Interracial therapy: It's not as black and white as it may seem

Mental health service providers and commissioners have a duty to meet the needs of all the communities they serve, as emphasised in today's Mental Health Act recommendations. Kimberly-Anne Evans - a psychotherapist and trainer of colour - shares her steers for white therapists who see black clients.

‘Black people don’t like to talk about their issues.’ This has been a comment made when trying to understand the low numbers of African and Afro-Caribbean people going into talking therapies versus the disproportionately higher number of African and Afro-Caribbean people who are regularly sectioned. What’s going on? For some groups within the black community this might be true, talking to a stranger does not appeal to them. However, there must be more to it than that.

'We might need to be resilient and have frank conversations in supervision about what it feels like to be mistrusted, while continuing to be non-judgemental and compassionate towards our clients.'

Black people are faced with historical and societal barriers which impact their day to day treatment, so are often treated as less than or must prove their worth. Ideas of which are so entrenched in the media and 'general banter' that they have now become normalised perspectives. Thus, some white professionals may not even be aware of the discrimination and prejudice their client is embedded in at a first glance. ‘All black men are aggressive,’ ‘Most black youths are criminals,’ ‘They aren’t academic but are usually athletic.’ And images of Africa only show desolate places and starving children.

Colour-blindness

‘I don’t see colour’ is sometimes said by white professionals to diffuse tensions around racial difference, with the naïve intentions of promoting equality. However, this basically means ‘I don’t see you or any restrictions you might have because of your skin colour.’  Even if the words are not articulated, a lack of openness to exploring race, which might be very important to your client, might be detected. Often the lack of openness is assumed, because of experience outside of the therapy room, where discussions about race in the workplace or with their white counterparts have not been received well. Therefore, white therapists might have to be proactively welcoming towards speaking about race.

To deny colour is to deny any awareness of power, privilege and oppression which are aspects which underlay the issues of race in western culture. According to modern genetics there is not much difference between black and white people, however, if you Google Social Darwinism or Eugenics you will see that there is a whole history of racialisation. Racialisation being the social construct of race, characterising a group based on their physical features to create otherness or an underclass for the social, political or economic benefits of another group. This, for example, supported the initiation and continuation of the transatlantic slave trade.

• See also: Breaking down racism in mental health care
• See also: Why do therapists find it so hard to talk about race?

The legacy of this has been described by Esther Stanford-Xosei and Dr Joy DeGruy as Post Traumatic Slave Syndrome, which has led to mistrust, internalised racism, loss of identity and the pressure to take on Westernised ideals of beauty and cultural norms. Accepting and understanding these issues means true empathy can be achieved as you are able to see the significance of the wider context which may have influenced some of what your black client is going through.

Trust

Trust is the basis of any good therapeutic relationship. Acknowledging the difficult history of white Britons and post-colonial black Britons and their descendants will support you in building that trust. In a recent article about Oxford University, black students discussed the importance of being able to see a black therapist if some of their mental health issues had been a result of racism and discrimination. This is an understandable request but what happens if in other settings black individuals don’t have a choice and how can a white therapist support them when exploring these difficult topics?

Well, it would be a similar situation if I, as a female counsellor, had a male client who had trust issues with women because of past relationships. I cannot take that personally, but I understand that establishing a relationship may be difficult at first. In addition to this if we can achieve the latter, this experience would be extremely healing for him.

I might need to be resilient and have frank conversations in supervision about what it feels like to be mistrusted, while continuing to be non-judgemental and compassionate towards my client. Thus, white therapists might need to explore their thoughts and relationship with the past and how it feels to support someone who talks about experiences of racism in therapy and supervision. Not all black clients will want to talk about race or the hardships associated with it but being open to confronting it at some point is key.

Unconscious bias

A few good questions to ask yourself could include:

‘How much contact have I had with people from black communities?’

‘How much of my understanding is based on media, inherited ideas or stereotypes?’

We have prejudices and judgements about different types of people, linking to our inherent fight or flight responses, which keep us safe from potential danger. However, we need a more conscious understanding of how or why we have inherited a bias towards people of a certain group: self-exploration about your upbringing, things you were told, how black people were spoken about around you, how they were portrayed on television and how this might be different when you meet different black people in real life.

Find out about black people’s positive history, this is not about pity or an apology it is about seeing beyond what you have been told and being open to light and shade, the Kings and the slaves, different parts of the black history and identity. Why should your black client’s heritage only be defined by slavery or poverty? Celebrate your new findings with them and make it a priority to ask them what you need to know about their culture, as it shows you want to find out more about who they really are.

Interracial therapy for me is a statement of unity against a historical wedge and psychological segregation. I see interracial therapy as learning for the therapist and healing for the client, a chance to benefit from the power of relationship. A small reflection of what could happen in society if we all took the time to face our own pain, guilt and histories. Moreover, a chance to impact change in mental health approaches and achieve psychological well-being for everyone.

Psychotherapist and trainer Kimberly-Anne Evans will be hosting an event, Trauma, The Church and Psychosis, in London on March 9.