for a while. And if you want to cry, go ahead now, this is the place to cry, let it out. Because if I go to change it and try to make your sad mood instantly happy, it’s more like I’m pushing your sad feelings underneath. Just let it out instead of bottling it up.” That’s something that I always tell my kids and something that I practice myself and I advise everyone: if you’re feeling sad, cry, it’ll help, and practice self-care. Self-care is so important, and I always say to just practice it. You need to have at least one hour a day for yourself.

“There is help, you just need to learn to reach out. And that’s something I know that we as Asian Brown kids struggle with – asking for help – because we don’t do that in our culture. But trust me, you should ask for help when you need it instead of bottling it up.”

Thank you for sharing that. Sometimes that’s all someone needs to hear before they get help. I’d like to ask – how does your identity factor into your therapeutic approach and research?

I really like this. It’s something that we emphasize as clinical psychologists: being culturally appropriate, culturally inclusive, and having cultural humility when you’re working with clients. For my cultural identity, I identify as South Asian, and I incorporate a lot of things that I learned from my religion and culture when I do therapy with my kids. Mostly it’s psychoeducation, meaning I teach them, “in my culture, we don’t do this, this, this; and in my culture, we do this, this this.” It’s always fun to teach kids about new cultures and stuff.

If I work with a client from the same culture as me, I want to be empathetic, validate their emotions, and maybe try to understand where they come from. Just because I have another South Asian in the room with me doesn’t mean that their cultural experience is the same as my cultural experience. It doesn’t mean that they grew up the same way that I grew up. So always asking, “hey, so tell me what your cultural ethnicity is, tell me what it was like growing up in your household, tell me what it was like practicing the religion that you practice...,” just getting to know my client, making sure that I include their preferences in the therapy and going ahead with that. It’s a huge thing, having cultural humility – taking a step back and looking at what you’re going through, and seeing how I can help as a therapist. Incorporating your cultural practices into my therapy is a huge thing that I emphasize when I work with my clients.

“Some people say, “no, no, my culture has nothing to do with my identity.” No, that’s a huge thing! You and I grew up in totally different ways, we were raised differently, you have different beliefs from myself. I would like to know your different beliefs so that I can better help you when going forward in your therapeutic journey.”

When I was looking for my own therapist – because that’s something that we’re required to have, at least a few hours done with our own therapist – it was so hard for me to find a South Asian therapist. I fear another therapist might not understand where I’m coming from, not understand my cultural background. I’m not saying any White therapist or Black therapist or anybody else is going to be bad, it’s just that I feel more comfortable talking to somebody from my culture because a South Asian would understand where I’m coming from. That being said, I’m sure there are other therapists from different ethnicities who would still understand if I sat down and took the time to explain it to them.

So I highly emphasize incorporating culture and being culturally humble when you’re working with clients from different backgrounds; making sure that you understand them, give them space to express themselves, and just let them be themselves in the therapeutic room. That’s a huge thing that I want going forward.

“Just know: I hear you, I empathize with you, and there’s so many of us out there. Just ask for help. Always reach out, don’t keep it inside, reach out. There are other people who’ve been through that journey who see you and who feel you.”

I really, really appreciate this country, this culture, I do. But I also want to emphasize that we’re still going to be South Asian. Don’t try to change your identity. There’s nothing shameful about who you are.