What All Therapists Should Know to Better Serve Black Clients

Black people often seek out Black therapists in the hope that they will receive better validation and understanding of their experiences—two essential keys to experiencing a safe therapeutic space. 

While about 14 percent of the U.S. population is Black, according to the American Psychological Association (APA), as of 2015, only 4 percent of psychologists were Black. 

It’s essential that all therapists practice cultural humility and learn to provide culturally competent care to Black clients. 

There is a historical legacy, and current continuation, of biased health care practices, misdiagnoses, and mistreatment Black people face when seeking care. 

For example, Black people are more likely to be misdiagnosed with severe psychiatric illnesses, such as schizophrenia, compared to their white counterparts.

Black Clients on What They Need

When Marcus Webster found he needed to talk about stress, he tried to seek treatment from a Black therapist, but he was unable to find one who was covered by his insurance. 

He currently sees a white male therapist, and they are building a trusting relationship. 

A previous therapist Webster saw, who was also a white male, didn’t validate Webster’s experiences around race. 

When Webster expressed his inability to be fully and authentically himself at his predominantly white university and described having few friendships with Black students, he felt his previous therapist had misunderstood his experience and reaction.

“I remember him being very confused as to why that would be something that would bother me—that even though I had a lot of friends, most of my friends were white,” Webster said. “It was a part of me not being 100 percent myself because I had to try to fit in, and be seen as approachable and friendly.”

According to Webster, if his therapist had been Black, “an explanation would not have been necessary, and the subtext would have been there.” 

To understand the impact of racism in a therapeutic context, Webster wishes more white therapists would connect with more Black people and serve more Black clients.

“As a client, it would’ve been a better experience if I could’ve bypassed the initial frustration of explaining things,” Webster explained. “This would be possible if therapists, and all healthcare professionals, had more experience with Black individuals—whether that means they’re volunteering to give services free to individuals or simply to become aware and familiarize themselves with [common Black] experiences.”

Danielle, a school administrator, sees a Black female therapist to discuss and address her issues related to work and parenting. 

She says she feels more comfortable with a Black counselor because she doesn’t want to explain her actions or feelings pertaining to race. 

With white work colleagues, Danielle says she often has to justify herself and feels that if she saw a white counselor, she would experience the same issues in therapy.

“Explain, convince, and defend is what it winds up being when you’re in a space that’s not germane to yours… when race comes into play,” Danielle says. “I don’t want that in my therapy sessions.”

According to Danielle, to make Black clients feel comfortable, white therapists need to research the unique problems faced by Black people and how to address these issues in therapy.

“Do your research, listen, you have to do the work,” Danielle says. “What they say can absolutely change the trajectory, or experience, for a person who is in therapy.”

Danielle says she’s more comfortable speaking with a Black therapist about parenting issues, including how to instill confidence in her adolescent daughter, and how racism could limit her daughter’s opportunities.

“I remember what it felt like to be the brown girl, and I didn’t want my baby to have to deal with that—what being brown will do to you, and how it impacts you,” Danielle said. “White therapists may not understand the emotional stressors and external pressures Black parents, who are often financially disadvantaged, may have.” 

A Black Therapist on Helping Black Clients

Understanding how inequality and stigma surrounding mental health impacts Black clients can improve the practice of white therapists, says Sharea Farmer, a Black LCSW, and the owner of RS Wellness and Counseling.

“We’ve viewed mental health as a white problem, and not so much a problem that’s been ours, or that we have the time or luxury to resolve,” Farmer explained.

Historically, poor treatment of Black people within healthcare systems, and other institutions, contribute to mental health stigmas. Traumas, such as police officers being involved in mental health crisis assessments, instead of “an actual social worker or therapist,” or social workers “removing [children] from their families,” are part of the Black collective experience of mental healthcare, Farmer adds.

Black clients may be reluctant to seek therapy, or appear non-compliant, due to feelings that arise from these issues. A Black client being late to therapy could appear disrespectful, when, in reality, the client could have anxiety surrounding therapy, Farmer says.

“Being a little bit late to the session, sometimes that’s almost viewed as something we have to create a consequence for, versus being able to have a conversation about—is there some anxiety or something else that’s causing the person to be late,” she says.

Farmer urges non-Black therapists to network with Black therapists to learn more about successful approaches to treating Black clients. 

Furthermore, Farmer reminds Black therapists to remain aware that their own life experiences may not be entirely identical to the experience of their Black clients.

“Even within my own culture, there are areas I have blind spots to because of my own personal experience,” Farmer said. “I need to be able to surround myself with a knowledge base that also can help me to see what I am missing in terms of my own history.”

Therapists of color, who aren’t Black, may also tap into their own experiences as racially marginalized people when treating Black clients. 

Farmer believes all therapists should strive to acknowledge race in their practices.

According to Farmer, ignoring race downplays the impact discrimination has on Black clients. Racism can be a significant contributor to mood disorders and other mental health issues. Stress hormones released in the bodies of Black people during situations that arise from racial inequities can contribute to higher levels of depression, anxiety, and heart disease.

“The reason [ignoring race] may be our mistake is that the client may not present in the space as someone who is dealing with racism,” Farmer said. “They may not realize or sense that part of why they are having stress at work, or conflict within their friendships, is because they’re not really dealing with some of the larger systemic issues around racism.”

A White Therapist on Building Safe Spaces for Black Youth

When a teen who had had a Taser used on him in front of his school shared the incident in a group therapy session, Fiona Brown, LPC, who works in youth substance abuse, said her initial reaction was to ask him ‘what did you do?’”

But her second thought was to be mindful of unconscious bias.“I thought, that’s insane—he’s a child,” she says. “At first it was that immediate reaction of… protecting that system’s decision making process as if it’s valid, and then realizing that’s complete insanity to tase a child.”

White therapists must challenge their unconscious bias, which often presents as disbelief of the extent to which systems of authority contribute to racism, Brown says. “The reaction I had when that young man was being tased was not wanting to believe that we have a system and people that would treat children this way,” she adds.

That disbelief may “go back to shame,” Brown says. “It’s hard to acknowledge that people who we see as ‘like us’ are capable of those things—prompting us to ask if we’re “capable of those things.” 

When white therapists don’t challenge their cognitive biases, they invalidate Black clients’ experiences, Brown said. 

“It’s a huge barrier, not only for systems to change, but also for [Black] people to share their experiences without the fear, or the legitimate expectation, that [they won’t be believed, or that] people will… minimize their experiences.”

According to Brown, white therapists will want to always be mindful about creating that safe space and validating their Black clients.

“Our role is to provide a safe space for that person where they can explore their own experiences, with the assumption that they are a worthy and valuable individual,” Brown said. “That’s really the core of therapy.”

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