Family therapy can help families, couples, or individuals overcome challenges. Relationship issues do not discriminate, and people of all cultures and races are vulnerable to family conflicts. This does not mean that people of every ethnicity embrace family therapy equally; African Americans are far less likely than Whites to seek out therapy for problems. The reasons for not utilizing therapy could include limited access to care, financial restrictions, mistrust of mental health professionals, and fear of stigma associated with counseling, but also the common belief of African American males to deal with problems on their own rather than seek therapy— and because “it’s a White thing to do” and Blacks see it more of a weakness rather than a strength to seek therapeutic help. (Of course we’re discussing a group rather than individuals and individual families).
The Cadmona A. Hall of the Marriage and Family Counseling Center at the Adler School of Professional Psychology in Illinois wanted to examine the specific barriers preventing African Americans from seeking treatment. In a recent study, Hall interviewed nine participants and found that stigma presented the biggest obstacle to treatment. Resilience was the most common personality trait that helped the participants overcome the stigma. Hall believes that African Americans are more likely to be resilient, having had to surmount the atrocities of slavery and the injustices of discrimination. This ability to overcome could have been an underlying force that led the participants to seek out help despite the barriers.
Hall also noted that eight of the nine individuals in her study were affiliated with the college where the counseling clinic was located. Having knowledge of and access to the services could have increased the willingness in this sample of participants. Another appealing aspect of the university clinic was the sliding fee scale, which was cited as a very beneficial aspect. Mistrust, which was listed as a barrier to treatment seeking, was addressed when the participants realized that their sessions were confidential and they felt comfortable enough to build rapport with their therapists. This was critical in setting them at ease and ensuring they would return to complete therapy.
The study was small but still revealed an insight into African Americans and psychotherapy. As therapists increase sensitivity and understanding of the unique features of African Americans, clinicians will have the increased ability to engage that particular ethnic population in therapy and increase quality of care.
Why race is important leads so many persons astray from the issue. To know why race is vital within any situation actually fixes the problem, and this is why race is important.
Issues in why Blacks avoid therapy or even seek outside help reveals itself in these questions: “why should I talk to a stranger?” “What would a White doctor know about my problems?” “The pastor has been helping me.” Another issue derives from African Americans wanting to support their own people and only recycling money back into their own people, communities, and businesses so for many it’s a must that they only support professionals that only reflect their own racial make-up so if they’re fewer choices of Black therapists then there’s a lack of Black individuals searching for outside help. The Black community shares the same concerns and mental health issues as Whites do, with arguably even greater stressors due to historical discrimination and economic inequities, but there still remains a connection of researching the dis-connect between African Americans and psychotherapy.
Little has been written about race and ethnicity in relation to the therapeutic professional field. Some suggest that less attention has been paid to this issue because patients and therapists of color are themselves under-represented. According to this perspective, the dynamics of race and ethnicity are understudied because most therapists are not familiar with the clinical issues presented by such clients due to the field mostly being “White.” Others have their own thoughts, perceptions, or opinions about why this topic isn’t written about more but nevertheless there are more studies focused on it today than any other time.
One topic in studies suggest “cultural mistrust” also being behind Blacks not receiving help from White psychotherapists. African Americans have a greater distrust of the medical establishment in general, and many American Black individuals believe medical institutions hold racist attitudes. If you think their distrust is silly then remember this goes way back to historical abuses of slaves by White doctors for medical experimentation; Blacks could neither consent or refuse to participate because of their low social status and were frequently victimized, even to the point of being used as examples of surgical techniques for medical students. Also, America has the events such as the Tuskegee Syphilis study, which confirms in many African Americans to be suspicious of any White health practitioners. Today African Americans are highly reluctant to participate in medical research due to the abuse their ancestors went through by the medical community in the past, and even today African Americans are underrepresented in many medical treatment studies.
