Calling Out Racist Behavior in Therapy:

10 Strategies Therapists Should Use to Address their Client's Biased Actions

Dr. Charmain Jackman

June 22, 2020 | 6 min read

Interrogating Psychology and Dismantling Racism in Mental Health

What is your social justice philosophy?

How does social justice show up in your professional practice? How do you inform your clients, co-workers, supervisees, supervisors, research participants, and trainees of your social justice values? How do you respond when a client makes a biased/derogatory statement about another group in session? These are questions that I am asking my mental health colleagues to consider as our society grapples with systemic racism and a call to dismantle institutional policies and practices that have served to perpetuate a system that has valued White people at the expense of Black Lives and the lives of those with other marginalized identities.

In the wake of a divisive and overtly racist political climate, the U. S. has seen an increase in hate crimes that involve personal attacks. The Federal Bureau of Investigation (FBI) 2018 Hate Crime data shows that almost 60% of reported hate crimes were based on racial/ethnic/ancestry bias. This significant increase in hate crime incidents directly resulted in increased fear and anxiety among people of color, and I was seeing it in the news and hearing about it from friends, colleagues, and clients. As overt racist speech continues to dominate the rhetoric from this country’s leader and in the wake of the ongoing police brutality against Black Lives, White people are being forced to address their White privilege at a whole new level.

As a psychologist, I have had to take a close look at how psychology has maintained systemic racism and oppression. It is no surprise that psychology did not consider people of color when it has formed. Over the years, there have been efforts to address multicultural issues in training, but with minimal requirements at the training and licensure level (only 5 states require psychologists to participate in continuing education programming as part of the licensure renewal process), these attempts continue to be segregated from the mainstream discussions in clinical practice, research, and training. Engaging a culturally proficient and social justice oriented practice is a life-long journey and requires intention. While many therapists are required to take one graduate level course on cultural bases of behavior (although some are not), it is highly likely that that is the only course they take on topics related to multiculturalism, diversity, and cross-cultural relations. Most licensing boards do not require any additional continuing education in this area, so it is quite possible that people received master’s and doctorate degrees with little experience engaging with or addressing cultural issues in their clinical work. As a Black woman who is also an immigrant, I have been intentional about learning about other cultures because I believe that I would be an inept clinician if I ignored this part of my ongoing education. However, neither my graduate training nor my subsequent continuing education taught me how to address a client’s biased statements during a session.

Social Justice in Practice

In December 2017, with the determination to solve the puzzle of how to address our clients’ biased statements in sessions, I launched a Social Justice in Mental Health Discussion Series to help mental health professionals (MHPs) learn how to address “isms” in their clinical work and professional practice. My goal was to provide a compassionate space for MHPs to have open conversations on how to confront these tricky issues in sessions, knowing that there were few spaces (if any) where these conversations were happening. During the series, we covered racism, sexism, LGBTQ+ phobia, and technology and mental health care access.

If you are striving to integrate a social justice framework into your clinical practice, here are 10 steps that you can take to address clients biased statements in sessions:

1. Reflect on the barriers to speaking up

What are barriers that might be preventing you from speaking up? Does your therapeutic approach or the way you were trained cause you to see confronting racism as counter to your clinical work? Does your career stage (e.g., trainee status, intern, post-doc) make you feel less empowered? Are you new in your position, which makes you concerned about job security? Are there systemic barriers in the organization or does the organizational culture make speaking up unsafe? Take time to reflect on the barriers that may get in the way of addressing bias in your professional practice and work to resolve them. You may need to consult with people outside of your department or outside of the organization in order to develop a strategy to address these issues. While it may be difficult, you do not have to figure it out alone.

2. Reflect on your social justice values

You must also come to an understanding with yourself about what your personal and professional values are around social justice. Do you believe in the humanity of everyone? Are you committed to dismantling racist structures that exist in society, in the mental health field, and in the client-therapist relationship? Do you have a social justice framework? Are these issues that you care about? I learned early on that the therapy session is a microcosm of the outside world. So, if your client is making biased statements in session, chances are they are also making these statements outside the session. As therapists, we take on the responsibility of reflecting to clients unhealthy patterns that we notice, so why would issues of racism or other “isms” be any different?

3. Share your social justice philosophy with clients

Once you can articulate your social justice philosophy, share it with others, especially your clients. A White colleague, Alex Soladyna, Psy.D., shared with me that he includes a social justice statement in his client agreement contract. Dr. Soladyna also has a rainbow and a Black Lives Matter sticker on his office door. He has made his social justice values visible for his clients, but he also discusses his values and expectations about the therapy space with his clients. Since that conversation with Dr. Soladyna, I have added a social justice statement to my agreement with clients. I read my statement to clients, which lets them know that certain statements are not allowed in session, and if they do come up, then we will discuss them.

