Skip to main content
SpringerLink
Log in

Clinical Toolkit: Providing Psychotherapy in a Contemporary Social Context

  • Chapter
  • First Online:
Book cover Racism and Psychiatry

Part of the book series: Current Clinical Psychiatry ((CCPSY))

  • 2726 Accesses

Abstract

How best is the mental health professional to provide psychotherapy that appropriately considers how the sociopolitical context outside the room influences the interpersonal dynamics between a provider and a patient of an underrepresented race? Psychotherapy stands out as one of the traditional forms of treatment for emotional distress, yet the extent to which its practice has adapted to fit the needs of minorities in a contemporary context is occasionally inadequate. Through the use of adapted case material, this chapter outlines the challenges posed when a history of institutional, interpersonal, and internal racism permeates treatment provided in the present by an individual who may or may not represent those systems of oppression. The current sociopolitical landscape characterized by disparities in access to care, diagnosis, and treatment of mental illness is discussed. An explanation of the psychological theories that describe how racial identity develops, or fails to develop, within an environment of race-based inequity is provided. A case is made for the importance of racial identity development among mental health providers, with strategies to change attitudes, gain knowledge, and apply skills to effectively treat patients in a psychotherapeutic context.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 54.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 69.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Keefe K, Cardemil E, Thompson M. Aftercare engagement: a review of the literature through the lens of disparities. Psychol Serv. 2017;14(1):87–101.

    Article  Google Scholar 

  2. Cook B, Doksum T, Chen C, Carle A, Alegría M. The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the US. Soc Sci Med. 2013;84:102–9.

    Article  Google Scholar 

  3. Jimenez D, Cook B, Bartels S, Alegría M. Disparities in mental health service use of racial and ethnic minority elderly adults. J Am Geriatr Soc. 2012;61(1):18–25.

    Article  Google Scholar 

  4. McGuire T, Miranda J. New evidence regarding racial and ethnic disparities in mental health: policy implications. Health Aff. 2008;27(2):393–403.

    Article  Google Scholar 

  5. Owen J, Imel Z, Adelson J, Rodolfa E. ‘No-show’: therapist racial/ethnic disparities in client unilateral termination. J Couns Psychol. 2012;59(2):314–20.

    Article  Google Scholar 

  6. Owen J, Drinane J, Tao K, Adelson J, Hook J, Davis D, et al. Racial/ethnic disparities in client unilateral termination: the role of therapists’ cultural comfort. Psychother Res. 2015;27(1):102–11.

    Article  Google Scholar 

  7. Cook B, Zuvekas S, Carson N, Wayne G, Vesper A, McGuire T. Assessing racial/ethnic disparities in treatment across episodes of mental health care. Health Serv Res. 2013;49(1):206–29.

    Article  Google Scholar 

  8. Sorkin D, Ngo-Metzger Q, De Alba I. Racial/ethnic discrimination in health care: impact on perceived quality of care. J Gen Intern Med. 2010;25(5):390–6.

    Article  Google Scholar 

  9. Sentell T, Shumway M, Snowden L. Access to mental health treatment by English language proficiency and race/ethnicity. J Gen Intern Med. 2007;22(S2):289–93.

    Article  Google Scholar 

  10. Betancourt J, Green A, Carrillo J, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118(4):293–302.

    Article  Google Scholar 

  11. Leong F, Lau A. Barriers to providing effective mental health services to Asian Americans. Ment Health Serv Res. 2001;3(4):201–14.

    Article  CAS  Google Scholar 

  12. Alegria M, Chatterji P, Wells K, Cao Z, Chen C, Takeuchi D, et al. Disparity in depression treatment among racial and ethnic minority populations in the United States. Psychiatr Serv. 2008;59(11):1264–72.

    Article  Google Scholar 

  13. Williams D, Priest N, Anderson N. Understanding associations among race, socioeconomic status, and health: patterns and prospects. Health Psychol. 2016;35(4):407–11.

    Article  Google Scholar 

  14. Ethnic and racial minorities & socioeconomic status. 2018. Available from: http://www.apa.org/pi/ses/resources/publications/factsheet-erm.pdf. Accessed 7 Jan 2018.

  15. Alverson H, Drake R, Carpenter-Song E, Chu E, Ritsema M, Smith B. Ethnocultural variations in mental illness discourse: some implications for building therapeutic alliances. Psychiatr Serv. 2007;58(12):1541–6.

    Article  Google Scholar 

  16. Sabin J, Rivara F, Greenwald A. Physician implicit attitudes and stereotypes about race and quality of medical care. Med Care. 2008;46(7):678–85.

    Article  Google Scholar 

  17. Shavers V, Fagan P, Jones D, Klein W, Boyington J, Moten C, Rorie E. The state of research on racial/ethnic discrimination in the receipt of health care. Am J Public Health. 2012;102(5):953–66.

    Article  Google Scholar 

  18. Schwartz R. Racial disparities in psychotic disorder diagnosis: a review of empirical literature. World J Psychiatry. 2014;4(4):133.

