Tag Archives: race

Black mental health matters

By Lindsey Phillips July 27, 2020

Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weaponization of Whiteness and privilege. Disparities in education and health care. The horrible and senseless killings of Black people throughout our nation’s history and into the present day.

How do daily acts of racial violence, injustice and discrimination affect the mental health of Black Americans? What is it like to work and live beside people who don’t value you as a human being? What is it like to live in a country where your rights are frequently threatened?

Dominique Hammonds, an assistant professor and testing coordinator in the Department of Human Development and Psychological Counseling at Appalachian State University, provides a quick glimpse into the complexities of being a Black woman and counselor in a racist society. Hammonds, wearing a shirt that read “Black and Educated,” was shopping in Walmart recently when a White woman passed by her and casually said, “You’re disgusting.” In that moment, Hammonds felt powerless. She feared the consequences of saying or doing anything in response.

Hammonds left the store and shortly thereafter went into a counseling session where her client recounted feeling powerless, angry and upset because of injustices they were experiencing in their life. Hammonds had to compartmentalize her own feelings of powerlessness to help the client.

Counselors play an important role in helping Black Americans cope with and heal from racial stress and trauma, but they can do more. Namely, they can also take steps toward changing an unjust and racist system that powerfully and negatively affects the mental health of Black Americans.

A distrust of mental health

Research indicates that Black Americans are 20% more likely to report serious psychological distress than are White Americans, yet they are less likely to use mental health services.

Loni Crumb and Janeé Avent Harris, who are both assistant professors of counselor education at East Carolina University (ECU), examined, along with two of their colleagues, the negative perceptions of mental illness and treatment among Black Americans. They found that stigma, a lack of trust in mental health care and a mislabeling of Black people’s presenting concerns make this group more apprehensive to seek counseling. Financial constraints and a lack of access to culturally responsive mental health care are additional barriers, explains Crumb, a research and innovation associate with the Rural Education Institute in the College of Education at ECU. (See their article “African Americans’ perceptions of mental illness and preferences for treatment” in the Journal of Counselor Practice for a more detailed discussion of their findings.)

This distrust is not unfounded. Black Americans have been misdiagnosed and overdiagnosed with schizophrenia for decades, for example. (For more, read “The historical roots of racial disparities in the mental health system” by Tahmi Perzichilli at CT Online.)

Angie D. Cartwright, an associate professor of counseling at the University of North Texas (UNT), stresses the importance of looking at how and why the mistrust of mental health began in the Black community. “Institutional and systemic racism is the foundation of a lot of our medical treatments, including mental health counseling,” Cartwright says. “And, historically, when [Black people] invite others into [their] homes and communities, then problems happen.”

Sitting with discomfort

Counselors, not clients, should be the first to broach issues of racism. This isn’t necessarily easy or comfortable.

Counselors often conflate comfort and safety, but they are two different things, insists Cartwright, a licensed professional counselor and licensed sex offender treatment provider who is the clinical director and owner of North Texas Counseling and Wellness.

As she explains, being comfortable enough to broach the topic does not mean the topic itself will be comfortable. “It’s not comfortable to say, ‘I was discriminated against,’ ‘I had a gun pulled on me’ or ‘I was fired because my boss is racist,’” she continues. “There are some conversations we will always feel some discomfort talking about. And that’s OK.” But clients should feel safe enough to share their experiences — ones that will often be uncomfortable for counselors to hear, she adds.

“You have to get comfortable with being uncomfortable,” says Hammonds, a licensed clinical mental health counselor (LCMHC) in North Carolina. “Part of the [counseling] skill set is learning how to have these discussions in a way that feels comfortable.” For example, can counselors say the word Black, acknowledge their own ethnic identities or discuss racism knowledgeably? If not, then clients know they won’t be able to go beyond a surface-level discussion with them, Hammonds explains.

What counselors say doesn’t even have to be overly complicated, notes Hammonds, an American Counseling Association member. They can simply say, “I just want to check in. There’s a lot going on around us right now. What’s that been like for you?” or “I’m curious how you as a Black American might be affected by racial violence and oppression.”

Being open and brave about this topic will likely result in some missteps. That’s part of the process, says Hammonds, who encourages counselors to use those mistakes as opportunities to learn.

One misstep may be getting defensive when clients express anger, distrust or sadness about their experiences. “If you find yourself getting defensive — trying to explain away the client’s experiences or identifying with client experiences and feeling like you have to apologize … on behalf of the system — don’t,” Hammonds says. “All you’re doing [in getting defensive] is communicating to the client that you’re still not comfortable and haven’t done your own personal work around this.” And apologizing just puts clients in a position where they feel obligated to say, “Oh, it’s OK,” she adds.

Instead, she advises counselors to reflect on their own internal experience and to tune in to what might be prompting that response. Perhaps it’s a case of the counselor wanting to protect their own ego, or maybe they are masking their own discomfort or lack of knowledge. If counselors find themselves becoming defensive in session, they can tell the client, “I feel like I’m reacting to something right now, and I recognize that I need to do some self-reflection. But I don’t want to heap that on you.” But do this briefly, Hammonds says, or else the session becomes about the counselor rather than the client.

Building trust and rapport also becomes critical to creating a sense of safety for these clients. Too often, counselors jump to diagnosis and treatment because the mental health system encourages them to have a solid plan and work toward a goal fairly early in treatment, Hammonds points out. She encourages counselors to slow down and first invest time in establishing good relationships with their Black clients.

Context matters

As Avent Harris, an ACA member, points out, counselors won’t be aware of needing to broach the topic of racism unless they understand its historical and political context. Put simply, they have to know what to look for and ask about.

“You don’t learn this context or gain this cultural awareness by just reading the DSM [Diagnostic and Statistical Manual of Mental Disorders],” says Avent Harris, who specializes in multicultural considerations in counselor education and the role of spirituality in Black mental health help-seeking behaviors. She advises counselors to move beyond reading only counseling texts to explore the works of Black scholars, theologians and authors.

Counselors may also need to adjust a technique or approach to better fit with their clients’ experiences. For example, the thought of going for a run in the evening sounds straightforward, but for many Black people, and Black men in particular, it can evoke a sense of fear. They question whether they will be safe or if their choice to run could cost them their life.

If a client brings this fear up in session, it could be dangerous for the counselor to use a thought-stopping technique, with the aim of interrupting, removing and replacing the client’s “problematic thoughts,” Hammonds explains. Suggesting that the client simply stop thinking that running could harm them ignores their experiences and the existence of the racism embedded in society, she says.

Instead, Hammonds, president-elect of the North Carolina Counseling Association, says the counselor should consider the context around the client’s fear of running alone at night. Where does that fear come from? How does society contribute to or perpetuate this client’s fear and anxiety?

“Those are the types of discussions that we need to be making space for,” she says.

Self-awareness and honesty about biases

Hammonds stresses the importance of counselors reflecting — honestly — on their own experiences and biases. As she points out, counselors often like to think, “I took this multicultural course, or I’ve worked with clients from diverse backgrounds, so I’m doing OK.” But it may not mean that at all, she emphasizes.

This self-awareness starts with counselor training. Working with diverse clients is the best way to learn to appreciate differences and to examine one’s own biases and beliefs, says Crumb, an LCMHC in North Carolina.

This diversity should also extend to counselors’ consultation groups. Avent Harris, an LCMHC associate in North Carolina, looks for colleagues who will provide honest feedback and challenge her own thoughts and beliefs. She says that if she has an uncomfortable moment in session, these colleagues would ask, “So, what made you uncomfortable in that moment? What questions do you need to ask yourself to reflect on that moment?” They wouldn’t just echo her thoughts or tell her “not to worry about it,” Avent Harris says.

Hammonds recommends that counselors continue to record and watch themselves in session just as they did during graduate school and supervision. “There’s so much value in replaying your words and listening from that outsider’s perspective,” she says. The process affords counselors a chance to (re)consider their words, think about the purpose of their statements or actions, and evaluate whether they really listened to and heard their clients.

