Tag Archives: Multiculturalism & Diversity

Multiculturalism & Diversity

Racial bias in gifted and talented programs

By Scott Sleek September 26, 2023

Flaws in testing and racial biases among teachers and school counselors are some of the reasons many Black boys are left out of advanced learning programs and misdirected into special education, according to the article “Inequitable representation of Black boys in gifted and talented education, Advanced Placement, and special education” published in the October issue of the Journal of Multicultural Counseling and Development (JMCD). The report is part of a special issue of the journal, “Understanding the Black Male Experience: Recommendations for Clinical, Community, and School Settings,” guest edited by Isaac Burt, Erik M. Hines and James L. Moore III.

Donna Y. Ford

In the article, Donna Y. Ford, a distinguished professor of education and human ecology at Ohio State University (OSU), and her colleagues describe why teachers too rarely refer Black boys to gifted and talented education programs and too often send them to special education. Educators often develop erroneous and harmful perceptions of Black boys as lazy, unruly and apathetic, the authors note. Furthermore, tests often lack cultural context for Black students and favor those who excel at pen-and-paper exams rather than oral expression, they say.

James L. Moore III

The co-authors include Moore, distinguished professor of urban education and inaugural executive director of the Todd Anthony Bell National Resource Center on the African American Male at OSU; Tanya J. Middleton, a clinical assistant professor of counselor education at OSU; and Hines, a professor of counseling at George Mason University.

Counseling Today recently spoke with Ford and Moore about their JMCD article and the issue of racial bias in academic placement. (This interview has been edited for clarity and length.)

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**What motivated you to write this JMCD article?**

Ford: In 2023, racism is still a problem, anti-Blackness is a problem, inequity is pervasive, and underrepresentation of Black boys in gifted and talented programs is a problem. I grew up believing in the United Negro College Fund, whose mantra is: “A mind is a terrible thing to waste.” In the article, we also talk about how a mind is a terrible thing to erase. And that’s why we want more Black boys in gifted and talented education, getting the services they deserve and need.

Moore: It was an opportunity to integrate the gifted education literature with the multicultural counseling literature. These combinations are not very common in the counseling literature.

Generally speaking, Black young men and boys occupy a distinctive space in American society. Too often this group is seen as a part of a group rather than the individual. There are inescapable experiences, regardless of whether your family comes from an affluent community or from humble beginnings. You can look in any school district in America, and Black men will be grossly underrepresented in gifted and talented programs or advanced academic programs. But they will be overrepresented in special education.

Ford: Black boys make up 9% of our school students, and they make up only 3.5% of students in gifted and talented education. So they are the most underrepresented of any group. We need to keep highlighting this fact, not just to teachers but to school counselors as well. When students are disengaged because they’re not challenged, then they become an underachiever, and it contributes to this overwhelming achievement gap.

What are the most critical points that you would like people to take away from the article?

Ford: We must address test bias and use alternative methods of testing, evaluating and assessing Black boys. In this article, for example, we talk about nonverbal measures and nonverbal subscales.

We must also stop placing our Black boys in special education because when you get services that you don’t need, there’s nothing special about special education. It is imperative that educators be careful and avoid racial bias when placing Black children in special education programs.

And then finally, culture matters and representation matters. We need to be culturally responsive and antiracist, and we need more minoritized professionals in our schools.

Moore: Broadly speaking, we need schools that adapt to students, rather than forcing students to adapt to schools. One of the things that we’ve written extensively about is deficit thinking and how it often becomes self-fulfilling. When a student has perceptions that the teacher doesn’t believe in their academic ability, it tends to have negative effects on their educational outcomes. It’s important that teachers communicate accurately and recognize that some communication styles convey to some students that they’re incapable.

Another issue is representation. When Black students enter gifted programs, they frequently opt out or want to get out of these advanced academic programs because there isn’t representation that is reflective of their experience or of people who look like them. In turn, they are sometimes asked to speak on subject matters that may be viewed as speaking on behalf of the group, and we know that creates anxiety, which then impacts performance.

What role do counselors play in working toward solutions for these issues?

Moore: School counselors play a critical role in students taking advanced academic courses. If the counselor only sees deficits, it will play out in how they consult and collaborate with teachers in helping students make decisions, or in how they make recommendations for the students to enter certain academic courses. So, it’s important that school counselors interrogate any deficit thinking that they may have about an individual. And sometimes the deficit thinking might be who their parents are or where they live. And we make broad assumptions. Fundamentally, I believe that great minds come from every ZIP code.

The other way counselors can help is with social, personal issues. Often, when students leave their comfort zone — and that might be friends or representation of their racial group or gender — and they enter a domain where there’s no one to draw inference from, it creates anxiety. So school counselors can help provide social emotional support. They may also need to help the student’s parents understand the significance of advanced academic curriculum and what the benefits are.

What are some problems associated with the current way we test for advanced academic programs?

Ford: Tests are biased, and in our article, we discuss two reasons for this. The first issue is the verbal loading of standardized achievement tests. The tests require an extensive vocabulary, and it does not take into consideration how Black individuals speak. We speak mainstream English, but the majority of us also speak Black English, which is a language, not a dialect.

Verbal loading means you have to have a certain vocabulary. You have to phrase things in a certain way or know certain words. And that is problematic.

The second issue is the cultural loading, which means the test items and correct responses are based on the culture of upper-income white people.

These two issues can be seen in the testing question “How are work and play alike?” We have to consider why the person writing this test chose the terms “work” and “play” and how others may interpret them. Some Black children, for example, may say, “Well, they both have four letters.” Although that’s true, they would get zero points. Instead, they may be expected to say something like, “They’re both something that you enjoy.” But this isn’t true for everyone. Do you think that sanitation workers dealing with the smell of your trash go home talking about, “Oh, I just love my job”? No. So tests are linguistically biased against Black populations and the rest of minoritized groups.

The underreferral of Black boys to gifted and talented education and the linguistically and culturally loaded tests are a double whammy that denies our Black boys opportunities to be challenged and reach their full potential.

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Watch the entire interview with Donna Y. Ford and James L. Moore III at Journal of Multicultural Counseling and Development Special Issue – Authors Interview – YouTube.

Scott Sleek is a freelance writer and editor in Silver Spring, Maryland. He specializes in content related to social and behavioral sciences and clinical care.

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.

Navigating white privilege in the counseling room

By Scott Gleeson September 8, 2023

older white man sitting at a table with a laptop and coffee cup, looking out the window

OPOLJA/Shutterstock.com

DeVona Alleyne, a licensed professional counselor (LPC) at Millennium Counseling Center in Chicago, says people of color who seek counseling services face a particular reality — the likelihood that the therapist sitting across from them will be white.

“The numbers are obvious,” Alleyne says. “There are far more white therapists than there are [nonwhite] therapists. So many clients would love to be seen by someone who looks like them, but unfortunately, that’s just not always possible.”

That stark reality puts the onus on white clinicians to own their white privilege. That ethical duty can be laced with hidden challenges if white therapists aren’t regularly building their self-awareness through reflection or assessing racial dynamics in supervision.

Alleyne knows firsthand that an unaware white clinician can induce emotional harm. Sitting in the client’s chair as a Black woman, she has experienced both subtle and not-so-subtle microaggressions with previous therapists.

