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Uncommon Strategies for a Common Problem: Addressing Racism in Family Therapy

TRACEY A. LASZLOFFY, Ph.D.f KENNETH V. HARDY, Ph.D.̂

Race and racism have a profound effect it may occur on different levels (individual on our daily lives and the practice of level or institutional level) and in different family therapy. Whether individual or ways (overtly or covertly, intentionally or institutional level, overt or covert, inten- unintentionally), all expressions of racism tional or unintentional, there are a variety are rooted in an ideology of racial superior- ofways in which racism can infiltrate the ity/inferiority that assumes some racial therapeutic process. Before therapists can groups are superior to others, and there- take steps to address racism effectively fore deserve preferential treatment. within the context of family therapy, it is important to attend to the development of LITERATURE REVIEW their racial awareness and racial sensitiv- ity. These provide the critical foundation ^^^^i^ ^^^ mental health hterature a upon which specific skills and strategies ^^"^^^^ f ^^''^'^^ ^^^^ examined the associated with effectively identifying and relationship between racial bias and psy- responding to racism intherapy are based. ^^^^^"^ diagnoses For example, Ade- This article defines racial awareness and ^impe (1981) found that subtle, uninten- sensitivity and provides suggestions for ^lonal racism seemed to play a role in the

, . u *u T *u *• 4^u + f 1 high numbers of black patients who were enhancing both. In the section that foL- f ,. , , . i • r m • / • i lows, three major ways in which racism misdiagnosed as schizophrenic. This find- can infiltrate the therapeutic process are 'l^ ^ ^ ^ supported in subsequent studies described. Skills and strategies for address- ^^^^ examined white, black and Hispanic ing each of these in family therapy are P̂ î̂ *̂̂ "̂ Respite sharing the same symp-

, J toms, black and Hispanic patients were uresented

' often misdiagnosed as schizophrenic while Fam Proc 39:35-50, 2000 white patients were almost always appro-

priately diagnosed with emotional or affec- R t i v e disorders (Garretson, 1993; Lopez &

ACISM is an act that denies a person or Nunez, 1987; Loring & Powell, 1988; group humane treatment or a fair Malgady, Rogler, & Constantino, 1987;

opportunity because of racial bias. While Pakov, Lewis & Lyons, 1989; Solomon, 1992).

t Assistant Professor of Family and Marriage Racial bias also has been studied in Therapy; send correspondence to the School of relation to psychiatric hospitalization Familv Studies University of Connecticut, U-58, . j j i i i.i_ r ramuy oiuuieh, ^m -̂ rates, drug dosage levels, the use of re- Storrs CT 06269; e-mail: traceylasz@aol.com. ^ . \ j , • . i • j î

t Professor of Marriage and Family Therapy, Syra- s t r a i n t s and seclusion techniques, and t h e cuse University, 008 Slocimi Hall, Syracuse NY 13244. average length of inpatient t r e a t m e n t .

35 Family Process, Vol. 39, No. 1, 2000 © FPI, Inc.

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Flaherty and Meagher (1980) found that among black and v^hite male schizo- phrenic inpatients who had similar global pathology ratings, "black patients spent less time in the hospital, obtained lower privilege levels, were given more p.r.n. medications, and were less likely to re- ceive recreation therapy and occupational therapy. Seclusion and restraints were more likely to be used with black patients" (p. 679). Based on these findings, the authors concluded that racial bias played a role in the psychiatric services provided to black patients as compared with whites. Similar studies have emphasized dispari- ties between racial groups in terms of hospitalization rates, with blacks consis- tently overrepresented and other minor- ity groups (Hispanics, Asian Americans/ Pacific Islanders, Native Americans) consistently underrepresented (Fernando, 1988; Lindsey & Paul, 1989; Snowden & Cheung, 1990; Wade, 1993). While avoid- ing cause-and-effect conclusions, most scholars cited racial bias as a critical intervening variable underpinning these disparities.

