Collaboratively written by members of TherapistsDAO’s ARIA Group
Each member of TherapistsDAO has committed to creating a decentralized organization aiming to dismantle systems of oppression, especially racism. Our vision of what we hope to co-create must be shaped by acknowledging and learning from ways in which the current system does not work and causes BIPOC and other marginalized clinicians harm.
Members of TherapistsDAO’s ARIA (Anti-Racism in Action) Group were asked to reflect on ways in which they have seen the mental health care system work against their BIPOC peers. They added their reflections below. The list is not exhaustive and continues to be part of ongoing conversations within the community.
The purpose of this reflection is to…
Serve as a jumping-off point for white members of the DAO’s founding team to converse with one another in a vulnerable way about the systems of oppression that have harmed their peers but that we have benefited from.
Explore how current systems function within the mental health industry, including how they harm our BIPOC peers and help us.
Use information gathered to inform TherapistsDAO’s policies, systems, and vision to create a more equitable organization.
Call attention and awareness to these harmful experiences so BIPOC members are not solely responsible for guiding these conversations.
Much like the article ‘Unpacking the Invisible Knapsack’ by Peggy McIntosh, this reflection lists ways in which the current mental health system and U.S. mainstream culture hurt BIPOC clinicians and support white therapists.
BIPOC clinicians are often preferred by BIPOC clients because they feel more seen, safe, and understood in the therapy room without having to explain their life experience. Many BIPOC clients, due to generations of trauma and oppression by racism in systems and institutions in which they live and work, have a higher degree of severity and emotional need. This leads to higher rates of emotional exhaustion for BIPOC therapists while at the same time, they are required to meet the same productivity expectations as white peers.
Many BIPOC clinicians are overwhelmed by the number of BIPOC individuals seeking to become clients and have to manage their desire to help and the danger of burnout.
White clinicians can walk away from conversations around inequality and institutional racism in a place of employment, or anywhere, with relative ease.
Because most psychological research has utilized standardization samples “made up of individuals from Western, educated, industrialized, rich, and democratic (WEIRD) societies, which can skew the generalizations we make about human behavior (Henrich, J., et al., Behavioral and Brain Sciences, Vol. 33, No. 2–3, 2010),”
BIPOC clinicians feel the resulting burden of lack of representation in psychological research shift to their shoulders. This burden can manifest in feeling unseen and unrepresented in both academic literature, clinical applications, and within collegial groups and organizations. [from https://www.apa.org/monitor/2021/04/cover-dismantle-racism]
The skewed psychological research results have long impacted the populations who seek training and licensure in mental health arenas, as BIPOC individuals have not seen themselves as reflected, mattering, and welcomed in fields of psychology. [from https://www.apa.org/monitor/2021/04/cover-dismantle-racism]
Becoming a licensed professional mental health provider is an expensive goal and one that is financially out of reach for many passionately dedicated individuals. After the costs of a graduate program (amounts can range from $10,000 to $30,000 per semester for 2 to 3 year programs), including unpaid internships for 1,000 to 3,000 hours, Associate-level or pre-license graduates who choose to enter private practice are on the hook for required weekly supervision for a minimum of 2 years and, in some cases, as long as 7 years before becoming fully licensed. Weekly supervision rates can vary from $30 (for group supervision) to $200.
While none of the clinical exams required for licensure (the ASWB, the NCMHCE, and the MFT exams) have been demonstrated to predict safe or effective practice, they do serve a purpose rooted in classism and racism. Ben Caldwell reports, “White examinees pass the ASWB Clinical Exam on their first attempt about twice as often as Black examinees do. A study in progress is showing a similar pattern on the California and National MFT exams.” [more from Caldwell on the matter can be found here https://www.psychotherapynotes.com/clinical-exams-mental-health-structural-racism/]
Some institutions still have the “good ol’ boys” club where established white leaders get away with racist comments and avoid penalization due to their white supervisors not taking reports seriously. This causes harm to BIPOC workers as well as white workers who are attempting to impact change by reporting discrimination as an ally. In some cases, workers who report discriminatory behavior in this environment are then outcast by their supervisors and unable to promote.
The major historical figures of psychotherapy are predominantly white and often male.
When treating clients of different racial or cultural backgrounds, BIPOC clinicians may be expected to naturally fit into white cultural norms by white clients, whereas this expectation to fully know, understand, and relate in culturally normed ways is not expected of white clinicians treating BIPOC clients.
White clinicians can disengage from news reports of ongoing violence against BIPOC folks and see their clients without having to carry that weight with them.
White graduate students are trained in approaches that align well with their worldview and do not require them to expend the additional energy to try to determine how those orientations would fit in with their culture.
White clinicians-in-training can choose not to engage in conversations about racism and oppression.
Research suggests that white supervisors are still doing an overwhelmingly terrible job of engaging supervisees in these conversations.
Black therapists make less money. This survey found that Black therapists make 10% less than white therapists.
The emotional work required to balance feelings of countertransference can be really intense for BIPOC clinicians working with clients who have experienced racial trauma. This feels different than for many white therapists who may have their own personal experiences to maneuver but don’t have the same intense and ubiquitous experience of being Black in America.
The guidelines and DSMs were not made for BIPOC people / with BIPOC people. This study found that Black women presented depression differently than what is captured by standard screening tools. This makes it even harder for BIPOC clinicians to have competent trustworthy tools to help their clients.
BIPOC clinicians often see more BIPOC clients who are experiencing generations of racial(-ized) trauma and oppression due to living and working within systemic racism. BIPOC therapists have to process what their clients face, and what they themselves face in real time–white therapists cannot fully understand the intensity and complexity of this. The challenges of providing therapy during the COVID-19 pandemic provided the tiniest insight to white therapists on what BIPOC clinicians face every day.
The deep-rooted negative consequences of systemic racism on BIPOC therapists are present in the mental health system. These clinicians are trying their best to provide healing opportunities to those in need while working in systems that actively work against their well-being.
TherapistsDAO is building a mental health care organization that operates differently and supports all therapists in the context of co-ownership and community. Ongoing discussion around DEI principles and understanding the experiences of BIPOC clinicians is imperative to our success and is placed at the heart of who we are.
We are co-creating an organization where therapists are valued, respected, have opportunities for leadership, and find fulfillment in community with one another. If you’re a clinician who is interested in learning more please watch our webinar. If you're ready to join, fill out this form. BIPOC Therapists encouraged to apply.