“Most of my therapists have been white guys,” says Alleyne, an American Counseling Association member. “One therapist kept praising me as a high achiever, as if I were some sort of anomaly, not realizing that he unconsciously was having an idea of how I should present as a Black woman. And then I had a therapist tell me I should slow down and not do all these things I’m doing. But even that statement is in ignorance because he’s got to understand that I have to do these things to be seen as competent. I had to say, ‘I can’t do that. I’m Black.’ He said, ‘I never thought about your race.’ I said, ‘That’s a problem because you need to.’”

Sadly, clients often won’t broach their discomfort with an offending counselor, leading to a fractured alliance or distrust in the therapeutic process as a whole.

That’s concerning for Kyle Goodwin, a licensed clinical professional counselor (LCPC) in Aurora, Illinois, who wrote his dissertation at Northern Illinois University on “Christianity and mental health counseling: Voices of the Black-Negro American experience.” Goodwin’s research outlines how African Americans have long turned to religion over therapy. The data illuminates the essentialness of white therapists doing their due diligence to understand their privilege because of the walls that have to come down for some marginalized clients to seek counseling in the first place.

“It all starts with the education white therapists receive, but then it doesn’t stop there,” says Goodwin, an ACA member. “There’s got to be a lot of self-reflecting, and that’s all before even stepping into session. A white therapist has to be able to say, ‘Hey, I have some biases or prejudices that I didn’t even know existed.’ That doesn’t mean you’re a racist, but you’re prone to show up in a discriminatory manner. Being able to take constructive criticism and see knowledge gaps [in supervision] is important to avoid perpetuating toxic whiteness in counseling spaces.”

Naming the elephant in the room

George McMahon, a clinical associate professor in the Department of Counseling and Human Development Services at the University of Georgia, says one of the primary concepts he teaches master ’s students is the importance of white clinicians broaching and naming their whiteness early in sessions.

“As a straight, white male myself, it’s hard to imagine me being an effective counselor without considering and naming the racial dynamics when working with a marginalized client,” McMahon says. “It’s very important that a counselor states it explicitly first, without waiting for the client to bring it up. … By broaching, you’re letting folks know, ‘It’s OK to talk about this, and I’m aware of my own privilege.’”

Alleyne concurs, saying that as a client, she felt her walls come down as soon as her white therapist mentioned her race.

“My therapist who I see now asked me something like, ‘Do you think they were treating you that way because you’re Black?’ I thought to myself, ‘Oh, you really see me, huh?’ Then I felt like I could stop coding and start saying Black stuff. I stopped wearing makeup and no longer had to be performing in a white world,” she recalls.

McMahon says many white therapists walk on eggshells or wallow in guilt because of the harm that the white world has caused clients. But he believes these therapists have a unique opportunity to offer a corrective emotional experience on a micro level.

“When a client is around a therapist who they think wouldn’t understand them outside of counseling and then they do understand them, it can lead to the client feeling seen in a unique and healing way,” McMahon explains. “When you’re broaching, you can show the client that you’re always trying to be aware of your privilege by stopping a conversation to make sure they feel like they’re being heard. That humility can help to build a therapeutic relationship quicker. But broaching isn’t just a one-time thing.”

Kristin Miserocchi, a staff psychologist and groups coordinator at Washington University in St. Louis, wrote her dissertation at the University of Kentucky on the effect of therapists’ white privilege attitudes on client outcomes and the therapist-client relationship. She says broaching isn’t just about naming race; it’s about acknowledging how the macro world — outside the therapy arena — has benefited the white therapist and potentially harmed or disenfranchised the marginalized client.

“It’s most important for white therapists to know that they can live their whole life oblivious to their privilege,” says Miserocchi, an ACA member. “I’m a white person, and so it’s a privilege for me to walk around the world thinking … that I don’t have it better than anyone else and that everyone has the same experience I do. That way of thinking alone can be an enormous knowledge gap and lead to invalidating a vulnerable client.”

“I do try to call that notion out,” she continues. “I work at a university where a lot of times clients will ask for a clinician who matches them racially or ethnically. That’s because that matching represents safety. Knowing that, it’s important to state my awareness … [that] I’ve had experiences you’ve never had and even ask if this could be a potential barrier for us. This shows that I have empathy, but [I explain] why I’m stating it so that it doesn’t feel like it’s all about the differences between us.”

Katherine Atkins, an LPC and clinical training director at Northwestern University, says various barriers can stand between white clinicians broaching their privilege with clients from marginalized groups.

“It’s undoubtedly the elephant in the room that needs to be addressed. When I was in my master’s [program] in 2003, there wasn’t even a multicultural course at the time,” says Atkins, an ACA member. “I vividly remember going into practicum being supervised behind a two-way mirror and told to call this stuff out. I didn’t know how to navigate those conversations because I was colorblind and hadn’t engaged in deeper self-reflection about how I see the world.”

Atkins says her personal life — she is in a biracial marriage and has a biracial daughter — has deepened her empathy and broadened her worldview in ways that classes never could.

“For a while, my go-to in talking with my husband was believing that everyone isn’t aware and they’re not intending to do harm,” Atkins explains. “That’s a privilege that I can see from that lens. The same thing happens in classes I teach or oversee, where students try to justify their stance. That’s damaging to ignore history, to not speak about the truth that’s occurred in our society. Broaching is about regularly checking in with the client and regularly checking in with yourself.”

Understanding white fragility

Robin DiAngelo coined the term “white fragility” in 2011 to describe discomfort by a white person when confronted by information about racial inequality. She further outlined its meaning in her 2018 book, White Fragility: Why It’s So Hard for White People to Talk About Racism. Among the key takeaways from the book is the notion that white people can immediately become defensive at the suggestion of racism or privilege.

Melanie Lindell, a licensed mental health counselor in Seattle, says she had to face her own white privilege when she moved to a predominantly African American neighborhood nearly three decades ago. Initially, she downplayed her level of privilege, reasoning that she had her own trauma background. But then she took the time to distinguish between her micro suffering and the macro trauma that has caused widespread pain to people of color.

“For white therapists, that initial defensiveness when someone … calls out your privilege isn’t necessarily the problem. It’s only wrong if you stop there and don’t do anything about it,” Lindell says. “Your defensiveness as a white therapist is more like a traffic light. It reveals something. It’s what you do with it next that matters.”

“There’s always room to say, ‘I’ve benefited from cultural racism, and I’ve had a leg up.’ That doesn’t take away from my trauma or experience. And it doesn’t need to be a shame spiral,” she adds.

McMahon says that sense of shame can initially be piercing for white clinicians because it is associated with a distinct feeling of failure.

“Counselors are particularly prone to white fragility because they get into this field wanting to be helpful and believe they’re good people who set out to make a difference,” McMahon says. “It goes against their identity if they’re confronted with this idea that doesn’t fit with how they see themselves. In other words, we’re prone to fragility because we care too much. It goes to the point of privilege is unearned. We didn’t do anything to create it, and there doesn’t need to be guilt attached to it. But it becomes a responsibility, particularly in counseling, to be part of a process to always be aware that oppression and power dynamics exist.”

