developing racially aware therapeutic practice

s ¥ n C. i

Developing racially awaretherapeutic practice

The development of a coherent style of counselling and psychotherapy isinevitably a process that evolves gradually as therapists apply theoreticalunderstanding to their practice. At the heart of competent therapeuticpractice lies the therapist's ability to integrate theoretical knowledge,skills and self-awareness. In view of the complexity of racial phenomena,the integration of racial awareness and understanding in practice is aparticularly slow and challenging process. This was highlighted in a studyconducted by D'Andrea et al. (1991) to assess the impact of a multiculturaltraining model. In their investigation of the components of the trainingprogramme, D'Andrea et al. found that the lowest scores were consist-ently associated with the acquisition of cross-cultural skills. They con-cluded that it is more difficult and more time-consuming to promoteappropriate skills than it is to improve students' cultural awareness andknowledge.

This chapter is grounded in the belief that racially aware therapeuticpractice proceeds from a thorough understanding of one's own racialidentity development and its relationship with the racially different other.In view of the complexity of racial processes, it is not possible to offer aset of specific skills and interventions in this field. Instead, the chapterposes a series of pertinent questions which encourage practitioners toexplore key themes and principles as a basis for incorporating racialunderstanding in their practice of therapy.

How does my racial identity influence my practiceas a therapist?

Throughout this discussion, racial identity has been seen as a psycho-logical phenomenon as well as a social characteristic, as each person

I

134 Racial identity, white counsellors and therapists

responds personally and interpersonally to racial experiences. In thisway, racial i den t i t y issues are inherent in the therapeutic process, wheretherap i s t and client hold in te rna l ized a l t i tudes , beliefs and feelings aboutthe i r own and each other 's racial group membership. As Carter (1995:227) noted, '[r|ace is not always apparent, but it is always present becauseit is part of each person's personality and i t is part of our institutionaland social s t ruc ture ' .

For many while therapists who have been socialized to disregard raceat a subjective level, the concept of race is only seen as significant inhcrapy when they are working w i t h clients from visibly different racial

groups, or when racial concerns are specifically presented by white clients.In most whi te dyads, the l ikelihood is tha t each individual engages in acomfortable silence about whiteness as a racial position. Clearly, it is notpossible to alter the course of sociopolitical history and the diverse factorsthat have led to this stance. Nor is it appropriate to use therapy solely asan educat ive process to confront white clients about the complacency ofEurocentr ic conditioning. As white therapists, however, it is vital thatwe develop an understanding of racial constructs so that we can incor-porate these into our practice as appropriate. In this way, we can drawon racial awareness to inform our work, and can begin to challenge thei n v i s i b i l i t y of whiteness.

Where there is l im i t ed racial awareness, the therapist will be unable to,take account of underlying racial issues t h a t form an important backdropto the the rapeu t i c work. White therapists need to ask themselves howthey might:

• he blocked from explor ing racial ident i ty issues with their clients by :

their lack of awareness of their own while racial identily.• of fe r a narrow therapeut ic approach that takes no account of racial

factors in psychological and social f u n c t i o n i n g .« avoid the sociopolitical implications of race by focusing solely on

psychological processes.« sl ip into a social ly conditioned postuie of white superiority (either

overt ly or covertly) in the therapeutic dyad.

The willingness to explore our own racial processes is crucial to over-coming these shortcomings, which may be manifested with both blackclients and white clients. In enlarging the racial vision, it is suggestedthai whi te practitioners locus on the i r own attitudes, beliefs, feelings andspecific defensive behaviours that tend to be evoked in relation to race-related factors. An understanding of white racial identily developmentmay be effective in providing a framework for examining individual andinteractional racial functioning. In this respect, attention is drawn toHelms's ( f 995} while racial identity model outlined in Table 4.1, and the

Developing racially aware therapeutic practice 135

four possible relationship types (parallel, crossed, progressive, regressive)described in Chapter 5. As Moodley (1998: 503) argued, ' | l |he t h e r a p i s t ' sawareness of her/his ident i ty in relation to the c l i e n t s u p p o r t s h i g h - l e v e lcommunication in therapy. This means t h a t the f u n c t i o n of i n t e r p r e t i n g ,analysing and extrapolating meaningful relationships of c l i en t s ' presenta-tions is at a well-developed level'. This search for h igh- leve l communica -tion is discussed in the remainder of this chapter, which explores spec i f i careas that are pertinent to racially aware practice.

In what ways do my biases, beliefs, assumptions andstereotypes impact on my work with clients?

ft was seen in Chapter 3 that counselling and psychotherapy arc rootedin philosophical assumptions about the na tu re of h u m a n beings. W h i l eeach theoretical model emphasizes a d i f f e r e n t aspect of h u m a n f u n c -tioning, the underpinning philosophical basis for all the conven t i ona lapproaches to therapy derives from Eurocentric notions of humandevelopment, personality formation, relationship styles and c o m m u n -ication patterns. It is therefore essential for p rac t i t i one r s who d rawon these Western approaches to understand the inherent c u l t u r a l biasembedded in various therapeut ic theories and practices. Since Westernmodels focus largely on individual psychological processes and give ' l i t t l eheed to historical or sociopolitical factors, there is also m u c h scope1 lortherapy to reinforce the customary s ta tus quo by imposing d o m i n a n twhite values on clients regardless of (heir i n d i v i d u a l or co l lec t ive exper i -ences. In this way, theranisK rnav eni'ai'e in a system of u n i n t e n i i o n a lracism simply Dy following their usual procedures and practices(Ponterotto and Pedersen 1993; Ridley 1995). While i l is possible lor anytherapist who has been trained in core Western models to adopt a t he r -apeutic approach that reinforces white values, this is pa r t i cu la r ly l i k e l yin the case of while therapists who have less reason to cha l l enge t h eunderlying Eurocentric assumptions.

