For many racialized folks, racial socialization occurs in stark contrast to that of White folks (Kivlighan et al., 2019). Engagement in explicit conversations about race is critical not just for the development of a positive racial identity, but also for successful navigation of the hostile world around us (Kivlighan et al., 2019). An example of this is the tragic necessity of early conversations between Black parents and their children about how to respond to law enforcement, how to exist in public spaces, and how to make sense of the messages they receive about themselves from the world around them – conversations which facilitate protective factors such as healthy skepticism and self-esteem (Kivlighan et al., 2019). A therapeutic relationship between a client and a racialized therapist can provide an extension of this dynamic - indeed, many studies have indicated engagement with culturally similar peers to be more advantageous for racialized folks (Jones & Pritchett-Johnson, 2018).
However, even in racialized therapeutic pairs it is impossible to fully match client and practitioner, since many aspects of identity - such as sexuality and disability - can remain invisible (Chen et al., 2008). It is dangerous to assume that all racial minorities share the same experience and awareness of racism. I can't remember who I am paraphrasing here, but it is often the ones who look most like you that can hurt you the most - by which is meant that when faced with an oppressor you can at least prepare for impact, but when the slap comes from an unexpected, closer to home source, you can be caught dangerously off-guard. Internalized racism is a powerful mechanism in the maintenance of that oppressive structure. It becomes even more important to be aware of when considered in the context of the therapeutic relationship - I know I cannot ever make the assumption that any individual shares my own understanding of what it means to exist on the margins.
Poor cultural competency in counselling can result in inappropriate and harmful case conceptualizations and interventions, an inability to recognize when microaggressions occur, poor counseling outcomes, poor adherence to treatment, poor health outcomes, increased prevalence of adverse events, and ultimately, premature termination of counselling services (Henderson-Daniel et al., 2004; Chang & Yoon, 2011; Brooks et al., 2019). Further, discrimination and prejudice in the lives of marginalized populations impacts their access to health care resources in the first place (Henderson-Daniel et al., 2004; Collado et al., 2017), with marginalized folks more likely to receive poorer quality mental health care and more likely to drop out from treatment than White populations (Yeh et al., 2004; Chang & Yoon, 2011; Collado et al., 2017; Graham-LoPresti et al., 2017; Pinedo et al., 2018; Horwitza et al., 2020). One issue here is that the mental health field continues to be understood and situated in a predominantly Eurocentric western paradigm and is often managed through programs and interventions that ignore cultural, historical, and social-political contexts (Henderson-Daniel et al., 2004; Lavallee & Poole, 2010; Daniels & Fitzpatrick, 2013; Vukic et al., 2011)
What literature there is on this issue indicates that due to their mistrust of service providers racialized folks tend make particular decisions about how we present and may tend to be reluctant to disclose in the therapeutic environment, because of the fear of being misinterpreted, misunderstood, stereotyped, overpathologized, even incarcerated, as a result (Moodley et al., 2008; Awosan et al., 2011; Chang & Yoon, 2011; Phiri et al., 2019). In this context, how exactly is healing meant to occur for racialized populations?
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
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
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), 1261-1278. DOI: 10.1002/jclp.20533
Collado, A., Lim, A. C., & MacPherson, L. (2017). A systematic review of depression psychotherapies among Latinos. Clinical Psychology Review, 45, 193-209. doi: 10.1016/j.cpr.2016.04.001
Daniels, C. & Fitzpatrick, M. (2013). Integrating Spirituality into Counselling and Psychotherapy: Theoretical and Clinical Perspectives. Canadian Journal of Counselling and Psychotherapy, 47 (3), pp. 315–341.
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
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
Horwitza, A. G., McGuire, T., Busby, D. R., Eisenberg, D., Zheng, K., Pistorello, J., Albucher, R., Coryell, W. & King, C. A. (2020). Sociodemographic differences in barriers to mental health care among college students at elevated suicide risk. Journal of Affective Disorders, 271, pp. 123–130. https://doi.org/10.1016/j.jad.2020.03.115
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), 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), 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
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Phiri, P., Rathod, S., Gobbi, M., Carr, H. & Kingdon, D. (2019). Culture and therapist self-disclosure. The Cognitive Behaviour Therapist , 12 (e25), pp. 1-20. doi:10.1017/S1754470X19000102
Pinedo, M., Zemore, S. & Rogers, S. (2018). Understanding barriers to specialty substance abuse treatment among Latinos. Journal of Substance Abuse Treatment, 94, 1–8. https://doi.org/10.1016/j.jsat.2018.08.004
Vukic, A., Gregory, D., Martin-Misener, R. & Etowa, J. (2011). Aboriginal and Western Conceptions of Mental Health and Illness. Pimatisiwin: A Journal of Aboriginal and Indigenous Community Health, 9 (1), pp. 65-86.
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
Thoughts on Therapy and Mental Health