Miserocchi says she has learned to lead with empathy as a way to mitigate her own defensive feelings that she believes are meant to be ironed out in supervision.

“We all want to help people, so when we hurt people instead, it’s the opposite of what we want to do,” Miserocchi says. “As vulnerable as I am learning that I hurt someone, it’s not nearly as vulnerable as a person who was hurt. It’s so important that I take ownership for any hurt I may have caused as a therapist. The fact that a client or supervisor is letting me know is generous of them. It goes a long way toward repairing those ruptures.”

Doing the work

Andrea Stiles, an LCPC at Klutch & Well in Chicago, says before white therapists can name the racial dynamics in a counseling room and build toward competency, they must find their own state of acceptance about their privilege.

“As an educator, supervisor and therapist, one of the things I see from someone struggling to manage their white privilege is an unwillingness to name their whiteness, not just in the room for the benefit of the client, but within themselves,” Stiles says. “When a clinician denies whiteness, for whatever reason, they’re denying what it means in the outside world and the type of impact it could have had on a particular client. That doesn’t just affect the counselor-client dynamic, it affects perception of a client for a diagnosis and a treatment plan.”

Stiles has often heard white colleagues in the field speak of their multicultural competency as if they’ve completed their training and are now equipped to treat clients from other cultures. Of course, it’s not that simple.

“In so many textbooks, it’s stressed that practicing multicultural competency is a lifelong journey. There’s no finish line,” says Stiles, an ACA member. “When therapists feel like they’re not done with something, that can be scary, but you’re missing the mark if you go into this work thinking awareness isn’t always ongoing. This goes beyond the white-Black dynamics too. This rings true for Muslims, Arabs and Jewish people. We should never stop trying to be attuned to a client’s culture.”

Goodwin views managing white privilege with clients as more of a responsibility or purpose than a form of progression.

“You’re not climbing a ladder of awareness about your whiteness,” Goodwin says. “I personally don’t believe in the term ‘multicultural competency.’ I believe in cultural sensitivity because competency insinuates that there’s this level to understand people of color. That ladder doesn’t exist. Culture is forever changing, and competency is a skill versus sensitivity, which is regularly and continuously choosing to set your power aside as a therapist. The reality is it would be a privilege for a white therapist to choose to not understand clients of color.”

Goodwin says an example of the need for white clinicians to regularly practice sensitivity comes with current events that traumatize marginalized clients on a macro scale, such as repeated news of police brutality toward people of color.

“I think the role of the white clinician is to acknowledge what’s happening in the world,” Goodwin says. “You don’t move forward unless you address it.”

Stiles says supervision plays a major role in holding white therapists accountable to regularly understand their privilege. Therefore, it’s essential for white supervisors to be comfortable bringing up racial dynamics with newer therapists.

“A lot of times what I’ll ask my class is, ‘Can you conceptualize this case from a culturally specific lens?’ It starts with the supervisor to help a therapist know that framework is necessary to cater treatment to a client’s culture,” Stiles says. “White supervisors have to acknowledge and lean into these things with inexperienced clinicians early on in development.”

One red flag Goodwin has noticed in supervisory sessions and other experiences is an unfair weight being placed on therapists from marginalized groups to educate white colleagues about privilege. “It’s not a person of color’s job to teach a white therapist about their community,” Goodwin stresses.

Alleyne says white clinicians in the field will often ask her what they can do to better immerse themselves in cultural awareness. She says as a Black client, she feels more emotionally held by a white clinician who doesn’t pretend to understand but also isn’t afraid to state what’s real in the world.

“I tell my white colleagues to start by noticing people of color in [their] orbit and try to engage,” Alleyne says. “Don’t just read about us in books that are written by white people. … No person of color in my opinion wants to hear, ‘I could never understand your experience.’ Well, duh. But state your awareness of discrimination that exists out there. Say, ‘Sorry you’re experiencing that.’ Because remember, Black people in particular are taught not to be angry or let those emotions out.”

Scott Gleeson is a licensed clinical professional counselor in the Chicago suburbs, specializing in trauma and relational dynamics. He spent over a decade writing for USA Today, where he won national writing awards from the Associated Press and NLGJA: The Association of LGBTQ+ Journalists. He’s collaborating on a book about fighting cancer with legendary broadcaster Dick Vitale, which is set to hit bookshelves in March 2024. His debut young adult fiction novel, The Walls of Color, comes out the following year.

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.

Treatment strategies for race-based traumatic stress

By Portia Allie-Turco July 18, 2023

A close-up of a Black person staring off to the side

fizkes/Shutterstock.com

Black Americans often face increased risk of health and mental health conditions because of systemic and structural racism. For example, they are more likely to face discrimination in employment, schooling, housing and health care or to be exposed to and die from preventable or manageable illnesses (such as the COVID-19 virus) because of medical neglect. Exposure to life stressors exacerbated by oppression and chronic socioeconomic disparities leads to higher rates of illness and death. In fact, across most health metrics, Black Americans have increased chances of physical deterioration and early death.

These physical experiences compound Black Americans’ risk for emotional and mental health challenges because they all contribute to the suffering and complications of trauma. In addition, these experiences with discrimination and oppression can result in race-based traumatic stress, a term used to describe the stress Black Americans experience because of cultural, individual and institutional encounters with racism.

Although Black Americans experience mental illness at rates similar to or higher than other populations, research shows that they face multiple barriers to effective mental health treatment. For instance, Black Americans are more likely to terminate counseling prematurely when they do initiate counseling services because of prohibitive cost, limited health insurance, limited numbers of facilities in stressed neighborhoods and transportation issues, among many others. Often, inadequate care is associated with mental health providers’ lack of cultural competence, which exacerbates these mental health inequities.

As the ACA Code of Ethics stipulates, counselors have the ethical obligation to develop the awareness, knowledge and skills related to cultural competence to eliminate barriers effectively for Black Americans. For mental health professionals, that means understanding how to treat Black American clients who are affected by racial trauma. Counselors have a role to play in dismantling racism and its complicated, corrosive effects within our society.

Creating a safe environment

To address race-based traumatic stress, counselors first need to prepare to broach issues of race in session. When counselors are comfortable discussing racial issues in counseling, they reduce the likelihood that Black American clients will water down their racialized experiences to make them palatable to the counselor. It is also important for counselors to emphasize to clients that the responsibility for inclusive counseling rests solely on the counselor. A counselor could approach this by saying, “I know that it’s not your job to educate me about race and racism, and I want you to know that I’m doing my part to keep learning and growing in this area.”

Counselors can acknowledge the difficult issues that are present due to systemic racism and broach the topic in session by saying, for example, “Do I have your permission to point out and talk about what seems to be a racially based survival strategy in the discussion we are having right now?” or “I’m wondering if you are feeling like I get it when you are sharing your experiences with microaggressions at work.”

Black American clients have developed several strategies to deal with racial trauma and stress, including double consciousness and code-switching. Double consciousness, a term coined by W.E.B. Du Bois, describes how Black Americans face pressure to embrace their Black American identity to distance themselves from the presumption that Black people are culturally inferior, while also being aware of the need to internalize a Eurocentric identity and value system to gain respectability. Thus, Black Americans constantly scan and make decisions about whether their Black American identity can be acceptable in white spaces. Living with this double consciousness results in increased stress and hypervigilance.

