Racial violence and discrimination are woven into the fabric of the United States. The way policies and laws are implemented. The weapon of white and privilege. Differences in education and health care. The terrible and senseless murders of blacks in our nation's history to the present day.
How do daily racist violence, injustice and discrimination affect the mental health of black Americans? What is it like to work and live next to people you don't appreciate as a human being? What is it like to live in a country where your rights are often threatened?
Dominique Hammonds, assistant professor and test coordinator in the Human Development and Psychological Counseling Department at Appalachian State University, gives a brief look at the complexity of a black woman and counselor in a racist society. Hammonds, who was wearing a shirt that said "Black and Educated," was shopping in Walmart recently when a white woman passed her and casually said, "You're disgusting." At that moment Hammonds felt powerless. She feared the consequences if she said or did something in response.
Hammonds left the shop and shortly after went into a counseling session in which her client said that she felt powerless, angry and upset due to injustices in her life. Hammonds had to divide her own feelings of fainting to help the client.
Consultants play an important role in helping black Americans cope with and cure racist stress and trauma, but they can do more. You can also take steps to change an unjust and racist system that has a strong and negative impact on the mental health of black Americans.
Distrust of Mental Health
Research shows that black Americans report 20% more serious psychological stress than white Americans, but use fewer psychosocial services.
Loni Crumb and Janeé Avent Harris, both assistant professors for consultancy training at East Carolina University (ECU), and two of their colleagues examined the negative perceptions of mental illness and treatment in black Americans. They found that stigmatization, lack of trust in mental health care, and misleading concerns about black people make this group more concerned about seeking advice. Financial bottlenecks and the lack of access to culturally appropriate psychiatric care are additional obstacles, explains Crumb, a research and innovation researcher at the Rural Education Institute at the ECU College of Education. (For a more detailed discussion of their results, see their article "Perception of Mental Illness by African Americans and Preferences for Treatment" in the Journal of Counselor Practice.)
This distrust is not without foundation. For example, black Americans have been misdiagnosed for decades and overdiagnosed with schizophrenia. (For more information, see Tahmi Perzichilli's Historical Roots of Racial Differences in Mental Health Systems at CT Online.)
Angie D. Cartwright, associate professor of counseling at the University of North Texas (UNT), emphasizes the importance of examining how and why suspicion of mental health began in the black community. "Institutional and systemic racism is the foundation of many of our medical treatments, including psychological health advice," said Cartwright. "And historically, problems arise when [Black people] invites others to [their] houses and communities."
Sitting with discomfort
Advisors, not clients, should be the first to address racism issues. This is not necessarily easy or convenient.
Consultants often combine comfort and security, but they are two different things, stresses Cartwright, a licensed professional consultant and licensed sex offender treatment provider who is the clinical director and owner of North Texas Counseling and Wellness.
As she explains, it doesn't mean that the topic itself is pleasant if you feel comfortable enough to address the topic. "It's not pleasant to say," I was discriminated against, "" I had a gun on myself, "or" I was fired because my boss is racist, "she continues will always feel uncomfortable. And that's fine. "But clients should feel confident enough to share their experiences – those that consultants often find unpleasant to hear," she adds.
"You have to make yourself comfortable to feel uncomfortable," says Hammonds, a licensed clinical mental health advisor (LCMHC) in North Carolina. "Part of [counseling]’s ability is to learn how to conduct these discussions in a way that feels comfortable." For example, can counselors say the word black, recognize their own ethnic identity, or discuss racism competently? If not, customers know that they cannot go beyond a top-level discussion with them, Hammonds explains.
What counselors say doesn't even have to be overly complicated, notes Hammonds, a member of the American Counseling Association. You can just say, "I just want to check in. There's a lot going on around us. How was it for you?" Or "I'm curious to see how you, as a black American, could be affected by racist violence and oppression."
Being open and courageous on this subject is likely to lead to some wrongdoing. It's part of the process, says Hammonds, who encourages the counselors to use these mistakes as an opportunity to learn.
A misstep can become defensive when customers express anger, suspicion, or sadness about their experience. "If you feel defensive – try to explain the customer's experience or identify with the customer's experience and feel like you have to apologize … on behalf of the system – don't do that," Hammonds says. "All you do [in getting defensive] is to inform the customer that you are still not feeling well and have not done your personal work." And the excuse only enables customers to feel obligated to say, "Oh, it's fine," she adds.
