A young Black woman, stressed out and overwhelmed from watching the video of George Floyd, a Black man, murdered at the hands of the police, decides she needs someone to talk to process the current event. She begins to search for a therapist in her area only to find that most, if not all, of the therapists in her area, are not Black. This makes her nervous. Will the therapist she meets be an ally? Will the therapist be racist? She is hoping the therapist can understand her, but honestly, lately she does not know what to believe or who to trust.
The nation is reeling from recent events that have put racism and police brutality at the forefront of people’s minds. For Black people, this is nothing new, and it can bring up many past traumas and incidents of racism and prejudice. Furthermore, the unrest all around them in the form of protests, social media outcries, and blatant defenses of racism and racial structures can be highly stressful. Black people are experiencing stress, fear, anxiety, anger, sadness, mental fatigue, and pressure. The need for Black mental health care is considerable as the Black community carries the weight of these significant events, yet again. This week, a friend said to me, “how am I supposed to just go to work after watching someone get killed, knowing it could have easily been me?”
Black mental health is not something that has been historically valued and can come with various taboos, even within the Black community. Structural barriers such as lack of insurance and availability of services are just a few reasons Blacks are shut out of receiving therapeutic support (Taukeuchi, Leaf, & Kuo, 1988). Many people who require therapy may never receive help. Lack of access and the stigma of therapy in the Black community can leave people who need treatment outside of the process.
Those that enter into the “scary” world of therapy for the first time amid the current events may find that there is a lack of Black therapists. Blacks are under-represented in the mental health field. According to the American Psychological Association, in 2015, 86 percent of all psychologists were White, and only 4% were Black. In 2017, Blacks received approximately 15 percent of all degrees awarded in marriage and family therapy (Department of Education, 2017). Given these realities, Black people are more likely to have a therapist who is not Black. Those therapists are given a significant charge and responsibility to enter into a therapeutic alliance with someone who may be a skeptic of therapy and is very likely processing race and current race relations in America. The beginning of the therapeutic relationship is a watershed moment that can make or break both the impending therapeutic alliance as well as the client’s perspective of therapy moving forward. No pressure.
In an ideal world, entering into the therapeutic relationship with a Black client, if you are not Black, would be no different than anyone else, and in some ways, it is no different. However, in many ways, it is different, and these differences must be acknowledged and addressed for the client to have the best experience possible. The therapist is always on the frontline of the mental health battle, and given the discrepancies, lack of access, and constant stress facing Blacks, it is a significant battle that must be hard-fought to be won.
Therapeutic Alliance
The therapeutic alliance has been connected to therapeutic outcomes. Rogers (1961) considered the three active components to the therapeutic relationship to be empathy, congruence, and unconditional positive regard. These qualities are to be cultivated and maintained by the therapist. According to Rogers (1961), these qualities help to establish a holding space for the processing of emotionally laden material. It is in that holding space that healing and transformation can occur. Blacks in America desperately need therapists who can provide a safe therapeutic space to heal from the stress caused by daily acts of racism and micro-aggressions, not to mention the many videos and reports of Blacks being killed.
A general concern of many therapists is whether they will be adequate to help their clients. These are honest feelings that must be addressed. The Rogerian concept of congruence is applicable in this situation as it is described as the therapist’s ability to acknowledge and communicate, as deemed therapeutically appropriate, their affective experience within the therapeutic dyad (Rogers, 1961). Congruence is critical as the therapist must be able to acknowledge limitations and remain authentic in the therapeutic process. This authenticity can elicit feelings of inadequacy. Doctoral candidate in clinical psychology and psychotherapist intern Denette Boyd-King, M.Ed., M.A., a Black woman, shared that in her work with Black clients, she has found that it is crucial to address these feelings. “Rather than sinking into feelings of professional inadequacy, it is more helpful to embrace our limitations, listen with compassion, and remain intentional about being present to whatever presents itself within the therapeutic process.” Therapeutic perfection is a myth, and no therapist should buy into a false ideology that they can solve someone’s problems, especially as it relates to racism. Your good intention is noted in your ability to extend compassion to your client and yourself.