In addition to the use of culturally encapsulated approaches ( W r e n n1962, 1985), as practitioners, we bring a range of i n d i v i d u a l a t t i t u d e sand beliefs to our therapeut ic practice. For whi te t h e r a p i s t s , these be l i e f sare formulated through mult iple experiences of being par t of a d o m i n a n twhite majority in which whiteness is the assumed norm. M a n y whi letherapists who have grown up in homogeneous c o m m u n i t i e s may havehad little contact with other racial groups at a social level, and t h e oppor-tunity to gain accurate information about other groups may therefore helimited. This has profound implications for working w i t h black c l i e n i s ,and the therapeutic process may be fer t i le g round for d i s t o r t i o n s andstereotypes. As discussed in Chapter 2, stereotypes are acqui red t h r o u g h


ear ly messages about perceived characteristics of various groups ofpeople, and these characteristics are applied to all members of the groupregardless of ind iv idua l differences. Stereotypes held by white peopleabout black people are rife and usually negative. These stereotypes maybe manifested by white therapists in various forms of behaviour, such asthose described by Axelson (1985) wi th regard to white therapist-blackclient dyads:

1 Patronizing the client. The therapist attempts to give support to theclient from a superior position, believing that the client does not havethe power, strength or intelligence to manage on their own. This ispart icularly disadvantageous to black clients for whom there is muchneed to develop a source of power to combat the effects of oppression.

2 Insensitivity to the client's individuality- The therapist does not recognizethe client as an individual, and prejudges them on the basis of stereo-typical beliefs about the client's racial or cultural group.

j Disbelief nt the client's story. The therapist is unable to accept the client'saccount of s i tua t ions in which they have encountered racism, believ-ing that the client is exaggerating or has a 'chip on their shoulder'.

In each of these examples, negative stereotypes held by white therapistsabout black clients lead to damaging effects for the therapeutic relation-ship and the outcome of therapy. In some instances, the stereotypesmay become self-fulfilling, and the negative perceptions may be enactedby black clients. In the therapy room, there is great potential for stereo-typical behaviour to become interact ional as the therapist and clientperceive each other as a representative of their respective group whocannot be trusted. This may lead to rigorous testing of the therapist, orto premature termination of therapy by the client.

Since therapists are generally well-intentioned towards their clients,have a sincere wish to help, and aspire to endorse ethical principles, theman i f e s t a t i on of stereotypes by a white therapist is likely to be subtle,and may be hard to discern. As pan of the process of challenging ourstereotypes, Parker (1998) encouraged practitioners to gain awareness ofspecific stereotypes at tached to dif ferent groups. He also pointed out thatracial stereotypes are often gender-specific, and that black males aregenerally viewed more negatively than black females. As white therapists,the recognition of our own stereotypes can be enhanced as we begin tounderstand ourselves as racial beings and become aware of what white-ness means to us at a deep level. This requires a willingness to admittha i we are not immune from the racial biases that are part of ourcollective history, and a need to acknowledge that the dynamics of whiteprivilege can and do influence our ability to relate to our clients. Sincestereotypes are often based on irrational perceptions and underlying fears


that are not ful ly conscious, the process of owning and relinquishing ourstereotypical views can only proceed when we are honest w i t h ourselves,and explore our altitudes at an affective level. As Parker (1998: 116)suggested, ' the growth process must guide one into the i n t e rna l world offears, beliefs, illusions, and hopes to produce more abundan t ef fec t ivenessfor the professional'.

How do I manage my emotional reactions to aracially different client?

Working with a client who is subs tan t ia l ly d i f f e r e n t f rom ourselvesinevitably evokes a range of emotional reactions. These react ions arcfrequently generated by uncertainty and anxiety about the unknown, andabout our abi l i ty to understand and relate to someone whose woildvievvand life experiences may be at variance with our own. Cruc ia l to thetherapeutic process with all clients is our capacity to pay a t t e n t i o n toour internal dynamics as a way of informing the work. The emot iona lreactiojismay be-particularly intense with a racially d i f f e r en t cl ient , sincethe therapeutic work cannot be divorced from the psychosocial h i s to ryof race and ongoing conflicts in black-white relationships.

For a while therapist working with a black cl ient , the react ions areoften complex and confusing. Alongside a sincere wish to 'gel i t r i g h t 'may be the therapist's concern about their own level of competence,anxiety about being racially insensitive, and fear of the cl ient 's possibleanger at the injustices of racism, discrimination and pre judice . Sincefeelings about race are often primitive and irrational, they may be d i r e c t l yat odds with the therapist's stated values and beliefs. The whi te therapis tmay thus experience conflict between i n t e l l e c t u a l ideas about racial j u s t i c eand racial equality, and uncomfortable emotional responses to a blackclient. These emotions, which sometimes simmer just below the thresh-old of awareness, have a powerful impact on how the t h e r a p i s t re la tes lothe client. In this way, cross-racial encounters are sometimes characlerixedby incongruence between beliefs, feelings and behaviours as therapists(and clients) struggle to come to terms with contradictory react ions tothe other.