Instead, she advises the advisors to think about their own internal experiences and to prepare for what could trigger this reaction. Perhaps it is a case where the counselor wants to protect his own ego, or maybe masking their own discomfort or lack of knowledge. When counselors become defensive in the session, they can tell the client, "I feel like I'm responding to something and I realize that I need to reflect on myself." But I don't want to pile that on you. "But make it short, says Hammonds, otherwise the session is more about the advisor than the client.
Building trust and rapport also becomes critical to creating a sense of security for these customers. Too often, consultants jump to diagnosis and treatment because the mental health system encourages them to have a solid plan and work towards a goal fairly early in treatment, Hammonds emphasizes. She encourages consultants to slow down and invest time in building good relationships with their black clients.
Context is important
As Avent Harris, an ACA member, emphasizes, advisors will not know that they need to address racism unless they understand its historical and political context. Simply put, they need to know what to look for and ask for.
"You don't learn this context and you don't get that cultural awareness by just reading the DSM [Diagnostic and Statistical Manual of Mental Disorders]," says Avent Harris, who focuses on multicultural considerations in adviser training and the role of spirituality in finding help for the mental health of blacks has specialized behaviors. She advises advisors not only to read advisory texts in order to research the works of black scholars, theologians and authors.
Consultants may also need to adapt a technique or approach to better fit their clients' experiences. For example, the thought of running in the evening sounds uncomplicated, but for many black people, and especially black people, it can create a feeling of fear. They wonder if they are safe or if their decision to run them could cost them their lives.
When a client brings up this fear in the session, it can be dangerous for the counselor to use a mind-stopping technique to interrupt, remove, and replace the client's “problematic thoughts,” explains Hammonds . She suggests that the client simply stop thinking that running could harm them and ignore her experience and the existence of racism embedded in society.
Instead, Hammonds, elected president of the North Carolina Counseling Association, says that the advisor should take into account the context surrounding the client's fear of running alone at night. Where does this fear come from? How does society add to or maintain that client's fear and worry?
"These are the types of discussions we have to make room for," she says.
Confidence and honesty regarding prejudice
Hammonds stresses the importance of honestly speaking that advisors think about their own experiences and prejudices. As she emphasizes, consultants often think: "I attended this multicultural course or worked with clients from different backgrounds, so I'm fine." But that shouldn't mean at all, she emphasizes.
This self-confidence begins with the training of consultants. Working with different customers is the best way to appreciate differences and examine your own prejudices and beliefs, says Crumb, an LCMHC in North Carolina.
This diversity should also extend to advisory advisory groups. Avent Harris, an LCMHC employee in North Carolina, is looking for colleagues who give honest feedback and question their own thoughts and beliefs. She says that if she has an uncomfortable moment in the session, these colleagues would ask, "So why did you feel uncomfortable at that moment? What questions do you have to ask yourself to think about this moment? "They wouldn't just repeat their thoughts or tell her" don't worry, "Avent Harris says.
Hammonds advises counselors to continue recording and observing during the session, just as during graduate school and supervision. "It is so valuable to repeat your words and to listen from the perspective of this outsider," she says. The process offers consultants the opportunity to (re) rethink their words, reflect on the purpose of their statements or actions, and assess whether they have really listened to and heard from their clients.
Advisors should also get their own adviser. “Some of these things are deeply rooted. It takes time to dig up, understand, unravel and repot these roots, ”says Cartwright.
She jokes that her mother always said to her: "Never trust a beautician with bad hair." The same principle applies to consultants, she says. You need to make sure that you take care of your own mental health before working with clients on their wellbeing. "And customers can tell if you've … done their job," she adds.
Cartwright, the project leader of UNT Classic (a program that addresses differences in psychiatric services for black and Hispanic populations in the Dallas-Fort Worth metropolitan areas) and UNT ICBH Project (a program that helps doctoral students during clinical Education Supports) suggests that their peers, especially those with privileged identities, work with a counselor who identifies with a marginalized group or with intersections that the privileged colleague is struggling with.
They should also deliberately put themselves in a minority position, Cartwright continues, a member of the ACA Advocacy Task Force and president of the International Association of Addictions and Offender Counselors, a division of ACA. For example, she suggests that white counselors visit a black church on a Sunday. "If you feel uncomfortable for the short amount of time you are there, imagine how your black customers feel every day when they are constantly in white-dominated rooms," she notes.
