What is the mental health provider’s responsibility in addressing the issues of white supremacy and structural racism, and how can we become more aware of how racism and power dynamics affect our work as clinicians?
“White Supremacy” is a term that not only defines a belief or a group of people belonging to hate groups that think white people are superior to people of color and should dominate them. It is also a term that describes the reality we live in; a culture which positions white people and all that is associated with them (whiteness) as the norm.
“Structural Racism” is defined as a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity. It identifies dimensions of our history and culture that have allowed privileges associated with “whiteness” and disadvantages associated with “color” to endure and adapt over time. Structural racism is not something that a few people or institutions choose to practice. Instead, it has been a feature of the social, economic and political systems in which we all exist. (1)
Over the past few years, there has been a paradigm shift in our understanding of how white supremacy and structural racism uphold power structures that are no longer tenable. The Black Lives Matter movement, due to events like the murder of George Floyd and the spotlight on a system that is purposefully violent and oppressive to non white people has forced the conversation towards a deeper understanding about what racist behavior, language, and impact really look like, at both a macro and micro level. Recently popularized and bestselling books such as “So You Want To Talk About Race”, “White Fragility”and “How To be An Anti racist” have deepened the discourse in ways that cause significant white discomfort to those who deny they live within a specific structure that has benefited their ancestors and continues to benefit them. We all need to acknowledge the very real experience of People of Color (POC) living within a system that harms, disempowers, and oppresses them. Consequently, everyone (including mental health practitioners) needs to examine their own internalized and often unconscious attitudes regarding race, racism and power, and how the embedded structures that currently exist intentionally uphold a system that maintains People of Color as second class citizens or worse.
This call for a much deeper examination of how we contribute to white supremacy and structural racism is crucially important in the mental health care field. Mental health practitioners can unknowingly and unintentionally carry these paradigms into their sessions with Clients of Color. While the profession itself has some mandates to stay up to date with “cultural competency training,” these mandates are often superficial and ineffective, and simply aren’t enough to be truly antiracist.
The canons of psychological theory remain white and Eurocentric, and yet are largely assumed to be universal. Psychological diagnostic criteria and assessment tools (which also inform courts, prisons, hospitals, schools and social welfare institutions) are based on research of population samples that are overwhelmingly white. In other words, European whiteness is still assumed to be the mainstream representation of the cultural and emotional experience of all human beings. Thankfully, this is slowly changing, as Feminist and Critical Race Theory lenses continue the paradigm shift in the mental health field.
So what can we do about it as clinicians? What does a well-intentioned, humble, and truly antiracist clinician do about the white-centric attitude that pervades the world of psychotherapy? Perhaps one of the ways to start becoming a racially responsible mental health provider (besides acknowledging your own limitations and your own white racial identity), is to listen to our clients of color and their experiences of therapy with white providers. To that end, I would like to share a few examples from my own practice. Because I am a person of color myself (Latinx) and have a practice partially dedicated to helping people of color cope and thrive in a racist world, I often see clients who come to me after having felt further wounded by a white therapist during treatment.
Some Examples of What We Can Do: A Baseline
Don’t be “Colorblind”
An example of a harmful belief taken into the session room when the subject of race is introduced by clients of color, white therapists will often claim to be “colorblind”. This does real harm, as this belief negates the very real issue of racial and cultural difference that needs to be explored in treatment as a factor in our clients’ suffering. Yet “colorblindness” is one of the more common claims that arise in conversations between “white folks” – therapists included. And of course, even people of color participate in racist behaviors (i.e., colorism, anti-Blackness) and uphold stereotypes, sometimes even within their own subgroup, as a way to assimilate and deal with their own powerlessness.
Don’t Negate or Deflect Your Client’s Experiences of Racism Due To Your Own Discomfort
Nancy, a 37 year old Black client came to me with a story of how she had felt her white female therapist “just didn’t get her.” When asked to elaborate, Nancy described how her therapist would change the subject or attempt to attribute her symptoms of depression to factors other than what Nancy was talking about, which was an incident at work in which she felt discriminated against and targeted because she was Black. Nancy eventually chose to leave her place of employment and had gone into a depressive episode due to the treatment she described to her therapist. Nancy described how any attempt to discuss the racism she experienced in the workplace was met by discomfort, questioning, and the therapist’s attempt to change the subject to explore other possible reasons for her symptoms. Even after Nancy made it clear that there was a direct correlation between what she described as overtly racist behavior by her supervisors and coworkers and her depression, the therapist did not validate her. Nancy left her therapist after two months, deeply disappointed with the experience of not being listened to and validated, and considered not resuming therapy at all. Thankfully, she was able to bravely enter into treatment again after this negative experience. In her own words:
“I don’t really think she wanted to talk about it. She didn’t get it. I felt so alone in that room, and I thought, if this is what therapy is going to be like, I don’t want any part of it.”