In terms of clinical practice, several studies have examined the relationship between racism and the presenting prob- lem (Garretson, 1993; Suman, 1984). Rac- ism also has been studied as a variable that informs dynamics between clients and therapists (Casimir & Morrison, 1993; Jenkins-Hall & Sacco, 1991; Lopez, 1989; Ridley, 1984, 1995; Teichner, Cadden, & Berry, 1981).

Most of the literature that has studied the relationship between racism and therapy has been heavily skewed toward examinations of black-white interactions. The preponderance of articles focused al- most exclusively on white therapist-black client configurations, although a few also considered black therapists working with white and black clients (Helms, 1984; Jackson, 1983; Jones, 1985; Ridley, 1984).

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A consideration of other racial minority groups, as either clients or therapists, has been largely ignored.

Furthermore, most of the articles that addressed racism and clinical practice were grounded in the psychiatric (Brant- ley, 1983; Fernando, 1988; Thomas & Sillen, 1972), psychology (Korchin, 1980; Stevenson & Renard, 1993), counseling (Gerrard, 1991; Katz, 1985; Ridley, 1995; Sue & Sue, 1990), and social work litera- ture (Goodman, 1973; Pinderhughes, 1989; Sykes, 1987). Within family therapy, a field that, ironically, is defined by its em- phasis upon context, there is a dearth of literature examining the relationship be- tween racism and the therapeutic process. Despite a few exceptions (Boyd-Franklin, 1988; Falicov, 1983; Hardy & Laszlofify, 1994; McGoldrick, 1998), this issue has been greatly underattended to within fam- ily therapy.

A CRITICAL FOUNDATION

There are a variety of ways in which racism can infiltrate the therapeutic pro- cess. However, before therapists can take steps to address racism within family therapy effectively, there is a critical foundation that must be established first. This foundation consists of the develop- ment of both racial awareness and racial sensitivity.

Racial Awareness

Racial awareness is the ability to recog- nize that race exists and that it shapes reality in inequitable and unjust ways. As racial awareness develops, individuals abandon common refrains such as: "I don't see race or skin color," and "we're all the same because we're all members of the human race." While these may be noble sentiments, they do not acknowledge the reality of the world in which we live. Concomitant with the onset of racial awareness is the ability to distinguish between one's belief about how things

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should be, versus the ways things really are in the present.

There are degrees of racial awareness, Those who possess the beginning stages of racial awareness have a generalized, cur- sory knowledge of the dynamics of a pro- racist ideology, which is "a generalized belief that espouses and supports the supe- riority of Whites" (p. 119; Hardy & Las- zloffy, 1998). Those with a more advanced level of racial awareness have a deeper, fuller cognitive grasp of the specific ways in which a pro-racist ideology shapes real- ity. They also have richer, keener insights about the ways in which perceptions of reahty differ between and even within diverse racial groups.

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quently, most people of color are able to relate to white people in a way that leaves the latter feeling racially comfortable. In contrast, many whites lack racial sensitiv- ity during cross-racial interactions. Be- cause many whites seldom interact with large numbers of people of color, or do not have intense, intimate relationships with them, they do not learn how most people of color see the world, or what is impor- tant to them, generally speaking. As a result, when interacting cross-racially, ^^^st do not demonstrate racial sensitivity because they do not know how to relate in ways that are racially meaningful, compas-

respectful from the perspec-

Racial Sensitivity

While it IS possible to have racial awareness without racial sensitivity, the reverse is not true. Those who are racially sensitive inevitably possess some cogni- tive understanding of the existence of race and racism and how they shape reality More importantly however, those who are racially sensitive can translate their awareness into action. In a global sense,