As a therapist, you may play a pivotal role in healing the racial tension for your clients. It begins with you doing the appropriate self-reflection regarding where you stand on the issues of race. Therapists are not 100% value-neutral and bring various elements of themselves and their beliefs into therapy, which is why self-reflection and assessment are so critical. An apprehensive Black client, testing out therapy for the first time, may assess you very differently than many of your other clients. If you have not done any self-reflection and addressed any issues you may have on the topic of race; then it may show. Subtle cues in your vocal tone, eye contact, and body language may be assessed to determine whether you hold any conscious or unconscious biases in regards to race. The client may also assess whether you are capable of withstanding what they may bring to therapy.
Once you have completed adequate self-assessment and are prepared for the therapeutic exchange with Black clients, you must also maintain a posture of curiosity and learning. People may represent the same ethnic background, but everyone has a unique set of experiences as a result of their ethnicity. Whaley and Davis (2007) point out that, in theory, cultural competence involves considering many components of the client’s diverse background, such as age, gender identity, sexual orientation/identity, socio-economic status, religious/spiritual beliefs, and educational attainment. Maintaining a posture of curiosity gives credence to clients as owners of their stories and experts on their lived experiences. Therapy is a journey, and the client is the pilot, and the therapist is along for the ride. Validating ownership is essential to remember as the experience of racism may lead Blacks to feel unheard and dismissed.
In Preparation for Therapy
Many Blacks are stressed out for a variety of reasons in today’s social climate. Unemployment rates are high across the US, and those rates tend to be higher among people of color. Recent reports are showing that the virus Covid-19 is striking the Black community at a disproportionate rate to other groups (Center for Disease Control, 2020). The Ahmaud Arbery, Breonna Taylor, and George Floyd deaths can activate genuine fears about being Black in America, and many Blacks are a range of angry and sad.
For some, these events may bring up past incidents of racism or brutality with the police. Blacks report more experiences of discrimination than any other ethnic group (Pieterse, Todd, Neville, & Carter, 2012). Some clients may even suffer from trauma as a result of racism or discrimination. Race-based traumatic stress is a conceptually, more defined understanding of the experience of trauma. It’s defined as:
(a) an emotional injury that is motivated by hate or fear of a person or group of people as a result of their race; (b) a racially motivated stressor that overwhelms a person’s capacity to cope; (c) a racially motivated, interpersonal severe stressor that causes bodily harm or threatens one’s life integrity; or a severe interpersonal or institutional stressor motivated by racism that causes fear, helplessness, or horror (p.135, Bryant-Davis, 2007).
All counselors should have training in how to address race-based traumatic stress (Carter, 2007). Thoroughly understanding and treating race-based traumatic stress also requires an understanding of power, privilege, and racial oppression (Sue & Sue, 2003). Being a self-aware, culturally competent therapist allows you to identify these potential areas of trauma for your client. Therapists must be able to address race-based traumatic stress as well as leverage race-related positive experiences in therapy. Bryant-Davis (2007) explains that therapists must be able to respond to racial traumas with compassion, validation, and competence, which is needed for any trauma.
Treatment
Therapists must listen to the stories their clients share and allow the emotions to felt by clients without minimizing and moving on. Clients can be left confused and uncomfortable when minimal attention is given to racial incidents in therapy (Scurfield and Mackey, 2001). Instead, when a therapist creates a safe therapeutic environment, built on compassion and validation, the client can feel free to express themselves entirely without shame. Viktor Frankl in Man’s Search for Meaning states, “But there was no need to be ashamed of tears, for tears bore witness that a man [woman] had the greatest of courage, the courage to suffer.” It is through the felt pain that courage and resilience are borne. A competent therapist must be able to hold and sit in the pain, anger, and trauma that the current events may elicit in Black clients.
In treating Black clients in therapy, utilizing strengths is an important strategy to consider (Jones, Huey, & Rubenson, 2018). Being able to align with your client and determine what their strengths are, is critical. For many Black people, family and community can be great sources of strength (Jones, Huey, & Rubenson, 2018). Spirituality and religion are also potential areas of strength that can explored. Strengths can be used in therapy to support the client through difficult times and affirm the client’s ability to overcome. In determining strengths, the therapeutic alliance is substantial. Together, the client and therapist can work through presenting problems, form a strong alliance, support stress relief, and walk on a path of health.