As white counsellors and psychotherapists, we can only engageauthentically with black clients as we come to greater recogni t ion ofdeep-seated feelings and defensive behaviours t ha i are engendered bywhiteness and blackness. An important prerequisite lor addressing race-related defensive behaviour is to understand our usua l ways of manag ingthreatening situations. In most instances, human beings, when confrontedwith fear, adopt behaviour which best protects them, either by a t t ack ingthe perceived cause of threat, or by withdrawing and thus escaping from


it. This f ight-f l ight continuum lias implications for the therapy room andour interventional style with racially different clients. As it is not appro-priate for therapists to he openly a t tacking their clients, the 'fight' char-acteristics are usual ly covert, and may he evident in forms of behavioursuch as rigorous enforcement of the authority of the therapist; stringentapplication of administrative and clinical procedures; and excessive chal-lenging. 'Flight' characteristics may also be seen in various kinds oftherapist behaviour including overprotectiveness or over-friendlinesstowards black clients; lack of challenge of the client's defences and dis-crepancies; and passive acceptance of the client's progress. Therapists whoadopt a colour-blind approach are also engaging in 'flight' behavioursince this serves to deny the perceived source of the threat. As Morgan(1998: 48) suggested, '[c|olour blindness, ignoring of difference of thisnature , is more comfortable, but 1 believe it to be a denial and a defenceagainst a complex array of emotions that includes anxiety, fear, guil t ,shame and envy'. The ult imate form of 'flight' behaviour is demon-strated by white therapists who deliberately make decisions that leadthem to work only with white clients. This is akin to the geographical'wh i l e flight' of the 1970s in which middle-class white families movedfrom u rban areas to a l l -whi te suburbs (Ponterotlo 1991).

Recognizing and working with emotional reactions is crucial topsychological insight in the therapeutic process, and helps prevent someof the defensive manoeuvres described above. As therapists, we can onlybe emotionally available to our clients by gaining awareness and experi-ence in identifying ottr personal reactions so that these do not intrudeunhelpfully in the therapeutic work. This is particularly important inracially mixed dyads where there is additional scope for complex inter-actions. As white therapists, we must find ways of overcoming the dis-comfort of acknowledging our own whiteness and our fear of being seenas racist if we are to become proficient in working with racial dynamics.Without this, we run the risk of perpetuating the disruptive silencedescribed by Morgan (1998: 49):

There is a silence generally w i t h i n our profession concerningracism, but 1 believe also that a silence can too easily develop in theconsulting room. I t is a dangerous silence for the therapy because itcontains too much background noise for it not to infect all the otherwork we- t ry to do. A frequent response by the black patient is tostop and leave therapy, often silently. Another response is not toenter in the first place - which is the loudest silence of all.

To transform this silence into racially aware practice, therapists need tofind a language in which to work more openly with racial issues at adynamic level.

How can I become more confident in working withracial dynamics with my clients?

For many therapists who may have received l i t t l e t r a i n i n g in racialmatters, difficulties that are experienced in working wi th racial dynamicsdo not necessarily stem from lack of interest or low mot iva t ion , butoften from uncertainty about how to go about it. Changes in racialterminology over several decades have increased concerns for many whitetherapists about using politically incorrect language and thereby beingopen to criticism or attack. In an area that is replete wi th p i t l a l l s olvarious kinds, some therapists feel insecure about asking cl ients abomtheir experiences of race for fear of opening up complex issties thai theywill not know how to respond to. Others rely heavily on in t e r roga t ingthe client about the i r cultural norms and values at the expense ol theclient's therapeut ic needs (Moodley 1998). To address racial dynamicsappropriately in therapeutic work requires a framework t h a t wil l enabletherapists to gain greater confidence in ta lking openly about race.

One of the keys to working effect ively with racial dynamics is torecognize the shared common humani ty at the root of every interpersonalencounter, while acknowledging that race is ever-present in the i n n e rand outer worlds of each individual. In steering a course between i d e n t i f y -ing sameness and difference in the therapeut ic re la t ionsh ip , whi le t he r -apists need to be aware of their own racial i d e n t i t y and i t ) recognizethemselves as racially positioned in society. This removes the idea of race-as being something that belongs only to black people, and underscoresthe notion that, as human beings, we are all subject to the his tor ica l andsociopolitical legacy of race, although our respective positions re la t ive tothe status quo undoubtedly lead to very different experiences. By p u t t i n grace firmly back in to the sociopolitical arena, therapists and clients maybe able to engage more freely wi th the consequences ol racism andoppression without resorting to denigration, scapegoating and g u i l t .