Finding voice and value
Black clients report to the counseling with the same common concerns as other clients. In addition, according to Hammonds, they often seek advice on questions of “voice and value”. They have experiences that either minimize their voice or communicate openly or covertly, that their ideas, opinions and problems do not apply. It does not matter or is not as important as that of others, she explains. The feeling of being undervalued, dismissed, and unheard of can lead to anxiety, depression, and other mental health problems, she adds.
Cartwright specializes in underserved population groups in the areas of counseling and counseling training, mentoring in counseling training as well as questions relating to counseling offenders and addicts. She once worked with a client who suffered from racism and discrimination in her workplace. The former customer was the only black woman on a large corporate team, and she noticed that meeting times would suddenly change without anyone notifying her. She also felt that her coworkers were talking about her behind her back. At first she internalized this discrimination and began to think that she must be bad at her job. She felt like a fraud.
However, after another colleague confirmed the woman's suspicion of racial discrimination, the former client filed a lawsuit and won. However, the victory was costly. She learned that employees had deliberately changed meeting times without notifying them. Other colleagues whom she had meant well had made racist and hurtful comments about her that were exposed during the lawsuit and investigation.
As a result, the client began to question her judgment and value. Cartwright helped the client to feel valued again and to trust herself. They worked to challenge the client's thoughts that she was not good enough. For example, they used self-affirmative techniques such as daily affirmations and self-statements that allowed the client to identify and recognize her strength and resilience.
Even though counselors cannot relate to discrimination at work, they can probably identify with the feeling that their voice was not heard, says Hammonds. From this perspective, counselors can take deliberate steps to empower these clients in the session.
For example, black clients often feel that they cannot or should not tell the advisors whether they do not like the way the adviser has spoken or whether a moment in the session makes them uncomfortable Hammonds. But they should feel good when they express these thoughts, she continues, and it is up to the consultants to create a space that invites feedback.
Hidden Battles
An article in the Washington Post on May 31 on protests after the murder of George Floyd described a less visible impact of racist violence: “The private fatigue and fear that many feel [B] lacks people in the country. In other words, many black people are exhausted.
Emotional fatigue is another reason black people often seek advice, says Hammonds. In addition to being tired of the discrimination and injustices they experience every day, they often find it necessary to change the code – to change the way they speak and express themselves when they are outside their homes and black communities. 
To explain this concept, Hammonds uses the analogy of consulting professionals who change their “hats” or roles. You can move from teaching to overseeing a client counseling session and returning to teaching on the same day, which can be stressful.
“Change roles, pause constantly and have to rethink how much you can share and what role you play in this new context, and always be aware of what you can say and what can't and what you can do and what isn't exhausting, ”says Hammonds. "And that's an emotional job that a lot of white Americans don't have to do."
Black women are often exposed to additional stress. Avent Harris explains: "Black women are expected to be vulnerable both inside and outside their community, not to share emotions, and to carry the weight of everything on their shoulders."
This unrealistic expectation can affect mental health. In fact, many Cartwright customers are struggling with the "Black Superwoman Syndrome" – the myth that black women are impenetrable. You feel the pressure to do everything and do it well. While not really a syndrome, it helps explain the chronic stress these women experience when trying to juggle multiple roles and keep up with the daily demands that family, work, and community place on them.
Cartwright customers often discuss how they feel misunderstood at work and how employees minimize their experience. Cartwright normalizes these experiences for their customers, but it also expresses how sad it is that this is their "normalcy".
The trauma of racist violence
Cases of brutality and violence against blacks are not new, just as are the racial differences with which they are regularly confronted. The main difference today is the ability to easily document such cases, says Hammonds, whose research interests include technology in counseling, multicultural counseling, and community determinants of mental health. Almost everyone has a smartphone in their pocket today, and more and more people are using it to record racial violence and call for justice and accountability.
These videos constantly expose others to these traumatic and hideous acts. This can be particularly traumatizing for blacks, who often internalize the traumas they experience because they know it could easily have happened to them, Hammonds says.
The derogatory comments on social media can also be traumatizing and triggering for black Americans, Crumb adds. For example, you can read a racist comment from a manager or colleague. Then they have to go back to work and sit next to that person to know how that person really deals with them.
"And so often [Black people] is expected to move around the world, hear all of this, see all of this, and have no emotional response or reaction," says Avent Harris. Consultants can help change this by validating clients' emotional responses to racist violence and discriminatory comments, she adds. This includes letting them know that it is okay to feel disappointed, sad, angry, scared, anxious, or whatever else they feel.