Counselors should also get their own counselor. “Some of this stuff is deep-rooted. It takes time to dig up those roots, to understand them, to untangle them and to repot them,” Cartwright says.

She jokes that her mother always told her, “Never trust a beautician with bad hair.” This same principle applies to counselors, she says. They have to make sure they take care of their own mental health before working with clients on their well-being. “And clients will be able to tell if you … have done your work,” she adds.

Cartwright, the project director for UNT Classic (a program that addresses disparities in mental health services for Black and Hispanic populations in the Dallas-Fort Worth metro areas) and UNT ICBH Project (a program that supports graduate students during clinical training), suggests that her colleagues, especially those who hold identities associated with privilege, work with a counselor who identifies with a marginalized group or with intersections with which the privileged colleague struggles.

They should also intentionally put themselves in a position in which they are the minority, continues Cartwright, a member of the ACA Advocacy Task Force and president of the International Association of Addictions and Offender Counselors, a division of ACA. For example, she suggests that White counselors attend a Black church one Sunday. “If you are uncomfortable for that short time that you’re there, imagine what your Black clients feel like on a daily basis when they are constantly in spaces dominated by White people,” she observes.   

Finding voice and value

Black clients report to counseling with the same common presenting concerns that other clients have. But in addition, Hammonds says, they often seek counseling because of issues of “voice and value.” They have experiences that either minimize their voice or communicate — overtly or covertly — that their ideas, opinions and problems don’t matter or don’t matter as much as those of others, she explains. Feeling undervalued, dismissed and unheard can lead to anxiety, depression and other mental health issues, she adds.

Cartwright specializes in underserved populations in counseling and counselor education, mentorship in counselor education, and offender and addictions counseling issues. She once worked with a client who was experiencing racism and discrimination at her job. The former client was the only Black woman on a large corporate team, and she noticed that meeting times would suddenly change without anyone alerting her. She also got the sense that her co-workers were talking about her behind her back. At first, she internalized this discrimination and started thinking that she must be bad at her job. She felt like an impostor.

But after another colleague confirmed the woman’s suspicions of racial discrimination, the former client filed a lawsuit and won. The win came at a cost, however. She learned that co-workers had purposely changed meeting times without letting her know. Other colleagues whom she had thought were well-intentioned had made racist and hurtful remarks about her that were uncovered during the lawsuit and investigation.

As a result, the client began to question her judgment and worth. Cartwright helped the client learn to feel valued and trust herself again. They worked on challenging the client’s thoughts that she wasn’t good enough. For instance, they used self-affirming techniques such as daily affirmations and “I” statements that allowed the client to identify and acknowledge her strength and resilience.

Even if counselors can’t relate to being discriminated against at work, they probably can identify with feeling like their voice hasn’t been heard, Hammonds says. With that perspective, counselors can take intentional steps to empower these clients in session.

For example, Black clients often feel like they can’t or shouldn’t tell counselors if they didn’t like the way the counselor phrased something or if a moment in session made them uncomfortable, Hammonds notes. But they should be made to feel comfortable voicing those thoughts, she continues, and it’s up to counselors to create a space that invites that feedback.

Hidden struggles

A May 31 article in the Washington Post reporting on protests in the wake of the killing of George Floyd described a less visible impact of racial violence: “the private weariness and anguish felt by many [B]lack people in the country.” In other words, many Black people are exhausted.

Emotional exhaustion is another reason that Black individuals often seek counseling, Hammonds says. Besides being fatigued from the discrimination and injustices that they experience daily, they often find it necessary to code-switch — changing the way they talk and express themselves when they are outside of their homes and Black communities.

To help explain this concept, Hammonds uses the analogy of counseling professionals switching their “hats” or roles. They may go from teaching to supervision to having a counseling session with a client and back to teaching again, all in the same day, which can be taxing.

“Switching roles, having to constantly pause and reconsider how much you can share and what is your role in this new context, and always being aware of what you can and can’t say and what you can and can’t do is exhausting,” Hammonds says. “And that’s an emotional labor that many White Americans aren’t required to do.”

Black women often face an extra burden. As Avent Harris explains, “Black women are expected both inside and outside their community to not be vulnerable, to not share emotions and to carry the weight of everything on their shoulders.”

This unrealistic expectation can take a toll on mental health. In fact, many of Cartwright’s clients struggle with the “Black superwoman syndrome” — the myth that Black women are impermeable. They feel pressure to do it all and to do it well. Although this isn’t really a syndrome, it does help explain the chronic stress these women endure while trying to juggle multiple roles and keep up with the daily demands placed on them by family, work and community.

Cartwright’s clients often discuss feeling misunderstood at work and how co-workers minimize their experiences. Cartwright normalizes these experiences for her clients, but she also expresses how sad it is that this is their “normal.”

The trauma of racial violence

Instances of brutality and violence against Black people are not new, and neither are the racial disparities that regularly confront them. The main difference today is the ability to easily document such instances, says Hammonds, whose research interests include technology in counseling, multicultural counseling and community determinants of mental health. Almost everyone today has a smartphone in their pockets, and more people are using them to record acts of race-based violence and to demand justice and accountability.

These videos also continually expose others to these traumatic and heinous acts. This can be particularly traumatizing for Black people, who often internalize the traumas they witness because they know it could have easily happened to them, Hammonds says.

The disparaging comments on social media can also be traumatizing and triggering for Black Americans, Crumb adds. For instance, they may read a racist comment made by a supervisor or colleague. Then they have to return to work and sit beside that person, knowing how that person really feels about them.

“And so often, [Black people] are expected to move through the world, to hear all this, to see all this, and have no emotional reaction or response,” Avent Harris says. Counselors can help change this by validating clients’ emotional reactions to racial violence and discriminatory remarks, she adds. This involves letting them know that it’s OK to feel disappointed, sad, angry, scared, anxious or whatever else they are feeling.

The trauma of being exposed to racial violence and remarks also has a collective effect. “Collective trauma is exposure to stressful events that threatened a sense of safety on a group level,” Hammonds explains.

On a recent episode of The Thoughtful Counselor podcast, Hammonds described how repeated exposure to racial violence and discrimination operates like a wound that won’t heal: “That spot’s been nicked so many times. We can go about the process of healing, but before you know it, there is another nick. Then you’re walking around doing your best to cope, shielding that spot, anticipating situations that might nick you again. … You are always on edge. You’re withdrawing. Your trust is slow to build in other people and situations. You feel angry and sad. And you start to think, ‘Is there something wrong with me? Why can’t I get out of this cycle?’”

This collective trauma correlates with symptoms of depression and posttraumatic stress disorder such as avoidance, reexperiencing, numbing and hyperarousal, she adds.

If a community experiences stress together, then counseling approaches that draw on the power of relationships are helpful, Hammonds says. These approaches include relational therapies, psychodrama, drama therapies, creative approaches and group therapy.

Hammonds often incorporates music into her sessions with clients. She describes music as being akin to a picture book because it connects people to a certain memory, place, emotion or experience in their life.

When clients can’t easily describe their thoughts, feelings or perceptions in their own words, she asks them to think of a song that best captures their emotions or that represents what they see around them. She then pulls up the song and plays it in session, asking the client, “What is powerful about this song? How do the lyrics or beat affect you?”

Impacts on Black children

In the summer of 2016, Philando Castile was fatally shot in his car by a Minnesota police officer during a traffic stop. Castile wasn’t alone. His girlfriend, Diamond Reynolds, and her 4-year-old daughter witnessed the entire incident.

After the shooting, Reynolds, who was now in handcuffs, was understandably distraught and emotional. Her daughter tried to comfort her, exclaiming, “Mom, please stop saying cusses and screaming ’cause I don’t want you to get shooted.” A few minutes later, the girl said, “I wish this town was safer. … I don’t want it to be like this anymore.”

The girl’s words illustrate how racism and racial violence affect children even at a young age. “Black youth are just as affected as their Black parents are by systemic racism and injustices,” says Crumb, an ACA member whose research interests include rural and school-based mental health services. Black children are affected directly and indirectly. They witness racial violence and discrimination themselves, and they hear adults talking about it at the kitchen table. “Then, they assume these thoughts, these fears … [and] this distrust,” Crumb adds.