In order to conceptualize the lived experiences of race, we need alanguage that ar t icula tes powerful dynamic processes. The nraciicc; oltherapy is rooted, in a belief that experience and language arc closelyintertwined, and that committing experiences to words helos i n d i v i d u a l sto-trmteistand their personal realitv more thoroughly. This is esscntia1

in the area ol racial identity development where beliefs abou t sell andother are deeply rooted in the inner world, and are complicated byexperiences of colonialism and racism. Racially mixed dyads are t h u sprone to processes of splitting and projective ident i f ica t ion , in which theblack person may become the object of negative project ions, while thewhite person represents the idealized object to be i d e n t i f i e d w i t h . Thisleads to what Moodley (1998: 499) described as 'a repeated cycle ofmutual negativeness'. He suggested that the therap is t and c l ien t can


become locked i n t o each other's 'otherness', so t h a t therapy becomesa process that "wounds rather t han heals'. Moodley argued that thetherapist's skills and willingness to lake risks are paramount in avoidingthis negative cycle in therapy. He recommended that therapists use a'frank talk' method which helps to promote client self-empowerment.Based on the black consciousness philosophy of Steve Biko, the principleof ' f r ank ta lk ' is a method of confronting issues and expressing ideas freelyand openly. Moodley (1998: 504) identified four key elements of 'frankta lk ' in relation to racial dynamics:

• Communicat ing ideas and thoughts freely without the inhibition ofcolonial and post-colonial phobias of cu l t u r a l inferiority.

• Recognising that the l i fe process has been inf luenced greatly by theprocesses of racism and oppression; . . .

• Interpreting deviance and discomfort as both a personal response toand an in f luence of the environment; . . .

• Constructing a real sense of 'self and finding a sense of 'being' asopposed to 'not being'.

This approach is not easy since it strikes at the heart of the original fearsassociated wi th racial difference. However, therapy i tself has derivedfrom a principle thai confronting one's fears, and exploring their under-ly ing causes, offers a dynamic way of f inding some resolution to d i f f i c u l tissues. As white therapis ts , we will only be effective in cross-racial work-to the extent that we are willing to forsake our comfortable, silentposition about whiteness and engage in live interaction with our clients.While we may discover jus t how d i f f i c u l t ' f rank talking' can he, we canalso move beyond our customary safely zone to allow the developmentof new levels of sophistication in discussing racial issues in the therapyprocess.

How can I work more effectively with issues of powerand oppression?

In a profession that has emerged from Western monocultural tradition,where there is a preponderance of white practitioners, and where prob-lems are located within the individual, there is much scope for counsel-l ing and psychotherapy to mirror the traditional power dynamics of whitedominance. This tendency is reflected in the words of a black client whoreferred to feeling 'shackled' while in therapy with a white therapistbecause there was no fo rum lor t a lk ing about her experiences of racismand oppression. Similarly, Moodley (2000), in a compelling presentation,suggested that therapy serves a 'sentence' on a range of disadvantagedpeople whose voices cannot be heard in the exclusive world of traditional


counselling and psychotherapy. These words isst ie a chal lenge to w h i t etherapists, and to the profession as a whole, to recogni7.e and rciillyunderstand how much our silence about racism anil oppression con t inuesto shackle and marginalize thel experiences of many cl ients who areoutside the customary while power-base.

The idea of power in the therapeutic re la t ionship may be uncomfort-able for many practitioners who' prefer to focus on not ions ol e q u a l i t y ,and often underplay differences; in power and a u t h o r i t y between t h e r -apist and client. In the case of a white therapist-black c l ien t dyad, thepower d i f fe ren t ia l is intensified because the re l a t ive s t a t u s in t h e t h e r a p yroom replicates the power imbalance in wider society. Since these posi-tions are deeply ingrained, there is a very real tendency for each p a r t i -cipant to replay their usual roles in relat ion to one another . In t h i s p u l ltowards homeoslasis, the white therapis t may enact t he d o m i n a n t roleof the professional white 'expert' who knows what is best for the blackclient. While the therapist may wish to act in a non-racis t way, by t h e i rfailure to recognize and acknowledge the power issues inhe ren t in the-therapeutic interaction they may end up p e r p e t u a t i n g the problem theyseek to avoid. Ridley (1995) pointed out t ha t racism is sometimes causedby therapist inaction, which usual ly reflects an unwi l l ingness to acceptresponsibility for addressing the issues.

As white therapists, our practice can be transformed by recognizingour position in the racial hierarchy, and lacing our own internalizedbeliefs about superiority and power in the therapy room. I f we are toencourage our clients to find liberation through ihe therapy process, i t isessential tha t we have sufficient understanding of how oppression maybe manifested within the therapeutic set t ing and at every stage of t he-therapy process. The following areas may be examined from the per-spective of power and oppression:

• receiving intake information;• making initial contact with the client;• managing administrative procedures;• selling up a contract;• forming a therapeut ic relationship;• understanding the client material;• making an assessment;• drawing on theoretical concepts;• selecting an intervenlional style and l inguis t ic code;• being aware of unconscious processes;• exploring the work in supervision;• working towards an agreed outcome;• negotiating the ending;• making onward referral, if appropriate.


The extent to which power and oppression impinge on each of theseareas is also l i nked to the setting in which therapy takes place. Ther-apis t s working in s t a tu to ry services, v o l u n t a r y counselling agencies, orindependent practice face d i f fe rent challenges with regard to the deliveryof non-oppressive practice. While it is not possible for us, as whitetherapists, to share the mul t ip le incidents of racism experienced by ourblack clients, we can become more s k i l f u l in recognizing and workingwith the explicit and implicit expressions of power and oppression. Thefollowing recommendations are made:

• Recognizing the lantaiaee of _o_ppression in our clients' stories (suchI aslmai/cs of nowenessness, discrimination and struggle) and working

with these either directly or mrlireciiv.• Being aware of issues of internalized oppression, Tid how.these may

be evident in the client's a t t i tudes and behaviour• Examining our own therapeutic practice for signs oi power and

oppression.• Being aware of our own i n t e r n a l i z e d beliefs about white superiority

and dominance.a Recognizing dynamic interactions in which therapist and client relate

to each oilier as if t hey were the victim or perpetrator of oppression.