The trauma of being exposed to racist violence and statements also has a collective effect. "Collective trauma is exposure to stressful events that threaten a sense of security at the group level," explains Hammonds.
In a recent episode of the podcast "The Thoughtful Counselor," Hammonds described how repeated exposure to racist violence and discrimination works like a wound that doesn't heal: "This point has been stolen so many times. We can do it Carry out the healing process, but before you know it there is another incision, then go around and do your best to deal with shielding this point and anticipating situations that could hit you again … You are always nervous . You withdraw. Your trust builds up slowly in other people and situations. You are angry and sad. And you start to think: "Something is wrong with me? Why can't I leave this cycle?"
This collective trauma correlates with symptoms of depression and post-traumatic stress disorder such as avoidance, reliving, numbness, and hyperarousality, she adds.
When a community experiences stress together, counseling approaches based on the power of relationships are helpful, says Hammonds. These approaches include relational therapies, psychodrama, drama therapies, creative approaches, and group therapy.
Hammonds often includes music in her meetings with clients. She describes music as a picture book because it connects people with a certain memory, place, emotion or experience in their lives.
If customers cannot simply describe their thoughts, feelings or perceptions in their own words, they ask them to come up with a song that best captures their emotions or represents what they see around them. Then she pulls up the song, plays it in the session and asks the customer: “What is powerful about this song? How do the lyrics or the beat affect you? "
Effects on Black Children
In summer 2016, a Minnesota police officer killed Philando Castile fatally in his car during a traffic incident. Castile was not alone. His girlfriend Diamond Reynolds and her 4-year-old daughter witnessed the entire incident.
After the shootout, Reynolds, who was now handcuffed, was understandably distraught and emotional. Her daughter tried to comfort her and exclaimed, "Mom, please stop swearing and screaming because I don't want you to be shot." A few minutes later the girl said: "I wish this city was safer. … I don't want it to be like this anymore. "
The girl's words illustrate how racism and racist violence affect children at a young age. "Black adolescents are just as affected by systemic racism and injustice as their black parents," said Crumb, an ACA member whose research interests include rural and school-based psychosocial services. Black children are directly and indirectly affected. You witness racist violence and discrimination yourself and hear adults talk about it at the kitchen table. "Then take on these thoughts, these fears … [and] this distrust," Crumb adds.
Here, too, advisors should take the initiative to address the issue of racism with these young people. Crumbs calls it "measuring the temperature of the room" because counselors can check in to see how the kids are doing. For example, an advisor could say, “It was a tough summer with COVID-19 and many people who were injured and died. How are you? "
Then counselors should let the children lead the talks, says Crumb. Some may verbalize their feelings. Others can play or draw a picture to express their feelings.
Crumb points out that school environments are often the only access that some black communities have to advisors. But due to distrust and fear, they may not see counselors and schools as “safe spaces”. Crumb advises the counselors to take into account the current and historical race differences within the school systems and to change their approaches accordingly in order to try to get in touch with these children.
Younger children may not have the vocabulary to communicate their feelings easily. They often "speak" through games and toys. Therefore, Cartwright advises counselors to keep a selection of toys, dolls, and activities that children can use to communicate the way they feel most comfortable. If they want to use a brown doll, consultants should make sure that it is available to them, she adds.
But as Reynolds' 4-year-old daughter has shown, some black children have an early awareness of racism and a vocabulary to discuss. You often have no other choice. Black children will experience inequalities earlier than their white peers based on their parents' experiences and the conversations they hear, Avent Harris explains.
Crumb encourages counselors, especially school-based counselors, to courageously work for black youth. Black adolescents are often overlooked academically and disproportionately suspended, she says. Consultants can vocalize why this is the reality. Likewise, counselors can ask questions and push for answers when diagnoses of attention deficit / hyperactivity disorders and behavioral disorders are disproportionate to ethnicity.
In addition, consultants can do something about such differences. For example, they can run teacher training courses, says Crumb.
Partnership with the Black Community
Black people can rely on informal support networks like family, friends, and their church communities to help them deal with problems related to their mental health, says Crumb. She adds that counselors should encourage clients to continue using these support networks, as it is imperative that they have trusted people to whom they can turn to discuss their experiences of racial trauma.
