Awosan, Sandberg, and Hall article

Here is the Abstract from the article:

Past research on Black clients’ utilization of therapy focused on the barriers that prevent Black clients from attending therapy and the reasons for these barriers. However, few studies have been conducted that focus on how Black clients attending therapy actually experience these barriers. This study utilized both Likert and open-ended questions to examine the obstacles 16 Black clients face in their attempts to attend family therapy. The most frequently identified obstacles were related to concerns over family member response and cultural barriers to therapy. Participants also reported concerns about racial and ⁄ or cultural differences and a lack of understanding by non-Black therapists. The implications of this study addressed how to effectively meet the therapeutic needs of Black clients.

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-It is important to recognize the variations among Blacks as these differences relate to the underutilization of therapy. People of African descent are not all the same.

-Blacks are fairly united in their negative perceptions of therapy. Their ‘‘negative’’ attitudes toward therapy can be linked to shared experiences of racism and oppression in a White society. Some differences, however, do exist based on SES and other factors.

African Americans and Mental Health Services

-Clinicians need to understand a concept termed Eurocentrism in the literature. Eurocentrism is characterized as a perception in which European (White) values, customs, traditions, and behaviors are used as the exclusive normative standards of merit against which other races and events in the world are viewed

-In order to understand the reluctance of many Blacks to engage in therapy, it is crucial to understand the perceptions and experiences in therapy of this population

-The difficulty for many Blacks in attending an institution that considers Black culture, values, and practices to be inferior or not normal has been indicated as one of the reasons why Black clients underutilize therapy and discontinue therapy after a few sessions.

-Misdiagnosis of Blacks in the mental health services has a profound connection to the pathologization of Black culture.

most non-Black clinicians lack empathy or understanding of Black culture and system values

-Stereotype or overpathologize Black people. Racist assumptions and multicultural ignorance of some clinicians have led to the misdiagnosis of Black clients. Consequently, the fear of being misdiagnosed, stereotyped, or pathologized keeps many Black people from seeking mental health services,

Mistrust

-historical acts of betrayal and oppression such as the Tuskegee syphilis study, among others, has laid the foundation of great and valid distrust

-most Blacks employ what is known as cultural mistrust in their interactions with Whites.

-this concept of cultural mistrust undeniably influences Black clients’ self-disclosure to White therapists and attitudes about therapy in general

-Black clients assess for levels of comfort and safety in the initial stage of therapy by observing the salience of cultural and ⁄ or race identity with the therapist and cultural understanding or sensitivity of the therapist

-Blacks are attuned to pay closer attention to the ways non-Blacks perceive their skin color and ⁄ or culture. The trust is therefore an essential element in obtaining and maintaining therapeutic services.

-Mistrust can hinder Black clients from disclosing ways that racism is connected with many problems they bring to therapy. Blacks fear how a White therapist, or therapist of color whom they perceive as being aligned with Whites by virtue of being members of the same social class, would react or respond to these problems in therapy.

Risk of Self-Disclosure in Therapy

-It can be dangerous for Black clients to self-disclose to White therapists whom they perceive as representing the oppressor. Self-disclosure in an environment that Black clients perceive as unsafe, and to White therapists whom they have some level of cultural paranoia for can impede the therapeutic process by making it less beneficial and effective for Black clients.

-It is crucial for White therapists to consciously and consistently address issues of power, privilege, racism, and oppression.

-the person with the most power also carries the greatest responsibility in that relationship.

-therapists need to embrace their responsibility and work to reconcile their own lack of historical cultural understanding and cultural sensitivity toward Black clients.

The Field of Marriage and Family Therapy and Black Clients

-MFT has struggled to recognize and focus on the topic of race and culture.

-New research is being done

Current Study

-This study is one of the first in the field of MFT to seek the perspective of Black clients who did attend family therapy, particularly regarding obstacles they face in their effort to utilize therapy.

Obstacles Relating to Lack of Family and Cultural Support for Therapy

- Concerns relating to a lack of family and cultural support for therapy were the barriers participants identified as the most difficult to overcome.

- The results of this study indicate that some participants see therapy as a sign of weakness or associated with being ‘‘crazy,’’ which is supported in extant literature that there is a stigma of therapy in Black culture

- Reactions of friends and family, suggesting there is real fear of stigmatization or rejection by family members or the larger community

- the cultural belief that a strong family should be able to resolve issues without professional help.

- belief that family problems should be kept within the family and not be exposed to the public.

Obstacles Relating to Working With Non-Black Therapists

-most Black clients prefer Black therapists to White therapists

-Studies suggest that African Americans would likely come to therapy if they know that the therapist they would see is African American.

- ‘‘lack of cultural understanding of therapist’’ was indicated by participants as a somewhat difficult obstacle to overcome in their attempt to seek family therapy.

- Need for Black clients to feel that their therapists have an ‘‘adequate knowledge of African American life’’ and do not need to ‘‘struggle to accept or understand them’’

- a therapist’s lack of cultural competency, awareness, and sensitivity toward Black culture and families can impede trust in therapy between Black clients and White therapists.

- ‘‘negative views about therapy’’ was significantly correlated with both ‘‘risk of being blamed by my therapist for my problems’’ and ‘‘fear of my therapist being racist.’’

Implications for Clinicians

-Black clients are often wary of working with White therapists.

- family therapists can address this concern of Black clients by taking active steps, both in and out of session, to adopt a multicultural perspective and approach in therapy.

- Racial awareness as ‘‘the ability to recognize that race exists and that it shapes reality in inequitable and unjust ways’’

- individuals who are racially sensitive ‘‘actively challenge attitudes, behaviors, and conditions that create or reinforce racial injustice’’

-Self of the therapist work is important

- family therapists must learn how to discuss race in session.

- the therapist would need to discuss with the client how it may be hard for him to feel safe enough to be honest.

- a culturally sensitive therapist would not place the responsibility on the client to speak up when the ‘‘white’’ comes out of her toward the client, but would instead use her inherent power as a therapist (and the accompanying responsibility that flows from it) to monitor herself through self exploration and supervision

- Taking extra time to process issues of confidentiality and privacy can show Black clients that a therapist is aware of past exploitation of Blacks both in and out of therapy.

- Clinicians need to understand the origin of barriers and how to address them in therapy.

- Most participants were highly religious. A therapist can effectively utilize a strength-based perspective by asking clients how spirituality and religion can serve or has served as a positive resource in their efforts to deal with life’s problems.