Overcoming Unintentional Racism in Counseling and Therapy

A Practitioner's Guide to Intentional Intervention

Charles R. Ridley

• Publisher: SAGE Publications, Inc
• Year: 2005
• ISBN:
  9781452237985
• Edition: 2
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Overcoming Unintentional Racism in Counseling and Therapy, Second Edition examines the dynamics and effects of racism in counseling with an emphasis on the insidiousness of unintentional racism.. The Second Edition provides a new section on the policies and practices of agencies and other institutions in the mental health system unintentionally resulting in service disparities. Macro-system and micro-system interventions are proposed to overcome these disparities.

Part I

Examining the Counselor's Unintentional Racism

1

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Minority Clients as Victims

Picture yourself as the victim of a driver who runs a red light. As a safety-conscious pedestrian, you wait on the sidewalk at the corner until the light turns green. Even though you have the right of way, you look both ways before you enter the intersection, and then you proceed. When you get halfway across the street, however, tragedy strikes. A speeding car knocks you off your feet, leaving you badly bruised and disheveled, with a few broken bones.

Numerous explanations could account for the driver's behavior. He may have been a young man rushing his pregnant wife to the hospital, and he may have been distracted by her labor pains. The driver may have been intoxicated. The driver may have been negligent about auto maintenance, and his car's brakes finally gave out. The driver may have been distracted by a pretty young lady walking down the street or temporarily blinded by the glare of the sun. The driver may have been a suspected burglar who was being pursued by police.

Add an interesting twist to the story. This is not the first time you or members of your family have been victimized while crossing the street. On many occasions, you and your family have encountered cars running red lights. Incidentally, such bad fortune has never struck your neighbor, Mr. Jones, even though he regularly walks the same streets as you and members of your family.

Understanding the Victim

Mental health professionals can gain useful insights that are applicable to counseling by envisioning themselves in the preceding story; these insights include a better understanding of what it means to be a victim and the importance of being sensitive to the victim's plight.¹ This story also sets the stage for the topic of this book—overcoming unintentional racism in counseling and therapy. Following are five brief discussions about victims that counselors should ponder.

Anyone Can Be a Victim

Few people go through life untouched by victimization. Victims of crimes, of physical or sexual abuse, of mental cruelty, of natural disasters, of wars, of jealous lovers, of deception and manipulation, of oppression, of their own careless actions—these and a host of other groups of victims bear the marks of trauma and injury.

Every victim has a unique story. The pedestrian crossing the street did not suspect impending danger. Although anyone in the wrong place at the wrong time can get hit by a car, no two victims have identical experiences. One of the great human tragedies is that some people are victimized many times over. Many people experience the reality of being victims, and we should not close our eyes to the fact that anyone can be a victim.

The Victim May Not Be at Fault

Most often, victims incur damage from forces outside of their control, and frequently those forces take the form of human victimizers. Ironically, individuals sometimes are victims of their own abuse, such as those who set themselves up for failure, choose self-defeating lifestyles, or attempt suicide. Most of these self-abusive people are acting out the unresolved pain of being victimized by others in the past.

Many victims are not responsible for their own victimization, and they should not be blamed for it. A pedestrian may be hit by a car despite making an honest attempt to avoid it. In our society, however, some victims experience double jeopardy—after they are victimized, they are blamed for what has happened to them. Society's fundamental denial of responsibility further cripples such victims, who often internalize feelings of irresponsibility and self-blame. However, victims do not deserve to be blamed for their victimization any more than they deserved to be victimized in the first place.

Intentions Are Not an Accurate Gauge for Measuring Victimization

People are victimized for many reasons. Sometimes victimization results from malicious intent: a clear and unequivocal decision on someone's part to harm the victim. Sometimes victimization is unintentional; that is, it is an outcome that does not result from malicious intent. Many attempts to prove victimization are really attempts to prove malicious intent. Victimization, however, may reflect something beyond intentionality. It always involves action—the negative behavior of one person toward another. To the injured pedestrian, it does not matter whether the driver of the car was a criminal, a drunkard, or a girl watcher. The only thing that really counts is the harm caused by the driver's actions.

We Need to Understand Victims From Their Perspective

It is easy to think we understand victims’ experiences when we really do not. People interacting with victims often discount the emotional toll of victimization. Feelings of shame, self-blame, humiliation, and rage are common in victims, as are a sense of intrusion, violation, and vulnerability, and even a desire for revenge. These feelings may linger long after the actual victimization. Many individuals continue to play the victim role for some time because their feelings about their victimization remain unresolved. As McCann, Sakheim, and Abrahamson (1988) explain, although victims’ scars are often invisible, they leave profound, persisting effects. To intervene with victims in a meaningful way, counselors must realize that victims often are in tremendous emotional pain and that many victims have a tendency to avoid their pain. Counselors also should understand that each victim views his or her experience of victimization from a unique perspective.