Just as there are gradations of racial awareness, the same is true of racial sensitivity. As individuals enter into the ^^^^' ^^f^' .°^ ̂ ^"^.^ awareness, the early stages of racial sensitivity begin to emerge. ^ ^ " ^ ^ ^^^ ^^^^^ ^^^^^^ ^^ ̂ ^̂ ^̂ ^ sensitiv- ^t '̂ individuals are able to translate their understanding into action, but there tends to be an awkwardness and lack of fluidity

awareness into action. In a global sense, ^ s racial sensitivity deepens, the transla- those who are racially sensitive use them- ^̂ n̂ of conscious thought into action gradu- selves "to actively challenge attitudes, ^^^y becomes smoother, more subtle, and behaviors, and conditions that create or more natural. One develops a greater sense reinforce racial injustice" (p. 119; Hardy & ^f ease, comfort, and congruence that are Laszloflfy, 1998). On a more individual conveyed in increasingly subtle, consis- level, racial sensitivity involves the capac- tent, and meaningful ways. Developing ity to anticipate how others may think racial sensitivity is similar to learning a and feel racially, and to adjust and new language. First, the learner begins to accommodate one's own behaviors accord- cognitively grasp the basic structure of ingly Racial sensitivity requires empathy the language (the rules of grammar) and and the capacity to relate, especially develop a working vocabulary Gradually, cross-racially, in ways that make others the learner begins to translate this grow- feel racially understood and comfortable. ing cognitive knowledge into action by

In general, most people of color are attempting to use the language in conver- capable of demonstrating a high degree of sation with others. Initially, the learner racial sensitivity when interacting with may understand the language in a conver- whites. Because most people of color have sational context, including knowing how had extensive exposure to whites, they to respond correctly in terms of grammar learn from an early age what is important and vocabulary, but it takes time to de- to whites, generally speaking. Conse- velop the sense of poise, comfort, fiuidity.

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and effortlessness that are the hallmarks of effectively using any language. It is only after having numerous experiences using a language in context that an individual shifts from: "I can speak X language," to "I am an X-language speaker."

To demonstrate the distinction between racial awareness and sensitivity, we offer the following example.

Naming the Unnamed Monya, a white female therapist, had her

first session with Jo and John, an interracial couple. Jo, a 27-year-old white female, and John, a 28-year-old Native American male, entered therapy because they were consider- ing marriage and wanted to engage in pre- marital preparation.

During the session, the couple explained they were committed to identifying potential obstacles they might encounter as a couple so they could begin to work on these before marriage. Monya asked Jo and John what ideas they each had about the potential obstacles they might encounter. At one point John said, "Well I really want to be a parent, but I think this could put a strain on our marriage. Kids can add or increase pres- sures from outside and inside of the family and it can be stressful for a couple to try to balance these pressures." Monya sat reflect- ing for a moment and then she responded by agreeing with John's point. After another brief pause she began to pursue a different topic.

Shortly after the session ended, Monya called a colleague to discuss the case and she explained: "I'm sure that one of the obstacles they are concerned with has to do with their racial diflferences. They talked about con- cerns related to having children and made a nonspecific reference to possible 'pressures.' I think this was a reference to racism they might encounter having biracial children. But I just didn't know how to make this overt. It's like we were talking about it but not talking about it. I just felt so uncomfort- able. I'm sure they sensed it."

Monya d e m o n s t r a t e d racial awareness. She recognized how race and racism may

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have been organizing the lives of her clients and how these issues may have been related to the presenting problem. During the consultation with her col- league, Monya's racial awareness was clearly demonstrated through her atten- tion and ability to deconstruct potential racial messages embedded in the client's more general comments about the pres- sures associated with having children. In terms of racial sensitivity, Monya seemed to be in the early stages. She was able to think about the presenting issue from John's racial perspective, however, she struggled with how to translate her under- standing into meaningful action. She struggled with finding the skills and com- fort necessary to approach a dialogue about the issues of race and racism.

There are several actions Monya might have taken had she possessed a more advanced degree of racial sensitivity. For example, she could have indirectly invited John to name and therefore begin discuss- ing any racial concerns by simply asking him to identify specifically some of the pressures he was concerned about. Monya also could have tried a more direct ap- proach by saying: "I appreciate your fore- sight about the huge responsibility in- volved in having children and some of the pressures that come along with this. Know- ing that we live in a racially divided society, your comment made me wonder if the two of you have ever discussed your racial differences and how you might handle the pressures of having biracial children in a society that tends to be very hard on biracial people? Is this a concern for either of you? Have you ever discussed this? Has this created any pressures in terms of relationships with your fami- lies?"

