Therapy

Why We Need to Be Anti-Racist Therapists for All Our Clients

Let's add a bow of 'anti-racism' to Yalom's "Gift of Therapy."

Posted Aug 01, 2020

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The Gift of [Anti-Racist] Therapy
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“No charitable black scheme can wash out the color of the Negro, change his inferior nature or save him from his inevitable fate.” 

This statement was said by an Ohio Congressman and documented in the 1619 Project article: “Why Doesn’t The United States Have Universal Health Care? The Answer Has Everything To Do With Race."

Unfortunately, I have encountered many teachers who still believe that Black children, and particularly socio-economically disadvantaged Black children, are unable to learn as well as their counterparts (measured through anonymous survey). We like to pretend, in our color-evasive society, that we are far removed from such beliefs. But they exist in many of us. A colleague and fellow mental-health therapist said to me last week, "I told my best friend that I don't see her as Black. Skin color doesn't matter to me." I referred her to Dr. Fergus' Confronting Colorblindness. "If you don't see your best friend as Black, then are you really seeing her experiences? And, what is wrong with being Black?!" She didn't have much of an answer: "Well, I don't know. This is just what I have always been taught. That we all bleed the same color." I told her I now worry about her interactions with clients of color. And, unfortunately, I found that there are no real resources for mental health clinicians to refer her to about race. At this point, we have to borrow from other professions to learn about race. So, the question is: How do these beliefs show up in mental health counselors? What are the deep beliefs of psychotherapists? What resources are available to therapists to explore these beliefs?

Mental health practitioners all over the world read Irving Yalom’s acclaimed The Gift of Therapy, in which he writes “a book of tips for beginning therapists.” He tells stories of his experiences with his clients and the gift he gets and gives through their journeys. His lessons from his 45 years of notes are invaluable: “encourag[ing] a focus on the therapeutic relationship, based on engagement, openness, and egalitarianism.” His methods resound with us therapists who find psychology to often be a cold, distancing, way of labeling others.

Yalom writes in his introduction, “But offering guidance and inspiration to the next generation of psychotherapists is exceedingly problematic today because our field is in such crises. An economically-driven health care system mandates a radical modification in psychological treatment and psychotherapy is now obliged to be streamlined — that is, above all, inexpensive and perforce, brief, superficial, and insubstantial.”

Yes, yes, and yes.

And we exist in a country and a profession that promotes white domination as the standard. The dehumanization occurs because of many reasons, all driven by systems created out of white supremacy. And we are far from solving it.

I am arguing that the crisis is greater than what Yalom mentions. If living, thinking, and healing is all determined by a colorblind/color-evasive, white standard of health, then where do BIPOC folx stand in mental health? We have to start at the origin of these beliefs to determine the impacts on counseling practices.

The mental health crisis stems from the medical crisis, which has his roots firmly anchored in the slavery crisis: 

1. “There has never been any period where the health of Blacks was equal to that of whites. Disparity is built into the system.” —Evelynn Hammonds, historian of science at Harvard University (1619 Project). 

2. To justify slavery, plantation owners (or forced labor-camp owners) and politicians (like Thomas Jefferson) paid researchers and scientists to prove what they believed: that Black people had

“large sex organs and small skulls—which translated to promiscuity and a lack of intelligence—and higher tolerance for heat, as well as immunity some illnesses and susceptibility to others. These fallacies, presented as fact and legitimized in medical journals, bolstered society’s view that enslaved people were fit for little outside forced labor and provided support for racist ideology and discriminatory public policies […] Over the centuries, the two most persistent physiological myths—that black people were impervious to pain and had weak lungs that could be strengthened through hard work” (1619 Project).  

3. After the Civil War and during Reconstruction, policies around free assistance for health care tried not to “breed dependence” (not unlike now) and programs for Black medical professionals were sparse—Meharry and Harvard were the only options in the USA. Then there was direct harm to Blacks in medicine, such as the 1932-1972 Tuskegee experiments which imposed STDs on 600 Black men and withheld the cures from them.

4. It has been only 56 years since segregation was outlawed for entities receiving federal funds—meaning hospitals were segregated not that long ago. We live in a country with historical beliefs that free and healthy Black Americans would “upend the racial hierarchy […] Federal policy reflected white ambivalence at every turn." (Jim Downs, Sick Freedom, 2012, quoted from the 1619 Project). 

