Everybody benefits when we’re all working toward cultural competency,” said Jackman, a licensed clinical/forensic psychologist whose metro-Boston area private practice, Innovative Psychological Services, recently hosted a panel discussion, “Join the Conversation: Navigating Racism & Other ‘Isms’ in Therapy.”
Attendees discussed strategies for mental health professionals to effectively address issues such as racism, xenophobia and heterosexism, whether working with clients who have experienced discrimination, with clients who express offensive comments in sessions or through issues that manifest with co-workers in the workplace.
Jackman, who is diversity subcommittee chair for the APA Committee of State Leaders, said such issues are not new territory for psychologists. However, “There’s definitely a new landscape that people are reacting and responding to,” Jackman said.
The socio-political climate of 2017 – which included much discussion on immigration, for example – led to such topics making their way into therapy sessions.
“People feel insecure in certain ways. It can feel really scary and unsafe,” Jackman said.
“As mental health professionals, I think it’s on us to be able to engage in conversations or support our clients who are dealing with these issues,” Jackman said.
Panelist Luana Bessa, Ph.D, staff psychologist and coordinator for diversity & inclusion at Commonwealth Psychology Associates and a member of the Massachusetts Psychological Association (MPA) Committee on Ethnic Minority Affairs, said she comes from an immigrant background and has always been both professionally and personally interested in the topic.
Bessa said a key takeaway is that clinical competence and cultural competence can’t be divorced.
“Cultural competence is clinical competence,” Bessa said. “I really think that it’s impossible to do the most effective, most ethical, most appropriate clinical work without taking into account issues of power and privilege and clients’ multiple identities and social context.”
Valene A. Whittaker, Ph.D., a psychologist at a federal agency in Massachusetts and one of the panelists, said, “My stance is that it’s our ethical and professional responsibility as psychologists to find ways to address different forms of injustice and specifically racism, sexism, homophobia, and xenophobia, as well as other injustices.”
As a woman psychologist of color, Whittaker said, she has a range of experience in different therapeutic modalities that speak to those issues, whether through one-one-one or group therapy, as well as with supervision and consultation to clinicians who themselves have experienced biases or prejudices.
For example, during one group therapy session, “There was a statement that was made. It was unclear whether it was made intentionally, but it did involve a white client saying a racial epithet in a conversation that included a black client,” Whittaker said.
“As a woman of color facilitating a therapy group with clients from different backgrounds, I found myself really grappling with not only knowing how to address that with the person who experienced the racist interaction, but also the person who initiated the interaction and also how to think about this from my perspective as a clinician of color addressing this issue.”
Current political and social issues can open up a conversation about personal experiences and systemic issues, Bessa said.
“I have had a couple of different clients in the past year, in the context of the ‘Me Too’ movement and all the things that are going on politically, disclose incidences of sexual harassment and assault that they had not disclosed previously and this opened up a conversation around systemic issues of sexism,” Bessa said.
If a client has a history of sexual assault, the MeToo movement might come into play – even if the client doesn’t say it aloud.
“It’s our responsibility as psychologists to be aware of what the elephant is in the room, or what forces may be in play,” Bessa said, and that includes not only a client’s history – but your own.
“As psychologists, what we need to think about when we work with folks in general is the importance of noticing our own positionality in the room,” Bessa said. “How does that impact what we bring into the space? Because we’re always bringing something into the space – we’re bringing our own history, our own values and assumptions and part of doing this clinical work is really being willing to be humble and never to fully be an expert so to speak; to come from a space of humility.”
Bessa said psychologists bring assumptions into the room as part of their own identities, and whether those assumptions have to do with issues you haven’t experienced personally – or those that you know very well – both can be dangerous.
For example, as a woman psychologist working with another woman, “We have this shared experience of being a woman, but we may have a completely different relationship to that experience,” Bessa said.
The key is to be present with the client, and hear their perspective, Jackman said. “Sometimes you think if somebody looks like you, they have the same experience, but they don’t,” Jackman said. “So, I feel like every client-therapist interaction is cross-cultural.”
Psychologists should think about how much they should self-disclose.
“If a client is dealing with an issue that you’ve dealt with before around discrimination or experiencing a microaggression, do you say ‘Yes, me, too or do you hold that?” Jackman said. “You have to think about how might that help the client. I think it’s context-dependent.”
Jackman said few states mandate continuing education that specifically addresses cultural diversity. She encourages psychologists to take the onus on themselves to seek out educational experiences to expand cultural competency.