These hypothetical questions would have demonstrated racial sensitivity in several ways. First, they would have cre- ated an opening for a discussion of race by

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using the framework the client had pre- sented (how children create or intensify external and internal pressures that can be difl&cult for a couple to balance). Sec- ond, if Monya had been the first one to name race explicitly, she would have sent a strong message that despite being white, she was tuned into the ways in which a person of color might think about issues of race. Finally, these types of questions would have invited the clients to share their perspectives, even if it meant deny- ing that race was a concern for them.

Our intent here is not to suggest that Monya lacked racial sensitivity, only that she was probably in the early stages. The mere fact that she was worried about not conveying to her clients that she had some understanding of potential racial con- cerns they might have had, indicated a level of racial sensitivity. However, the discomfort she felt about how to use her insight to explore possible racial mean- ings associated with John's worries about having children, suggested her racial sen- sitivity was still developing.

In addition, Monya's racial sensitivity would also have been reflected through her demeanor, intonation, afifect, and non- verbal gestures. As Monya mentioned to her colleague, she was feeling uncomfort- able because she believed that race was an unnamed but critical issue for the couple, yet she felt awkward about how to address the issue. It is likely that if she were feeling uncomfortable, this was conveyed through the subtleties of her nonverbal communication. She may have been send- ing "vibes" that revealed her discomfort. Vibes involve "all of the nuances of behav- ior and not just the verbal message. Per- ceptions are not just based on what is seen or what is said but on a very basic 'gut feeling'level" (Boyd-Franklin, 1989, p. 96).

For Monya, as for the rest of us, her overall racial sensitivity depended on her skill and comfort discussing race, both in

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terms of the words she used and the vibes she conveyed through the subtleties of her disposition, nonverbal behavior, tone of voice, and affect. Because racial sensitiv- ity is largely subjective, clients are ulti- mately the final judges of one's overall level of racial sensitivity. In this case, John and Jo's racial perceptions of Monya should serve as the ultimate litmus test for assessing her overall level of racial sensitivity during her therapy with them.

Strategies

This section provides several strategies that family therapists can employ to help develop racial awareness and racial sensi- tivity.

Reading publications I books and watch- ing movies: Reading books/publications and watching movies that address the experiences of racial groups other than one's own, are excellent ways to enhance racial awareness. Since racial awareness is largely a cognitive state, didactically oriented activities can be an excellent way of enhancing awareness. For those who are in the early stages of racial awareness, it is particularly important to select sources that overtly address the topics of race and racism.

As racial awareness expands, eventu- ally one can read any hook/publication or watch any movie and realize that it can teach as much about race and racism as do those that explicitly address the subject. For example, one can easily learn about race and racism overtly by reading materi- als targeted for audiences of color, which explicitly address these topics on a routine basis. One can learn as much about these topics indirectly by reading materials tar- geted for "mainstream" audiences, which convey powerful messages and lessons about race and racism through the subtle- ties of their composition. For example, while "mainstream" publications rarely claim that they are targeted at white audiences, the nuances of their composi-

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tion often fail to take people of color into consideration. These subtle and innocent omissions make a powerful statement about race and illustrate poignantly the pervasive, insidious nature of racism.

Attending and I or participating in cross- racial I cultural events: One of the best ways to enhance racial awareness and sensitivity is through having direct, per- sonal experience in cross-racial interac- tion. This can be accomplished in any number of ways, such as attending activi- ties or functions that require one to have cross-racial contact (worship services, dra- matic or musical productions, political, civic, or community events). Increased cross-racial exposure makes it possible to learn and practice communicating effec- tively in diverse racial situations.

