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Racialized women can experience discrimination based on both gender and race, and as such be doubly at risk of psychological effects (Hall & Sandberg, 2012; Jones & Pritchett-Johnson, 2018). However, the heterogeneity of racialized women prevents a one-size-fits-all approach (Henderson-Daniel et al., 2004). For example, Black women may experience pressure to embody strength and resilience rather than seek support or express emotional needs (Jones & Pritchett-Johnson, 2018), while for Indigenous women an awareness of the legacy of colonization and current social practices which wreak devastation upon Indigenous peoples’ mental and physical health may be the minimum understanding required of a therapist (Lavallee & Poole, 2010). Asian women may require consideration of other factors, such as the greater somatization seen in this broad category (Presley & Day, 2019). For Latinx women the scapegoating of Latinx people in North America may have exposed them to higher risk for mental health issues (Elias-Juarez & Knudson-Martin, 2016).
The intersecting oppression experienced by these populations is linked to various mental and physical health issues (Rojas-Vilches et al., 2011; Nygaard, 2012; Abrams et al., 2019) as well as an underutilization of services (Yeh et al., 2004; Interian & Díaz-Martínez, 2007; Chen et al., 2008; Awosan et al., 2011). Each client’s meaning-making around race in the therapeutic relationship may impact their presentation and disclosure (Chang & Yoon, 2011), while issues of transference and countertransference may arise (Nagai, 2009), with practitioners needing to be particularly attuned to potentially traumatizing responses (Stevens & Abernethy, 2018). Conversations about race may be critical to treatment (Kivlighan et al., 2019) - but even if not related to the client’s presenting problem, an understanding of the unique stressors that result from multiple marginalized identities is key for any therapist aiming to create safety and develop and maintain a functioning therapeutic alliance (Jones & Pritchett-Johnson, 2018). Abrams, J. A., Hill, A. & Maxwell, M. (2019). Underneath the Mask of the Strong Black Woman Schema: Disentangling Influences of Strength and Self-Silencing on Depressive Symptoms among U.S. Black Women. Sex Roles, 80, pp. 517–526. https://doi.org/10.1007/s11199-018-0956-y Awosan, C. I., Sandberg, J. G. & Hall, C. A. (2011). Understanding the experience of black clients in marriage and family therapy. Journal of Marital and Family Therapy, 37 (2), pp. 153-168. doi: 10.1111/j.1752-0606.2009.00166.x Chang, D. F. & Yoon, P. (2011). Ethnic minority clients’ perceptions of the significance of race in cross-racial therapy relationships. Psychotherapy Research, 21 (5), pp. 567-582. doi:10.1080/10503307.2011.592549 Chen, E. C., Kakkad, D. & Balzan, J. (2008). Multicultural Competence and Evidence-Based Practice in Group Therapy. Journal of Clinical Psychology: In Session, 64 (11), pp. 1261-1278. doi:10.1002/jclp.20533 Elias-Juarez, M. A. & Knudson-Martin, C. (2016). Cultural attunement in therapy with Mexican-heritage couples: a grounded theory analysis of client and therapist experience. Journal of Marital and Family Therapy, 43 (1), pp. 100–114. doi: 10.1111/jmft.12183 Hall, C. A. & Sandberg, J. G. (2012). “We Shall Overcome”: A Qualitative Exploratory Study of the Experiences of African Americans Who Overcame Barriers to Engage in Family Therapy. The American Journal of Family Therapy, 40, pp. 445–458. doi: 10.1080/01926187.2011.637486 Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. doi:10.1002/jclp.20014 Interian, A. & Díaz-Martínez, A. M. (2007). Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients. Cognitive and Behavioral Practice, 14, pp. 84—97. https://doi.org/10.1016/j.cbpra.2006.01.006 Jones, M. K. & Pritchett-Johnson, B. (2018). “Invincible Black Women”: Group Therapy for Black College Women. The Journal for Specialists in Group Work, 43 (4), pp. 348-375. doi:https://doi.org/10.1080/01933922.2018.1484536 Kivlighan, D. M., Drinane, J. M., Tao, K. W., Owen, J. & Liu, W. M. (2019). Detrimental Effect of Fragile Groups: Examining the Role of Cultural Comfort for Group Therapy Members of Color. Journal of Counseling Psychology, 66 (6), pp. 763–770. http://dx.doi.org/10.1037/cou0000352 Lavallee, L. F. & Poole, J. M. (2010). Beyond Recovery: Colonization, Health and Healing for Indigenous People in Canada. International Journal of Mental Health and Addiction, 8, pp. 271–281. doi:10.1007/s11469-009-9239-8 Nagai, C. (2009). Ethno-cultural and linguistic transference and countertransference: from Asian perspectives. American Journal of Psychotherapy, 63 (1), pp. 13-23. doi: 10.1176/appi.psychotherapy.2009.63.1.13 Nygaard, A. (2012). Cultural Authenticity and Recovery Maintenance in a Rural First Nation Community. International Journal of Mental Health and Addiction, 10, pp. 162–173. doi:10.1007/s11469-011-9317-6 Presley, S. & Day, S. X. (2019). Counseling Dropout, Retention, and Ethnic/Language Match for Asian Americans. Psychological Services, 16 (3), pp. 491–497. http://dx.doi.org/10.1037/ser0000223 Rojas-Vilches, A. P., Negy, C. & Reig-Ferrer, A. (2011). Attitudes toward seeking therapy among Puerto Rican and Cuban American young adults and their parents. International Journal of Clinical and Health Psychology, 2 (2), pp. 313-341. Stevens, F. L. & Abernethy, A. D. (2018). Neuroscience and Racism: The Power of Groups for Overcoming Implicit Bias. International Journal of Group Psychotherapy, 68: 4, pp. 561-584. doi:10.1080/00207284.2017.1315583 Yeh, C. J., Hunter, C. D., Madan-Bahel, A., Chiang, L. & Arora, A. K. (2004). Indigenous and Interdependent Perspectives of Healing: Implications for Counseling and Research. Journal of Counseling & Development, 82, pp. 410-419. https://doi.org/10.1002/j.1556-6678.2004.tb00328.x Cultural competence in therapy involves - but is not limited to - an awareness of someone’s country of birth, ancestry, their parent’s country(ies) of birth, languages spoken, Indigeneity, sexuality, gender expression, religion or spirituality, social behaviour and customs, physical and neurological differences, age and socio-economic status (Brooks et al., 2019). But such information is only useful if used to discover how an individual uniquely experiences these aspects of their identity (Dyche & Zayas, 2001).
