Devika Jamkhedkar
Mental illness is like a common cold. It affects all people of diverse identities - black, white, Asian and more. Each race and ethnicity has a distinct cultural effect on an individual’s mental health. From fatherlessness in the African American community to the hefty academic pressure piled onto Asian children, these specific issues require an in depth understanding of the cultural factors that affect a person’s mental health.
While therapists are trained to be understanding of a patient’s unique set of concerns, they may fail to assist patients of a different race. Past studies in the Institute of Medicine suggest that when white therapists treated African Americans and Hispanic people, they had an an unsatisfactory experience that yielded poor outcomes (Ito & Maramba, 2002). Asian Americans too, had similar dissatisfaction and suggested a need for a more culturally sensitive treatment (Zane, Enomoto &, Chun, 1994). This suggests that white therapists may not be adept at treating people of colour. African American therapist Dr Monnica T Williams raises the issue of ‘micro aggressions.’ These are phrases like ‘You’re pretty quiet for a strong black woman‘ that reflect implicit biases and stereotypes (Williams, 2013). Worse still, therapists may negate the impact of cultural context in mental illness altogether. Unlike the white population, people of colour face racial struggles that impact their therapy experience.
Interest in racial matching of patients and therapists has entered psychological thought. Proponents believe that the shared identity will allow for greater trust and empathy in the therapy relationship. Further, a patient will be more comfortable with a therapist with whom they may share the same socio-political worldview (Smith & Cabral, 2011). For example, an Hispanic therapist may grasp a patient’s anxieties around anti-immigration president Donald Trump much better than a white therapist, as they are likely to share similar cultural experiences.
Is race-matching really the answer? Assumptions have floated around for long, but research says otherwise. A meta-analysis of 10 studies comparing dyads of same and opposing race therapists revealed that the results in the overall functioning and attending treatment of African American and white clients was basically identical (Shin et al., 2005). This suggests that any person’s race did not affect therapy outcomes at all. A 2002 meta-analysis by Maramba and Nagayama Hall with seven studies found “…virtually no effect of racial/ethnic matching on client dropout, number of sessions attended, and level of functioning at termination.” (Smith & Cabral, 2011, p.8).
While it may be ‘common sense’ to think that a therapist and a patient of the same race will share the same worldview, this can be completely untrue. A first generation Indian immigrant will have little in common with an Indian therapist who was born and raised in the urban United States. If a patient expects that the therapist will share their worldview, they may be throughly disappointed and find it difficult to establish trust (Smith & Cabral, 2011).
While race-matching may not be the solution, it is still worth investigating why racial minorities can feel averse to white therapists. In particular, African American patients much prefer therapists of the same race and experience marginally better outcomes. One factor was that patients were uncertain of the biases of predominantly white mental health services and therapists (Smith & Cabral, 2011). Even in 2015, white therapists are 86.6% of the workforce (Lin et al., 2018). Compared to the US population, racial minorities are largely underrepresented in mental health fields. For better understanding of racial issues, it is necessary to diversify the mental health workforce.
How to tackle race specific mental health concerns? The American Psychological Association has laid down guidelines for culturally sensitive therapy. Therapists are required to acknowledge the role of race and culture in shaping socio-psychological states. They are trained to constantly educate themselves on the nuances of different cultures, even learning traces of the patient’s native language. White therapists may be unfamiliar with culture-specific behavioural phenomena (‘Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations’, n.d).
For example, 'healthy paranoia’ in ethnic minorities seen in the 2016 presidential election was a reaction to feared discrimination. This may seem alien to a white therapist, but must be dealt with genuineness and empathy. Most importantly, all therapists are under check for any overt or implicit forms of racial prejudice. They are to constantly assess whether they are treating a racial minority differently than a patient of their own race (‘Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations’, n.d).
Racial minorities face an barrage of social hurdles. The first step to enhancing their mental health is culture sensitive therapy- eventually creating a more harmonious society.
References
Meyer, Oanh L & Zane, Nolan. ’THE INFLUENCE OF RACE AND ETHNICITY IN CLIENTS’ EXPERIENCES OF MENTAL HEALTH TREATMENT.’ The National Centre for Biotechnology Information (2013). Retrieved from
Smith, Timothy B & Cabral, Raquel R. ’Racial/Ethnic Matching of Clients and Therapists in Mental Health Services: A Meta-Analytic Review of Preferences, Perceptions, and Outcomes’ Brigham Young University Scholars Archive (2011). Retrieved from https://scholarsarchive.byu.edu/cgi/viewcontent.cgi?article=1079&context=facpub .
Williams, Monnica T. ’How Therapists Drive Away Minority Clients.’ Psychology Today (2013). Retrieved from https://www.psychologytoday.com/intl/blog/culturally-speaking/201306/how-therapists-drive-away-minority-clients.
Williams, Monnica T. ‘How Well-Meaning Therapists Commit Racism’ Psychology Today (2013). Retrieved from https://www.psychologytoday.com/intl/blog/culturally-speaking/201308/how-well-meaning-therapists-commit-racism .
‘Guidelines for Providers of Psychological Services to Ethnic, Linguistic, and Culturally Diverse Populations.’ American Psychological Association (n.d). Retrieved from
Ito KL & Maramba GG. ‘Therapeutic beliefs of Asian American therapists: Views from an ethnic specific clinic.’ Transcultural Psychiatry (2002). Retrieved from https://journals.sagepub.com/doi/abs/10.1177/136346150203900102.
Zane N, Enomoto K & Chun CA. ‘Treatment outcomes of Asian- and White-American clients in outpatient therapy.’ Journal of Community Psychology (1994). Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/1520-6629%28199404%2922%3A2%3C177%3A%3AAID-JCOP2290220212%3E3.0.CO%3B2-7 .
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