By Sorcha Ní Chobhthaigh, M.Sc.
My thoughts on being a White mental health clinician, in a White-led mental health service, during a public health crisis impacting the mental health of the Black community.
During this time of uprising, rejection of the historical and current reality of systemic and racial injustice, Black people are forced to cope with a constant barrage of triggering images, descriptions, and the weight of constant advocacy. Add to this the presently heightened burden of white fragility and defensiveness on top of the pre-existing daily lived experiences of this reality. It is essential that non-Black mental health clinicians (including myself) recognise and acknowledge the impact of these experiences as detrimental to the physical and psychological well-being of the Black community and cannot be underestimated. Even more so, it is critical that non-Black mental health clinicians and service providers recognise the importance of providing appropriate, attuned, and genuinely accessible mental health support to the Black community. It is also our duty to amplify the voices and work of our Black colleagues and Black-led mental health services as they continue to provide invaluable support.
We know already that everyday experiences of overt or covert racism (including microaggressions) can induce a biological stress response and symptoms associated with trauma which, in turn, increases the risk of experiencing stress-related chronic illnesses (Carter & Forsyth, 2010; Carter et al., 2020; CMHA, 2008; Pieterse et al., 2010). Moreover, the trauma doesnʼt start at first exposure ‒ it is also thought to be ʻpassed downʼ through generations. Intergenerational or transgenerational trauma results from the legacy of inequality, oppression, and colonization inflicted upon a community over generations (Evans-Campbell, 2008; Yehuda & Lehmer, 2018). Clearly, the impact of racism needs to be incorporated into the assessment, formulation, and intervention plan of clientsʼ presenting concerns.
We also know that therapistsʼ perceived level of cultural competence or incompetence ‒ including their knowledge, understanding, and sensitivity to their clientsʼ lived experiences - impacts the therapeutic relationship and subsequently facilitates, or impedes, intervention effectiveness (Awosan et al., 2011; Chang & Berk, 2009; Fuertes et al., 2006; Thompson et al., 2004).
On a fundamental level, for non-Black mental health clinicians to effectively support Black clients, we need to engage in advanced trainings on racial competence and provide culturally responsive and racially informed assessments and interventions with racialized groups (Helms et al., 2012). However, that in itself is not sufficient to truly honour the lived experiences of Black individuals and families, to understand the significance of racial experiences, and to overcome difficulties addressing race in session. We need to actively reflect on and examine our own privilege and racism, in addition to recognising the inherent power dynamics of, and the significance of the racial composition of, the therapeutic dyad (Carter, 2015; Gordic, 2014). Moreover, we need to actively engage in dialogue with clients about race and racism, the implications for patient well-being, and clinical practice (Murray-Garcia et al., 2014). Without utilising trauma-informed, anti-racism, anti-oppressive frameworks, we risk perpetuating the oppressive power dynamics experienced in everyday life in the therapeutic space. Simply put, if we do not have the necessary awareness, training or skillset, we risk causing more harm. As such, it is our responsibility to recognise our limitations and support the client to access clinicians better matched to meet their needs.
*Disclaimer: I am not an expert. I am just a White mental health clinician trying to educate myself and other wannabe allies to do better. Please see references and resources below for real learning.
Below are some cultural competence resources for therapeutic spaces. This list is by no means exhaustive ‒ but itʼs a start. Contributions most welcome and encouraged.
Black-led healing spaces in Toronto*
Read: In therapy
Read: In everyday life
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), 153-168. doi: 10.1111/j.1752-0606.2009.00166.
Canadian Mental Health Association (CMHA) (2008). Recommendations for Preventing and Managing Co-Existing Chronic Physical Conditions and Mental Illnesses. https://ontario.cmha.ca/documents/the-relationship-between- mental-health-mental-illness-and-chronic-physical-conditions/#:~:text=People%20living%20with%20a%20serious%20mental%20illness%20are%20at%20higher,rate%20o f%20the%20general%20population.
Carter, R. T. (2007). Racism and Psychological and Emotional Injury: Recognizing and Assessing Race-Based
Traumatic Stress. The Counseling Psychologist, 35(1), 13‒105. doi: 10.1177/0011000006292033
Carter, R. T., & Sant-Barket, S. M. (2015). Assessment of the impact of racial discrimination and racism: How to use the Race-Based Traumatic Stress Symptom Scale in practice. Traumatology, 21(1), 32‒39. doi: 10.1037/trm0000018
Carter, R. T., Kirkinis, K., & Johnson, V. E. (2020). Relationships between trauma symptoms and race-based
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