Again, counselors should take the initiative to broach the topic of racism with these youth. Crumbs calls it “taking the temperature of the room” because counselors can check in to see how children are doing. For example, a counselor could say, “This has been a tough summer with COVID-19 and a lot of people getting harmed and dying. How are you feeling?”

Then counselors should let the children guide the conversations, Crumb says. Some may verbalize their feelings. Others may use play or draw a picture to express their emotions.

Crumb points out that school settings are often the only access that some Black communities have to counselors. But because of mistrust and fear, they may not view counselors and schools as “safe spaces.” Crumb advises counselors to be mindful of current and historical racial inequities within school systems and to alter their approaches accordingly in attempting to connect with these children.

Younger children may not have the vocabulary to easily communicate their feelings. They often “speak” through play and toys. So, Cartwright recommends that counselors keep an assortment of toys, dolls and activities that will allow children to communicate in the way in which they feel most comfortable. If they want to use a brown doll, counselors should make sure it is available to them, she adds.

But as Reynold’s 4-year-old daughter demonstrated, some Black children possess an early awareness of racism and a vocabulary to discuss it. They often have little choice. Black children will be exposed to inequities earlier than their White peers because of their parents’ lived experiences and the conversations they overhear, Avent Harris explains.

Crumb encourages counselors, especially school-based counselors, to be courageous in advocating for Black youth. Black youth are often overlooked academically and are disproportionately suspended, she says. Counselors can be vocal in questioning why that is the reality. Likewise, if diagnoses of attention deficit/hyperactivity disorder and conduct disorders are disproportionate toward one ethnicity, counselors can ask questions and press for answers.

More than that, counselors can do something about such disparities. For example, they can lead professional development trainings for teachers, Crumb says.

Partnering with the Black community

Black people may rely on informal networks of support such as family, friends and their church communities when it comes to issues having to do with their mental health, Crumb says. She add that counselors should encourage clients to continue using these supportive networks because it is imperative that they have trusted individuals to whom they can turn to discuss their experiences of race-based trauma.

Counselors should also reach out and form relationships with stakeholders in Black communities. Crumb and Avent Harris recommend partnering with community organizers, historically Black Greek-letter organizations, those involved with the juvenile justice system, law enforcement personnel and faith leaders.

Faith leaders are often both spiritual and political leaders in the Black community, Avent Harris says, so collaboration with them is crucial. “A lot of times, how [Black Americans] conceptualize events, crises, pain and suffering is coming from [their] spiritual beliefs systems,” she adds.

In an article written for CT Online after the 2015 church shooting in Charleston, South Carolina, that took the lives of nine Black people, Avent Harris suggested that counselors could meet with Black pastors and offer to speak in their Sunday morning services, co-sponsor a mental health day or provide referral resources.

Counselors should also think of these partnerships as a preventive measure. Counselors need to be invested and involved with Black communities before crises happen, Avent Harris stresses. She challenges her colleagues to name five contacts they have a working relationship with in the Black community and could reach out to immediately. If they can’t name five, she says, then they have some work to do.

Less talk, more action

The words diversity and inclusion have steadily gained prominence in the counseling profession, but Avent Harris believes this has allowed counselors to largely become complacent and not move past thinking of “change” as simply including and hiring diverse individuals.

“It’s not just diversity and inclusion. It’s how we’re doing equity work, how we are doing anti-racism work,” she emphasizes. “What are our actions behind the words that we say? And do our actions align with what we say and who we say we are as a profession?”

Avent Harris, like many other Black people, is exhausted from having the same conversation over and over again about what the Black experience is like. “It’s time to move beyond that talk and really implement action,” she says.

Taking action doesn’t mean that all counselors have to hit the streets and protest, but they can commit to influencing the spaces they are in, Crumb says. Maybe that’s writing an article. Maybe that’s offering a training. Maybe it’s working to inform policy. Maybe it involves working toward making positive change in their communities or within themselves.

Cartwright also suggests one small step counselors could take that would have a huge impact: making their services more accessible to communities of color by offering one pro bono slot a week or having a sliding scale.

Although 2020 hasn’t been the year we wanted, it may be the one we need. Every day, we hear the global rallying cry, “Black Lives Matter.” Behind that cry are Black people who are suffering and dying because of systemic racism. We hear the refrain: Trayvon Martin, Tamir Rice, Eric Garner, Philando Castile, Charleena Lyles, Atatiana Jefferson, Breonna Taylor, Ahmaud Arbery, George Floyd, Tony McDade, Rayshard Brooks, and countless others who have died.

These are the tragic killings that make the news. But how many others die daily without drawing widespread attention? How many more face daily injustices or discrimination?

Yes, their lives matter. And their mental health does too.

 

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On June 22, the ACA Governing Council issued a statement on anti-racism. As this article was being written, ACA leadership was listening to a cross section of members and volunteers to develop an action plan that would give life to the statement. For more, see tinyurl.com/ACAAntiRacism.

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Lindsey Phillips is a contributing writer to Counseling Today and a UX content strategist. Contact her at hello@lindseynphillips.com or through her website at lindseynphillips.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

A quest for identity and connection

By Laurie Meyers June 25, 2020

“In some ways, the ‘one-drop rule’ still exists in the minds of society,” says Derrick Paladino, a licensed mental health counselor and professor of counseling at Rollins College in Winter Park, Florida. “I will always be brown to others, and not white and Puerto Rican, upon first look. Along with that comes people’s immediate perceptions of me based solely on phenotype.”

American society’s understanding of race and ethnicity is still based primarily on skin color. Although cultural identity is composed of myriad factors such as shared tradition, language, religion and familial connections, for people who come from varied ethnicities and diverse communities, racism too often resides in the foreground.

The unbearable whiteness of being

“I really hated being brown, as it was not seen as positive in my youth in that community,” says Paladino, who grew up in a predominantly white neighborhood in Connecticut. At a young age, he began adding a special prayer to his nightly Hail Marys and Our Fathers.

“I asked God if I could be white like my dad [who was Italian American] when I woke up in the morning,” recalls Paladino, an American Counseling Association member who helped develop the Competencies for Counseling the Multiracial Population as part of ACA’s Multiracial/Ethnic Counseling Concerns Interest Network. “Each morning, I would walk into our hallway and look at this wooden, ornate — fake gold — mirror and stare with disappointment. I have a picture of that mirror, and it is a reminder of that struggle.”

From a young age, Paladino also received a “brown is bad” message from his paternal grandfather, an unrepentant racist who disapproved of the marriage of Paladino’s parents and was hostile and disrespectful to his mother, who was Puerto Rican. When Paladino was born, his grandfather asked his mother “if the baby was black,” Paladino says.

“I also always felt like my grandfather favored my brother because he had light skin,” Paladino adds.

Paladino’s mother also managed to convey a “brown is bad” message by making him wear an undershirt whenever he went to the public pool so that he “wouldn’t get so dark.”

Paladino believes his mother probably downplayed his heritage as a person of color because she thought it would protect him, but the approach instead contributed to his self-stigmatization. Paladino’s parents never talked to him about being biracial and how that might affect the way others in the community viewed him.

Colorism is also a problem within the Latinx community. Being of European descent is still prized, despite the reality that most Latinx people are multiracial, says ACA member Carlos P. Hipolito-Delgado, an associate professor of counseling at the University of Colorado Denver who researches the ethnic identity development of Chicanas/os and Latinas/os and the effects of internalized racism on students of color.

Those in the community who are of Afro-Latinx descent experience the most stigma — often considered too dark to be Latinx but not African enough to be African American, Hipolito-Delgado explains. “They have nowhere to turn, no cultural support,” he says.

Sometimes belonging isn’t about color and the perception of race but other cultural signifiers. As an undergraduate, Paladino attended the University of Florida, where he at last encountered numerous fellow students who looked like he did. He enthusiastically joined a Latino student group on campus, only to find out that because he didn’t speak Spanish or have specific shared experiences, he was “not Latino enough.”

