Cultural Blindness in Therapy and its Effect on Black Mental Health

Therapy is meant to be a safe space – a place where people can talk about their struggles without judgment, heal from trauma, and seek support for their mental health. As luxurious as this sounds, certain groups may not fully benefit from this privilege. For many people of color, therapy does not always feel welcoming. Instead, it can be another space where they face systemic racism. While many therapists strive to be culturally competent and inclusive, the basis of American counseling practices are deeply rooted in White American cultural values. When a single framework shapes mental healthcare, some approaches can unintentionally alienate or dismiss the lived experiences of people of color. This can make it harder for people to fully connect with their therapist or get the necessary help they need.

Historical View 

Let's break this down using historical context. For centuries, the U.S has had biased views concerning mental health care, often leaving people of color at a disadvantage. For example, the 1840 U.S. census falsely claimed that Black people in the North had higher rates of mental illness than those enslaved in the South (Maharaj et al., 2021). This flawed data was used to justify slavery, suggesting that Black people needed enslavement to maintain their mental well-being. Furthermore, the Jim Crow era contributed to Black Americans being denied access to psychiatric care or placed in underfunded, segregated institutions, as they operated under the assumption that Black patients had lower intellectual capacities. This misinformation reinforced systemic oppression and shaped biased views on Black mental health.

These biases aren't just a thing of the past; they continue to affect access to care and the quality of treatment today. Studies continue to show that Black and Latino patients are less likely to receive accurate mental health diagnoses and proper treatment. For example, African Americans are almost five times more likely to be diagnosed with schizophrenia compared with Euro-Americans (Schwartz & Blankenship, 2014). This apparent pattern shows that misdiagnosis occurs more often in areas where they may be dealing with depression or PTSD, leaving their symptoms overlooked or untreated. 

How Cultural Differences Affect Therapy

Now we know everyone experiences mental health differently, and culture plays a significant role in how people express emotions, handle stress, and seek support. When therapists fail to consider these differences, people of color may feel unheard or misunderstood. 

Giving a scenario-  A black individual faces stress-related issues in their workplace and reports to their therapist. A culturally insensitive therapist might dismiss a Black client's workplace stress by suggesting they may be "too sensitive" or may have overreacted and should "just ignore it," failing to acknowledge racial microaggressions. In contrast, when a White client expresses similar stress, the therapist validates their feelings and offers supportive coping strategies. A culturally sensitive therapist, however, would recognize the racial stressors the Black client faces, validate their experiences, and provide equitable care, ensuring both clients feel heard and supported in their struggles.

Why does this matter?

Many therapists try to be "colorblind," assuming that treating everyone equally ensures fairness. However, ignoring a person's racial identity and cultural background can lead to misdiagnosis or ineffective treatment. 

While not fully considering or understanding the experiences of people of color, clients can feel frustrated and possibly leave the premises worse than they came in. It can alter the perception they once had of themselves and lead them to believe there is something wrong with them, when in reality, the approach is just different. When clients perceive they are misunderstood, it can discourage them from continuing therapy. They might dismiss seeking professional help altogether, leaving them without the necessary support.

Ways therapists can  make a more inclusive mental health space:

1. Acknowledging race and racial issues: Avoiding discussions about race can invalidate a client's experiences. Therapists should recognize racial trauma and be open to addressing issues related to it

2. Being aware of their own biases: Therapists should reflect on the biases they unintentionally have to avoid assumptions about clients based on stereotypes

3. Learn About Different Cultures – Therapists should educate themselves on how different communities view mental health, emotions, and healing.

4. Being a good listener: Therapists must listen to what clients say to understand areas where they can help. This can avoid misinterpretation and misdiagnosis.

5. Adopting new therapeutic approaches: Therapists should try to tailor their strategies and match them with their client's needs

6. Creating a welcoming space to ensure clients feel seen and valued.

7. Seeking feedback: Therapists can ask clients for feedback on their approach and if it aligns with their cultural identity.

References

1. Bringing it in the room: Addressing the impact of racism on the therapeutic alliance. (2021). Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC8667703/

2. Schwartz, R. C., & Blankenship, J. R. (2014). Racial disparities in psychotic disorder diagnosis: A review of empirical literature. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC4274585/