3 Questions Therapists Should Ask Clients of Color Right Now

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This year has been completely unpredictable. As a society at large, we have experienced multiple losses. Most will not end this year without knowing at least one person who has contracted the coronavirus, also known as COVID-19.

According to the CDC, the coronavirus has killed a disproportionate number of people of color. Black or African American, Hispanic or Latinx persons, and American Indian and Alaska Native Americans have been hospitalized and/or experienced higher rates of death due to COVID-19 (Moore et al., 2020; Hatcher et al., 2020). Many in Black, Latinx, and indigenous communities have previously underlying health conditions which are fatal risk factors for encountering COVID-19. Many families have lost loved ones, endured medical racism, and experienced job losses and pay cuts, any of which could lead to emotional turmoil or mental breakdown. This is not to mention the increased burden that caregivers for family members are facing by having to give more emotionally and financially.

Furthermore, people of color, specifically Black Americans, have also faced another illness—systemic racism. This year, countless people took to their streets in nationwide rallies and protests to fight against racial injustice and police brutality and to combat white supremacy. In turn, many ended up being assaulted or arrested, and some were left physically and emotionally exhausted. Experiences of racism and discrimination can lead to depression and suicidal ideation. Overall, this racial turmoil has likely caused increased feelings of hopelessness and powerlessness for many.

In the late summer or early fall, another familiar phenomenon reemerged: seasonal affective disorder, also referred to as SAD. This disorder, which is classified as a subtype of major depressive disorder, occurs when low light exposure results in symptoms of depression, hopelessness, fatigue, and social withdrawal (Rastad, Wetterberg, Martin, 2017). As the seasonal shift begins, people may experience lower energy, a change in mood, and anxiety symptoms.

Unfortunately, SAD in communities of color often goes underreported. This is because it's not always a clearly identifiable diagnosis given other stressors that are encountered daily. Clients of color can easily dismiss and minimize SAD symptoms (such as a lack of self-worth, isolation, or weight gain) without the proper help from a professional. For those who are familiar, they may just prepare to expect the worst before their SAD eventually gets better, rather than seeking treatment.

All of these experiences—COVID-19, racism, and SAD—can lead to immense challenges when experienced individually. When combined, their effects are often magnified.

The intersectionality between experiencing grief, racism, and depression is profound and should be further explored in treatment, if possible. Counselors and therapists should consider including specific process questions in their assessments and updates of treatment planning this year, especially among clients of color with known anxiety and depressive symptoms. Specific questions can include:

1. What meaning have you made from experiencing COVID-19 as a person of color?
2. What has been your experience when you have thought or talked about racism this year or in another time period?
3. What is it like for you to feel sad, particularly this fall and winter season?

As agreed upon with the client, clinicians should explore the symptoms that have emerged, as well as their impact on the client's family system. Clinicians should then collaborate with the client to find the best treatment approach and self-care strategies with the identified client/system. Help clients create a plan that will prepare them to overcome an unprecedented year.