That experience — of being part of different worlds but not quite belonging in either — is not uncommon for individuals with biracial and multiracial backgrounds. After all, we still live in a society that largely equates identity with placing a check mark in one of a few racial “boxes.” Multiracial people are often relegated to “other” in such instances, but rather than choosing to shade squares, they are creating their own categories out of the cultural elements with which they resonate.

Pieces of the cultural mosaic

Hipolito-Delgado recommends that individuals with multiracial backgrounds learn as much about their culture and history as they can. “Think about what is meaningful to you and speaks to you, not what the media says,” he asserts. He explains that in his time as a college professor, he has seen many first-generation or immigrant Africans seize upon a stereotypical image of what it means to be African American, including dressing like rappers and listening exclusively to hip-hop, even when those weren’t things they particularly enjoyed. “It wasn’t necessarily a piece of them,” he says.

Hipolito-Delgado urges multiracial individuals to go and experience pieces and parts of their heritage to find what feels authentic to them. “Don’t feel like you need to do X, Y or Z,” he says. “Start by looking back at your family. … What is your story? What is your experience? What spoke to you?” 

“Ask yourself what has affirmed me so far and made me feel happy. Like when my mom makes tamales at Christmas,” Hipolito-Delgado says. He notes that his mother recently threatened to skip making tamales this year, but a united family rebellion — centered on the necessity of a significant, shared cultural experience — quashed that notion.

Hipolito-Delgado acknowledges that the search can be difficult, and it can help for biracial and multiracial individuals to have a guide. However, this may require showing up at a community group meeting where acceptance is not readily given. A first visit might be met by stares and people saying that the individual doesn’t belong there, but Hipolito-Delgado urges those who genuinely want to learn about that piece of their culture to keep trying. By the third or fourth time, the group’s members will typically realize that the individual is authentic. Being greeted initially with hostility can be disconcerting, but it is also understandable. As Hipolito-Delgado explains, people of color often have a legitimate fear of the outsider based on a long history of people coming in and appropriating their traditions.

Paladino sought community through social groups and individual friends but says his sense of cultural identity didn’t really begin to solidify until he was in his master’s program, also at the University of Florida. That’s when, through his multicultural counseling class, he started gaining a deeper understanding of the meaning and experience of being biracial.

In college, Paladino’s sense of self shifted, as is true for most students of all backgrounds. “I have found that community is very important for college students and in my personal life,” he says. “In some ways, our sense of self is connected to who we decide to surround ourselves with. College students run in many social circles — mini-communities — and depending on their level of perceived connection, they will fall within a continuum of feeling completely connected to feeling completely alienated. … Students experience a strong sense of self when they can be fully congruent and genuine in other spaces, thus not shifting who they are in order to feel connected.”

For many people with multiracial backgrounds, this is hard to achieve during the college years and throughout life in general, Paladino says. Struggling with one’s identity can create a feeling of balancing on a fence between worlds — an act that requires significant energy, he says.

When that feeling of not belonging runs deep and lasts a long time, it can have a profound effect on a person’s mental health, eliciting symptoms of depression and anxiety, low-self-esteem, low self-efficacy and harmful coping mechanisms, Paladino explains. In other words, “It’s not good to be siloed from society,” he says.

However, Paladino cautions counselors not to assume that all clients with multiracial backgrounds need or want to talk about their racial, cultural and ethnic identities in counseling. “Counselors would be wise to notice it on the intake and ask if the client sees that as a part of their work. If the client says no, then we should honor and respect that,” he says. “It may eventually become part of therapy, as identity usually is at some level, but we don’t push that. Looking back on the history surrounding anti-miscegenation, the limitations of the census, the one-drop rule, and the continuation of parts of society disapproving of interracial unions, much power and voice have been taken away from this population. The last thing a counselor wants to do is continue this.” 

Paladino urges counselors to educate themselves about the multiracial population by reading personal histories, reviewing both ACA’s Competencies for Counseling the Multiracial Population and the Multicultural and Social Justice Counseling Competencies (see counseling.org/knowledge-center/competencies), and learning more about multiracial and interracial organizations.

“There is a lot of information out there, and it continues to increase,” he says. “If you are working in college counseling, check to see if there is a student cultural organization that matches what the student would like in a community. If the client wants to work on discovering their identity, having them interview family they feel safe with or researching the population on their own can be very helpful.”

Paladino emphasizes that the issues the multiracial population struggles with can be as diverse as the people themselves. Although there is no one-size-fits-all approach for working with multiracial clients, he recommends some tools that may assist in their exploration of identity, including:

  • Using an ecological framework such as an ecomap
  • Providing psychoeducation
  • Using bibliotherapy
  • Introducing Maria P. P. Root’s “A Bill of Rights for Racially Mixed People”
  • Guiding a free expression of emotions attached to lived experiences

Paladino encourages counselors to enable clients to identify in whatever way they desire — e.g., by only one race, culture or ethnicity; as biracial, multiracial or mixed race; as multiple heritage, multiethnic, bicultural, hapa or mestizo — by including the full range of choices on intake forms.

“Don’t expect them to want to write it under ‘other,’” he emphasizes. After all, too many of these clients have been “othered” their entire lives.

Counseling multiracial couples

Melody Li is a licensed marriage and family therapist from Austin, Texas, whose practice specialties include counseling multiracial couples. Her approach is centered on social justice and creating a place to understand the oppression that has made it harder for clients to thrive individually and as a couple. Li believes this is essential for helping to establish client confidence and trust in the therapeutic relationship, but it is also a practical necessity because life doesn’t happen in a vacuum.

For example, the coronavirus pandemic is disproportionately affecting people of color, Li notes. Asian communities are experiencing violence, immigrant businesses are being lost, one or two family members are trying to support extended family and friend communities, and the deaths of brown and black people are being swept under the rug, she emphasizes. If one partner in a couple minimizes the other’s racial struggles or how their family is handling the crisis, this can leave that partner feeling isolated and alone in their grief.

What is particularly difficult about the pandemic is the way it has disrupted everything, putting plans and goals on hold (if not derailing them permanently) and leaving many things outside of people’s control, Li says. In addition, there is a systemic pattern in which marginalized communities often get hit first and hardest when disasters strike.

In collectivist cultures, the response to individual tragedy is shared by the community, Li points out. Some of the couples she counsels are currently trying to get pregnant or have recently endured miscarriages while simultaneously providing financial support to multiple family members who have lost their jobs or businesses and access to health care. “They [the couples] are going through disappointment and grief. Having that added [sense of responsibility] is hard, heavy,” Li explains. “Without that understanding of collectivism, [one partner] might say, ‘Why is this on you? We’re all having problems.’”

But for the other partner, collectivism is a part of their cultural and personal strength. So, Li will work together with the couple to come to an understanding and, ultimately, a compromise. She guides the partner making the request through the steps of nonviolent communication: Make an observation, state how the observed situation is making them feel, state what they need to address the emotional reaction, and make a request.

For example, the partner might say, “When my family asks for support and you describe them as overbearing or too demanding, it makes me feel small and misunderstood. I feel like you don’t understand my culture and our strengths, and I need that validation from you. Would you be willing to learn more about our family dynamics and what that closeness is about?”

The other partner may acknowledge and respect the tradition behind the request but still have concerns. So, that partner might say, “I understand and want to help you honor your desire to do all that you can to support your family, but I feel that taking on the responsibility for everyone’s needs will be emotionally and financially overwhelming. Is there a way that we can provide some of the needed resources and perhaps help locate other sources of assistance?”

Ramadan also occurred recently and, as was the case with other religious observances such as Passover and Easter, the performing of traditional rituals was challenging under quarantine conditions. As Li observes, “One partner might say, ‘What is the big deal about fasting and having to see family right now? We are in crisis. … This is not a big deal. Why don’t you just skip it this year?’”

Li notes that such minimization on the part of one member of a multiracial couple is hurtful to the other. She would help the partner develop a more respectful message, such as, “I know this is important to you and your people and family. I understand the significance, and I want to incorporate as much [tradition] as possible. How do we minimize risk while honoring the rituals?”