Advisors should also contact and build relationships with interest groups in black communities. Crumb and Avent Harris recommend working with community organizers, historically black Greek-letter organizations, juvenile justice officers, law enforcement officers, and faith leaders.
Faith leaders are often both spiritual and political leaders in the black community, says Avent Harris, so working with them is vital. "How [Black Americans] conceptualizes events, crises, pain and suffering often comes from [their] spiritual belief systems," she adds.
In an article written for CT Online after the 2015 church shootings in Charleston, South Carolina, in which nine blacks were killed, Avent Harris suggested that counselors deal with black pastors could meet and offer to speak on their Sunday morning services, co-sponsor one day for mental health, or provide referral resources.
Consultants should also consider these partnerships as a preventive measure. Consultants need to be invested and involved in black communities before crises occur, Avent Harris emphasizes. She encourages her colleagues to name five contacts with whom they work in the black community and who they could reach immediately. If they can't name five, she says, they have something to do.
Talk less, act more
Die Wörter Vielfalt und Inklusion haben im Beratungsberuf stetig an Bedeutung gewonnen, aber Avent Harris glaubt, dass dies es den Beratern ermöglicht hat, weitgehend selbstgefällig zu werden und nicht über das Denken von „Veränderung“ hinauszugehen, indem sie einfach verschiedene Personen einbeziehen und einstellen.
„Es geht nicht nur um Vielfalt und Inklusion. So machen wir Gerechtigkeitsarbeit, so machen wir Antirassismusarbeit “, betont sie. „Was sind unsere Handlungen hinter den Worten, die wir sagen? Und stimmen unsere Handlungen mit dem überein, was wir sagen und wer wir als Beruf sind? “
Avent Harris ist wie viele andere Schwarze erschöpft davon, immer wieder das gleiche Gespräch darüber zu führen, wie die Erfahrung der Schwarzen ist. "Es ist Zeit, über dieses Gespräch hinauszugehen und Maßnahmen wirklich umzusetzen", sagt sie.
Maßnahmen zu ergreifen bedeutet nicht, dass alle Berater auf die Straße gehen und protestieren müssen, aber sie können sich dazu verpflichten, die Räume zu beeinflussen, in denen sie sich befinden, sagt Crumb. Vielleicht schreibt das einen Artikel. Vielleicht bietet das eine Schulung an. Vielleicht funktioniert es, um die Politik zu informieren. Vielleicht geht es darum, auf positive Veränderungen in ihren Gemeinschaften oder in sich selbst hinzuarbeiten.
Cartwright schlägt auch vor, dass ein kleiner Schritt, den Berater unternehmen könnten, einen großen Einfluss haben könnte: ihre Dienste für Farbgemeinschaften zugänglicher zu machen, indem ein Pro-Bono-Slot pro Woche angeboten wird oder eine Staffelung vorliegt.
Obwohl 2020 nicht das Jahr war, das wir wollten, kann es das sein, das wir brauchen. Jeden Tag hören wir den weltweiten Rallyeschrei „Black Lives Matter“. Hinter diesem Schrei stehen schwarze Menschen, die unter systemischem Rassismus leiden und sterben. Wir hören den Refrain: Trayvon Martin, Tamir Rice, Eric Garner, Philando Castile, Charleena Lyles, Atatiana Jefferson, Breonna Taylor, Ahmaud Arbery, George Floyd, Tony McDade, Rayshard Brooks und unzählige andere, die gestorben sind.
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Dies sind die tragischen Morde, die die Nachrichten machen. Aber wie viele andere sterben täglich, ohne große Aufmerksamkeit zu erregen? Wie viele weitere sind täglich Ungerechtigkeiten oder Diskriminierungen ausgesetzt?
Ja, ihr Leben ist wichtig. Und ihre geistige Gesundheit auch.
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Am 22. Juni gab der ACA-Regierungsrat eine Erklärung zum Antirassismus ab. Während dieser Artikel geschrieben wurde, hörte die ACA-Führung einem Querschnitt von Mitgliedern und Freiwilligen zu, um einen Aktionsplan zu entwickeln, der der Erklärung Leben einhauchen würde. Weitere Informationen finden Sie unter tinyurl.com/ACAAntiRacism.
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Lindsey Phillips ist Autorin von Counseling Today und UX-Content-Strategin. Kontaktieren Sie sie unter [email protected] oder über ihre Website unter lindseynphillips.com.
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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.