For whites, entering into a situation where people of color constitute the major- ity will create critical growth-enhancing opportunities. Just being in a situation as "the only one" (or one of a few) creates an intense visceral experience that allows whites to feel the awkwardness, self- consciousness, and discomfort that most people of color have had to learn to negoti- ate as a part of their daily existence. Any white person who was prone to state- ments like: "I don't see color; we're all just human beings," will likely reconsider this position when cast in the role of a racial minority. Suddenly she or he becomes overtly attentive to race in a way that was formerly unimaginable.

It is important for whites to enter not only situations where they are one of the only ones, but also to challenge them- selves to interact directly with the people of color around them. It is not enough, for example, for a white person to attend an all-black church service and sit quietly in the last row, only to exit as soon as the service ends. Just recently, we spoke with a white person who attended an emotion- ally gripping film on slavery sponsored by

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an African American organization. When the movie ended, she left immediately instead of staying for the question/answer session that followed. Initially, she said she had "things to do and didn't have time to stay." Upon greater reflection however, she admitted she was uncomfortable stay- ing and facing what she feared would be the rage and pain of the black people. She stated, "I was afraid they would see me as the only white person there and all the fury that must have been triggered by the movie would come pouring out at me." By exercising her privilege to "leave the scene," she missed the most crucial part of the experience which involved facing the black people whose rage and pain she feared, and finding ways as a white person to tolerate the discomfort this created in her. To develop racial sensitivity, she needed to learn how to remain physically and emotionally present, nonreactive, and empathic with people of color even during the most heated and intense moments. This capacity is best gained through di- rect experience.

Racial self-exploration process: An inte- gral component of developing racial aware- ness and sensitivity involves undergoing an in-depth exploration of one's own racial identity. Before one can fully appreciate how race shapes reality, it is necessary to understand one's self as a racial being. This can be a challenging and at times painful process. However, confronting what it means to be "this" or "that" pro- vides the most intimate and concrete ex- ample of the ways in which race shapes reality. The following questions can be used to begin a racial identity exploration process:

• How do I define myself racially? • When did I first become aware of

race/skin color in general, and mine in particular?

• What messages did I learn about race/

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skin color based on that first experi- point may be obvious, it is worth mention- ence? ing that one cannot develop a complete

• What direct and indirect messages did I sense of racial awareness and sensitivity receive about race/skin color from my without a strong sense of commitment family and friends throughout my child- and determination. Therapists who effec- hood? Adulthood? tively deal with racism in therapy, believe

• How did the messages that I received deeply in the importance of recognizing about race/skin color affect how I and challenging racism in general. Hence, thought and felt about myself racially? the degree to which one addresses racism Others? effectively in therapy, depends largely on

• What benefits did I gain because of my one's overall commitment to increasing race/skin color? her/his racial awareness and sensitivity

• What did I lose because of my race/skin to eradicating racism whenever and color? wherever it exists.

• Have I ever dated cross-racially? Why or why not? RACISM IN THERAPY

• How many friends of a different race do Racial awareness and sensitivity pro- I have? vide the critical foundation for the develop-

While initially it is helpful to begin ment of specific skills and strategies exploring these questions alone, eventu- associated with effectively identifying and ally it is most helpful to consider these responding to racism in therapy. The questions in mixed-race groups. It is following section describes three major through cross-racial interactions that the ways in which racism can infiltrate the complexities of race and racism become therapeutic process. Skills and strategies fully revealed ^^^ addressing each of these effectively in