Transracial adoption

“Adoption is really complicated. It’s not a win-win situation,” says Amanda Baden, an ACA member who specializes in working with transracial adoptees and their families. “Adoptions have gains and losses; you don’t just get one without the other.”

These dynamics can be particularly fraught in transracial adoptions, which makes it especially important that adoptive parents not hold what Baden calls “antiquated notions of adoption,” such as the chosen child or rescue narrative. “The chosen child narrative ignores that to be chosen, they [children] have to be released,” she says. Some adoptive parents from Western countries may also view international adoption as a “rescue,” without considering the child’s loss of ethnic or biological ties.

Baden, a counseling psychologist who is herself a transracial adoptee, is not condemning such adoptions. However, she says, it becomes problematic when families don’t see the need to expose these children to their birth culture. Some families also fail to consider how the rest of the world perceives their transracial child.

Baden, whose practice is in New York City, sees a lot of adopted children and adolescents who struggle with being Asian but feeling white, although the world clearly does not view them that way. The adoption is obvious — an Asian child with two white parents — so these kids often get asked questions such as, “Who is your real mom?” Baden says. When the family goes out to places such as restaurants, the transracial child may inadvertently not be seated because they aren’t immediately recognized as belonging, particularly if they have a white sibling. Adoptive families often minimize these incidents, which creates tension, Baden says. 

As transracial children grow older and become more aware of how their experiences diverge from those of their adoptive families, they start to realize that, yes, they are a person of color, and this is something their parents have never really understood, Baden says. That is part of why having a connection to their birth culture can be so important, she adds. Adoptive parents want to believe that if they love their children and give them everything they need, that should be enough — but they have never experienced racism themselves, Baden explains. 

Baden was adopted before there was much awareness of the importance of establishing a connection to a transracial adoptee’s birth culture, but she says her parents did make an effort. “In my high school of approximately 550 students, I think there were three Asian kids, including me. … My parents tried to make friends, but there were not many Asian people [in their area],” she says. “We did talk about race, which was one of the best things they did.” Baden says her parents never tried to pretend that she wasn’t experiencing racism and never told her that she just had to “deal with it.” In addition, they always reassured her that the incidents were not her fault.

Ultimately, Baden says, her parents could have moved to a more integrated neighborhood, which is what she mentions to parents who are interested in adopting transracial children.

Baden also tells parents to begin talking to their children from the start about racism and how to handle it so they will be prepared the first time they encounter it. “Parents want to believe it is not going to happen, but it is,” she says. “Talk about racism not being about them [the child]; it’s about the other person.”

In fact, Baden advises parents of transracial adoptees to get really comfortable talking about race. This is something that many white parents can struggle to do without personalizing it or feeling attacked.

“A lot of people think racism is just about violence, but it is a system,” Baden says, noting that policies can be racist. It’s not that everyone who is white is racist but rather that the system benefits whiteness, Baden continues. One way of explaining systemic racism to children might be to say that sometimes groups of people in charge will treat them differently because of the way they look. However, this happens not because there is something wrong with them (the children), but because the people in charge think it’s OK to not treat everyone fairly.

“One of the things I really worry about is that because it [transracial adoption] has become more common, the bar has maybe been lowered for parents,” Baden says. Many adoptive parents want to think of themselves as being colorblind and assume the majority of the world will be that way too. She advises parents to not even think about adopting a child from a race they know nothing about, and if they already have, she strongly suggests they go out and meet others from their child’s birth culture. 

“What am I supposed to do?” clients ask Baden. “Go to a black church and say, ‘Hi, my name is so and so, I want to be your friend?’”

“Yes,” Baden responds. “That’s what you are asking your kid to do every day.”

Baden also works with adult transracial adoptees who are deciding how they would like to connect with their birth culture. Some people want to immerse themselves, whereas others just want to gain a little bit of knowledge. She encourages people to connect with adoptee groups.

Baden also helps clients learn more about the different aspects of their birth culture, with an emphasis on how family structures and expectations are often very different. Adoptees also need to consider how their experiences growing up in the white world set them apart from those who were raised in their birth culture. “There’s an assumption that certain cultural values are universal, and they’re not,” Baden says.

 

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Additional resources

To learn more about the topics discussed in this article, take advantage of the following select resources offered by the American Counseling Association:

Counseling Today (ct.counseling.org)

Books (counseling.org/publications/bookstore)

  • Counseling for Multiculturalism and Social Justice: Integration, Theory, and Application, Fourth Edition, by Manivong J. Ratts and Paul B. Pedersen
  • Multicultural Issues in Counseling: New Approaches to Diversity, Fifth Edition, edited by Courtland C. Lee
  • Culturally Responsive Counseling With Latinas/os by Patricia Arredondo, Maritza Gallardo-Cooper, Edward A. Delgado-Romero and Angela L. Zapata

Continuing Professional Development: Multicultural (aca.digitellinc.com/aca/specialties/158/view)

  • “Addressing Clients’ Experiences of Racism: A Model for Clinical Practice” with Scott Schaefle and Krista M. Malott
  • “Counseling Refugees: Addressing Trauma, Stress and Resilience” with Rachael D. Goodman
  • “Multicultural Counseling With Immigrant and Refugee Communities” with Vivian V. Lee and Courtland C. Lee
  • “Affirmative Intakes: Creating Intentional, Inclusive Forms to Retain Diverse Clients” with Shannon M. Skaistis, Jennifer M. Cook, Dhanya Nair and Sydney C. Borden

Counseling competencies (counseling.org/knowledge-center/competencies)

  • Competencies for Counseling the Multiracial Population
  • Multicultural and Social Justice Counseling Competencies

Association for Multicultural Counseling and Development (multiculturalcounselingdevelopment.org)

 

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Laurie Meyers is a senior writer for Counseling Today. Contact her at lmeyers@counseling.org.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The historical roots of racial disparities in the mental health system

By Tahmi Perzichilli May 7, 2020

Racial disparities, or unfair differences, within the system of mental health are well documented. Research indicates that compared with people who are white, black, indigenous and people of color (BIPOC) are:

  • Less likely to have access to mental health services
  • Less likely to seek out services
  • Less likely to receive needed care
  • More likely to receive poor quality of care
  • More likely to end services prematurely

Regarding racial disparities in misdiagnosis, black men, for example, are overdiagnosed with schizophrenia (four times more likely than white men to be diagnosed), while underdiagnosed with posttraumatic stress disorder and mood disorders. Additionally, concerns are compounded by the fact that for BIPOC, mental health care is often provided in prisons, which infers a multitude of issues.

BIPOC are overrepresented in the criminal justice system, as the system overlays race with criminality. Statistics show that over 50% of those incarcerated have mental health concerns. This suggests that rather than receiving treatment for mental illness, BIPOC end up incarcerated because of their symptoms. In jails and prisons, the standard of care for mental health treatment is generally low, and prison practices themselves are often traumatic.

The vast majority of mental health treatment providers in the United States are white. For example, approximately 86% of psychologists are white, and less than 2% of American Psychological Association members are African American. Some research has demonstrated that provider bias and stereotyping are relevant factors in health disparities. For nearly four decades, the mental health field has been called to focus on increasing cultural competency training, which has focused on the examination of provider attitudes/beliefs and increasing cultural awareness, knowledge and skills.

Despite such efforts, racial disparities still exist even after controlling for factors such as income, insurance status, age, and symptom presentation.Established barriers for BIPOC are the following:

  • Different cultural perceptions about mental illness, help-seeking behaviors and well-being
  • Racism and discrimination
  • Greater vulnerability to being uninsured, access barriers, and communication barriers
  • Fear and mistrust of treatment

In addition to emphasizing culturally competent services, other recommendations to bridging the gaps and addressing barriers have largely focused on diversifying workforces and reducing stigma of mental illness in communities of color.

One area not often noted is the historical (and traumatic) context of systemic racism within the institution of mental health, although it is well known that race and insanity share a long and troubled past. This focus may begin to account for how racial differences shape treatment encounters, or a lack thereof, even when barriers are controlled for and the explicit races of the provider and client are not at issue.

