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The Think FLEXibly Blog

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To my fellow white therapists...

6/23/2020

 
By Sorcha Ní Chobhthaigh, M.Sc.
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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*
  • The Most Nurtured
  • Black Mental Health Matters
  • Women's Health In Women's Hands
  • Black Health Alliance
  • WellNest
  • Gray Matter Health
  • Across Boundaries
  • Heart of the Matter
    *This is just a few, there are many more.

Read: In therapy

  • Eliminating Race-Based Mental Health Disparities: Promoting Equity and Culturally Responsive Care across Settings by Monnica T. Williams, Daniel C. Rosen, and Jonathan W. Kanter
  • Counseling the Culturally Diverse: Theory and Practice by Derald Wing Sue and David Sue
  • Measuring the Effects of Racism: Guidelines for the Assessment and Treatment of Race-Based Traumatic Stress Injury by Robert T. Carter and Alex L. Pieterse
  • Intersectionality and Relational Psychoanalysis: New Perspectives on Race, Gender, and Sexuality by Max Belkin and Cleonie White
  • Care Work: Dreaming Disability Justice by Leah Lakshmi Piepzna-Samarasinha
  • The Cost of Racism for People of Color: Contextualizing Experiences of
    Discrimination by Alvin N. Alvarez, Christopher Liang, Helen A. Neville
  • The Challenge of Racism in Therapeutic Practice: Engaging with Oppression in
    Practice and Supervision by Isha McKenzie-Mavinga
  • Race Talk and the Conspiracy of Silence: Understanding and Facilitating Difficult Dialogues on Race by Derald Wing Sue

Read: In everyday life
  • How to be an Anti-Racist by Ibram X. Kendi
  • Me & White Supremacy: How to Recognise your Privilege, Combat Racism and
    Change the World by Layla F. Saad
  • White Fragility: Why Itʼs So Hard For White People To Talk About Racism by Robin DiAngelo PhD
  • So You Want to Talk About Race by Ijeoma Oluo
  • Biased: Uncovering the Hidden Prejudice That Shapes What We See, Think, and Do by Jennifer L. Eberhardt PhD.
  • The Skin We're In: A Year of Black Resistance and Power by Desmond Cole
  • Pushout: The Criminalization of Black Girls in Schools by Monique W. Morris
  • Until We Are Free: Reflections on Black Lives Matter in Canada by Rodney Diverlus, Sandy Hudson, Syrus Marcus Ware

Read: Healing from Racism
  • The Racial Healing Handbook: Practical Activities to Help You Challenge Privilege, Confront Systemic Racism, and Engage in Collective Healing by Anneliese A. Singh, PhD.
  • Healing Racial Trauma: The Road to Resilience by Sheila Wise Rowe
  • The State of Black Girls: A Go-To Guide for Creating Safe Spaces for Black Girls by Marline Francois-Madden
  • The Inner Work of Racial Justice: Healing Ourselves and Transforming Our
    Communities Through Mindfulness by Rhonda V. Magee
  • Post Traumatic Slave Syndrome by Joy Degruy Leary
  • The Unapologetic Guide to Black Mental Health: Navigate an Unequal System,
    Learn Tools for Emotional Wellness, and Get the Help you Deserve by Rheeda Walker, PhD.
​
Listen
  • Therapy for Black Girls by Dr. Joy Harden Bradford
  • Melanin & Mental Health by Eliza Boquin and Eboni Harris
  • Highwater Podcast ‒ Episode ʻThe Artistʼs Guide To Mental Healthʼ with Alice Berry & ʻ#NoShameDay: Telling our mental health storiesʼ with Bassey Ikpi
  • NATAL by a team of Black creatives and parents
  • Sisters in Loss by Erica M. McAfee
  • The Friend Zone by Dustin Ross, HeyFranHey & Assante

Follow
  • @ decolonizingtherapy
  • @ ogorchukwuu
  • @ ajabarber
  • @ blackmentalwellness
  • @ inclusivetherapists
  • @ liberatemeditation
  • @ blackgirlinom
  • @ flora.mind
​
Other Resources
  • Black Health Alliance
  • Therapy for Black Men
  • The Loveland Foundation
  • Ethelʼs Club
  • Black Mental Wellness
  • Omnoire
  • Black Youth Helpline
  • Black Women in Motion
  • Black Men Heal

References

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
Photo used under Creative Commons license. Source here.
Image: Black Lives Matter by John Lucia. See side panel for further copyright information.

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