4. Devise a strategy for responding to clients’

Think through how you will address a violation to your social justice values. Are you prepared to stop the client immediately to address the statement or behavior or would you rather wait until an ‘opportune’ time? Would it matter if it is a new client or someone you have seen for a long time? The only way to get comfortable interrupting and addressing bias statements is to practice doing it. Use your peer supervision to role-play different scenarios and obtain feedback. Because of the emotion that we are likely to feel when triggered by a violation, being prepared by having a rehearsed statement can also be effective. Remember, you have that lovely contract that they signed, so you can refer to it or even read it to your client.

5. Coping with missed opportunities

We can often be hard on ourselves when we fail to address an “ism” that made its way into the therapy room. While we know that hindsight is 20/20, our occupational hazard of analyzing sessions can go too far. Give yourself a time-limit to ruminate, and after the time is up, let it go. Again, if this is a skill that you are developing, consult with a colleague or have a discussion in your peer supervision. Remember, there is likely to be another opportunity to discuss with the client. Use the time between sessions to obtain strategies about how to respond when you see the client again.

6. Understand the historical meaning and power behind biased statements and actions

As part of your work, you will need to understand the historical context behind biased actions. For example, I had a colleague say to me that he did not know how to confront a Black client who used the N-word in session. First thing to understand, it’s not the same when a client from a marginalized group uses a word or statement that has historically been used to dehumanize that person’s group. Let’s take the “N-word.” It is very different if a White client uses the "N-word" in a session compared to when a Black client uses the word. You have to understand the history and the context in which the N-word was created and was used to support a system that dehumanized Black people. You will also have to understand that some Black people chose to take back the N-word as a way to diffuse its power. However, in no means should you equate identical meaning when a White person and a Black person use the N-word. Still don't get it? Read So You Want to Talk about Race by Ijeoma Oluo.

7. Engage in crucial conversations

Create compassionate spaces in your work environment to talk about these issues. Many therapists struggle with having conversations about race and racism, and guess what, the more you avoid these types of discussions, the more challenging they become. So, show self-compassion and be comforted with the fact that you will make mistakes. When you receive feedback about your biased beliefs, avoid becoming defensive or minimizing the other person’s concerns. Instead, own your actions and receive the feedback with an open heart and open mind. The more you lean in to these conversations, the more skilled you will become. If you work alone, bring these discussions to your peer supervision as everyone will benefit from unpacking this topic together.

8. Consult, consult, consult

Navigating these conversations with clients can be hard, but avoiding them can also leave you feeling unsettled, guilty, and a host of other feelings. Additionally, relationships with supervisors and co-workers who have limited knowledge of multiculturalism and/or who are not interested in social justice work can make your training experience traumatic. Be sure to report your concerns to your site supervisors and obtain support from someone outside of the organization if nothing changes. If you run a research or training program team, be sure to create spaces for you and your team members to interrogate how racism has impacted the organization. There are many people who consult on diversity, equity and inclusion, so you may need to hire a consultant to help you develop an implementation plan to address the needed institutional change.

9. Commit to deepening your knowledge by participating in annual continuing education on diversity, equity, and inclusion.

As you plan out your annual professional development, be sure to include workshops on diversity, equity, and inclusion, multiculturalism, and social justice in the programs you select. Frame this work as essential to your practice as an ethical mental health professional. Remember, this work is life-long and you need to be intentional about making diversity, equity, and inclusion a part of your life-long learning.

10. Engage in advocacy

While many states now require psychologists to take a cultural bases of behavior course as a requirement for licensure, only 5 states (i.e., Maryland, New Mexico, Tennessee, Texas and Oregon) require continuing education as part of licensure renewal. Now more than ever, it is clear that these minimal requirements are not enough. The inspiration for my company, InnoPsych, Inc., an organization with a mission to disrupt racial disparities in mental health and to increase access to therapists of color, came from direct client experiences who were harmed by culturally incompetent therapists. These therapists’ lack of understanding of the client’s culture led them to commit micro-aggressions, and never did these therapists stop to consider the ethical violation of practicing outside of their area of competence. Given the current racial tension due to the racial violence and unchecked white privilege, now more than ever, it has become abundantly apparent that the minimal requirements in understanding a large segment of society is no longer acceptable. I will be advocating for my home state to require mental health professionals to take continuing education workshops in diversity as part of their license renewal process. I hope that you join me too.

Acknowledgments

Dr. Jackman acknowledges Dr. Luana Bessa, Dr. Valene Whittaker, and Dr. Damon Pryor who were panelists on the Social Justice in Mental Health Discussion Series on Racism and Other "Isms" in Therapy in December 2017. In addition, a special thanks to Dr. Alex Soladyna who shared his social justice practices prior to the panel discussion.