The process of racial self-exploration is therapy are also presented, essential to achieving racial sensitivity in particular. Most often, the greatest bar- Racism and the Presenting Problem rier to racial sensitivity stems from a deep Racism is most likely to be tied to the sense of anxiety that individuals possess presenting problem among clients of color, about themselves as racial beings. For In situations where therapists are white, example, white people often are uncomfort- or therapists of color are perceived as able talking about race and racism in being aligned with whites, clients of color mixed-race company because they fear tend to be less willing to disclose the ways they will say something racist. Many in which racism is integral to their whites say they "fear the reactions of problem. Moreover, even when clients are black people." However, whites only fear open to discussing racism, therapists' this possibility to the extent to which they reactivity may become an obstacle. In unconsciously fear the parts of themselves such cases, it is necessary for therapists to that are racist. Individuals who under- work through their own "racial triggers" stand and are resolved about their racial so that they are free to recognize and identity, are comfortable discussing race respond effectively to the relationship and racism because they do not live in fear between racism and the presenting prob- of discovering and/or exposing parts of lem. themselves which they or others would To successfully respond to the ways in find objectionable. which racism may inform the presenting

Internal commitment: While, this last problem, there are several steps we rec-

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ommend. The first step involves being attentive to the ways in which race and racism shape reality. Therapists must think racially in a conscious, overt man- ner and be able to engage in the "language of race." This includes being able to intro- duce the topic of race overtly or metaphori- cally, as well as being able to decode indirect and metaphorical racial com- ments made by clients. In situations where clients believe racism is germane to their problem, the second step involves joining with clients around their definition of the problem. Therapists must be able to vali- date the role that racism plays in the life of the problem, even in situations where they do not agree with this perspective. It is worth mentioning here that validation is not synonymous with agreement. It is possible to validate a perspective without necessarily agreeing with it. Hence, even in situations where therapists do not agree that racism is a salient factor underpin- ning the problem, they must be able to validate this view and find ways of intro- ducing alternative perspectives that do not require clients to abandon theirs. Dur- ing this step, it also is important for therapists to create space for clients to express emotions associated with feeling targeted and victimized by racism.

The third and final step involves work- ing to address the problem based on the assumption that racism is a critical, under- lying factor. Typically this requires a two- prong approach. The first prong involves having clients change things that are di- rectly within their sphere of control. This might include, for example, helping cli- ents develop constructive ways of dealing with the rage they feel in response to racial discrimination, or developing inner strategies for avoiding or effectively con- fronting racist situations. The second prong involves addressing external condi- tions that underpin the role racism plays in the life of the problem. For example.

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therapists can serve as advocates on be- half of clients to address unjust situa- tions, wherever these may occur (schools, the workplace, etc.). Therapists can also help mobilize clients to advocate effec- tively on their own behalf to address and confront situations that involve racism. However, therapists cannot successfully execute any of these steps if they lack racial awareness and sensitivity, or if they have unresolved racial issues that create reactivity and obscure their clinical clar- ity.

The following example illustrates how a therapist and supervision team were un- successful in identifying and addressing the role that racism played in the present- ing problem. Through this example, we intend to punctuate the problems associ- ated with not addressing the relationship between racism and the presenting prob- lem, as well as offer specific ideas about how to negotiate this issue efifectively.

A Matter of Misunderstanding The therapist, Karen, a white female was

working with an 11-year-old African Ameri- can male, Tyson, who had been referred to therapy by the school psychologist for con- duct problems. During the first session, Karen attempted to solicit Tyson's percep- tions of why he was having such a difficult time in school. For much of the session, Tyson sat quietly and offered httle verbal feedback. Eventually however, he began to open up, and he explained that he felt angry at school and did not like his teacher. Upon further prompting from Karen, he explained hesitantly that he felt his teacher, who was white, was racist toward him. He offered several examples of the ways in which he felt he had been racially mistreated by her. When he finished, Karen explained to him that maybe he had misunderstood the teach- er's intentions and actions. Moreover, she gently proceeded to reprimand him by ex- plaining that there was never an excuse for the poor behavior he had been exhibiting in school: "feeling mad at someone is never an excuse to break the rules and act up."

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Following the session Karen consulted with the supervision team who had been observ- ing from behind the one-way mirror. The team, who consisted of the supervisor, a white female, and three members (a white female, a white male and a Native American female) supported Karens handling of the session. Interestmgly, no one on the team made explicit mention of the issue of race or racism, although several members agreed that Tyson was resistant to authority and was looking for reasons to justify his defi- ance.

