Treating people of color: Three essential ways to prepare

Psychologists are reporting an increase in people of color seeking therapy and mental health services, as many communities of color are disproportionately impacted by the COVID-19 pandemic, and protests against police mistreatment and killing of Black Americans persist.

Discrimination has long been a source of worry and anxiety for people of color, and APA’s most recent Stress in America Survey found that discrimination continues to be a significant source of stress for Black Americans. Anxiety and depression spiked for Black and Asian Americans after the police killing of George Floyd, federal data show.

Now, more than ever, it’s essential for all psychologists to be prepared to work with people of diverse and intersecting identities, said licensed clinical psychologist Wei-Chin Hwang, PhD, a psychology professor at Claremont McKenna College who’s helping launch Ayana, a psychotherapy app for marginalized and intersectional communities.

“Often these clients are perpetually referred out and can’t find someone to treat them,” Hwang said, “when it really is a duty and responsibility of therapists to be open to learning about new cultures.”

As growing numbers of people of color seek out mental health services now and in the coming years, here are three essentials ways to prepare your practice:

Just as psychologists learn about different clinical diagnoses, treatment orientations and paradigms, said Hwang, they have a responsibility to learn about cultures and their intersection with other identities and contexts, such as LGBT identities, the immigrant experience, or poverty.

For example, when Hwang first treated a Filipino American, he prepared by reading nine books about Filipino culture and talking with several Filipino American colleagues.

Such learning should be ongoing, according to APA’s revised “Race and Ethnicity Guidelines in Psychology.” The guidelines note that psychologists should develop racial and ethnocultural responsiveness—taking deliberate, continuous action to maintain knowledge, grow in awareness, and address inequities and injustice.

“The number of psychologists [of color] in our field does not reflect the population,” said APA Chief Diversity Officer Maysa Akbar, PhD, ABPP. Data from APA’s Center for Workforce Studies show that 84% of the psychology workforce is White, so a person of color will likely see a White psychologist. “That means it’s the responsibility of White psychologists to get educated,” Akbar said.

Read widely, experts advise—including mainstream books like “How to Be An Antiracist” and within the psychological literature—to develop the clinical skills to understand how culture interacts with generational racial trauma, today’s current events, and a patient’s mental health.

“If you’re not considering cultural and racial issues in the diagnostic process, you’re probably overlooking them in treatment,” said psychologist Monica Lyn Thompson, PsyD, founder of Therapy for Queer People for Color, a mental health network of therapists.

Worries about the pandemic can be compounded by race-based trauma, such as Asian Americans experiencing increased xenophobia and acts of hate, the stress of Black Americans repeatedly being exposed to footage of police violence, economic and health-care inequalities, or the lack of attention when Black women or Black trans people are hurt by police.

Negotiating such conversations should rest on a strong therapeutic alliance with patients, said Akbar, a leader in race-based trauma. “Sometimes we overlook that because we want to get to the meat of treatment,” Akbar noted. “But our compassion and our empathy are paramount right now.”

But cultural knowledge is only the start, experts said. Psychologists must also reflect on their own “positionality,” a term referring to one’s place in the racial and sociocultural hierarchy.

“We all have [biases,] no matter who you are,” said Akbar, author of “Beyond Ally” a book that explores allyship as a spectrum of identities. “The faster we’re able to acknowledge our biases, the better our authenticity and genuineness will show throughout the therapeutic alliance.”

Without such reflection about themselves or deep understanding of a patient’s culture, therapists could misread cues about how someone expresses distress, apply stereotypes or commit microaggressions, Hwang and Akbar said.

Discuss your positionality in your own therapeutic process and within your community, said Thompson, but “do not go to people of color to assist you with doing this work, especially if you are not willing and ready to pay them for their emotional labor.”

Psychologists should also consider how their practice is set up, said Thompson. For example, does your staff reflect the diversity of the community you serve? Does your practice offer sufficient flexibility for patients who may have caregiving responsibilities, unpredictable job schedules, and transportation or internet access challenges?

At the outset of COVID-19 closures, Integrated Wellness Group, the clinical practice Akbar founded and led in New Haven, Connecticut, worked tirelessly to transition patients to teletherapy, even helping them get free WiFi from a local internet provider. The results were stunning: The practice’s show rate increased from about 70% to nearly 100%.

We weren’t considering how transportation, childcare, and lack of flexibility in terms of having to come into the office were a barrier.” Akbar said. “Teletherapy has eliminated all of those barriers.”

Look into contracting with a therapist of color for consultation on how your practice can be more responsive to the needs of people of color and establish a plan of action, said Thompson. “Flexibility is going to be valuable to Black and brown folks whose lives have so much going on.”