    Article  Google Scholar 

  19. Stockdale S, Lagomasino I, Siddique J, McGuire T, Miranda J. Racial and ethnic disparities in detection and treatment of depression and anxiety among psychiatric and primary health care visits, 1995–2005. Med Care. 2008;46(7):668–77.

    Article  Google Scholar 

  20. Cultural Formulation. In: Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  21. Hays P. Addressing cultural complexities in practice: a framework for clinicians and counselors. Washington, DC: American Psychological Association; 2001.

    Book  Google Scholar 

  22. Kazdin AE. Encyclopedia of psychology. New York: Oxford University Press; 2000.

    Google Scholar 

  23. Derlega VJ, Winstead BA, Jones WH. Self-concept, self-esteem, and identity. In: Personality: contemporary theory and research. 3rd ed. Boston: Cengage Learning; 2004. p. 246–80.

    Google Scholar 

  24. Troiden RR. Self, self-concept, identity, and homosexual identity. J Homosex. 1985;10(3–4):97–110.

    Article  Google Scholar 

  25. Erikson EH. Identity: youth and crisis. New York: Norton; 1968.

    Google Scholar 

  26. Koch S. A theory of therapy, personality, and interpersonal relationships as developed in the client-centered framework. In: Psychology: a study of a science. New York: McGraw-Hill; 1959. p. 184–256.

    Google Scholar 

  27. Cross WE. The Thomas and Cross models of psychological nigrescence: a review. J Black Psychol. 1978;5(1):13–31.

    Article  Google Scholar 

  28. Spencer MB. Self-concept development. In: New Directions for Child Adolescent Development. San Francisco: Jossey-Bass; 1988. p. 59–72.

    Google Scholar 

  29. Phinney JS. Stages of ethnic identity development in minority group adolescents. J Early Adolesc. 1989;9(1–2):34–49.

    Article  Google Scholar 

  30. Kim J. The process of Asian American identity development: a study of Japanese American women’s perceptions of their struggle to achieve positive identities. Doctoral dissertation. University of Massachusetts; 1981.

    Google Scholar 

  31. Helms JE. An update of white and people of color racial identity model. In: Ponterotto JG, Casas JM, Suzuki LA, Alexander CM, editors. Handbook of multicultural counseling, vol. 1995. Thousand Oaks: Sage; 1995. p. 181–98.

    Google Scholar 

  32. Doamekpor LA, Dinwiddie GY. Allostatic load in foreign-born and US-born blacks: evidence from the 2001–2010 national health and nutrition examination survey. Am J Public Health. 2015;105(3):591–7. https://doi.org/10.2105/AJPH.2014.302285.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Bartoli E, Bentley-Edwards KL, García AM, Michael A, Ervin A. What do white counselors and psychotherapists need to know about race? White racial socialization in counseling and psychotherapy training programs. Women Ther. 2015;38(3–4):246–62. https://doi.org/10.1080/02703149.2015.1059206.

    Article  Google Scholar 

  34. Ridley AR. Overcoming unintentional racism in counseling and therapy. 2nd ed. Thousand Oaks: Sage; 2005.

    Google Scholar 

  35. Sue DW. Whiteness and ethnocentric monoculturalism: making the “invisible” visible. Am Psychol. 2004;59(8):761–70. https://doi.org/10.1037/0003-066x.59.8.761.

    Article  Google Scholar 

  36. Tatum BD. Why are all the black kids sitting together in the cafeteria? New York: Basic Books; 2003.

    Google Scholar 

  37. Trivedi P. Racism, social exclusion and mental health: a black user’s perspective. In: Bhui K, editor. Racism and mental health. London: Jessica Kingsley Publishers; 2002. p. 71–82.

    Google Scholar 

  38. Sholock A. Methodology of the privileged: white anti-racist feminism, systematic ignorance, and epistemic uncertainty. Hypatia. 2012;27(4):701–14. https://doi.org/10.1111/j.15272001.2012.01275.

  39. Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health. 2000;90(8):1212.

    Article  CAS  Google Scholar 

  40. Meyer OL, Zane N. The influence of race and ethnicity in clients’ experiences of mental health treatment. J Community Psychol. 2013;41(7):884–901.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Kali D. Cyrus

  2. Vaden Health Center, Stanford University, Stanford, CA, USA

    Asale A. Hubbard

Authors
  1. Kali D. Cyrus
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Asale A. Hubbard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kali D. Cyrus .

Editor information

Editors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Howard University Hospital, Washington, DC, USA

    Morgan M. Medlock

  2. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Derri Shtasel

  3. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Nhi-Ha T. Trinh

  4. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    David R. Williams

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Cyrus, K.D., Hubbard, A.A. (2019). Clinical Toolkit: Providing Psychotherapy in a Contemporary Social Context. In: Medlock, M., Shtasel, D., Trinh, NH., Williams, D. (eds) Racism and Psychiatry. Current Clinical Psychiatry. Humana Press, Cham. https://doi.org/10.1007/978-3-319-90197-8_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90197-8_13

  • Published:

  • Publisher Name: Humana Press, Cham

  • Print ISBN: 978-3-319-90196-1

  • Online ISBN: 978-3-319-90197-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation