We believe this and, as healers, we want to foster growth and resilience in all of our clients. But what we don’t know can and does hurt our clients when we work cross-culturally without the right awareness and skill. Potential clients may hesitate to access resources or to be forthcoming about experiences of racially-based trauma with a therapist who doesn’t share their background and doesn’t invite sensitive and frank exploration of the way these issues inform case conceptualization, treatment planning, and the therapeutic relationship.
As a white therapist, Consultant, and EMDR Trainer, I wanted to know more about how to better serve clients and therapists of color in my office, EMDR consultation groups, and our Connect trainings.
This post evolved from some reading and research on my part, plus rich conversations held last summer with two incredibly generous Black female business owners:
Shamara Gibson, LCSW-QS, CWCM, is an EMDR therapist and director of Mara’s Lighthouse Counseling Center, LLC.
Shamara and Nicole were kind enough to gather and share information about how our EMDR community can better respond to Black clients; especially those who are experiencing current racial trauma and pre-existing traumas that may be reactivated by current awareness of violence against Black men, women, and children in the U.S. They both gave excellent suggestions for media resources, which are included toward the bottom of this post. While these discussions began primarily to address issues around non-Black therapists working with Black clients, the recommendations may serve as guiding principals for work with other clients who have been marginalized, discriminated against, and/or oppressed due to being part of or perceived as part of a particular group or as having a particular identity. This includes but is not limited to race, sex, sexual & gender identity, socio-economic status, mental health, weight, physical disability, intellectual disability, etc.
Shamara spoke to our Greater Orlando Trauma Recovery Network about best practices for cross-cultural counseling, and Nicole spent many hours talking to friends, colleagues, and therapists in the Black community about what could remove barriers to seeking therapy in general, and EMDR Therapy specifically. The overarching themes were education, awareness, safety, and responsibility.
Here are some concrete suggestions related to those themes.
- Understand your own background (race, culture, gender, social location, etc.) and how that may impact you and the therapeutic process. Can show up in the room with openness and humility? Explore barriers to trust and disclosure in the therapeutic relationship. The responsibility lies with the therapist to be culturally competent and to create conditions of safety for the client by proactively addressing issues of race as they may impact the client both outside of and within the therapeutic space. Medical and mental health mistrust also make sense in the context of personal and historical trauma and should be explored and addressed with clients as needed.
- Anticipate and explore the question: Can therapy be effective if my therapist is not Black? EMDR therapists routinely help clients reprocess disturbing life events that are outside of the therapist’s own experience. Unlike talk therapy, the AIP model relies on the client’s own inherent, biologically-based ability to process information to adaptive resolution. It is necessary for clients to have enough sense of safety and trust in the therapist and the process that they can share relevant history and successfully reprocess the life experiences that are contributing to their presenting issues. This is a very personal decision and one that should be addressed by the therapist and explored collaboratively early in therapy. Clinicians should be prepared to make appropriate referrals based on the client’s preference and best interests.
- Explain the process of EMDR Therapy for full informed consent and to increase the client’s sense of power, control, and choices over the process. Explore how EMDR differs from other forms of therapy. What can the client expect during and between sessions? How might EMDR lend itself to respectful cross-cultural practice? (The AIP model honors and focuses on what is causing disturbance for the client and trusts that memory reprocessing will allow the client will move toward what is adaptive for them. The therapist does not impose their own values or perspectives on the client.)
- Illustrate how “Trauma Therapy” is for everyone – normalize therapy and demystify “trauma” so clients understand that it is not just “Big T” traumas, but also chronic stressors, including racism, that can have a significant impact on health and well-being.
- Contextualize Racial trauma as trauma – the goal of therapy is help people to understand that they have experienced trauma, including multigenerational trauma. Unwanted symptoms and any maladaptive coping can then be understood in terms of cause and effect rather than weakness or deficit. In AIP terms, therapists can help clients to begin to identify and address how life events related to systemic racism have led to maladaptively stored information in the domains of Responsibility/Defectiveness, Safety, and Power/Control/Choices. It’s also important to discuss the intersectionality of trauma related to multiple identities, roles, and contexts throughout the lifespan. This cumulative, compounded trauma can result in a more complex presentation (C-PTSD) and can take time to tease apart.
- Address potential worries. Some clients might wonder if EMDR will make them apathetic to the fight against injustice, or if they will no longer care about these issues once their trauma symptoms are eliminated. It can help to explain that when clients relieve the suffering and limitations related to past events, they are often more empowered to take appropriate and effective action in the present and future. Clients might also have concerns about opening up too much, too fast, while still having to face ongoing daily life stressors. Spending enough time in preparation phase is vital, as is building up resources of connection and positive affiliation through RDI, action plans, etc.
- Personalize interventions and pacing. What are the client’s goals, hopes, and fears? Time spent on comprehensive, collaborative case conceptualization and treatment planning will pay off here. A therapist who understands the intersectionality of trauma in terms of memory networks and channels of association can modify standard protocol and use fractionated processing where necessary to keep clients within the window of tolerance during and after therapy. Be ready to adapt quickly based on feedback elicited during reevaluation.
