Could more black therapists mean better outcomes?
In many African American communities, mental health issues have a history of being undertreated and underdiagnosed. According to the federal government’s Office of Minority Health, African Americans are 20% more likely to experience serious mental health problems than the general population, but less likely to seek treatment.
This is part two of a three-part series addressing mental health care within black communities.
“When I look back on my life and I look at the things that I did, they were always people-centered,” says Cedric Jackson. He’s training to become a clinical psychologist, and says it’s something that’s always appealed to him.
At the Pacific Institute of Agesong, a residential home for elders, he greets everyone with a smile. Many "How are you’s" and "hello darlings" are shouted from across the room. His long dreadlocks swing back and forth as he maneuvers through the hallways. Everyone seems drawn to him.
Jackson is a rare person: an African-American clinically trained psychologist. Nationwide they make up about 5% of the psychologist workforce -- that’s up from 2% in 2005. Jackson thinks the reason behind that is simple.
“I know there aren’t more black therapists because they can’t afford to become therapists,” he says. “This whole year that I’m working – this is a 40-hour-a week-gig for free.”
It’s taken six years and more than $200,000 to work up to getting his PhD – now, he works with the elders here in an unpaid residency. That’s out of reach for many black people, who don’t have the resources to take on that much debt. But Jackson says when it comes to finding employment after his degree, his race may be to his advantage: when it comes to one-on-one work, race can play a big part in people’s preferences.
“I fancy myself as a people person and able to deal with anybody,” he says. “But a Chinese person isn’t going to be as comfortable with me, or a Hispanic person as comfortable, as they would be with someone who lives and shares their customs. And I think it’s the same with black people.”
Finding similarities through awareness
The National Association of Black Social workers has found that African Americans experience better treatment results when paired with clinicians of similar race and background. In Alameda County, low-income African Americans with serious mental illness receive about 40% of all of mental health services that the county provides.
There’s a need for black clinicians, but there just aren’t that many to pair.
A lot of people have tried to help solve this problem, like Dr. Theopia Jackson, who’s also the chapter president for The Association of Black Psychologists. She thinks there have been a number of positive programs to educate non-black therapists about how to best work with populations that aren’t like theirs. But stereotypes and stigmas have some deep roots, that started back in the early days of psychology.
“People would say for example black folk are loud and more boisterous and there's something wrong with that,” she says.
A white therapist might have seen the boisterous black person as unstable. Jackson says, a black therapist might see it differently.
This transition to incorporate training for therapists to be more racially aware started back in the 1980s. It was called "cultural competency," and it was all about learning to recognize that “normal” behavior isn’t uniform.
“We used to compare black groups to white groups and whenever there was a difference we would say that the difference is because there's something wrong with the black group,” says Jackson. “That was our early psychologies with a lot of fear.”
California made cultural competency training mandatory, hoping it would help bridge the racial healthcare gap. But black Americans still have the worst health outcomes when compared to other races, and traditional tools aren’t always appropriate. Dr. Jackson gives the example of a simple breathing exercise that a therapist might initiate.
“We have to be careful but when we ask clients to close their eyes,” she says. “Because by definition in many inner cities across the United States there's a high prevalence of community violence. So closing your eyes is not safe.”
Dr. Jackson says instead she would probably skip the closing of the eyes and just focus on the breathing.
There are other layers of complexity here, too. Jackson says she’s never had a patient decline to see her because she’s black. But it does happen.
“Somehow along the way there’s a story that to be black is to be less-than,” she says. “So somehow it got conveyed that even when it comes to things like your medical treatment, you are are going to get better treatment from someone who is white because they are supposed to know more than a black physician does.”
Having distance to feel closer
A lot of therapy comes down to who you click with, and race can play a role there too.
Danielle Taylor grew up in a mostly African-American neighborhood in East Oakland and struggled with the idea of going to therapy at all. Her family didn’t talk about mental health. She thought maybe a white therapist would bring something different.
“I thought maybe a black person can want to make excuses for black people,” she says. “Something about it scared me about it, with a black woman being, 'These are your problems,’ being too familial when I was actively trying to work on family dynamic and the culture of my family and power dynamics. I guess it felt too close.”
More distance from her personal experience was more helpful. The therapist she found understood that there could be some challenges.
“One of the first things she said is, ‘You are a black woman, I’m a white woman, so because of that there is maybe some work that I have to do that’s different than the work you have to do,’” Taylor recalls. “So, I was like, boom! I can be comfortable talking about blackness and know it is something that you think of.”
Of course there is no guarantee that a therapist will be culturally aware, empathetic and engaging. But acknowledging those cultural gaps is one place to start.
This report was produced for the California Health Journalism Fellowship, a program of the USC Annenberg School for Communication and Journalism.