Understanding victims is a challenge, especially for those who have never been victimized. The tragedy of not being understood as a victim is second only to the tragedy of actually being one. To understand victims fully, counselors require empathy, patience, and the willingness to set aside their own preconceived ideas. Counselors who do not exhibit these qualities likely will misunderstand the unique experiences and perspectives of the victims they seek to help. Tragically, they may victimize their clients further through their lack of understanding.

When Victimization Is Selective and Repeated, It Is Not Just Victimization

When people victimize each other, it is appalling, and it is a blight on society. Although society has increased its efforts to prevent victimization, many forms of victimization remain social enigmas and continue to proliferate. For some people, this means they are victimized repeatedly.

When some individuals are repeatedly victimized while others of similar status are not, there is a larger problem at hand. One could argue that Mr. Jones in the opening story is never struck by a car because he is luckier, smarter, or somehow better than the injured pedestrian. But this explanation does not seem plausible. A more realistic explanation is that some force is working against the pedestrian but not against Mr. Jones. In that sense, the pedestrian is a selected victim.

Racism in Counseling and Therapy

Mental health clients who are members of minority groups are selected victims. They are victims of racism in the mental health care delivery system. This type of victimization is an almost unbelievable irony, in that many minority clients experience abuse, neglect, and mistreatment at the hands of counselors who should be helping them. Further, the ethical codes of the mental health professions hold that all clients deserve equitable treatment, regardless of their backgrounds. Counselors should be the most unlikely professionals to victimize their clients.

Unfortunately, racism in mental health care delivery systems is not new, nor has it been dealt with adequately since coming to society's attention during the civil rights movement of the 1950s and 1960s. The history of racism in U.S. mental health care dates back to the nation's early years. Thomas and Sillen (1972) examined the history of racism in psychiatry. They focused primarily on the experiences of African American patients, but their findings appear to be applicable to the mistreatment of racial minority patients in general. Two quotes from their book capture this despicable legacy:

Thus a well-known physician of the ante-bellum South, Dr. Samuel Cartwright of Louisiana, had a psychiatric explanation for runaway slaves. He diagnosed their malady as drapetomania, literally the flight-from-home madness, “as much a disease of the mind as any other species of mental alienation.” Another ailment peculiar to black people was dysaesthesia Aethiopica, sometimes called rascality by overseers, but actually due to “insensibility of nerves” and “hebetude of mind.” (p. 2)

Actually, most asylums in the North excluded blacks—for example, the Indiana Hospital for the Insane did not take Negroes on the ground that they were not legal citizens of the state…. In the few asylums that sometimes admitted Negroes the ratio was one to several thousand white patients. Dr. John S. Butler, superintendent of the Hartford Retreat, attributed the small number of blacks in his institution to their constitutional cheerfulness, which made them less vulnerable to insanity. The Northern psychiatrists “did not seem to see the contradiction in ascribing the lack of Negroes in their hospitals to their alleged general immunity to the disease and at the same time admitting that hospitals did not ordinarily admit Negroes.” (p. 18)

Studies from the mid-20th century onward have documented the enduring pattern of racism in mental health care delivery systems. Researchers have examined the effects of racism on members of various racial minority groups, including African Americans, Asian Americans, Hispanics, and Native Americans. Scholars also have reported on racism in a variety of treatment settings, including inpatient and outpatient facilities. Table 1.1 lists citations of representative publications devoted to the topic of racism in counseling and mental health care delivery. Several of these studies date back to the 1950s.

This research, an accumulation of more than a half century of scholarly inquiry, yields a clear, unavoidable conclusion: Racism exists in mental health care delivery systems across the United States. Of course, not all professionals or practice settings are racist, and not all behave in consistently racist ways. Indeed, some investigations of this issue have produced no evidence pointing toward racism in mental health care, and others have generated mixed or inconclusive results (e.g., Broman, 1987; Goodman & Siegel, 1978; Neighbors et al., 1992; Warner, 1979). These findings are exceptions rather than the rule, however. As Table 1.1 reveals, more than 175 separate studies and commentaries have uncovered racism in American mental health care delivery systems. Professionals cannot dismiss racism as an anomaly in the face of such an overwhelming body of literature attesting to its pervasiveness. When counselors ignore racism, they not only jeopardize the well-being of minority consumers of mental health care but also threaten the very foundation of counseling, which holds the ideals of social justice and equality at its core. Thus, for the welfare of consumers and the integrity of the field as a whole, mental health professionals must confront racism and work to overcome it.

