Working with clients in therapy who feel oppressed by racism

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I frequently give trainings on working effectively with people of color. And given that most therapeutic work takes place in the context of our racialized society, the issue of racism is generally relevant to care. It is well established that people tend to automatically make unfair judgments of others based on their race. These judgments then translate into acts of racism, such as racial microaggressions. All forms of racism impact the well-being of people of color on many levels, and good clinicians must be able to effectively engage their clients of color around these issues.

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Source: Breathtaking Art / Shutterstock

racism is real

A cardinal rule when working with people of color is to refrain from questioning the veracity of reports of racism. Therapists should approach all clients’ experiences of racism as if they were true and provide appropriate support and validation. This can be difficult for therapists who are not victims of racism, as these events will not be consistent with their reality. Additionally, most people have been socialized to ignore or minimize the presence of racism. Some therapists will attempt Socratic questioning as a way to get clients to question their experiences of racism. But this is quite harmful because the very nature of racism is to enlighten the victim, and the damage is compounded when therapists reproduce this violence.

The good news is that it seems the importance of validating racist experiences has taken hold, and I hear more and more therapists say that they are increasingly accepting of their clients’ descriptions of their personal experiences. of racism as valid.

But what should therapists do when clients expand their experiences of racism and generalize them into overall conclusions? Here are some examples of client statements that have baffled well-meaning clinicians:

“I can’t walk on any street because the police will arrest me and interrogate me.”

“You know, these white teachers don’t care about native kids.”

“They want to keep black people at the bottom.”

Therapists have told me that it is difficult to validate statements like this, which they call cognitive distortions. Therapists may believe they have a responsibility to help clients identify maladaptive notions that may be aggravating their mental health problems. And while it is certainly true that cognitive distortions need to be addressed, therapists must be prepared to challenge their own perceptions. Are the above statements better classified as cognitive distortions? Or are clients describing an aspect of a reality that needs to be understood and acknowledged?

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Racism is systemic

Racism does not just operate at the individual level. It is systemic and clients may need to express their distress and pain surrounding systems of oppression in addition to the individual acts of racism they experience. They may not have the precise words to describe these secret systems that harm them, and their attempts to do so may seem like gross generalizations. But understanding should be the starting point, don’t assume they are wrong. Therapists can ask questions if they don’t understand. But how do you do that without invalidating customers?

Client: “I can’t walk on any street because the police stop me and interrogate me.”

Therapist: Is it really true that you get stopped by the police every time you walk down the street?

No, this is the wrong approach and results in invalidation of the client. Although the client’s statement may be a generalization, the person is trying to communicate the real difficulties they are experiencing that contribute to their mental health issues. Here’s a better approach:

Client: “I can’t walk on any street because the police stop me and interrogate me.”

Therapist: That sounds terrible. Tell me about the last time this happened to you.

Similarly, the other statements also require understanding and validation.

Client: “You know, those white teachers don’t care about native kids.”

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Therapist: Based on what you told me about your daughter’s experiences in school, I can really see it. It’s sad that teachers act like this.

And sometimes what looks like a gross generalization is 100% correct.

Client: “They want to keep black people down.”

Therapist: Given that there are no black people in the upper management of your workplace, it sounds like you’re right. It is wrong and unfair.

It’s important to consider that just because something is uncomfortable and awkward doesn’t mean it’s wrong. In fact, a recent NY Times article discussed the very issue raised by this client in an article titled The Truth Is, Many Americans Just Dont Want Black People to Get Ahead. The therapist could share this article with the client to validate and better illuminate their observation.

Understanding and validating systemic oppression is essential for effective anti-racist mental health care. In The Lancet, Dr. Jude Cnat describes anti-racism mental health care as proactive in that it addresses racial issues without waiting for clients to report them. Anti-racism care incorporates cultural aspects and offers some form of reparation for the harms caused by racism, which can include discrimination, racial profiling and racial microaggressions.

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Clinicians can use tools such as the UConn Racism/Ethnic Stress and Trauma Survey (UnRESTS) to better understand all facets of clients’ experiences of racism.

The references

Cnat, JM (2020). How to provide anti-racist mental health care. The Lancet Psychiatry, 7(11), 929-931.

Gran-Ruaz, S., Feliciano, J., Bartlett, A. and Williams, MT (2022). Implicit racial bias between ethnoracial groups in Canada and the United States and black mental health. Canadian Psychology, 63(4), 608622.

Haeny, AM, Holmes, SC and Williams, MT (2021). Apply anti-racism to clinical care and research. JAMA Psychiatry, 78(11), 1187-1188.

Williams, MT, Faber, SC and Duniya, C. (2022). Be an anti-racism clinician. The cognitive-behavioral therapist, 15, e19.

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