Black Women and Therapy- Why Race Matters

pexels-photo-818819.jpeg“What would a White doctor know about my problems?” “They’ll call me crazy and lock me up!” “The pastor has been helping me,” and “Where would I even find a good Black counselor?”   Although the Black community shares the same concerns and mental health issues as others  and with  even greater stressors due to discrimination and economic inequities,   many shy away from psychotherapy.    This is due to many factors such as feeling unable to find a therapist they feel can truly help them,  being distrustful of White people, the belief that seeking help makes you weak and also the idea that therapy is for “crazy” people.

 

Cultural Mistrust

African Americans have a greater distrust of the medical establishment in general, and many feel that  medical institutions hold racist attitudes. This goes  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 often victimized, even to the point of being used as examples of surgical techniques for medical students.

Cultural mistrust is partially responsible for  the under use of  mental health  services, leaving many without needed care. Black people may fear mistreatment, being hospitalized involuntarily, or being used as research “guinea pigs.” Black people who regularly encounter prejudice often  develop “healthy paranoia” — a cultural response style based on experiences of racism and oppression in White society.  Worries  about being judged or wrongly  diagnosed may lead many African Americans to exercise caution or avoidance of mental health care. This reaction has lead some clinicians to over diagnose paranoia in  Black clients, which then leads to greater mistrust on the part of the client.

Therapist Factors

White therapists often don’t understand why Black clients  are cautious.  Unfortunately ethnic and racial stereotypes often affect therapeutic relationship.  The therapist’s reaction to the client  can be complicated by unacknowledged prejudice, stereotypes, and feelings of guilt.  An honest discussion of ethnic and racial factors in the therapeutic relationship can increase trust and mutual understanding.  However, many therapists are unsure how to approach racial differences, and may prefer a “colorblind” approach.

Colorblindness Is Not the Answer

A colorblind approach only relieves the therapist of his or her obligation to address racial differences and difficulties.  Being  colorblind allows the denial of uncomfortable racial and cultural differences.    Being colorblind  ignores the experience of being stigmatized by society and represents a failure on the part of the therapist.

 

The Black Client and White Therapist

In my work as a therapist working primarily with Black clients, I have had many clients tell me about difficulties they’ve had with White therapists.  Many clients felt there were subjects they couldn’t discuss with their therapist because they felt the therapist couldn’t possibly understand due to cultural and racial differences.  I have also had clients say that they have discussed racism they’ve experienced and felt that their therapist felt that they were making a “big deal” out of something.  These situations led to clients being distrustful of their therapists.

 

 

Choosing a Therapist

It’s important when choosing a therapist to choose someone who you feel understands you and will be empathetic and non judgmental towards you.  Sometimes it takes going to different therapists to find the right one for you.  Finding a culturally competent therapist can be especially difficult but not impossible.  Remember  no matter what race or ethnic background your therapist is, the most important thing is that you feel heard, understood and safe to express yourself in therapy.

 

African American Women and Mental Health

There’s often a fear of putting our business in the street . . . of somehow revealing too much. Black women often perceive going to a therapist as something we don’t do.

African American women have the highest mortality rate for heart disease and stroke and the highest prevalence of high blood pressure and obesity. Recent research indicates that mental health plays a role in these health disparities. While many black women know and discuss the threats to their physical health, when it comes to mental health, there’s often silence and inaction.
Many black women are struggling with mental health issues but are not seeking professional help. Improving black women’s access to mental health treatment as a crucial element to addressing the serious, but often manageable, illnesses plaguing their physical health.

Women Who Need Care Go Without
Despite the emotional and physical consequences of mental-health problems, black women are less likely to seek treatment. The percentage of African Americans overall who receive needed mental-health care is only half that of whites, according to a Surgeon General report on mental health. By some estimates, only 7 percent of black women suffering from depression receive any treatment, compared with 20 percent of the general population.
The California Black Women’s Health Project, released the results of a study of more than 1,300 African American women across the state. The subjects in the study revealed that they tended to repress feelings, let frustration build and release tension through tears or conflict. The findings of the study, which included a series of focus group discussions across the state, led to a launch of a mental health initiative to improve African American women’s acceptance of and access to mental health treatment.

It’s important for African American women to realize that self care is not selfish and you must take care of you so you can take care of others. It is also important to recognize something is wrong and you deserve to feel well.

Many Black women have a distrust and place a stigma that black women on mental-health treatment, in part from their difficulty in finding a therapist to whom they can readily relate. African Americans comprise less than 6 percent of mental-health care providers nationally. Overcoming this shortage may be crucial to improving treatment outcomes for African American women. In my work in the mental health field, I have found from interviews with clients that mental-health practitioners “don’t get it when they are working with people who don’t look like them.”

African American women also struggle against the stigma associated with mental-health treatment.
One study found that the proportion of African Americans who feared mental-health treatment was more than twice that of whites, according to the surgeon general’s report. Part of the fear stems from wariness of the medical establishment that arises from past abuses, such as the Tuskegee experiment. (In 1932, the federal government sponsored a study to examine the impact of untreated syphilis involving black men. The experiment went on until 1972 without the test subjects’ knowledge and most of the subjects died without receiving treatment.) As a result of the distrust engendered by the now-infamous experiment and the stigma associated with seeking help, many black women rely on spiritual leaders and community members to handle personal problems. There’s also an added pressure from the ethic of the strong black woman, a cultural value that promotes toughness and self-sacrifice. They often think ‘My mother suffered. My grandmother suffered. It’s just the lot of black women in America. It doesn’t have to be that way.
There’s a deep-seated feeling that going to seek professional help is a sign of weakness. These ideas and feelings must change in order for all women to function at their best ability.