Code-switching, or alternating between two or more languages or varieties of language in conversation, is a protective strategy that Black Americans use when responding to environmental stress associated with being Black in white spaces. In therapy, a Black American client might change their vernacular when expressing themselves to a non-Black clinician. For example, a client might not use the phrase “do you feel me,” which is a phrase commonly used in the Black community to establish relatability and check for cognitive and emotional connection and understanding, with a racially different counselor. Instead, they may say, “Do you understand what I mean?” to ensure that the clinician understands them. But this change in phrasing causes the counselor to lose the richness of the client’s desire for connection and relatability.

Code-switching also applies to appearance. A Black American client, for example, might feel pressure to conform to white norms of beauty or dress rather than embracing an Afrocentric aesthetic in how they style their hair or what clothes they wear. This constant switching is mentally and emotionally exhausting and prevents Black American clients from fully engaging in therapy as their authentic selves.

It is the counselor’s responsibility to unburden the Black American client from having to code-switch for the counselor’s benefit. Clinicians should develop awareness and address the pressure their clients feel to code-switch by saying, for example, “I wanted to let you know that I’m familiar with the phenomenon of code-switching and why it may have been necessary. In this space, I would like to support you in feeling safe to be fully yourself without fear of encountering microaggressions or being stereotyped.”

Treating race-based traumatic stress

Individuals with race-based traumatic stress can experience psychological and physiological symptoms similar to posttraumatic stress disorder, including avoidance, hypervigilance, flashbacks, nightmares and physical pains. They may also experience grief, loss, anger, shame and self-blame. Counselors who do not understand race-based trauma symptomatology, however, may overlook signs of this type of trauma, which further limits Black Americans’ ability to receive adequate treatment. (For more on assessing racial trauma, read the online exclusive “Conceptualizing and assessing race-based traumatic stress.”)

After assessing for race-based traumatic stress, counselors can use the following treatment approaches to ensure they are addressing the underlying mental health issues related to racial stress.

Disenfranchised grief. Effective trauma treatment universally requires acknowledging and addressing losses that have occurred as a result of the trauma. The treatment considerations are similar when the trauma is caused by racism. Living as a Black American means dealing with pervasive impacts of systemic and structural racism stemming from slavery. It is no wonder then that Black Americans suffer from a profound sense of grief that often manifests as a loss of trust and safety on every level in both social and personal life. Furthermore, this type of grief is disenfranchised, meaning that it is not openly acknowledged, mourned or publicly supported as being legitimate.

To address the profound grief of racial trauma, counselors must recognize that single-incident racist experiences are compounded by collective racial trauma. This larger narrative of disempowerment, which is part of a whole history of trauma inflicted on people of African descent, needs to be recognized and validated as part of the process of healing.

When a Black client expresses grief related to their own racialized experience, or the cultural grief they carry, a counselor can ask the client to name the specific grief, and they may also need to situate the grief in the context of historical losses, such as the long-lasting impacts of slavery. It may be helpful to offer a validating comment such as “What you are experiencing is called disenfranchised grief because the grief that you feel is not always acknowledged or recognized by others.” In addition, the counselor can facilitate a grief ritual, or suggest that the client develop one that will have meaning and healing potential for them, such as sharing with other Black clients in group therapy.

Emotional processing and regulation. Clients who have survived racially charged incidents often present to counseling with complex emotions surrounding these experiences, which require processing in therapy. Several emotions that can be challenging for counselors to work through with Black American clients are anger, shame, humiliation, and internalization of stigma and racist attitudes that stereotype Black Americans as threatening, explosive, dangerous or impervious to pain.

Counselors need to acknowledge that Black people spend a lot of time managing their emotions in white spaces to protect against potential backlash resulting from stereotypes of aggression and violence. Part of this protection is to self-silence and push down emotional responses, such as anger. Dealing with anger and underlying hurt, however, is necessary for the recovery process. Therefore, counselors must work to elicit truthful expressions of anger that may be suppressed by the clients. For example, a counselor might broach this topic by saying, “I’m noticing that you seem agitated when we talk about this certain topic. I’m wondering how it feels to express your emotions in this space. I’d like you to know there is no need to self-silence here.” The counselor can also encourage the client to identify and deal with the underlying emotions, including hurt, injustice, and generational pain and oppression, and they can validate that these emotional expressions are justified considering the historical and ongoing racial issues.

When a counselor can sit with and hear the client’s anger, it creates a safe space for the expression of painful emotions. Thus, the ability to remain grounded when a Black American client expresses anger is an important skill for counselors to have when working with this population and requires an inner posture of non-defensiveness, particularly for white counselors who may experience their own discomfort with the interaction. Counselors need to practice being grounded before entering sessions with clients experiencing racial trauma. This may mean taking time to regulate their own breathing, thoughts or body tension; cultivating a curious and open mind; and seeking supervision with mentors to explore biases and process emotionally charged sessions.

Counselors can also support Black American clients in expressing anger in healthy ways, such as through journaling, music, dance, art and social justice activism.

Internalized racism. Trauma undermines the sense of self and the belief in one’s worthiness, so in racial trauma treatment, counselors must also directly address shame and self-blame. The humiliation that is associated with experiences of trauma often results in a sense of shame that leaves the person feeling intrinsically unworthy. These feelings are related to self-blame where a client might internalize a violator’s view of them and believe that aspects of themselves are responsible for the racial trauma they have experienced, rather than holding the violator alone responsible. Black American clients who internalize racism might speak derogatorily about themselves as a member of the Black American community.

Clinicians can address internalized racism with clients by using culturally adapted cognitive behavioral approaches that focus on restructuring the cognitive distortions that result from trauma and false beliefs. By holding those who violated them accountable, Black American clients can begin to heal and move toward healthy trauma integration.

Focusing on cultural strengths

Counselors must also challenge the notion that Black Americans live in communities that are riddled with problems that can only be solved by adopting Eurocentric solutions. That approach is based on deficit models, in which systemic and structural challenges due to oppression are assigned to Black people and their responses are pathologized. Instead of applying a Eurocentric lens to try to understand an Afrocentric culture, counselors should incorporate an Afrocentric worldview as an antiracist and culturally responsive approach to the treatment of Black American clients. Although largely ignored in counselor training, professional development and even scholarship, an Afrocentric worldview supports the development and maintenance of cultural pride, which research has found increases resilience as a buffer in the continued struggle against oppression. An Afrocentric worldview includes an awareness that Black Americans have retained elements of the ancestral wisdom of Africa, passed down generationally. This ancestral wisdom is reflected in many aspects of their cultural worldview, including:

An understanding that spirituality is central to many Black American clients
A focus on community connection, as opposed to individualism
A holistic view of life experiences that includes natural rhythms and cycles
A circular thought pattern that goes beyond a linear approach to include broader contexts
An understanding of the importance of relational storytelling

Counselors can become knowledgeable about Black American culture through social justice initiatives such as Nikole Hannah-Jones’ The 1619 Project, which highlights the legacy of slavery in the United States. Counselors must be willing and able to listen to their clients’ stories and be mindful that storytelling may be fuller and more detailed and does not immediately “get to the point” in a way that they are used to. In addition, counselors must be comfortable exploring spirituality with clients and encourage them to use their cultural identity to care for themselves, their families and their communities as a part of healing.