Therapists are trained to sit in discomfort, and we often hear narratives that are deeply disturbing and that trigger intense emotions in the session room. White therapists who have never examined their own feelings and attitudes regarding race and racism and who hear hurtful and even traumatizing racist experiences suffered by people of color might experience overwhelming sadness, shame and guilt as they listen to these narratives. It is our responsibility not only to acknowledge how unprepared we might be to enter into dialogues about the effects of racism on our clients, but also do the work to truly begin to understand these experiences, validate them, and help our clients deal with these realities in their lives. This includes receiving supervision from peers who have an awareness of racism as a contributing factor in our clients’ suffering, and being honest with clients of color (or any other oppressed group) about where you are in your awareness of the issues, and if necessary, refer them to a therapist who might be able to meet them where they are.
Know Your Client’s Cultural Norms
During the early part of my career working in an outpatient mental health clinic in East Harlem (El Barrio) many years ago, numerous Latinx clients shared their experiences with what they looked upon as a disconnection and deep disappointment with their white therapists. This centered around a specific rule that is often taught in clinical training, which is to never accept gifts from clients, as this might create a “boundary violation” that has the potential to affect treatment by blurring the lines between therapist and client. While this rule has validity in keeping certain boundaries intact within treatment, this is also an example of a white, Eurocentric framework regarding clinical boundaries that is taught in clinical training.
My Latinx clients were confused when they attempted to give their white therapists gifts and were rejected, mainly during holidays like Christmas. In the words of Zoraida, one of my clients, a 56 y.o. Puerto Rican woman:
“No se porque me rechazo. Le habia hecho una botella de coquito para su familia. Despues de que me rechazo, ya no pude confiar en el. Me dolio mucho.”
(“I don’t know why he rejected me. I made a bottle of coquito (a Puerto Rican homemade drink for the holidays) for him and his family. After he rejected me, I didn’t feel I could trust him any more. It really hurt.”
Notice that the therapist’s rejection of the gift was seen by the client as a rejection of herself. In Latinx culture generally, gift giving is viewed as a way to establish an intimate connection with the other, especially gifts that are homemade or involve thoughtfulness. In my client’s view, this rejection made it impossible for her to continue treatment with her white therapist, because it made it impossible for her to establish that connection due to his rejection.
It’s important to adjust our norms and expectations to our clients. The most basic responsibility in this situation is to know and understand the cultural norms of the client you are working with and adjust accordingly. To not do so risks a serious rupture in the client/therapist relationship.
The Pervasiveness of White Supremacy (Even In “Safe” Spaces)
I was recently part of an online anti-racism workshop, composed mainly of therapists of color (Black and Latinx identified), and a handful of white therapists who wanted to increase their awareness of the issues I have presented here. The moderators wanted to create a safe space for the therapists of color in the group, which included giving more space to them and encouraging the white therapists to primarily listen to their experiences. In our social environment of white supremacy, where whiteness is the norm, people of color are often silenced or disempowered in numerous ways and are told, overtly or not, that they shouldn’t take up as much space as white people. The workshop was held on eight consecutive Friday mornings, not without tension at the outset, until everyone felt safe enough to share experiences that were deeply hurtful to them, or to share the fact that they had not been aware how painful the experiences of overt and “soft” racism had been to the therapists of color in the workshop. During the penultimate workshop day, a Black male therapist felt that he had taken up too much space and offered space to the “sisters of color” in the workshop to share their experiences on the topic discussed for that day. There were a few seconds of silence, and then a white female therapist spoke, to make “an observation.” It was striking that even in this space that was assumed to have been safe, and with six weeks of discussion and education about the pervasiveness of racism, whiteness, and white supremacy, a white woman was taking up the space that had been specifically opened up in that moment for a woman of color.
Even in a safe space dedicated to raising awareness, white supremacy was still an issue. It was shocking to experience this, and it was a reminder of how pervasive and insidious white supremacy is in our lives, and how much work we all have to do to be aware of what our own internalized prejudices, biases and blind spots are in order to best serve our clients of color.
- Aspen Institute, 11 Terms You Should Know To Better Understand Structural Racism, internet article, July 11, 2016.
Ridley, C. R. (2005). Overcoming unintentional racism in counseling and therapy: A practitioner’s guide to intentional intervention (Vol. 5). Sage publications.