Historical context

In the United States, scientific racism was used to justify slavery to appease the moral opposition to the Atlantic slave trade. Black men were described as having “primitive psychological organization,” making them “uniquely fitted for bondage.”

Benjamin Rush, often referred to as the “father of American psychiatry” and a signer of the Declaration of Independence, described “Negroes as suffering from an affliction called Negritude.” This “disorder” was thought to be a mild form of leprosy in which the only cure was to become white. Ironically Rush was a leading mental health reformer and co-founder of the first anti-slavery society in America. Rush did observe, however, that “the Africans become insane, we are told, in some instances, soon after they enter upon the toils of perpetual slavery in the West Indies.”

In 1851, prominent American physician Samuel Cartwright defined “drapetomania” as a treatable mental illness that caused black slaves to flee captivity. He stated that the disorder was a consequence of slave masters who “made themselves too familiar with the slaves, treating them as equals.” Cartwright used the Bible as support for his position, stating that slaves needed to be kept in a submissive state and treated like children to both prevent and cure them from running away. Treatment included “whipping the devil out of them” as a preventative measure if the warning sign of “sulky and dissatisfied without cause” was present. Remedy included the removal of big toes to make running a physical impossibility.

Cartwright also described “dysaethesia aethiopica,” an alleged mental illness that was the proposed cause of laziness, “rascality” and “disrespect for the master’s property” among slaves. Cartwright claimed that the disorder was characterized by symptoms of lesions or insensitivity of the skin and “so great a hebetude [mental dullness or lethargy] of the intellectual faculties, as to be like a person half asleep.” Undoubtedly, whipping was prescribed as treatment. Furthermore, according to Cartwright dysaethesia aethiopica was more prevalent among “free negroes.”

The claim that those who were free suffered mental illness at higher rates than those who were enslaved was not unique to Cartwright. The U.S. census made the same claim, and this was used as a political weapon against abolitionists, although the claim was found to be based on flawed statistics.

Even at the turn of the 20th century, leading academic psychiatrists claimed that “negroes” were “psychologically unfit” for freedom. And as late as 1914, drapetomania was listed in the Practical Medical Dictionary.

Furthermore, after slavery was abolished, Southern states embraced the criminal justice system as a means of racial control. “Black codes” led to the imprisonment of unprecedented numbers of black men, women and children, who were returned to slavery-like conditions through forced labor and convict leasing that lasted well into the 20th century.

Scientific racism early on indicates motives of control and containment for profitability. Leading health professionals propagated the idea that blacks were “less than” to justify exploitation and experimentation. The mislabeling of behavior, such as escaping slavery, as a byproduct of mental illness did not stop there. Significant transformations in defining mental illness also occurred in the civil rights era, suggesting that institutional racism becomes more powerful in the context of moments of heightened racial tensions in the collective social consciousness.

Prior to the civil rights movement, schizophrenia was described as a largely white, docile and generally harmless condition. Mainstream magazines from the 1920s to the 1950s connected schizophrenia to neurosis and, as a result, attached the term to middle-class housewives.

Assumptions about the race, gender and temperament of schizophrenia changed beginning in the 1960s. The American public and the scientific community began to increasingly describe schizophrenia as a violent social disease, even as psychiatry took its first steps toward defining schizophrenia as a disorder of biological brain function. Growing numbers of research articles asserted that the disorder manifested by rage, volatility and aggression, and was a condition that afflicted “Negro men.” The cause of urban violence was now due to “brain dysfunction,” and the use of psychosurgery to prevent outbreaks of violence was recommended by leading neuroscientists.

Researchers further conflated the symptoms of black individuals with perceived schizophrenia of civil rights protests. In a 1968 article in the esteemed Archives of General Psychiatry, schizophrenia was described as a “protest psychosis” in which black men developed “hostile and aggressive feelings” and “delusional anti-whiteness” after listening to or aligning with activist groups such as Black Power, the Black Panthers or the Nation of Islam. The authors wrote that psychiatric treatment was required because symptoms threatened black men’s own sanity as well as the social order of white America.

Advertisements for new pharmacological treatments for schizophrenia in the 1960s and 1970s reflected similar themes. An ad for the antipsychotic Haldol depicted angry black men with clenched fists in urban scenes with the headline: “Assaultive and belligerent?” At the same time, mainstream white media was describing schizophrenia as a condition of angry black masculinity or warning of crazed black schizophrenic killers on the loose. A category of paranoid schizophrenia for black males was created, while casting women, neurotics and other nonthreatening individuals into other expanded categories of mood disorders.

The black psyche was increasingly portrayed as unwell, immoral and inherently criminal. This helped justify the need for police brutality in the civil rights movement, Jim Crow laws, and mass incarceration in prisons and psychiatric hospitals, which at times was an exceedingly thin line. In general, attempts to rehabilitate took a back seat to structural attempts to control. Some state hospitals, presided over by white male superintendents, employed unlicensed doctors to administer massive amounts of electroshock and chemical “therapies,” and put patients to work in the fields. Deplorable conditions went unchallenged as late as 1969 in some states.

Deinstitutionalization, a government policy of closing state psychiatric hospitals and instead funding community mental health centers, began in 1955. Over the next four decades, most state hospitals were closed, discharging those with mental illness and permanently reducing the availability of long-term inpatient care facilities. Currently, there are more than three times as many people with serious mental illnesses in jails and prisons than in hospitals. The shifts in defining what constitutes mental health reflects the reality that the definition is shaped by social, political and, ultimately, institutional factors in addition to chemical or biological ones.

Conclusion

Looking at the historical and systemic context of the mental health system may provide insight into why racial disparities continue to exist and why these disparities have been resistant to interventions such as cultural competency training and standardized diagnostic tools. Focusing primarily on the race of the provider and the client, while valid, is an approach that does not consider the system itself, the functions of the diagnosis, and its structurally developed links to protest, resistance, racism and other associations that work against the therapeutic connection.

Racial concerns, including overt racism at times, were written into the mental health system in ways that are invisible to us now. Understanding the past enables new ways of addressing current implications and identified barriers, including how schizophrenia became a “black disease,” why prisons emerged where hospitals once stood, and how racial disparities continue to exist in the mental health system today.

 

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Additional resources

 

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Tahmi Perzichilli is a licensed professional clinical counselor and licensed alcohol and drug counselor working as a psychotherapist in private practice in Minneapolis. Contact her through her website at www.tahmiperzichilli.com.

 

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

The psychosocial impact of COVID-19 on Asian Americans: Counselor interventions and considerations

By Adrianne L. Johnson April 27, 2020

April is Counseling Awareness Month, and every year, counselors dedicate efforts to promoting our profession through evaluation of service delivery, community promotion, and increased legislative advocacy efforts. This year, counselors are faced with an unprecedented challenge: to promote mental health while transitioning to telehealth session delivery, modeling physical distancing while closing cultural mental health gaps, and connecting clients with services from their own homes.

This is a critical time in our profession’s history, and we are needed now more than ever. Treatment is now largely shifting to a triage approach as counselors move to the front lines in psychosocial stabilization amid fear, isolation, anger, anxiety and depression.

One population being alarmingly affected is the Asian American population. The novel coronavirus global pandemic has observably spurred a stark increase in violent attacks on people of Asian descent. Xenophobic racism against Asian Americans has surged as the coronavirus sweeps the U.S., with reports of hate crimes averaging approximately 100 per day, according to Rep. Judy Chu (D-Calif.).

Counselors are now called upon to address the concerns of this population in our practice. Knowing the multicultural considerations of this population, and prioritizing culturally sensitive treatment approaches, has become an essential service now and for the foreseeable future.

Counselor advocacy

Through advocacy, we are able to influence the creation and delivery of transformative initiatives and programs that offer immediate and long-standing benefits to our clients. For example, we may lobby legislators to implement targeted mental health screening of at-risk populations, including clients with prior mental health diagnoses. The psychosocial needs and responses of Asian populations will be unique, and interventions should be trauma-focused, including components of building social support and community resources.