By b u i l d i n g these checks into our practice, we will be more able torecognize issues of power and oppression as they impinge on the ther-apeutic work. In challenging the hierarchical nature of t radi t ional ther-apeutic approaches, Ivey (1995) suggested tha t therapy is most liberatingwhen therapists and clients engage in a collaborative process in whichthey develop critical consciousness of themselves and consciousness ofthe social and historical context.

How can I be racially sensitive in making an assessmentof my clients?

A therapist's ab i l i ty to make an accurate assessment of the client's con-cerns and needs is the bedrock of effect ive therapy. A myriad of inter-re la t ing factors contr ibutes to the client's presentation, and therapistsdraw on the i r theoretical unders tanding to conceptualize the nature ofthe client's difficulties. Given the Eurocentric nature of mainstream theor-e t i ca l approaches, and the lack of therapist training in race and culture,the area of assessment with a diverse client population raises complexissues. Par t i cu la r dif f icul t ies have arisen with regard to the assessmentanil treatment of black groups in the mental health field, and this hasbecome a highly content ious area. These difficulties include the misun-der s t and ing of psychological symptoms and behaviour across racial and


cul tura l groups; the use of c u l t u r a l l y biased psychometr ic i n s t r u m e n t sto screen mental heal th problems; and the f o r m u l a t i o n of t r e a t m e n tprogrammes based on stereotypical perceptions of va r ious groups.

For therapists to become racially sensi t ive iu t h e i r assessments ofclients, it is necessary to develop an understanding of t h e ways in whichracial material may be interwoven in t h e client 's p resen t ing difficult ies.Car te r ( t 9 9 5 ) highlighted the need for p rac t i t ioners to view t h e c l i e n t ' srace as a psychological and sociopolitical fac tor r a the r t h a n a descriptivecharacteristic. From this perspective, clients are regarded as i n d i v i d u a l swhose psychological development and interpersonal f u n c t i o n i n g arcshaped within a racial context . This approach seeks to avoid the t h e r -apeutic d i f f i c u l t i e s arising from underemphas iz ing rac ia l f ac to rs (colourblindness) or from overemphasizing racial in l lueuces (colour conscious-ness). Ridley ( 1 9 9 5 ) pointed out that the consequence of both thesepositions is misdiagnosis. hi a co lour-b l ind approach, the the rap i s t lendsto overlook the influence of race and racism on the psychological exper i -ence of the client. In the case of interaction between a wh i l e therapistand a black client, the therapist's neglect of race factors may lead to amisinterpretation of the client's a t t i tudes , feelings and behaviour , as wellas disregard for the influence of their own whiteness on the c l i e n t . Ina colour-conscious approach, the therapis t focuses i n a p p r o p r i a t e l y onracial issues to the exclusion of the cl ient 's par t i cu la r d i f f i c u l t i e s . In t h i sway, the therapist may f a i l to recognize the c l i en t ' s c o n t r i b u t i o n to t h esituation, and may be unable to work w i th issues of r e spons ib i l i t y . Theymay also overlook severe psychopalhological symptoms t h a t requi respecific treatment.

Effective and appropriate assessment procedures invo lve an u n d e r -standing of the interaction between i n d i v i d u a l psychological f u n c t i o n i n gand wider sociopolitical experiences. For most c l i e n t s who present intherapy, the impact of race on t h e i r in i t ia l concerns and symptoms islikely to be indirect. As Carter (1995) suggested, c l i en t s arc p r i m a r i l yconcerned with their particular issues. The task of the t he r ap i s t is tofocus on the dienl 's presenting d i f f i c u l t y whi le seeking to unde r s t andthe influence of the racial context. Carter (1995: 234) gave the f o l l o w i n gexample:

A p a t i e n t . . . who presents with depressive symptoms may haveexperienced traumas and losses tha i gave rise to the depression. I t isimportant that the therapist unearths the p a r t i c u l a r s regarding thet raumas or losses while remaining aware t h a i racial soc i a l i z a t i onand sociopolitical experiences can cont r ibu te to t h e depressivesymptoms.

In this approach, racial issues are integrated in to the assessment process,recognizing that the client's personal experiences are filtered t h r o u g h


I he lens of i heir racial i d e n t i t y and their relationships with their own,ind o t h e r racial groups. The therapist thus draws on their understandingof racial dynamics w i t h i n the inner world and the outer world, andthese are incorporated i n t o the assessment and ongoing therapeutic work,w h e t h e r or no t t hey are addressed directly with the client.