- Ask yourself: What would it mean for you and your clients if you were to move beyond cultural competence to embrace an anti-racist stance?
It’s clear that therapists can do harm by not addressing these issues mentioned above or, worse, by dismissing or minimizing client experiences, committing microaggressions, displaying signs of white fragility, or engaging in overtly racist statements and/or behaviors. When working cross-culturally, we probably won’t know if we are in danger of any or all of the above unless we do some open-hearted and open-minded listening, reading, and learning on the subject.
Our professional codes of ethics and statements of values are a great place to start. Take a look at these guidelines from the American Counseling Association:
Professional values are an important way of living out an ethical commitment. The following are core professional values of the counseling profession:
- enhancing human development throughout the life span;
- honoring diversity and embracing a multicultural approach in support of the worth, dignity, potential, and uniqueness of people within their social and cultural contexts;
- promoting social justice;
- safeguarding the integrity of the counselor–client relationship; and
- practicing in a competent and ethical manner.
A.2.c. Developmental and Cultural Sensitivity
Counselors communicate information in ways that are both developmentally and culturally appropriate. Counselors use clear and understandable language when discussing issues related to informed consent. When clients have difficulty understanding the language that counselors use, counselors provide necessary services (e.g., arranging for a qualified interpreter or translator) to ensure comprehension by clients. In collaboration with clients, counselors consider cultural implications of informed consent procedures and, where possible, counselors adjust their practices accordingly.
A.4.b. Personal Values
Counselors are aware of—and avoid imposing—their own values, attitudes, beliefs, and behaviors. Counselors respect the diversity of clients, trainees, and research participants and seek training in areas in which they are at risk of imposing their values onto clients, especially when the counselor’s values are inconsistent with the client’s goals or are discriminatory in nature.
As you can see, our ethical values and codes point us in the right direction but don’t give us a clear map of how to get there. The good news is that there are a multitude incredible resources we can turn to understand institutional racism, racially-based trauma, and best practices for cross-cultural counseling that truly heals. This post includes just a small sampling of the many YouTube videos, TedTalks, podcasts, blogs, articles, books, and workshops available to us. Some are EMDR and trauma focused, and some are more general. Some are specifically geared toward therapists, and some offer information for laypeople as well. Happy reading, watching, and learning!
A Few Recommended Resources (just the tip of the iceberg)
Therapyforblackgirls.com Also has a resource directory for finding therapists in all 50 states.
My Grandmother’s Hands: Racialized Trauma and the Pathway to Mending Hearts and Bodies by Resmaa Menakem, MSW, LICSW.
White Fragility: Why It’s So Hard for White People to Talk about Racism by Robin Diangelo
Lipscomb, Allen and Ashley, Wendy (2021) “A Critical Analysis of the Utilization of Eye Movement Desensitization and Reprocessing (EMDR) Psychotherapy with African American Clients,” Journal of Human Services: Training, Research, and Practice: Vol. 7 : Iss. 1 , Article 3.
Available at: https://scholarworks.sfasu.edu/jhstrp/vol7/iss1/3
Kira, I. A., Shuwiekh, H., Al-Huwailah, A. H., Lewandowski, L., Alawneh, A.-W. N., Abou-Mediene, S., Al Ibraheem, B., & Aljakoub, J. (2019). The central role of social identity in oppression, discrimination and social-structural violence: Collective identity stressors and traumas, their dynamics and mental health impact. Peace and Conflict: Journal of Peace Psychology, 25(3), 262–268. https://doi.org/10.1037/pac0000363
Go With That Magazine Fall 2020, Volume 25, Issue 3 (EMDR International Association)
Cross-Cutting factors of culture graphic: Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Exhibit 1.1-4, Cross-Cutting Factors of Culture. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207195/figure/part1_ch1.f3/
Therapy for Black Girls: Session 25: What in the World is EMDR? Dr. Joy Harden Bradford
Moving from Cultural Competence to Antiracism; Dr. Thelma Bryant Davis; NICABM (2020)
Interview with Resmaa Menakem about My Grandmother’s Hands and his trauma and violence prevention work with African Americans, Europeans Americans, soldiers, and police officers:https://video.search.yahoo.com/yhs/search?fr=yhs-Lkry-SF01&hsimp=yhs-SF01&hspart=Lkry&p=Resmaa+Menakem#id=2&vid=d78ee010e88d3f958984645c53ae4e5f&action=view
Post Traumatic Slave Syndrome. How Is It Different From PTSD?; Dr. Joy Degruy (2019)
Empathy for Black people in America; Dr. Joy Degruy (2018):
Assessment Tools developed by David R. Williams, et. al.: (David R. Williams is the Florence and Laura Norman Professor of Public Health; Professor of African and African American Studies and Sociology at the Harvard T.H. Chan School of Public Health )