In 1978, the President's Commission on Mental Health produced an important publication that documented the continuing problems encountered by minority clients:

Racial and ethnic minorities … continue to be underserved…. It makes little sense to speak about American society as pluralistic and culturally diverse, or to urge the development of mental health services that respect and respond to that diversity, unless we focus attention on the special status of the groups which account for the diversity…. Too often, services which are available are not in accord with their cultural and linguistic traditions…. A frequent and vigorous complaint of minority people who need care is that they often feel abused, intimidated, and harassed by non-minority personnel. (pp. 4–6)

Five years later, Jackson (1983), who has written extensively on race and psychotherapy, poignantly described racism in counseling. Two of her comments highlight the problem:

Table 1.1 Representative Publications Reporting Racism in Mental Health Delivery Systems

Acosta (1979)

P. L. Adams (1970)

W. A. Adams (1950)

Adebimpe (1981, 1982)

Adebimpe & Cohen (1989)

Adebimpe, Gigandet, & Harris (1979)

Adebimpe, Klein, & Fried (1981)

Armstrong, Ishiki, Heiman, Mundt, & Womack (1984)

Babigian (1976)

Baskin (1984)

Baskin, Bluestone, & Nelson (1981)

Bell & Mehta (1980, 1981)

Blake (1973)

Blazer, Hybels, Simonsick, & Hanlon (2000)

Bond, DiCandia, & MacKinnon (1988)

Boyd-Franklin (1989)

Brantley (1983)

Brody, Derbyshire, & Schleifer (1967)

Butts (1969, 1971)

Calnek (1970)

Carter (1979, 1983)

Casimir & Morrison (1993)

Cervantes & Arroyo (1994)

Coleman & Baker (1994)

Collins, Rickman, & Mathura (1980)

J. E. Cooper et al. (1972)

P. D. Cooper & Werner (1990)

S. Cooper (1973)

Corvin & Wiggins (1989)

Cuffe, Waller, Cuccaro, Pumariega, & Garrison (1995)

d'Ardenne (1993)

DeHoyos & DeHoyos (1965)

Dreger & Miller (1960)

Edwards (1982)

Fernando (1988)

Flaherty & Meagher (1980)

Flaskerud & Hu (1992a, 1992b)

Garb (1997)

Gardner (1971)

Garretson (1993)

Garza (1981)

Geller (1988)

Gerrard (1991)

A. B. Goodman & Hoffer (1979)

J. A. Goodman (1973)

Graham (1992)

Grantham (1973)

Greene (1994a, 1994b)

Grier & Cobbs (1968, 1992)

Griffith (1977)

Griffith & Jones (1978)

Gross, Herbert, Knatterud, & Donner (1969)

Gurland (1972)

Guthrie (1976)

Hall (1997)

Hampton & Newberger (1985)

Hanson & Klerman (1974)

Hoffman (1993)

Hollingshead & Redlich (1958)

Hu, Snowden, Jerrell, & Nguyen (1991)

Jackson (1973, 1976)

Jackson, Berkowitz, & Farley (1974)

Jaco (1960)

Jenkins-Hall & Sacco (1991)

A. Jones & Seagull (1977)

B. E. Jones & Gray (1983, 1986)

B. E. Jones, Lightfoot, Palmer, Wilkerson, & Williams (1970)

D. L. Jones (1979)

E. E. Jones & Korchin (1982)

Kadushin (1972)

Karno (1966)

Katz (1985)

Keefe & Casas (1980)

Korchin (1980)

Kramer (1973)

Lasser, Himmelstein, Woolhandler, McCormick, & Bor (2002)

Lawson, Hepler, Holladay, & Cuffel (1994)

Lefley & Bestman (1984)

Lindsey & Paul (1989)

López (1989)

Loring & Powell (1988)

Lu, Lim, & Mezzich (1995)

Malgady, Rogler, & Costantino (1987)

Manderscheid & Barrett (1987)

Manderscheid & Henderson (1998)

Manly (2001)

Mass (1967)

Masserman (1960)

Maultsby (1982)

Mayo (1974)

McNeil & Binder (1995)

Melfi, Croghan, Hanna, & Robinson (2000)

Mercer (1984)

Mollica (1990)

Mollica, Blum, & Redlich (1980)

Mukherjee, Shukla, Woodle, Rosen, & Olarte (1983)

Neighbors, Jackson, Campbell, ...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Series Editor's Foreword
• Preface
• Acknowledgments
• Part I. Examining the Counselor's Unintentional Racism
• Part II. Overcoming the Counselor's Unintentional Racism
• Part III. Examining and Overcoming the Unintentional Racism of the Mental Health System
• References
• Index
• About the Author