An i m p o r t a n t considerat ion of the assessment process is the suitabilityi l l t h e t h e r a p i s t for working with the client. The idea of e thn ic matchingbetween t h e r a p i s t ami c l ient has been discussed hy various writers (Sue1988; Kareem 1992; A l l a d i n 1994). Undoubtedly, the development of aI . K ' i l i l i i l i v c t h e r a p e u t i c relat ionship requires a capacity for the therapistand c l i en t to re la te to one another and to build understanding and trust.In some cases, d i f fe rences in worldview, cul tura l a t t i t udes and thedeve lopmen ta l s tage of ihe client may indicate a part icular match int e rms of gender, e t h n i c i t y or c u l t u r e . There are, however, many clinicaland prac t ica l issues involved in t he idea of matching, and the fact that at h e r a p i s t and c l i en t belong to a similar group does not automaticallyg u a r a n t e e compa t ib i l i ty in t h e therapeutic alliance. Issues of social class,e d u c a t i o n , age1, language, and economic status are also s i g n i f i c a n t char-a c t e r i s t i c s . Sue (1988: 306) argued tha t racial match may lead to culturalm i s m a t c h , b u t l h a l racial 'mismatch does not necessarily imply culturalmismatches , because the rap i s t s and cl ients from d i f f e r e n t [racial] groupsmay share s i m i l a r values , l i festyles, and experiences'. This concurs withthe t e n e t s of racial i d e n t i t y theory (Helms 1984, 1995) where it is sug-gested t h a t t h e racial i d e n t i t y ego s ta tus of each individual , regardless oft h e i r racia l group, w i l l resul t in the therapeutic relationship being parallel,crossed, progressive or regressive. This was discussed in Chapter 5.

II can be seen l h a l e f fec t ive assessment and therapeutic treatment of,1 d ive r se c l i en t p o p u l a t i o n poses many challenges for therapis t s . While itis nol possible to address t h i s area more f u l l y wi th in the scope of thishonk, i h e fo l lowing considerat ions are offered to inform the assessmentprocess:

• Race is i n t e g r a l to the client's and therapist's personal and interpersonallives, and i t therefore permeates therapeutic interactions, both explicitlya n d i m p l i c i l l y .

• R l f e c t i v e and appropriate assessment procedures require a compre-hens ive p i c t u r e of the client, t a k i n g account of racial effects on Ihec l i e n t ' s h i s t o r y and psychological f u n c t i o n i n g .

• D i a g n o s t i c i n s t r u m e n t s such as DSM-1V t ha t have been normed onm a j o r i t y w h i l e p o p u l a t i o n s are not reliable when used wi th otherrac ia l groups.

e S p e c i f i c issues may arise in the assessment of black clients with regardto racism and oppression, and these are frequently reflected in insti-t u t i o n a l barr iers in the mental heal th services.


• Mainstream Eurocentric approaches to counsel l ing and psychotherapyare not universally relevant tos all c l i e n t s , and o the r forms of healingmay sometimes be appropriate.

• Racial dynamics and racial ident i ty development are per t inent to thetherapeutic process and represent a dimension for assessing therapist-client compatibility.

• Awareness of other therapeutic resources and specialist agencies inthe vicinity enables a therapis t to assess issues of onward referral to adif ferent therapist or a d i f ferent form of help, if appropriate.

What specific information do I need in therapeutic workwith racially different clients?

Counsellors and therapists on t r a i n i n g courses sometimes ask for specificinformation about different client groups. Their requests o f ten referto cultural practices associated with re l ig ious beliefs, f a m i l y structures,marriage r i tuals , child-rearing methods, and so fo r th . Clearly, these areasare important in the lives of many of our clients and it is incumbent ontherapists to acquire some broad knowledge and awareness of cu l tura ldifferences, and thus relieve our clients of the burden of having to educatethe therapist. However, it is impossible for the rap i s t s to have detailedknowledge of the practices and beliefs of all e t h n i c and cul tura l groups,and the search for specific information can also deny the individualdifferences and variations that occur w i t h i n groups. Behind the quest forinformation seems to be an assumption t h a t each group is composed ofmembers who hold monoli thic views of the world. This takes us backinto the realm ol stereotypes.

As therapists, we are faced with a paradox. On the .one hand, the useof assumptions is a valuable part of the the rapeu t i c work which helpsus to explore and elucidate meanings and dynamic processes wi th ourclients. On the other hand, assumptions t h a t are based on ignorance orstereotypes are l ikely to block the therapeutic interact ion and lead tomisunderstanding and antagonism. While f a c t u a l i n f o r m a t i o n and experi-ence in cross-cultural and cross-racial work can only be bu i l t up gradually,practitioners may find it helpful to consider the fo l lowing broad areas.

The historical background

In the post-colonial age of the twenty-f i rs t century, na t iona l boundariesand i n t e r n a t i o n a l re la t ions have been p ro found ly shaped by historical andpolitical events of earlier centuries. For the rap i s t s to unders tand contem-porary racial issues, it is necessary to have a broad perspective of thehistorical development of race and racism. Unders tand ing is needed of


wor ld -chang ing events such as slavery and colonization, and the signi-l ic i in l pa l le i ' i i s resu l t ing from these events, including immigration andn a t i o n a l i t y issues, population changes and social policies. These majordi 've lopmenis in t h e Western world were founded on the principle ofw h i l e dominance and white supremacy. At the root of all these eventsare po l i t i ca l ami economic issues concerned with the distribution of power,as well as psychological processes re la t ing to difference.

The ini/'ticl and operation of oppression

Racism and olhers forms of oppression are deeply embedded in social1 and i n s l i l u l i o n a l s t ructures , which generally uphold the position of the

d o m i n a n t whi te group. Despite the implementat ion of equal opportunity; policies and anti-harassment legislation, many forms of oppression con-! l i n t i e to operate at a covert level. Therapists need an unders tanding of

how racism and inequality maybe manifested in the therapeutic process,where I here is a tendency to reproduce power imbalances of the wider

i society. Oppressive practices in the outer world may be reflected in the' i n n e r world where there is evidence of collective attitudes such as inter-' na l iml oppression and internalized superiority. Wi thout awareness of

these processes, the therap is t may inadver ten t ly contribute to the enact-m e n t of these racial posi t ions in the therapeutic relationship.