Cultural beliefs and practices are protective for people who have experienced historical trauma. Counselors can use narrative counseling approaches to help Black clients facilitate a strong connection with Black American culture, which can help buffer them against racial harm, as noted in the literature. Viewing Black American culture as a rich source of strength and power can promote wellness by leveraging existing resources within the culture that have endured despite overwhelming and systemic oppression. Researchers have identified six primary cultural resources that operate as forms of wealth or capital for communities of color:

Aspirational capital: the ability to pursue hopes and dreams even in the face of barriers
Linguistic capital: the language and communication skills that a person has acquired throughout their life, including core expressive concepts such as virtuosity, originality, creativity and beauty, which are reflected in dance, music, poetry, theater and art
Social capital: the ability to develop and maintain supportive relationships and networks
Navigational capital: the ability to adaptively negotiate social institutions that are unwelcoming and exclusionary
Familial capital: using kinship connection to build on generational knowledge and intuition
Resistance capital: the endurance, perseverance and skill to stand firm in one’s cultural identity and engage in actions that protect and promote equality

Counselors can tap into all these expressions of cultural strengths when working with Black American clients to support them in healing and in using cultural buffers to shield against the ongoing onslaught of racial trauma. Working from this framework and accessing each empowering aspect require counselors to identify, affirm and incorporate them in treatment planning. This is crucial because cultural strengths have provided the bedrock for Black Americans’ survival and enable their ongoing ability to persevere.

Promoting healthy coping strategies

Trauma recovery involves learning effective coping strategies. In counseling sessions, counselors can teach emotional regulation and stress tolerance skills, such as breathing techniques, somatic therapies and other trauma-responsive care, all with the understanding that these efforts are necessary to address the unique and ever-present racial stressors. Other coping strategies include inviting Black American clients to create a space for rest and restoration, exercise, movement and dance, self-expression and spiritual practice.

Counselors can also explore how Black American clients have coped in the past, including engaging with community support. Research shows the benefits that communal healing has for Black Americans, so group counseling can improve the well-being of survivors of racial trauma. Racial healing circles, for example, offer a supportive healing environment for processing racial wounds. Similarly, sister circles — a sacred space that Black women create to accompany one another as sisters on their healing journeys — is another example of communal healing that also draws from ancient African wisdom. Counselors can facilitate similar types of support through traditional group counseling that is modeled after healing circles or by referring clients to locally run racial healing circles within their community.

Another mental health strategy is to empower and support Black American clients’ need to self-advocate for social justice. Research shows that Black American clients benefit from resistance strategies that encompass activism, such as non-violent confrontation with racism, lobbying for anti-racist policies and other actions that support the client.

When counselors adopt an anti-racist stance and communicate it consistently, they join the client in actively challenging the status quo. In learning about culturally inclusive care and applying strategies for treating race-based traumatic stress, counselors can fulfill their ethical responsibility and make significant advances in addressing the existing mental health inequities for Black Americans.

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Learn how to access for race-based traumatic stress in the companion article “Conceptualizing and assessing race-based traumatic stress.”

Portia Allie-Turco is an assistant professor, clinic director and program coordinator in the Counselor Education Department at the State University of New York at Plattsburgh. She is also a licensed mental health counselor who specializes in healing racial, generational and complex trauma. Contact her at p.allieturco@gmail.com.

Knowledge Share articles are developed from sessions presented at American Counseling Association conferences.

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.

Adapting CBT to meet clients’ needs

By Lisa R. Rhodes July 13, 2023

A woman facing the ocean with her eye closed and taking a deep breath

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Cognitive behavior therapy (CBT) is one of the most widely used forms of psychotherapy in the mental health professions. It is also the most empirically tested modality, with more than 2,000 evidence-based studies, according to the Beck Institute for Cognitive Therapy and Research, a nonprofit organization (co-founded by the late Dr. Aaron Beck, the psychiatrist who developed CBT) that works to advance CBT and train mental health practitioners and organizations around the world.

This short-term, highly structured form of therapy helps clients pinpoint and examine negative thoughts to reframe their thinking so they can develop a pragmatic view of difficult situations and learn to better manage them. CBT can be used to treat a wide range of mental health conditions, including anger, eating disorders, stress and attention-deficit/hyperactivity disorder.

Vanessa Teixeira, a licensed mental health counselor who specializes in trauma-focused CBT (TF-CBT), says one advantage to using CBT with clients is that it is “simple, concrete and makes sense.” Clients learn “why they are thinking what they are thinking, feeling what they are feeling and behaving how they are behaving,” Teixeira explains. “Once they have that knowledge, they can choose to actively participate in their treatment by making certain simple and concrete changes to their thinking and behavior.”

Positive therapeutic outcomes

CBT is most commonly used to treat anxiety and depression. Janeé Steele, a licensed professional counselor (LPC) and certified CBT therapist, says CBT can help anxious and depressed clients decrease their psychological distress and improve their ability to cope with life stressors. This can happen by teaching clients how to use CBT skills such as identifying and reappraising maladaptive thoughts and beliefs.

Steele, author of the forthcoming book Racism and African American Mental Health: Using Cognitive Behavior Therapy to Empower Healing, says clients can also learn to apply CBT skills such as behavioral activation to positively affect their mood by increasing the amount of time they spend engaged in activities that provide a sense of pleasure or accomplishment. By teaching clients mindfulness strategies, such as deep breathing and relaxation techniques, counselors can help them with emotion regulation.

Some variations have been developed to tailor CBT to better meet the needs of certain mental health issues. For example, TF-CBT was developed in the 1990s to address the needs of children who had experienced sexual abuse, but today the scope has broadened, and clinicians can use TF-CBT to help children and adolescents recovering from all types of trauma. Christa Butler, an LPC who is certified in TF-CBT, says TF-CBT can help reduce the symptoms of trauma in children and teens and enhance their inner sense of safety. The modality, which includes parents and caregivers in the therapeutic process, is also effective in emotion regulation and building cognitive and social awareness skills, she adds.

Although CBT is an effective clinical approach for many mental health disorders, some mental health professionals argue that some of the techniques do not best address the needs of all clients, particularly those from marginalized communities. Practicing counselors are making cultural adaptations to the modality to better serve clients of color, and they are finding creative ways to combine other clinical techniques with CBT and TF-CBT to help adapt and modernize this approach to better address clients’ individual needs.

“The more we adapt CBT to suit the individualized needs of our clients, the more effective the treatment outcomes will be,” Teixeira says. “Any counseling theory and technique should first and foremost focus on the client as a unique individual and how counseling treatment can be best modified to produce successful results.”

Cultural adaptations

Steele, owner of Kalamazoo Cognitive and Behavioral Therapy PLLC, stresses the need for clinicians to culturally adapt CBT to better meet the needs of clients of color. Like all therapeutic approaches, CBT can’t be separated from the cultural context in which it was developed, Steele says. CBT “was developed with Eurocentric, individualistic assumptions that are not always suitable for clients from more collectivistic cultural groups,” she notes. And this may cause some clinicians to inadvertently overlook the environmental influences in a client’s life, she adds.