5. Recent data shows that present-day doctors fail to sufficiently treat the pain of black adults and children for many medical issues. Doctors-to-be have been shown in numerous studies to believe that black skin is thicker than white skin. There is even technology that “controls for the assumption that blacks have less lung capacity than whites.” In other words, we are so used to these assumptions that the medical field has created technology to undo what our brain is liable to do to patients (1619 Project). 

Now, where is that technology in the therapeutic field? We don’t have machines doing these checks and balances in psychotherapy. We have to work at undoing biases we inflict on clients—constantly and continually.

All of these historical factors and many more cause major stigmas against health services and certainly mental-health services, particularly for Black and Indigenous populations. BIPOC clients who ignore the stigmas and decide to face the trouble of potential microaggressions (or macroaggressions) but are determined to seek therapy have few choices other than white therapists who uphold white-dominant systems. And, some BIPOC patients seek and find BIPOC therapists who have also not rid their therapy of colonial imposition. The issue is that most therapeutic training and curricula do not provide an anti-racist framework for a profession that started out as racist. (Reminder: the systems we have now are derived from the racist systems during Reconstruction.)

Yalom writes in A Gift of Therapy that “readers may have a different clinical situation: a different setting with a different patient population and a briefer duration of therapy.” He still “hope[s] that readers may find their own creative way to adapt and apply what I have learned to their own particular work situation.” 

He is right: We can be creative and figure out how to apply it. But to address systematic racism through therapy, we need to do more than to harness our best imaginative strategies and innovative methods. We need active interrogation of our practices, connective peer supervision, to learn revisionist history by the people, and to do deep reflection of our past, present, and future. It requires a lot more than the therapy we learned about in school.

In the writing of The Gift of [Anti-Racist] Therapy, I want to add the gift wrap and bow to Yalom’s Gift of Therapy. We need to examine how to give and get the gift of being anti-racist in wellness and mental health. Undoing racism while working with clients is vital to work with people of color and white folx. 

We can receive wisdom from therapeutic texts that teach us to use the relationship as the therapy but can still perpetuate harm to clients due to white-dominant cultural norms that are pervasive and stuck in our psyche, and passed back and forth from client to practitioner and back again. This cycle can do damage to the client and also the clinician, including white clinician to white client or Black clinician to Black client. If the greatest psychological texts don’t address race outside of cultural competence and cultural humility, then how can we do it in our practice? We need real accounts of being human in racist systems, and of being a person of color, Black, Indigenous person within the world of psychotherapy. 

While I am no expertI have had many trials and tribulations in clinical work: play therapy, cognitive behavioral methods, 'trauma-informed' approaches, school counseling in NYC schools, and DEI strategies in nonprofits. I offer many clinical moments of mistakes, epiphanies, corrections, movements, and strategies of being an anti-oppressive mixed immigrant Black and white therapist. The Gift of [Anti-Racist] Therapy is a blog that details 15 years of clinical experiences and vignettes involving race. 

I’m going to write an addendum to Yalom’s work. 

Join me on this journey and add the homepage to your favorites.

Discussion Questions: 

Did you know the histories documented in the 1619 project’s essay? If not, why not? If yes, where did you learn them from and what experiences are related to that learning?

How has your (physical and emotional) pain been validated/invalidated? How do you validate/invalidate your pain to yourself? How is this related to your identities?

What identities are seen to be able to hold more pain than others? What biases do you hold around who can cry, and who shouldn’t? Whose crying or pain are you most uncomfortable around? Whose pain have you or haven’t you witnessed? Why? 

References

References

Interlandi, J. (2019). Why doesn’t the United States have universal health care? The answer begins with policies enacted after the Civil War. 1619 Project, New York Times, Pages 44-45

Villarosa, L. (2019). Myths about physical racial differences were used to justify slavery-and are still believed by doctors today. 1619 Project, New York Times, 56-57.

Yalom, I. D. (2002). The gift of therapy: An open letter to a new generation of therapistsand their patients. New York: HarperCollins.

For Continued Reading and Listening: 

The 1619 Project is an ongoing initiative from The New York Times Magazine that began in August 2019, the 400th anniversary of the beginning of American slavery. It aims to reframe the country’s history by placing the consequences of slavery and the contributions of black Americans at the very center of our national narrative.

Fergus, E. (2017). Confronting colorblindness, Phi Delta Kappan. https://kappanonline.org/confronting-colorblindness/