Feminist and multicultural theorists indicate the importance of awareness and integration of the various intersections of a client’s identity to the development of an effective therapeutic relationship (Knox et al., 2003; Collins et al., 2010; Ecklund, 2012). Culturally competent therapy also requires a practitioner’s self-examination of their own reactions, a humility and openness to learning, the ability to use culture appropriately (and to ascertain when it is not related to the presenting issue), patience, empathy, and an awareness of the differential power status which, in cross-cultural therapy, can be significant (Dyche & Zayas, 2001; Yeung et al., 2018; Brooks et al., 2019; Lee & Neese, 2020). Awareness and incorporation of cultural differences in values, attitudes and behaviors (Interian & Díaz-Martínez, 2007) has been linked to better rapport, intimacy, disclosure, risk-taking, involvement, and therapy outcomes in marginalized clients (Henderson-Daniel et al., 2004; La Roche & Lustig, 2013; Graham-LoPresti et al., 2017). Treatment that fails to address contributing sociocultural factors in their lives may prove insufficient (Abrams, Hill & Maxwell, 2019). An exploration of intersecting aspects of a marginalized client’s identity, where relevant, and an awareness of the barrier to therapy different folks face, for example, may instead facilitate greater engagement among groups who often don’t get the support they most need (Abrams, Hill & Maxwell, 2019). As a member of such a group, and as someone for whom the idea of going to therapy was for the longest time simply unthinkable, I am determined to bring the healing power of this work to those so often failed by the mental health industry. Abrams, J. A., Hill, A. & Maxwell, M. (2019). Underneath the Mask of the Strong Black Woman Schema: Disentangling Influences of Strength and Self-Silencing on Depressive Symptoms among U.S. Black Women. Sex Roles, 80, pp. 517–526. https://doi.org/10.1007/s11199-018-0956-y Brooks, L. A., Manias, E. & Bloomer, M. J. (2019). Culturally sensitive communication in healthcare: A concept analysis. Collegian, 26, pp. 383–391. https://doi.org/10.1016/j.colegn.2018.09.007 Collins, S., Arthur, N. & Wong-Wylie, G. (2010). Enhancing Reflective Practice in Multicultural Counseling Through Cultural Auditing. Journal of Counseling & Development, 88, pp. 340-347. https://doi.org/10.1002/j.1556-6678.2010.tb00031.x Dyche, L. & Zayas, L. H. (2001). Cross-cultural empathy and training the contemporary psychotherapist. Clinical Social Work Journal, 29 (3), pp. 245–258. https://doi.org/10.1023/A:1010407728614 Ecklund, K. (2012). Intersectionality of Identity in Children: A Case Study. Professional Psychology: Research and Practice, 43 (3), pp. 256–264. doi: 10.1037/a0028654 Graham-LoPresti, J. R., Gautier, S. W., Sorenson, S. & Hayes-Skelton, S. A. (2017). Culturally Sensitive Adaptations to Evidence-Based Cognitive Behavioral Treatment for Social Anxiety Disorder: A Case Paper. Cognitive and Behavioral Practice, 24, pp. 459-471. https://doi.org/10.1016/j.cbpra.2016.12.003 Henderson-Daniel, J., Roysircar, G., Abeles, N. & Boyd, C. (2004). Individual and Cultural-Diversity Competency: Focus on the Therapist. Journal of Clinical Psychology, 60 (7), pp. 755-770. doi:10.1002/jclp.20014 Interian, A. & Díaz-Martínez, A. M. (2007). Considerations for Culturally Competent Cognitive-Behavioral Therapy for Depression with Hispanic Patients. Cognitive and Behavioral Practice, 14, pp. 84—97. https://doi.org/10.1016/j.cbpra.2006.01.006 Knox, S. Burkard, A. W., Johnson, A. J., Suzuki, L. A. & Ponterotto, J. G. (2003). African American and European American Therapists’ Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads. Journal of Counseling Psychology, 50 (4), pp. 466–481. doi:10.1037/0022-0167.50.4.466 La Roche, M. & Lustig, K. (2013). Being Mindful About the Assessment of Culture: A Cultural Analysis of Culturally Adapted Acceptance-Based Behavior Therapy Approaches. Cognitive and Behavioral Practice, 20, pp. 60-63. doi:10.1016/j.cbpra.2012.04.002 Lee , H. Y. & Neese, J. A. (2020). Mental and Behavioral Health of Immigrants in the United States. Academic Press, pp. 157-178. https://doi.org/10.1016/B978-0-12-816117-3.00008-7 Yeung, A. S., Trinh, N-H. T., Chen, J. A., Chang, T. E. & Stern, T. A. (2018). Cultural Humility for Consultation-Liaison Psychiatrists. Psychosomatics, 59 (6), pp. 554-560. doi:10.1016/j.psym.2018.06.004 |
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