Psychotherapists Should Acknowledge the Black Experience

In 2003, the Institute of Medicine (now the National Academy of Medicine) released a ground-breaking report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The report demonstrated the staggering inequities in both health and mental health services, regardless of insurance coverage. Regrettably, 20 years on, it doesn’t appear that there have been any meaningful changes.

This article takes a brief look at the observations of Black mental health professionals with specific reference to psychotherapy among Black individuals. In 2004 and 2005, I conducted 10 interviews with Black psychiatrists and psychologists (nine participants were US-based and one was UK-based). Their reflections about the state of Black therapy services are (sadly) still very relevant today.

The Diagnosis of Black Individuals

The overall consensus among interviewees was that in Western societies, the diagnosis of Black mental health concerns is based on the White experience and does not recognize the racialized stressors affecting Black clients, resulting in frequent diagnostic errors. As one psychologist pointed out, the diagnosis of Black patients is based on “the conceptual and experiential framework of European and European American cultural reality.” Another respondent stated that when the mental health symptoms of Black patients are interpreted using a Eurocentric framework, “culturally acceptable experiences may be interpreted as paranoia.”

Anti-Racist Therapy

In general, the interviewees noted that much of mainstream therapy is irrelevant when it comes to helping Black clients since it ignores the societal context of Black mental health. In the words of one psychologist:

“I have not found any one traditional therapy relevant for Black clients. I have taken bits and pieces from Euro-American therapies and added a considerable amount of cultural knowledge and understanding to enable proper engagement with my Black clients.”

Another practitioner stated that therapy for Black people needs to address not just the problems of the Black individual but also the pathology in society that must be navigated by that individual:

“In a society that is essentially racist, in addition to dealing with the psychopathology of the individual of African descent, one must also deal with the sociopathy or sickness of the society.”

A third participant noted the lack of meaningful progress in providing relevant therapy to Black clients:

“Individual Black psychologists have written scholarly books on theory. Very few of the writings have been ‘translated’ into treatment plans.”

Alas, little has changed since these observations were made. In the Journal of Mental Health Counseling (2022), Drs. Janeé Steele and Charmeka Newton point out that while racism-related issues are significant psychological stressors among African Americans, it is difficult to treat such issues due to the lack of a suitable conceptual framework in mainstream psychology. This view is mirrored in The Lancet (2020) by Dr. Jude Mary Cénat, an Associate Professor at the University of Ottawa. Cénat notes that while guidelines have been developed by psychiatry and psychology associations to provide anti-racist mental health care, there are a lack of tangible solutions.

Should Black Therapists Treat Black Clients?

The general agreement among the study participants was that it is preferable for Black clinicians to treat Black clients due to their shared experience in being part of a marginalized minority group. This shared experience provides the clinician with a natural understanding of the kinds of situational obstacles that Black people must navigate. Similarly, the Black client is likely to feel more comfortable discussing problems with a therapist who has at least some insight into the reality of their day-to-day experiences. One psychologist put it like this:

“Racism and White supremacy (anti-Blackness) are so deeply ingrained in the American psyche that it is totally unreasonable, if not utterly impossible, to conceive of a White and Non-Black therapist as not directly or symbolically conveying such (racism and White supremacy/anti-Blackness) messages in the so-called therapeutic interaction (which I might add is ‘always’ injurious to the Black client). The conscious motives or intentions (or other personal qualities) of the therapist is not at issue here.”

At the same time, most of the respondents indicated that ethnic matching of clients and clinicians was not possible given the lack of Black psychiatrists and psychologists relative to their proportion of the population. Others noted the assimilationist, “white-oriented” attitudes of some Black clinicians, arguing that such individuals may not be any more helpful to Black individuals than White clinicians. One psychiatrist made the following observations:

“Some Black folk try to be more White than White folk, some Black folk are so over-identified with Black folk, they lose their objectivity and are of less help, some Black folk are in a position to understand the impact of racism without losing perspective.”

Over several decades, there has been a plethora of academic work that demonstrates the impact of racial discrimination on the mental health of Black people. Studies have been conducted; reports have been generated; and a multitude of policy recommendations have been made.

Furthermore, in 2020, following the murder of George Floyd, there was a “racial reckoning” in the US, with many in leadership positions making public statements regarding their commitment to tackle racial inequities. Despite all of this, in 2023, there has been no significant progress in making psychotherapy relevant for Black clients. Similar to many other policy issues affecting Black communities, these inequities are well-documented; there is more than enough evidence of deep-seated injustices. Thus, moving forward, the focus must be on real, meaningful, tangible change.

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