Cultural mistrust is linked to the under-use of vital mental health care services, leaving many without needed care. African Americans may fear mistreatment, being hospitalized involuntarily, or being used as “research guinea pigs.” Black people who regularly encounter prejudice may develop what has been coined “healthy paranoia” which is a cultural response style based on experiences of racism and oppression in White society. Concern about being judged or improperly diagnosed may lead many African Americans to exercise excessive caution or avoidance of mental health care altogether. Unfortunately, this reaction has lead certain clinicians to over-diagnose paranoia in suspicious Black patients, that’s only perpetuating the cycle.
As much as psychologists hate to admit it, prospective Black patients are right to be cautious. Ethnic and racial stereotypes often affect therapeutic relationship, and not always to the client’s benefit. The therapist’s reaction to the patient can be complicated by unacknowledged prejudice, stereotypes, and feelings of guilt that therapists may hold themselves. An honest discussion of ethnic and racial factors in the therapeutic relationship can increase trust and mutual understanding which can lead to better progress. On the other hand, many therapists are unsure of how to approach racial differences, and rather try the “colorblind” approach, but that’s if they even realize that the problem exists.
Color-blindness isn’t the answer, and may backfire rather than help. A color-blind approach merely relieves the therapist of his or her obligation to address racial differences and difficulties, and hinder progress rather than make progress and a difference in the lives of people.
“Color-blindness is actually a form of racism.” The color-blind approach allows for the denial of uncomfortable racial and cultural differences between people. The word “blind” means not being able to see things, and it’s been said that wanting to be “blind” to color or race means wanting to ignore race or to pretend its social and historical effects don’t exist, and instead ignores the experience of being stigmatized by society, and furthermore signifies an empathetic failure on the therapist.
Many White therapists minimize the importance of acknowledging cultural issues in the therapeutic setting. Many White therapists will say “there is no scientific difference in the way Blacks and Whites habituate to stimuli,” which reduces the substance of treatment to brain chemicals and conditioning theory. This is acceptable until you figure in this, that approach fails to account for the very real differences in experiences and expectations of Black Americans.
Psychotherapists with a culturally different patient provide more opportunities for empathic stumbling blocks. Black clients often evoke more complicated reactions from the therapist than White clients since stereotypes of Blacks make them easier targets for the therapists’ own projections.
Another issue may arise when the Black client feels disrespected due to historical reasons that carry all the way from the slavery and the Jim Crow eras. For example, this scenario was taken from a study:
A White psychotherapist explains how it can go bad quickly; the patient was nervous, talking excessively, fidgeting, and getting in and out of his seat, so the therapist said, “down boy,” to calm down the patient (and maybe to a White person from a fellow White person this would of been alright because this is only a historical racist comment against a White to a Black person), so the Black patient felt degraded and disrespected. The patient in this case actually was then written off as defensive which made him a poor candidate for psychotherapy, so the patient was denied treatment. Instead, if that White therapist had understood the relevance of that insult within that remark (as the term “boy” has been used historically to demean African American males), then it would of been a smooth process. Now, we can all argue “what modern day White person doesn’t know this?” but it’s in fact a true part of everyday lives.
Speaking of “everyday life” every Black person, group, and family don’t come from poor backgrounds so now you have another level to deal with. Black professionals or Blacks who come from upper-middle class to the higher classes seeking clinical help may be subjected to White therapists who may not understand all the layers of difficulty such Black patients experience; the pressure of being a minority in a White corporate world filled with blocks that you must push through for succeeding generations may go right above the therapist’ head and fail the client seeking to experience a breakthrough.
Black people seeking only Black therapists will have difficulty. Black therapists, psychologists, or psychiatrists are underrepresented, especially those with a doctorate. We’re not stating that because it’s a Black therapist that it automatically qualifies them to be the best to address the issue(s), but we’re stating that it’s very common for Blacks to only want to give their dollars to Black businesses and because this is true in most Black groups this will stop them from seeking the help they need. It’s maybe unheard of for many White persons to know that because you wait around for the White person to leave and ask, “is he or she a Black doctor, lawyer or other professional type?” For that reason alone, it’s not enough for a White therapist to be specialized in whatever makes them qualified to best help. Yes, yes it would help to have more Black therapists to deflect this issue, but until then choosing a therapist who has a reputation for being ethnically open-minded, flexible, and who makes you feel understood and validated as an African American.