Address terminology: On March 20, the U.S. Commission on Civil Rights voted to issue a statement expressing “grave concern” regarding “growing anti-Asian racism and xenophobia” related to the coronavirus pandemic. The commission suggested that using terminology such as “Chinese coronavirus,” “Wuhan flu” and “Yellow Peril” was fueling xenophobic animosity toward Asian-Americans. Using racially based language to describe a pandemic attaches ethnicity to a viral outbreak and contributes to the instigation of race-based assaults.

We have an ethical obligation as counselors to redirect the language of our colleagues and to address this language with our clients as our approaches and frameworks allow. Using proper, professional terminology for this pandemic and directly addressing defamatory language with clients can expand a culturally humble dialogue and allow clients to explore their fears and anxieties in the safety of our offices.

Offer trainings: We may also use our expertise to offer site training in trauma and crisis response to help educate the public and health care workers about how best to deal with the immense pressure and anxiety of Asian American families. This may help minimize the detrimental psychosocial response in these times of crisis.

The American Counseling Association has compiled a comprehensive database of trauma resources and continuing education opportunities for counselors. ACA states that “disasters tend to stress emotional, cognitive, behavioral, physiological, and religious/spiritual beliefs.” Among the tools provides are external trauma and disaster resources, disaster mental health resources, sheltering-in-place resources, and trauma-related articles from Counseling Today. The database also offers information on resiliency, grief, and helping survivors manage skills and healing.

Educating our colleagues on the disaster impact and recovery model has particularly relevant and important applications at this time. This model incorporates several phases of assessment and identification of trauma stages preceding anticipated grief.

Client interventions

Asian Americans are experiencing exhaustion from elevated fears of harm beyond microaggressions outside of the home. Stress-based responses to dramatic environmental changes often lead to a dissolution of coping skills that previously have served as protective factors for Asian American clients.

As global attention is largely focused on the active physical treatment and recovery of patients on a medical level, the cultural considerations of specific populations have largely been left unaddressed. Many symptoms of post-trauma will not present for several months. Until then, we can rely only on our knowledge of disaster models to meet the needs of these clients.

Currently, our focus should be on intervention and prevention through building resiliency, developing community support, and encouraging social connectivity during physical distancing. Consider the following suggestions:

  • Encourage individuals of Asian descent to reach out to one another through social media and other technologies to share experiences and feelings related to these fears and exposure to aggressive acts. It would be helpful to suggest joining an Asian American online community or advocacy organization to build feelings of self-agency and empowerment.
  • Introduce mindfulness. When our clients notice sensations in their bodies such as a tightening in the chest or quickened heart rate, the observation of these feelings can build insight into the triggers. This helps clients develop awareness and a heightened sense of mind-body connection. Introduce mindfulness activities such as breathing, body mapping, and concentration to help clients focus on emotional balance. When in public, clients are more likely to access rapid-action options when they are calm, instead of habitually relying on immediate defensive or avoidant impulses.
  • Directly address symptoms related to depression, anxiety and hypervigilance. Discussing these symptoms and suggesting evidence-based practices to aid in restoring rituals, connecting with family and friends, and incorporating spirituality may offer critical tools to prevent symptom-related impairment.
  • Prompt clients to lean into literature, such as Grace Lee Boggs, Maxine Hong Kingston and Thich Nhat Hanh. Understanding how others of Asian descent have persevered through pain and difficulty is emboldening in a time of isolation and disenfranchisement.
  • Be ready to discuss and disseminate resources on financial help, vocational disruption or academic distress, and maintenance of a cohesive family environment. Have handouts and weblinks prepared, phone numbers for emergency help and response, and community locations that will aid clients if they are in active crisis and cannot reach authorities or hospital treatment centers in their areas. As this public health crisis escalates, it is critical that Asian American clients have multiple resources on which they can rely for a sense of needed safety and security. 

Suicide prevention

The potential for suicide cannot be overlooked in this vulnerable, targeted population. Suicide screening should be done early and often. In Asian American clients, warning signs of suicidal ideation are often ignored because of stereotypes associated with Asian ethnicity. Counselors should approach the issue from a culturally informed perspective and consider intergenerational influences, pressures of perfection, collectivistic values, and the attributed image of being a “model minority.” The pressure of cultural expectations is elevated in times of severe stress and trauma exposure, and counselors should be direct when assessing risk factors, protective factors and treatment options.

According to the U.S. Department of Health and Human Services Office of Minority Health:

  • Asian American females in grades 9-12 are 20% more likely to attempt suicide compared with non-Hispanic white female students.
  • Southeast Asian refugees are at risk for posttraumatic stress disorder (PTSD) associated with trauma experienced before and after immigration to the U.S. One study found that 70% of Southeast Asian refugees receiving mental health care were diagnosed with PTSD.

The American Psychological Association offers additional data:

  • Suicide is the second-leading cause of death for Asian Americans ages 15-34, which is consistent with the national data across all racial/ethnic groups (the second-leading cause for those 15 to 24 years old and the third-leading cause for those 25-34).
  • Among all Asian-Americans, those ages 20-24 have the highest suicide rate (12.44 per 100,000).
  • Among females from all racial backgrounds between the ages of 65 and 84, Asian Americans have the highest suicide rate.

Counselors should remember the importance of confidentiality and informed consent as a delicate balance between rapport and mandated reporting. Two tools to consider using in suicide screening are the Collaborative Assessment and Management of Suicidality model and the Suicide Intervention Response Inventory−2.

Other counselor considerations

Compassion fatigue. Effectively managing our own emotional responses to trauma has been a focus of training and continuing education for professional counselors. As of today, the majority of counselors have transitioned to providing online telebehavioralhealth services to their regular caseloads and have taken on additional responsibilities in their communities, including providing crisis intervention for individuals whose exposure to sudden violence has superseded their ability to cope effectively.

This presents unique challenges for counselors who are experiencing multiple pressures to fulfill additional responsibilities for decompensating clients and new referrals. It is not uncommon for counselors to feel physical, emotional and psychological fatigue daily due to our deep concern for the safety and well-being of our Asian American clients during the current circumstances. Dennis Portney (2011) described compassion fatigue as “burnout plus the accumulation of stress resulting from empathizing with clients over time.” Compassion fatigue may appear suddenly and feel pervasive, interfering with normally ascribed self-care routines. To combat compassion fatigue, counselors need to affirm for themselves that commitment, not perfectionism, is the key to maintaining energy during this time.

Self-care. Counselors should consider the work they do as essential, necessary and sacred. And we cannot minimize, trivialize or dismiss our own emotional trauma-based reactions through overidentification and countertransference. We should commit to honor ourselves and our mental health, just as we do with our Asian American clients, and monitor our investment in their care within this framework. As our resilience wears down, we may see our usual compartmentalization skills regress into exhaustion, anxiety, impaired sleep, and reduced investment in client care.

Another important application of self-care is diligently reminding ourselves to practice what we preach. We need to apply our prescribed coping skills to our own daily routine during this time. Yoga, breathing techniques, visualization, and staying connected with positive, supportive groups builds our resiliency and reminds us of Irving Yalom’s key principle of universality. The incorporation of coping skills that Asian cultures embrace are applicable to our own lives and will ease our own trauma-based reactivity during this time.

Promoting posttraumatic growth for ourselves and our clients In the Counseling Today article “The transformative power of trauma” (2012), Lea Flowers and Gerard Lawson suggest that positive psychological change experienced as the result of a struggle with highly challenging life circumstances can lead to personal transformation as a by-product of the traumatic experience itself.

Focusing on the client’s growth, and not just the circumstances of xenophobically based violence, can help Asian American clients deliberately build a repository of demonstrated strengths and skills to help them reframe their experiences. These reframes will shape their reactions to future traumatic events and build emotional, psychological and mental resilience.

In the words of Lawson, “This is right in our wheelhouse as counselors. What are the strengths that this person continues to demonstrate despite their traumatic experience? We need to be deliberate about highlighting those for our clients.”

And ourselves as counselor.

