Is Therapy Just for White People?

Co-authored by Phil Newsome

In 2022, Kiara Imani released her memoir, which details her severe anxiety, its links with racial trauma, and how therapy has significantly improved her psychological health. Like many, she did not know one Black person who sought mental health treatment before she made the decision to try it herself.

This book’s message is important and timely. Between 2018 and 2021, suicide among White individuals has decreased, while the suicide rate in the Black community has increased by a staggering 20%. Sadly, Black people continue to seek out mental healthcare less often than their White counterparts. Imani’s memoir is powerful and hopefully persuades more of the Black community to give therapy a shot.

However, as clinical science researchers, one of us a Black man who is an aspiring clinical psychologist, we wanted to offer an insider perspective on her conclusion, Therapy Isn’t Just for White People.

Scholars in our department at the University of Southern California and others have clarified that (evidence-based) interventions similarly improve mental health across cultures and racial-ethnic groups. Here’s the problem:

• Black people are two times less likely to seek mental health services compared to White people in the US.
• Black people are much less likely to receive medication than White people with similar symptom profiles.
• Black people are more likely to be diagnosed with schizophrenia and drug-related diagnoses and much less likely to be diagnosed with mood disorders (and other nonpsychotic disorders).
• Therapy clients who are racial-ethnic minorities are much more likely to drop out of therapy compared to White clients.

And the list goes on.

In short, experiences with mental health services vary across races and ethnicities, and these differences often undermine successful treatment for groups most vulnerable to enduring psychological distress.

So, what is driving these disparities in mental healthcare? A central challenge of clinical psychology is to continuously develop, refine, and administer effective and equitable treatment to improve psychological health. However, we have remained relatively stagnant with regard to advancing a culture of equitable access to mental health services. In our opinion, two limitations of our field underlie disparities in mental health treatment:

1. Participants included in most studies evaluating how well a treatment works have mostly been White. In part, the underpinnings of this disparity are logistical. Rigorous intervention research requires many participants; thus, many scientists will recruit study participants who are accessible and reliable (aka, “convenience samples”). As you might expect, these “convenience samples” are often comprised of mostly participants who are WEIRD (White and Educated participants from Industrialized, Rich, and Democratic countries). On the one hand, racial-ethnic minority individuals may avoid participating in human research due to a lengthy history of exploitative protocols. Further, participation in research may require privileges (transportation, time off work, insurance, etc.) that disproportionally challenge racial-ethnic minorities.

Lastly, much of the impactful intervention research throughout history has been conducted at universities located in predominately White communities. As a result, our evidence-based treatments are well established in a subgroup of the population and may not extend to groups beyond those strongly represented in study samples.

2. While the benefits of prioritizing diversity within research teams are well studied, clinical psychology remains one of the Whitest fields in the sciences (~80%). The historical exclusion of Black people and other minority groups in higher education may offer some explanatory value here and could be magnified by the uniquely challenging and costly road towards admission into and completion of a clinical psychology Ph.D. program. It may also be the case that Black scholars are not drawn to clinical psychology early in the academic pipeline due to a lack of representation in the field and encouragement to pursue an academic path from those dominating the space. For the few that are admitted into these programs, the nature of the training is not well suited for those with limited financial and geographic flexibility.

Without deliberate and thoughtful consideration of these barriers, the gap between study participants and the United States population will continue to grow, maintaining disparities in treatment access, willingness, and completion.

Fortunately, there has been increasing focus on addressing racial disparities in mental health treatment as of late. On the research front, there has been recent interest in developing, testing, and disseminating cultural adaptations to treatment strategies well-established in nonminority populations. Research done a few years ago by Evrim Anik and colleagues from the University of Leeds found that culturally adapted psychotherapies for depression worked a little bit better than the boilerplate treatment protocols in populations that the therapies were adapted for. A more recent study from Sarah Silveus and colleagues reported similar findings, including evidence of culturally adapted treatments for anxiety patients. Importantly, these studies provide a strong motivation to continue down the path of developing interventions specifically adapted for groups not initially targeted.

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Further, there is growing emphasis on how cultural competency is integrated into therapists’ training. As noted in a report from Lorraine Benuto and colleagues, the effects of current cultural competency training are somewhat mixed; however, these efforts reflect a motivation to provide more thoughtful and culturally sensitive treatments. Taken together, clinical psychology is still far behind where it needs to be to provide an equitable therapy experience for Black individuals and other racial minorities, and systemic refinement of our field is much needed. However, the extraordinary recent efforts by our colleagues and others in similar fields are encouraging and have begun to (slightly) move the needle towards equitable practice.

So, is therapy just for White people? The evidence would suggest no. Still, serious racial disparities exist due at least in part to shortcomings from within the field of clinical psychology. Who we help reflects who we are. We are hopeful that the future is brighter than our traditions and that established clinical researchers and practitioners will lift diverse perspectives, which will undoubtedly improve our field’s rigor and reach. We are hopeful emerging professionals in the field will prioritize mental health equity in their scholarship, training, policy, and practice. We are hopeful that better days are ahead.

Phil Newsome is a graduate student in the University of Southern California's clinical psychological science doctoral program.