Addressing Racism-Related Stress and Trauma in Psychotherapy

A new article published in the journal Psychotherapy explores a psychotherapeutic approach entitled Keeping Radical Healing in Mind – a strength-based, culturally relevant, and racially responsive approach to treatment for Black, Indigenous, and People of Color (BIPOC).

Led by Hector Adames at The Chicago School of Professional Psychology, the authors utilize a clinical case example and model how providers can implement antiracist and liberatory approaches to psychotherapy by using the Psychology of Radical Healing (PRH) – a new theoretical framework that considers the cultural and systemic mental health concerns of BIPOC from a collectivist standpoint.

Abundant evidence shows how racism and race-related stress adversely impact the health and well-being of BIPOC, including anxiety symptoms, reduction in personal self-worth and life satisfaction, hopelessness and stress, and physical ailments such as obesity and vascular disease. Given this knowledge, the need for therapists to address the role of racism on the health of BIPOC has become increasingly discussed within the profession.

Racism can be defined as the system of structuring opportunity based on the belief that one race is superior to another. It is designed to exhaust and harm the well-being of Communities of Color. It can manifest through institutional racism, cultural racism, interpersonal racism, as well as internalized racism, which can be defined as “the individual inculcation of the racist stereotypes, values, images, and ideologies perpetuated by the White dominant society about one’s racial group, leading to feelings of self-doubt, disgust, and disrespect for one’s race and/or oneself.”

Healing, a central goal within psychotherapy, requires deconstructing how professional training and ideas of healing have been grounded in a Eurocentric understanding of human behavior. There has been ample evidence showing how psychology and psychiatry have systemically upheld racism, which has only recently been acknowledged. Both fields have been criticized for locating problems within individuals (i.e., pathology) that often stem from broader systems of oppression and social determinants.

BIPOC scholars and therapists have long advocated for the need to develop psychotherapeutic approaches designed to address the impact of racism on people’s lives and have foregrounded methods developed by and for BIPOC communities. Examples include the Treating Racist-Incident Based Trauma approach, the Ethnopolitical Approach, Intersectionality in Psychotherapy, and Community Healing and Resistance Through Storytelling.

Building upon these works, The Psychology of Radical Healing (PRH) integrates liberation psychology, Ethnopolitical Psychology, Black Psychology, and Intersectionality Theory as foundational theories for the framework. The founders of PRH, psychologists Bryana French, Jioni Lewis, and Della Mosley, discuss how this framework fosters a sense of hope and possibilities for the future. They write:

The PRH is grounded in five anchors, including (a) Critical Consciousness, described as a person’s capability to critically reflect and act upon their sociopolitical conditions; (b) Cultural Authenticity and Self-Knowledge, which honors cultural wisdom and self-definition; (c) Radical Hope and Envisioning Possibilities to improve the collective human existence; (d) Collectivism and belonging to one’s culture for validation, joy, and healing; and (e) Strength and Resistance to create joy-filled lives despite awareness of racism and oppression.

Keeping Radical Healing in Mind: A Therapeutic Approach

Much research has been done on the empirical support for psychotherapy and the actions of effective therapists, including providing an acceptable and flexible etiology of the client’s distress, developing a treatment plan, not avoiding complex and challenging content in therapy, being aware of the client’s demographics and context, and the importance of the therapeutic alliance.

While these foundational concepts are essential, most psychotherapy research fails to explicitly center on healing from the wounds of racial oppression, which can be linked back to the earlier point of Eurocentric underpinnings of the profession and conceptualization of what and who psychotherapy was made for. The authors write:

Keeping Radical Healing in Mind requires a therapeutic stance of curiosity, unassuming openness, and responsiveness to the interlocking ways BIPOC clients are oppressed – a more effective practice than simply matching therapists and clients by shared racial/ethnic identity. It goes beyond multicultural competence. The authors provide an image of how this cycle is used, and it can be analogous to a compass – helping a BIPOC client navigate living in White supremacy culture by resisting self-blame for racism and forms of oppression directed at them and their ethnic-racial group. It also supports the client in internalizing, developing, and nurturing the five anchors of PRH.

The Case of Brenda

The authors provide a clinical exchange from a two-year working alliance with a client, Brenda, demonstrating how providers can keep radical healing in mind.

Brenda is a 32-year-old cisgender, heterosexual, African American woman. She lives with her mother and has a 6-year-old son. Her reason for seeking treatment was primarily due to increased anxiety that worsened during the COVID-19 pandemic. Her symptoms included feeling on edge, difficulties with concentration, loss of appetite, difficulty sleeping, and gastrointestinal issues.

The authors provide an overview of various exchanges between the therapist and Brenda, including how she has been experiencing the news and her son’s questions about police brutality. A valid concern of Brenda’s, as research shows that repeated exposure to online traumatic events such as police killings of Black people are related to youth experiencing depression and posttraumatic stress disorder (PTSD).

Keeping Radical Healing in Mind models how client and therapist become curious together and co-develop a shared account of the presenting problem. To foster critical consciousness, the therapist validates and connects (a) what Brenda is discussing in session to what is taking place in society and (b) how oppression can be a source of distress for both her and her son.

This conceptualization connects the ways in which Brenda’s concerns stem from racism-related stress and allows the therapist to observe the psychological toll of racism on Brenda to provide emotional support by recognizing how her lived experience and the sociopolitical environment impact her life. In addition, by being attuned to Brenda’s indirect description of her collectivistic worldview through her statement, “I am not the only one who has to worry about their child’s safety,” the therapist has an opportunity to become curious about ways for Brenda to collectively heal.

In their clinical exchange, it was healing for Brenda to be reminded of how her mother raised her and maintained a sense of hope in the face of oppression. This gave way to helping Brenda develop Cultural Authenticity and Self-Knowledge. Thus, Radical Hope and Envisioning Possibilities were also an essential component of Brenda’s healing because she could begin to imagine future possibilities for her Black son to live in a more socially just world and live a joy-filled life, and in doing so, participate in community healing. Ultimately, the exchange provided in the article focused primarily on helping Brenda internalize, develop, and nurture five anchors of the approach.

In summarizing her case, the authors write:

In closing, the authors highlight how PRH is viewed as cyclical, ongoing, and co-constructed between therapists and their BIPOC clients. Therefore, it is essential that therapists themselves develop critical consciousness and critically reflect and act upon their sociopolitical conditions before assisting their clients in increasing their critical consciousness.

This approach requires clinicians to know the history and have an understanding of the client’s culture, develop a deep understanding of what their ascribed race means to them and what it represents in a White supremacist culture, and lastly, recognize how power and oppression operate in society as well as within clinical settings.

 

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Adames, H. Y., Chavez-Dueñas, N. Y., Lewis, J. A., Neville, H. A., French, B. H., Chen, G. A., & Mosley, D. V. (2022, March 10). Radical healing in psychotherapy: Addressing the wounds of racism-related stress and trauma. Psychotherapy. Advance online publication. http://dx.doi.org/10.1037/pst0000435 (Link)