 

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Adrianne L. Johnson is a licensed professional clinical counselor supervisor and an associate professor at Wright State University in Dayton, Ohio. She is the past president (2018-2019) of the Ohio Counseling Association and the executive editor of the Journal of Counselor Practice. Contact her at adriannejohnson@gmail.com.

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Opinions expressed and statements made in articles appearing on CT Online should not be assumed to represent the opinions of the editors or policies of the American Counseling Association.

Five points of discussion for conversations about racial injustice

By Amanda L. Giordano April 10, 2019

When teaching multicultural counseling courses, I often get questions from White students about how they can leverage their White privilege to help change America’s broken social system that privileges some while oppressing others. In addition to continuing to explore their own White racial identities, I encourage these students to initiate conversations with other White people in their lives about racial injustice. As more White individuals become aware of their White privilege and the racial injustice that exists in our country, greater degrees of systemic change are possible.

Counselors and counselors-in-training are uniquely equipped to facilitate these discussions, given their strong interpersonal skills and passion for advocacy. The goal of the conversation is to invite White individuals to engage in a dialogue about systemic privilege and oppression rather than become defensive. In an effort to assist White individuals who desire to initiate conversations with other White people about racial injustice, this article provides five possible points of discussion.

 

1) What characteristics do we attribute to race? Since the start of this country, we have fallen prey to an insidious scheme based on faulty logic: attributing characteristics and behaviors to race that have no rational correlation. We do it so frequently and so automatically that it often goes unrecognized. For example, if a Latino contractor does not complete his work satisfactorily, we are tempted to conclude, “Latino contractors cannot be trusted.” We erroneously attribute personal work ethic to race. Or, if we are cut off in traffic by a Black woman, we somehow link her behavior to the fact that she is Black rather than to an isolated driving decision.

When we pause and reflect on what characteristics and behaviors we attribute to race, we may be surprised by what we find. Logically, we know that skin color, eye shape and hair texture have no correlation with an individual’s morality, intelligence or trustworthiness — yet we have been socialized to make these associations. This is something that we need to unlearn.

Consider what would happen if someone watched a documentary about Charles Manson and concluded that he was a cult leader because he was White. We likely would explain that Manson’s role as a cult leader was the result of myriad factors (psychological state, early childhood experiences, environment, etc.) and that his behavior cannot be attributed to his race. In the same way, we need to examine the correlations we make between a person’s race and her or his personal characteristics or behaviors. How logical are these attributions? 

2) Do we desire people of color to “act White”? Many White people are genuinely trying to learn how to be culturally competent, but sometimes they can get stuck in a particular mentality: “I enjoy diversity … just as long as people of color act/talk/think in ways that I am familiar with.” Whether intentionally or unintentionally, we may encourage people of color to deemphasize their unique cultural identities to fit into the mold of White cultural norms. As a result, many people of color expend a lot of energy working to make White people feel comfortable around them (such as expressing only certain aspects of themselves while in the company of White individuals).

What is the cause of our desire for people of color to “act White”? It’s likely that we feel more at ease with what is familiar to us. There is a certain way of being that we deem “normal,” and it makes us comfortable when people behave accordingly. Therefore, the desire for people of color to “act White” is for our comfort.

Sadly, we rarely consider the discomfort that people of color face as they navigate White cultural norms every day. Often, their culturally diverse ways of being are not reflected back by those around them. As a result, people of color are forced to learn all the nuances of White cultural norms, whereas White individuals know very little about the cultural norms of other racial/ethnic groups.

What would it be like to let go of the strong grasp we have on our own cultural preferences and enter into the preferences of others (despite the unfamiliarity)? “Different” doesn’t have to be synonymous with “negative”; different can be exciting, invigorating, enlightening. Can we create space for all people to be proud of their cultural identities and to express those identities in whatever ways they choose?

3) Do we acknowledge that multiple interpretations exist for past and current events? Education is an amazing gift, and the opportunity to learn is something we should never take for granted or outgrow. At the same time, we must acknowledge that the stories we’ve read and the accounts we’ve learned in school represent one perspective, one side of the story. Authors of textbooks and class curricula write from their own frames of reference — they are not neutral, blank slates who simply report the facts. These authors make interpretations, derive meaning and present information from their personal lenses. It is important to consider that authors from different cultural backgrounds may have different interpretations, derive different meanings and present information differently, simply due to their frame of reference.

Consider an example from history: the Pueblo Revolt of 1680. Depending on the perspective of the storyteller, this could have been a brutal uprising against the Spanish who were dedicated to bettering the community (Spanish as protagonists) or a liberating revolt in which oppressed Pueblo Native Americans took back the land that was rightfully theirs (Native Americans as protagonists). There are always multiple perspectives to every event, and it is important for us to consider differing viewpoints. Can we concede that what we think we know is only one perspective and that multiple, equally valid viewpoints exist?

4) Does defensiveness keep us from truly listening to people of color? It is important to consider what comes up for us when we hear people of color share their experiences of oppression. If our initial response is defensiveness, it is likely that our focus in that moment is off. Rather than focusing on the lived experience of the speaker, we are focused on what the information says about us. We are not attending to the oppression of our neighbors and how they feel; instead, we are attending to the impact of the information on our own sense of self.

One strategy that can help us maintain the proper focus is to listen with the goal of understanding rather than evaluating. Often when we listen, we are evaluating what we have just heard (Is this information right or wrong? Do I agree or disagree? What does this mean about me?) and simultaneously developing responses and counterpoints in our head. This process keeps the focus on us — our reactions, our beliefs and our assessment — and gets in the way of truly listening. There certainly are times when evaluation in conversation is necessary, but when people of color are sharing their experiences of oppression, it is more helpful to listen with the intent to understand, not to evaluate.

If we feel ourselves becoming defensive, we should do a quick mental check-in: “Am I evaluating what is being said and focusing on what it means about me?” If so, perhaps we should press pause and mentally switch our focus back to the speaker (“What was that like for her? How did she feel when it happened? How did this experience affect her life?”). When a person of color shares her or his experience, can we truly listen with the goal of understanding rather than evaluating?

5) We could do nothing about racial injustice, but do we want to? If we are honest, we all know that something is wrong with our social system. It is clear that people are treated differently as a result of their race. Consider two high school students (one White and one Black) who get caught with marijuana. Sadly, it is more likely that one of these students will be sent home with a warning (to a family who will “get him back on track”), while the other will be ushered into the criminal justice system. Or consider two identically qualified job applicants — one with the last name Jones and the other with the last name Hussain — who submit their résumés for an open position. Again, it is likely that one will get the interview because he seems like a “better fit,” whereas the other will stay on the job market.

We know, just by looking at the world around us, that inequity exists and that things are unjust. We also know that we can go our whole lives without saying or doing anything about it. We can choose to live in silent disapproval and never challenge the status quo, but is that what we want? Saying and doing nothing despite evidence of racial injustice likely means that we are living in opposition to our values (e.g., equality, justice, respect for the innate worth of all human beings), which can lead to incongruence and cognitive dissonance.

Also, if we allow our unjust system to continue, we likely will never experience the true joy that comes from living in a diverse community and celebrating cultural differences. We will not have the opportunity to see the world from different perspectives or to feel the excitement of experiencing new cultural norms. We may never form deep, meaningful relationships with those from different racial/ethnic backgrounds or experience the gifts that come only through diverse friendships. If we remain silent, we may be living life, but are we living it to its fullest? Those with privilege have a responsibility to leverage their unearned advantages to combat injustice and oppression. What does that look like for us personally?

There are many more talking points to consider, but these might help start conversations with White people in our spheres of influence. Let’s remember that as counselors, we have a unique set of interpersonal skills that can be extremely useful when facilitating conversations about racial injustice. We are primed to listen well, validate, and gently present alterative viewpoints. Perhaps we can all commit to using our skills to facilitate meaningful dialogue that could lead to lasting, systemic change.

 

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Amanda L. Giordano is an assistant professor in the Department of Counseling and Human Development Services at the University of Georgia. Her research interests include addictions counseling, multiculturalism, and religious and spiritual issues in counseling. She is a licensed professional counselor and national certified counselor. Contact her at amanda.giordano@uga.edu.

 

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