Culliti'ii/ svaic/ns and worldviews

As <i d y n a m i c force, cu l tu re represents the shared body of beliefs andpractices t h a i are t r a n s m i t t e d w i t h i n a group of people from one genera-l ion to I he n e x t . The term embraces a range of philosophical and spiritualbel iefs ; social pa t t e rn s and socialization processes; and forms of art is t icexpression. C u l t u r a l t r ad i t i ons are both embodied and transmitted throughf o r m a l and i n f o r m a l codes of language. In a mul t i cu l tu ra l society, it. ise s s e n t i a l t h a i t h e r a p i s t s have an unders tanding of the c u l t u r a l context ofc o u n s e l l i n g and psychotherapy, and how the underlying assumptionsmay clash w i l h t h e c u l t u r a l values of specific client groups. Major areasfor consideration i n c l u d e the tension between individual autonomy andcolleclive v a l u e systems, cultural patterns of behaviour and emotionalexpress ion , and a l t i t u d e s towards self- and f a m i l y disclosure.

Health and healing

A l t i t u d e s towards i l l n e s s and heal th vary considerably across differentc u l t u r a l groups. Disease and emotional disturbance maybe attributed, iv a r y i n g degrees, to physical , psychological, spir i tual , social, environment;

in


and personal factors, and beliefs about I be cause of the i l lness will deter-mine the mode of healing that is sough t . Whereas Western medicineis founded on a division between physical and menta l disorders, manyother traditions adopt a more holist ic approach. Indigenous forms ofhelp may be sought from traditional healers who use a variety of methods,often connected with altered states of consciousness and deliverance fromevil spirits. For therapists working with c l i en t s from non-Western t r ad i -tions, it is important to assess how far the c l ient ' s background divergesfrom the tenets of Western therapy, so t h a t the c l ien t ' s d i f f i c u l t i e s can beunderstood within their c u l t u r a l f rame of reference. The therapist mustalso consider the client 's level of psychological mindedness, and theircapacity to engage in t h i s form of help. The client's expectation of theauthori ty and power of the therapist is also a s ign i f ican t aspect.

The areas that have been h ighl igh ted in this section are discussedmore f u l l y in Chapters 1, 2 and 3. F u n d a m e n t a l to the process of seekinginformation about racially and cu l tu ra l ly d i f f e r e n t c l i e n t s is the ther-apist's need to be aware of the i r own c u l l u r a l heritage, and to understandhow their att i tudes, values and beliefs impac t on the therapeutic work.

How can I integrate my understanding of racial processesin my use of therapeutic skills and interventions?

While the s k i l l s and intervent ions of counsel l ing and psychotherapy aremany and varied, they all have a s imi la r f u n c t i o n in encouraging theclient to express their concerns and to work wi th persona! issues. At theheart of the therapeutic process is an in te rpersona l in te rac t ion whichrelies on the individuals concerned f o r m i n g a connection with oneanother. The therapist's use of basic l i s t e n i n g and a t t e n d i n g ski l ls , andtheir empathy with the client, are thus cent ra l to the process in alltherapeutic encounters. In a white therapist-black cl ient dyad, effectivecommunication requires the therapis t to be sensi t ive to racial nuancesthat inf luence the therapeut ic process, and to move beyond a un ive r sa lapproach, in which methods and s k i l l s are applied un i fo rmly to all cli-ents. Particular attention mus t be given to the use of s k i l l s t ha t proceedfrom Eurocentric models and approaches which largely disregard racialconstructs. The following areas are regarded as crucia l to effect ive integ-ration of racial processes in the ski l l s and in te rven t ions of the therapist.

Balance of power

In therapy, as elsewhere, black clients are of ten required to constructa voice to fit the norms of the white ma jo r i t y . As whi te therapistsin a therapeutic alliance with a black cl ient , we need to challenge the


t r a d i t i o n a l power imbalance and select interventions t h a t redefine thea s y m m e t r y of the t he rapeu t i c relat ionship. This is reflected in Ivey's( 1 9 9 5 ) use of the term client colleague to emphasize the importance ofj ienera l ing a more m u t u a l approach to therapy. Recognizing the societalc o n t e x t of w h i l e dominance, and the far-reaching effects of racism andoppression on ind iv idua l identity, the therapist may draw on interven-t ions t h a t t a k e account of both their own and the client's racial andpsychosocial development. At times, it may be appropriate to articulateissues of power and dominance openly with the client, and to explorehow these are mani fes ted in the client material and/or the therapeuticprocess. S imi la r ly , vvilh white clients, the white therapist may drawa t t e n t i o n to issues of whiteness and white superiority, as appropriate. Byrecognizing and acknowledging power different ia ls , we may enable coun-s e l l i n g and psychotherapy to take a more active role in addressing andcha l l eng ing p re jud ice and racism.