This can mean that there is the potential for clinicians who use CBT to “blame clients for problems that are primarily environmentally based, which can lead to an invalidation of their experiences,” Steele notes.

This can lead to negative outcomes. For example, she says that if the perspective and lived experience of people from marginalized backgrounds are not considered in therapy, they may decide to end treatment prematurely or they may experience a worsening of mental health symptoms.

Teixeira, an assistant professor in the Department of Counseling at Nova Southeastern University in Fort Lauderdale, Florida, also advises counselors to make cultural adaptations to CBT when working with clients who are vulnerable, underprivileged, disadvantaged or facing systemic discrimination. The adaptations should be made “to acknowledge that certain populations are not always in control of their environment and [that] certain groups of people have a major unfair disadvantage that directly impacts their thoughts, feelings and behaviors,” she says.

For clients who are dealing with racial trauma, Steele says cultural adaptations to CBT such as psychoeducation and culturally adapted cognitive restructuring can help them reduce their mental distress and build coping skills that foster their resilience in adverse situations. Steele discusses how to use these two cultural adaptations to treat a hypothetical client: a Black man in his mid-40s, who was the only Black male volunteer in a predominantly white organization. The client was having difficulty managing feelings of anxiety about fitting in at the organization. She says the client reported feeling worried and nervous when he tried to contribute his ideas in staff meetings, and he also experienced feeling dismissed and insecure when he was not considered for community assignments.

Steele found that using enhanced psychoeducation helped the client understand how social anxiety, which was the client’s presenting concern, works. For example, she talked to him about “stereotype threat,” a fear that people of color have about aligning themselves with negative stereotypes about their racial group, and how this threat may have contributed to his unease.

In this case example, the client felt an internal pressure to try to prove that he did not conform to the negative stereotype of Black men as inarticulate and only able to achieve in athletics, Steele explains. “This contributed to the self-focused attention aspect of his social anxiety and worsened the client’s performance, as his attention was often directed to perceived deficits in his use of language and [his] ability to communicate rather than the task at hand,” she notes, which often caused him to appear as though he could not concentrate or was forgetful.

“Intentionally situating problems in their cultural context in this way is omitted from traditional CBT,” Steele says. But the cultural context piece is critical in cases such as this one. Discussing stereotype threat in counseling allowed the client to better situate his problem within the cultural context and validate his lived experience as a racial being, she says.

Steele also adjusted how she approached cognitive restructuring with this client. “Traditionally, cognitive restructuring focuses on teaching clients to examine the rationality of their thinking through techniques such as Socratic questioning,” she notes. “Questioning clients’ experiences with race-related concerns, however, can be invalidating and may exacerbate their symptoms.”

Instead, she used Socratic questioning to examine the client’s negative self-thought and account for the impact of racial oppression in his life. “Adapted cognitive restructuring focuses on validating the painful emotions that arise in the face of these experiences, acknowledging that we live in a society where these painful experiences occur, and challenging negative thoughts about self that occur in response to these experiences rather than the experiences themselves,” she explains.

Working with this client, Steele asked questions to determine the thoughts he had that contributed to his anxiety and nervousness during staff meetings, such as “I sound too Black” or “I’m never going to fit in here.” She continued using Socratic questioning and asked culturally framed questions to help the client recognize and examine stereotypes that contributed to his negative thoughts about his self-worth and competence.

Using traditional CBT questioning, counselors may ask this client, “What evidence do you have to support the idea that you won’t fit in at work?” or “What’s another way to view the situation?” But this type of questioning can be insensitive to the client’s life and cultural context, and it could be perceived as a microaggression because it often requires people of color to prove their experiences with race, Steele says. Instead, she advises counselors to ask questions that consider the cultural context. For example, clinicians could ask, “What are the stereotypes that relate to being a Black man?” “When did you first encounter these stereotypes?” or “How do these stereotypes influence how you feel and what you think about the way people may perceive you?”

Steele reminds counselors to be careful when using CBT and avoid asking questions that might suggest the client’s discomfort about their experience is unreasonable or abnormal. “Microaggressions and questions that invalidate the client’s experience with race, ethnicity or culture can lead to ruptures in the therapeutic relationship or even worsen the client’s symptoms,” she notes. “They can also reinforce stigma associated with [the] receipt of mental health services and the perception that counseling is only for certain racial groups.”

Creative clinical approaches

When applying CBT and TF-CBT to other mental health issues, such as panic and trauma, the counselors interviewed for this article recommend incorporating creative techniques alongside these therapeutic approaches. Teixeira says using creative, individualized and unique CBT interventions such as spontaneous journal writing, gardening, coloring mandalas, and creating video blogs, vision boards and music playlists can help teach adults how to process and better manage difficult thoughts and emotions.

Grounding exercises are another creative CBT technique that Teixeira recommends counselors use with adult clients. These exercises use the five senses to help the client refocus their physical and emotional attention when they feel anxious, for example. “It allows the mind and body to take a break from the anxiety and panic it is currently experiencing by shifting the focus to more neutral and/or positive items that can temporarily change the client’s thoughts and feelings,” she explains.

Teixeira says counselors can ask clients to create a “grounding box” that can be used when they are experiencing panic or anxiety. The box should be filled with items that engage the five senses and provide the client comfort, she says. For example, the box could contain the following items:

A ball that can be squeezed
A beach shell that allows the client to hear the ocean
A dried lavender flower to smell
A pack of gum that the client can taste
A funny or relaxing picture that the client can look at

Teixeira says this technique can be adapted to use with children and adolescents by having them fill it with items that bring them comfort, such as a small toy, fidget spinner, scented play dough, lollipops or a whistle.

Butler, a professional counseling issues specialist at the American Counseling Association and a registered play therapist supervisor, says TF-CBT can help children and teens process their thoughts and feelings about traumatic experiences, while providing them with a safe container to explore the impact of their experiences. She recommends counselors pair this approach with play therapy or play-based expressive therapy approaches, such as sand tray interventions and art-based activities.

The trauma narration process in TF-CBT can be “emotionally overwhelming” for children and teens who may be sharing the details of their trauma for the first time in therapy, Butler adds. So she advises counselors to incorporate age-appropriate games, such as flashcards, and expressive outlets, such as painting, to help make the therapeutic process more engaging while also providing a safe distance for clients to project their thoughts, feelings and emotions about lived traumatic experiences.

Counselors can also pair mindfulness-based techniques with TF-CBT. Butler and Teixeira suggest counselors use the activity of blowing bubbles to teach children about mindfulness. Clinicians can ask clients to breathe in and then slowly exhale as they blow the bubbles, which relaxes their body and mind.

When using games and art-based interventions, counselors must be sure to use tools that are culturally inclusive, Butler adds. This includes selecting miniatures, toys, dolls and images used in making collages that are representative of diversity and intersectionality. For example, counselors who use play therapy or work with children need to have a full spectrum of colors in their crayons, markers and pencils so clients can depict all different shades and tones of skin color in their drawings, Butler says. Counselors should also look for culturally diverse miniatures for use in sand tray therapy, she adds.

