Working with Therapy Clients Who Feel Oppressed by Racism

I frequently conduct training on effectively working with people of color. And given that most of the therapeutic work occurs in the context of our racialized society, the issue of racism is generally relevant to care. It is well-established that people tend to make automatic unfair judgements about others based on race. These judgements then result in acts of racism, such as racial microaggressions. All forms of racism impact the well-being of people of color on multiple levels, and good clinicians need to be able to effectively engage their clients of color around these issues.

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Racism Is Real

One cardinal rule when working with people of color is to refrain from questioning the veracity of reports of racism. Therapists should approach all client experiences of racism as if they are true and provide appropriate support and validation. This can be challenging for therapists who do not experience racism as these events will not be congruent with their reality. Further, most people have been socialized to ignore or minimize the presence of racism. Some therapists will attempt Socratic questioning as a way to get clients to doubt their experiences of racism. But this is quite harmful as the very nature of racism is to gaslight the victim, and the damage is compounded when therapists re-enact this violence.

The good news is that it seems the importance of validating racist experiences has taken hold, and I hear from more therapists that they are increasingly accepting their clients’ descriptions of their personal experiences of racism as valid.

But what should therapists do when clients broaden their experiences of racism and generalize these into global conclusions? Here are some examples of client statements that have stumped well-meaning clinicians:

"I can't walk down any street because the police will stop me and question me."

"You know these White teachers don't care about Indigenous kids."

"They want to keep Black people at the bottom."

Therapists have told me that it is difficult to validate comments like this, which they classify as cognitive distortions. Therapists may believe they have the responsibility to help clients identify maladaptive notions that can worsen their mental health issues. And while it is certainly true that cognitive distortions should be addressed, therapists need to be willing to challenge their own perceptions. Are the statements above best classified as cognitive distortions? Or are clients describing some aspect of a reality that needs to be understood and acknowledged?

Racism Is Systemic

Racism does not simply operate on an individual level. It is systemic, and clients may need to express their distress and pain surrounding systems of oppression in addition to the individual acts of racism they experience. They may not have the precise words to describe these covert systems that cause them harm, and their attempts to do so may sound like gross generalizations. But understanding must be the starting point, do not assume they are wrong. Therapists can ask questions if they don’t understand. But how do we do this without invalidating clients?

Client: "I can't walk down any street because the police stop me and question me."

Therapist: “Is it really true that you get stopped by police every time you walk down the street?”

No, this is the wrong approach and results in invalidating the client. Even though the client statement may be a generalization, the person is trying to communicate real difficulties they experience that are contributing to their mental health concerns. Here is a better approach:

Client: "I can't walk down any street because the police stop me and question me."

Therapist: “That sounds terrible. Tell me about the last time this happened to you.”

Likewise, the other statements also require understanding and validation.

Client: "You know these White teachers don't care about Indigenous kids."

Therapist: “Based on what you’ve told me about your daughter’s experiences at school, I can really see that. It’s sad the teachers act that way.”

And sometimes what sounds like a gross generalization is 100 percent correct.

Client: "They want to keep Black people at the bottom."

Therapist: “Given that there are no Black people in upper management at your workplace, it sounds like you are right. It’s wrong and unfair.”

It is important to consider that just because something is uncomfortable and inconvenient does not mean it is untrue. In fact, a recent NY Times article discussed the very issue raised by this client in an article entitled, The Truth Is, Many Americans Just Don’t Want Black People to Get Ahead. The therapist could share this article with the client to validate and better inform their observation.

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Understanding and validating systemic oppression is key to effective anti-racist mental health care. In the Lancet, Dr. Jude Cénat describes anti-racist mental health care as proactive in the sense that it addresses racial issues without waiting for clients to bring these issues forward. Anti-racist care incorporates cultural aspects and provides some form of redress for the damage caused by racism, which can include discrimination, racial profiling, and racial microaggressions.

Clinicians can use tools like the UConn Racism / Ethnic Stress and Trauma Survey (UnRESTS) to better understand all facets of client experiences of racism.