W o r k i n g w i t h complex issues of racial diversity calls on us as therapistst o adopt a f l e x i b l e s ty le t h a t recognizes both outer world issues and innerworld processes. In a f l ex ib l e approach, the therapist seeks to work with<i diverse c l ien t population in ways tha t make sense within the client'sown f r a m e of reference. The therapist needs a broad repertoire of skillst h a t locus on I he m e a n i n g of the individual 's experiences. A variety ofmethods may be used creatively, and these include the use of metaphorto exp l i ca t e t h e c l i e n t ' s personal issues and defences. While the therapistmus t he congruent in owning a personal set of philosophical assump-l i o n s , t h e y are also challenged to extend their range of responses. Thef l e x i b i l i t y of t h i s approach must be balanced by clear boundaries and anexpl ic i t work ing agreement. This helps to clar i fy the client's expectationsof t he rapy , and t h e i r unders tanding of the role of the therapist. Issuesa r o u n d non-d i rcc l iveness and ind iv idua l autonomy are pertinent to th i swork ing agreement. While race factors do not necessarily emerge explicitlyin t h e therapeutic process, the prac t i t ioner may draw on a broad under-s t a n d i n g of t h e sub t l e and complex ways in which racial processes arein terwoven in t h e c l ien t material . In the absence of a coherent theoret-ical model for addressing racial matters, the practitioner is required toa p p l y t h e i r own i n s i g h t and awareness, and to engage in the process ofincorporating r ac i a l unders tanding in t h e i r practice.

Communication style

In seeking to understand our client's world and their personal constructs,we must l ake note of the client's style of communication. Relative


attention given to affective, cognitive and behavioural aspects of theclient's experiences may enable us to assess the client 's unders tanding oftheir personal world and their I awareness of racial issues. As therapists,we may consider the following questions:

• Does the client view thei r d i f f icul t ies p r ima r i l y in terms of the outerworld or the inner world?

• How far does the client appear to re la te to psychological and socio-political concepts?

• To what extent does the client describe their individual functioningin relation to a wider reference group (for example, extended familyor religious group)?

• Are racial dynamics explicit or implicit in the the rapeu t i c interaction?

By paying at tention to the client's conceptual framework, the therapistmay gain an understanding of 1he client 's perceptions and experiences.Racial cues may be evident in both verbal messages and non-verbalcommunication such as body language, use of eye contact and vocalqualities. By identifying the client's style of communicat ion, the therapistis better able to determine which interventions are most l ikely to beeffective, and to focus on racial processes, as appropriate.

Racial identity development

Our capacity as therapists to work with racial processes is fundamental lylinked to our own racial identity development and our awareness ofracial attitudes within our own personality. Our use of skil ls and in ter-ventions in relation to racial ident i ty may be informed by the whiteracial identi ty model (Helms 1995) and the people of colour racial iden-tity model (Helms 1995). These models provide a framework for thetherapist to assess the client's racial i d e n t i t y status. By paying attentionto racial cues sent by the client, the therapist can choose interventions thattake account of the meaning of race in the client 's world. The therapistcan thus explore racial processes in the cl ient mater ia l at a level tha t iscongruent with the client 's racial a t t i tudes , and can fac i l i ta te the client'sracial awareness by articulating unstated racial assumptions. This approachis appropriate in both same-race and cross-race dyads. The therapist'sunderstanding of the interactional model (Helms 1984) can also act asan aid in identifying the na tu re of the the rapeu t ic re la t ionship. The fou rrelationship types proposed by Helms (para l le l , crossed, progressive,regressive) can also help us recognize the i n f l u e n c e of our own racialattitudes on the therapeutic process. This awareness may help to deter-mine what style of interventions is likely to faci l i ta te an effective workingrelationship.

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! 50 Racial identity, white counsellors and therapists

Unconscious processes

Recognizing the influence of unconscious processes associated with raceposes the greatest challenge to the therapist. The numerous and oftensubtle effects of racial dynamics in racially mixed dyads are frequentlyrelated to transferential and projective processes. Since therapists areactively involved in the interaction, we may only be able to make senseof the complex processes through supervision. Of particular relevancein a white therapist-black client dyad are the interrelated notions ofinternalized superiority and internalized oppression, which may be deeplyembedded In" the wriiteF and black psyche as a result of historical events.Moodley (1998: 498) referred to these concepts as 'false images of iden-tity' that need to be brought to consciousness and challenged within thetherapeutic interaction. The process of deconstructing the false imagesof the client clearly calls on us as therapists to exercise a level of under-standing and competence in working with racial dynamics. Moodley's(1998) principle of 'frank talking' emphasized the need for open interac-tion between the therapist and the client. Our confidence in addressingcomplex interactive processes is directly related to our willingness toexplore our own feelings and to extend our own racial awareness.

Summing up

In view of the limited attention given to racial phenomena in the ther-apeutic world, many practitioners are poorly equipped, both personallyand professionally, to address racial material and dynamics in therapeuticinteractions, and struggle to know how to apply racial awareness to theirpractice. Attention has been given in this chapter to key areas of personalawareness, theoretical knowledge and skills for working effectively withracial dynamics. In the quest for racially aware therapeutic practice, thetherapist is brought face to face with their own racial attitudes, and it issuggested that personal freedom in addressing complex racial processescan only be realized through a resolution of one's own racial identityissues. For white therapists, who have rarely needed to consider theirown whiteness, there is a particular challenge in understanding themeaning of white identity as it impacts on therapeutic practice. Recog-nizing that there is no easy way of acquiring specific skills in relation toracial processes, therapists have been encouraged to develop an openinteractive approach in which complex processes may be addresseddirectly.

developing racially aware therapeutic practice

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