A staple approach

The counselors interviewed for this article say that CBT’s ability to treat a wide range of mental health disorders and its adaptability to fit clients’ needs are two reasons why the modality is likely to remain a staple in mental health. Teixeira also encourages new counselors not only to develop a mastery in understanding the main concepts of CBT, but also to engage in additional training for using CBT with special and vulnerable populations, which is important for the ethical use of the modality, she says.

Steele agrees that CBT “will continue to be the gold standard in behavioral care.” The emphasis on the empirical validation of treatments continues to be a priority within the profession, she says, “especially as it relates to increasing validation of the approach among culturally diverse groups.”

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For more ways to adapt cognitive behavior therapy (CBT) and cultivate an awareness for cultural diversity, check out the following resources:

“Culturally adapted CBT with African Americans” (video) by Janeé Steele, 2022
“The multidimensional model of broaching behavior” by Norma L. Day-Vines, Fallon Cluxton-Keller, Courtney Agorsor, Sarah Gubara and Nana Aba A. Otabil, Journal of Counseling & Development, 2020
“Strategies for broaching the subjects of race, ethnicity and culture” by Norma L. Day-Vines, Fallon Cluxton-Keller, Courtney Agorsor and Sarah Gubara, Journal of Counseling & Development, 2021

Lisa R. Rhodes is a senior writer for Counseling Today. Contact her at lrhodes@counseling.org.

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.

Conceptualizing and assessing race-based traumatic stress

By Portia Allie-Turco July 6, 2023

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Counselors have a responsibility to promote and provide equitable care and treatment as outlined in the ACA Advocacy Competencies and the Multicultural and Social Justice Counseling Competencies. To do so, counselors require awareness, knowledge and skills to work effectively with Black American clients. Clinicians seeking to treat Black American clients must understand that racial trauma is deeply rooted in historical, generational and ongoing systemic oppression and has a pervasive impact on the well-being of Black individuals and communities. The toll of racism is implicated in health and mental health disparities that can be addressed only through knowledge, awareness and a commitment to culturally responsive care. Culturally competent counseling requires specialized conceptualization, assessment and treatment of racial trauma.

A foundational understanding is that racism is embedded in all aspects of daily life and is a common and frequent experience for Black Americans. Racial inequity has profound economic, health and mental health impacts. Racial disparities contribute to unequal access to employment, education, housing and other material resources. Black families are more likely to live in dangerous neighborhoods and areas of concentrated poverty, have limited employment and poor access to quality health care, and experience food deserts, all of which exacerbate the effects of poverty and impede access to opportunity. Racism contributes to mental health issues such as anxiety, depression and posttraumatic stress. Racism is implicated in the phenomenon of weathering — a trauma response related to repeated exposure to chronic stress and adversity — resulting in myriad chronic health issues including hypertension, obesity, heart disease and early death.

The effects of racism extend to the counseling realm. Historically, racial trauma in Black American slaves was attributed to mental health conditions not believed to exist in other people. In 1851, Dr. Samuel Cartwright, who had apprenticed under Dr. Benjamin Rush, the “father of American psychiatry,” diagnosed two slave disorders he labeled “drapetomania” and “dysaesthesia aethiopica” (or “rascality”). Supposedly, drapetomania caused slaves to escape plantations; rascality was understood as an inherent trait of laziness and carelessness. Unfortunately, the idea of rascality continues to permeate views of Black Americans in relation to poor work ethic and criminality. The recommended treatment for both drapetomania and dysaesthesia aethiopica was physical torture. Today, these false diagnoses are associated with justifying police brutality and the harsh treatment of Black Americans facing legal authorities.

In counseling, Black Americans face an increased risk of retraumatization because of inappropriate assessment, misdiagnosis and poor treatment. Given this reality, and the resulting cultural mistrust of health care professionals, it is not surprising that rates of unilateral termination in counseling are much higher among Black American clients.

Conceptualizing historical trauma and slavery’s lasting effects

Historical racial trauma reflects the unresolved collective grief and cultural wounding that are passed down generationally. The field of epigenetics highlights that negative environmental conditions and stressors affect human beings down to the cellular level. For Black Americans, the racial trauma of slavery underpins a soul injury of unresolved grief that affects the whole being. In this context, the social-cultural wound is a collective experience of an internalized racial injury so pervasive that it impacts Black American culture in distinct racialized ways.

Anti-Black racism is rooted in the belief that people of darker skin tones are uncivilized, savage and prone to violence, regardless of how much status, achievement and standing a Black person may attain. This manifests in the phenomenon of colorism — the preference for lighter skin tone and Eurocentric features. Counselors need to know that colorism affects all aspects of a Black person’s life and influences their life chances, both within and outside of the Black American community. Black Americans face greater likelihood of poverty, more restricted access to education, and higher rates of imprisonment, underemployment and health inequity the further removed they are from the white ideal.

Posttraumatic slave syndrome (PTSS) is a theory of historical trauma that highlights the multifaceted impact of the violence of slavery, institutionalized segregation and oppression, and ongoing struggles for racial justice on the lives of Black Americans who are descendants of enslaved Africans. Counselors need to know the theory of PTSS, which was developed by researcher and educator Joy DeGruy-Leary to describe the survival strategies that were necessary for enduring the hostile conditions of slavery. PTSS accounts for both negative responses and positive adaptations and can explain some of the behavioral patterns of present-day Black Americans.

Controlling images and stereotypes

When Black American clients come to therapy, counselors should be aware of the controlling images and racial stereotypes these clients face.

The labeling starts early. In school, Black children are disciplined at higher rates than other children, with severe consequences that can include out-of-school suspensions, law enforcement involvement and, ultimately, even imprisonment for some Black children. Black boys are disciplined for being too “aggressive.” Black girls are disciplined for being “too loud” or dressing in a sexually provocative way. This reflects “adultification bias,” wherein school authorities hold Black girls to excruciatingly high standards because the girls are perceived to be more developed than they actually are. These responses stem from broader toxic stereotypes against Black Americans, deriving from slavery.

Controlling images underlie many of the mental health and stress-related concerns among Black women. One controlling image, the “Jezebel,” originated during slavery to justify the raping of Black women by white slave owners. It continues to have repercussions today in the increased risk of violent sexual assault against Black women due to the perception that they possess voracious sexual appetites and welcome aggression. The media also exploits the Jezebel trope and reinforces it in music videos, social media, television and movies, where Black women are often hypersexualized projections.

When counselors buy into the Jezebel myth, they risk misdiagnosing and mistreating sexually related concerns in therapy. Therefore, it is important to explore healthy sexual identity development and to challenge traumatic internalization of this controlling image. To further support and advocate for Black clients effectively, counselors need to be aware of these controlling images that discourage women from reporting sexual crimes and make it less likely they will be believed or find justice in court.

Another trope is the “Angry Black Woman.” This is routinely applied to Black women who are assertive and stand up in defiance of expectations of being demure and submissive. When they challenge injustice, they are labeled as domineering, masculine and emasculating. This combines racialized and gendered oppression and encourages the self-silencing of Black American women.

