“In the African American community there’s more of an expectation of give and take, maybe in the pattern of call and response,” she said. “Culturally competent care does require some flexibility on the part of the provider, to understanding where people are coming from, what their needs are.”

The cultural dissonance has abated somewhat as more African Americans go into the field as providers. The 2007 American Psychological Association’s Doctorate Employment Surveyfound that 22 percent of new doctorates in psychology were members of a minority group, up from 15 percent in 2000.

“The door was virtually slammed shut through the 1960s,” said Halford Fairchild, professor of psychology at Pitzer College in Claremont, Calif., adding that African Americans began entering the field in larger numbers starting in the 1970s.

As more African Americans pursue higher education, the stigma lessens.

“The more educated you are and the more you understand your disorder, the more you’re likely to get it treated,” said Donna Holland Barnes, director of the Suicide Prevention Action Group at Howard University. “The more educated you are, the more you understand this is a normal part of life.

Other factors include gender — women are more likely than men to seek help — and money. Many psychologists and psychiatrists do not accept insurance, and the cost can be prohibitive for those with lower incomes.

Age also plays a role — younger people tend to be more open to therapy, said Sonja Williams, a marriage and family counselor who shares a practice with Waters in Upper Marlboro.

“In the last 20 years, there’s a lot more television programming that is much more accepting of seeking mental health services, so it’s made it, in some populations, more trendy,” she said, adding that celebrities such as Oprah Winfrey talk openly about it. “Probably amongst the younger crowd it can be a little trendy to say, ‘Oh, I’m seeing a therapist.’ ”

Religion and therapy