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Key points
- Psychotherapy is rooted in a Western cultural context and may not fit all individuals to promote healing.
- Evidence shows racial and ethnic minorities engage in therapy less often, drop out at higher rates, and see less positive results from therapy.
- Culturally responsive psychotherapy, inclusive of communities and culture in the healing process, may be notably helpful to communities of color.
As a psychologist, my role commonly includes assessing psychological symptoms and determining appropriate diagnoses and treatment plans. Often, I see a constellation of symptoms that fit within a certain diagnosis, or many diagnoses, using the framework of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)1. Other times, it can be challenging to fully characterize a person’s suffering within the confines of a DSM diagnosis.
The uniqueness of personal suffering and the heterogeneity with which symptoms are present for my patients also require that I remain careful to fit people into diagnostic buckets. Don’t get me wrong, accurate diagnosis, the disclosure of that diagnosis to the person, and the resulting psychoeducation that follows are essential and therapeutic parts of effective mental health care.
Yet, yesterday as I sat in a room filled with scholars and activists from varied fields and backgrounds from around the world in a discussion on intergenerational trauma, I was struck by how important it is for me to ensure a broader definition of healing remains at the forefront in how I approach care.
According to the Oxford dictionary, healing is the process of making or becoming sound or healthy again.
As a mental health practitioner, my primary goal is to facilitate healing and alleviate suffering for those struggling with mental health challenges to live a personally meaningful and fulfilling life. And as I work toward that goal with my patients, context matters. As articulated by psychologist Robinder Bedi2, “the professional practices of counseling and psychotherapy were developed in the Western world to address problems common in Western countries in a manner consistent with Western understandings.” (p. 96).
Thus, psychotherapy is a healing practice designed from a specific cultural context and for a specific culture3. What does this mean for my approach to clinical care? The evidence-based interventions I use are rooted in Western culture, and I must tread lightly to assume that this approach fits all individuals to promote healing.
The evidence is clear that despite the broad effectiveness of psychotherapy in the United States, racial and ethnic minority individuals engage in therapy less often, drop out at higher rates, and see less positive results from therapy than their white counterparts2. But, culturally adapted therapies help address these gaps (at least to some extent)3.
Culturally responsive psychotherapy includes engaging the community being served and ensuring that healing processes fit within that cultural context. Moving beyond the conceptual healing model of Western psychotherapy may be necessary to promote healing in communities of color more effectively. Part of that may be taking it out of the therapy space and redefining where healing occurs.
Racial socialization, or the process of transmitting culture, attitudes, and values, helps empower individuals to cope adaptively and combat stressors associated with ethnoracial minority status4. Community-based healing spaces and peer/family support and engagement are vital components to healing. Healing is also not forgetting or fixing. Instead, the healing process is about helping individuals to hold their pain and find their path.
Kintsukuroi (金繕い ), or gold mending, is a Japanese pottery practice that focuses on the beauty and utility of breaks or imperfections.
Attending to the breaks, to the pain, and helping to mend the cracks without removing the imperfections or changing them is part of healing, in whatever form it may take. However, as a clinical scientist focused so much on helping to promote the integration of science and practice in my own work and for future generations of mental health professionals, I also find it so important to step back and consider the voices not heard or not represented in the research so far and make sure that my definition of healing can be inclusive for all.
How do you define healing?
References
1. American Psychiatric Association, A. P., & American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5.l therapy for African American youth. Child Maltreatment, 26(1), 17-27.
2. Bedi, R. P. (2018). Racial, ethnic, cultural, and national disparities in counseling and psychotherapy outcome are inevitable but eliminating global mental health disparities with indigenous healing is not. Archives of Scientific Psychology, 6(1), 96.
3. Benish, S. G., Quintana, S., & Wampold, B. E. (2011). Culturally adapted psychotherapy and the legitimacy of myth: a direct-comparison meta-analysis. Journal of Counseling Psychology, 58(3), 279.
4. Metzger, I. W., Anderson, R. E., Are, F., & Ritchwood, T. (2021). Healing interpersonal and racial trauma: Integrating racial socialization into trauma-focused cognitive behavioral therapy for African American youth. Child Maltreatment, 26(1), 17-27.