In response to these damaging stereotypes, Black American culture sought to reclaim the dignity of Black femininity. This was done in part by cultivating virtues of a Black matriarch who embodied strength, self-reliance, care of others and emotional containment while being a pillar of the community. In internalizing this “Strong Black Woman” schema, however, Black women are under enormous pressure to achieve excellence, block their emotions and care for others to the exclusion of their own needs. If counselors are unaware of this schema, they may not recognize the self-silencing, emotional dysregulation and fatigue that are the result of an endless demand on Black women for strength and voiceless endurance. Counselors should know that Black women who internalize this schema are most at risk for pain-numbing behaviors such as binge eating disorder, which is not about image or dieting, but rather an emotional regulation strategy.

Microaggressions and racial trauma in daily life

Psychiatrist and Harvard University professor Chester M. Pierce first proposed the term “racial microaggressions” to describe brief, commonplace verbal or behavioral racial slights, whether intentional or unintentional, that communicate hostile, derogatory or negative insults toward Black Americans. Microaggressions are often veiled and ambiguous; for example, complimenting a Black person about how well-spoken they are. The implication is that the listener is surprised because they did not expect the Black person to be articulate.

The subtle nature of microaggressions makes them especially frustrating for victims, who may be unsure of the intention behind the slight and unclear about whether or how to respond. This distress is damaging to a person’s well-being, especially when accumulated over time. Microaggressions result in increased stress, anxiety, depression and other trauma-related conditions. They can also lead to anger, voicelessness, internalized self-devaluation and an assaulted sense of self.

Race-based traumatic stress

Experiences with discrimination and oppression can result in race-based traumatic stress (RBTS), a term coined by researcher Robert Carter and colleagues to describe the significant stress Black Americans experience because of cultural, individual and institutional encounters with racism. Much like posttraumatic stress disorder (PTSD), RBTS carries psychological and physiological effects such as avoidance, hypervigilance, flashbacks, nightmares and somatic expressions (e.g., headaches, stomachaches, heart palpitations). At the same time, racial trauma differs from PTSD in significant ways. For instance, racial trauma involves ongoing cumulative injuries due to exposure, both direct (such as physical assault) and indirect (such as vicarious injury when other Black people are racially harmed or when witnessing racist incidents in person or in the media).

RBTS also includes reexposure to race-based stressors. Criteria include exposure to a racist event that is experienced as painful and uncontrollable. The traumatic reaction of avoidance, intrusion or arousal can manifest in several ways, including emotionally, cognitively, behaviorally and physiologically. Unfortunately, most of these wounds are easily overlooked if counselors do not understand race-based trauma symptomatology. Black American clients may need help in understanding and managing their strong reactions to these events. It is incumbent on counselors to have this awareness because Black American clients may not know that these exposures are considered traumatic.

The fact that racism is a stressor that can harm or injure its targets is still not recognized as an official diagnosis in the most recent iteration of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This decreases the chances that counselors can identify, assess and treat RBTS, even though researchers have reported higher rates of traumatic experiences among Black Americans when compared with the general population.

Although the current diagnostic criteria for PTSD in the DSM-5-TR is more expansive with respect to trauma generally, it does not account for the symptoms of RBTS due to its limiting of the types of experiences that lead to trauma. For instance, Criterion A specifies “exposure to actual or threatened death, serious injury or sexual violence” as the main diagnostic criteria, even though other types of stressful experiences, such as racism, have been linked to negative mental health outcomes.

Criterion A also contains a specific notification, under Criterion A4, that explicitly states “experiencing repeated or extreme exposure to aversive details of the traumatic event(s) does not apply to exposure through electronic media, television, movies or pictures, unless this exposure is work-related.” This is concerning because advancements in technology and the ubiquitous reach of media have increased the exposure of Black Americans to heightened images of racial injustice and trauma, such as the gruesome images, in real time, of the murder of George Floyd.

Similarly, newer forms of hate crimes have emerged in social media networks as a convenient means of transmitting hate. All of this can have the effect of retriggering and retraumatizing previous racialized experiences. Black American clients might present to counseling with trauma stirred up by these media exposures to racism, but it may not be apparent because of the everyday nature of these incidences. In addition, diagnosis is difficult because of the electronic media exclusion note in Criterion A4.

The current definition of PTSD in the DSM-5-TR is problematic. It contributes to potential misdiagnosis and the pathologizing of racial stress symptoms, and it limits the ability of Black American clients to receive adequate racial trauma treatment. Additionally, without an official diagnosis, health care insurance coverage and reimbursement can be restricted.

RBTS assessment measures

Despite the limitations of the DSM-5-TR diagnostic criteria, counselors can still offer an appropriate assessment of RBTS, if they have the necessary knowledge and awareness and the proper tools. Experts in the racial trauma field have developed several scientifically validated instruments that accurately assess trauma symptomatology. Counselors can choose any of these instruments during a scheduled intake or following a session when a client presents with symptoms that may be indicative of racial trauma. These tools can help counselors assess Black American clients and develop treatment strategies for healing their traumatic experiences.

The University of Connecticut Racial/Ethnic Stress & Trauma Scale (UnRESTS) uses an interview format to facilitate communication regarding clients’ experiences with racism. UnRESTS uses a two-column format: one column with instructions for the counselor to prepare the interview and the other column describing questions to ask the client. This measure is helpful for counselors who are inexperienced in identifying racial trauma or those who are hesitant to broach racially charged topics in counseling. It provides clinicians with a structure to conduct the interview, starting with identifying racial or ethnic identity development and moving through experiences of covert and overt racism, including vicarious racism. This provides counselors with the confidence that they have elicited the greatest input from their clients on these issues and can make a treatment plan based on this comprehensive review.
The Race-Based Traumatic Stress Symptom Scale (RBTSSS) evaluates a client’s exposure to racist experiences and the symptoms that can result, including emotional and physiological reactivity. The measure includes 52 items in seven categories that explore self-esteem, physical reactions, anger, avoidance, depression, intrusion and hypervigilance or arousal, all associated with racial trauma. When using the RBTSSS, the clinician begins with open-ended questions to obtain information from the client about racist experiences. This is followed by closed-ended questions about the client’s reactions. A clinician can assist in administering this assessment, or it can be administered as a self-report measure.
The General Ethnic Discrimination Scale (GEDS) is an instrument specially designed for measuring clients’ frequency of exposure to racism. It is appropriate to use with most ethnic groups affected by racial trauma. GEDS consists of 18 self-reported items that measure the client’s personal perception of racial discrimination. This tool is similarly structured to other existing stress inventories currently in use. Because this is a self-reporting tool, instructions have been simplified for participants whose first language is not English. It is also specifically useful when faced with time constraints because it is a relatively quick measure for assessing racial trauma.
The Racial Microaggressions Scale (RMAS) is a tool measuring racial slights and the resulting distress of microaggressions. It specifically explores six types of microaggressions using a 32-item questionnaire in a Likert scale format. The distress subscales include criminality distress, low achieving/undesirable culture distress, sexualization distress, invisibility distress, foreigner distress and environmental distress. Counselors might choose this assessment when Black American clients report experiencing insults and invalidations that undermine their sense of self.

Because racial trauma is so deeply rooted in historical and generational oppression going back to slavery, Black Americans continue to experience the devastating toll. Counselors who work with Black Americans must understand the conceptualization of this experience and be competent in evaluating its impact on their clients.

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Learn how to treat race-based traumatic stress in July’s Knowledge Share article “Treatment strategies for race-based traumatic stress.”

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.