In this case, neither the therapist nor the supervision team discussed the issue of racism. While the issue was explicitly raised by the client, it went virtually "untouched" by all of the professionals involved. As a result, the therapist failed to validate a significant dimension of the client's reality. Since Tyson never re- turned for therapy it is not clear what impact Karen had on him, but it is very likely that, in his eyes, there was little difference between his therapist and teacher. Whether or not the teacher was acting racist toward Tyson was irrelevant, at least initially. Because Tyson perceived things in that way, it was incumbent upon Karen to understand the problem from his perspective. By not validating his reality, Karen missed a critical opportunity to connectwithTyson. Moreover, the supervi- sion team "colluded" with her to deny his reality by not addressing the issue of racism.

This case is complicated by the interac- tion between racial dynamics and Tyson's conduct disorder diagnosis. Because the therapist and team were perceiving Tyson solely in terms of his conduct disorder (one team member said, "he's hostile and un- willing to take responsibility for his prob- lem behavior), they seemed unable to con- sider simultaneously the impact of race and racism on Tyson's behavior Tyson may very well have been suffering from a

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conduct disorder. He may have needed help with his hostility and learning how to accept responsibility for his behaviors. But it also is possible that he felt racially targeted by his teacher, which may have contributed to his problem behaviors. We believe it IS important to ejcpa/ia me aen^ii-

understood in terms of multiple levels, ^^ther than only one or a select few. We believe a more effective way of approach- iiig the case would have involved the following:

1. Since Tyson had introduced racism as the basis for the presenting problem, Karen's job was made considerably easier by the fact that she did not have to introduce the topic, engage in a metaphori- cal dialogue about race, or make a transi- tion from a metaphorical dialogue to a more overt discussion of the topic. She merely had to be open to the possibility that race and racism were germane to Tyson's problem, and join with him in the overt discussion he had initiated.

g. Given that Tyson had identified rac- ^^^ ^g ^he basis for his problem behavior, j ^ was important for Karen to engage with ĵ ĵ̂ ^ around this definition of the problem, j ^ other words, she needed to validate his perspective, even if she did not agree with it. She might have said to Tyson, "It's really unfair how your teacher has been treating you. I'm sure that has to be very hard for you." She could have gone on to invite further disclosures from Tyson by asking him to share examples of when he felt racially mistreated, and she could have empathized with his position. It also would have been important to create op- portunities for Tyson to express feelings of anger and hurt in relation to being un- justly discriminated against. For example, Karen might have said, "How does this make you feel? What do you do with these feelings? Have you told anyone else what's happening? Do you feel like there's any-

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one else who understands what you're going through?"

After having joined with Tyson around his definition of the problem, it would have been useful for Karen to broaden the therapy to include his family. With his family present, Karen's initial goals might have been to: a) find out how everyone in the family viewed the problem; b) support Tyson's view of the problem in the pres- ence of his family; and c) create an oppor- tunity for Tyson to express his feelings about the problem to his family and en- courage them to validate and support him (even if it turned out that they did not share his view). Hence, in the first session with Tyson's family, Karen might have invited everyone to share their view of the problem, including Tyson. Following this she might have said to his parents: "Tyson seems to have a remarkable sense of ra- cial consciousness. How w âs he able to develop this?" A statement like this would have indirectly validated Tyson's view of the problem, while paving the way for a deeper discussion and exploration of the issue of race and its role in the life of the problem. Next, Karen could have encour- aged Tyson to share his feelings vv̂ ith his parents about being racially mistreated. In response to his disclosures, she could have guided his parents to listen, reflect, and affirm their son's feelings.

3. The last step would involve address- ing the problem both in terms of w^hat Tyson contributed, and in terms of what the teacher and school environment con- tributed. First, Karen could have asked Tyson's parents to draw upon their ov^n life experiences and share with their son: a) incidents when they may have been racially mistreated, and b) strategies they developed to survive in these situations. The goal would be one of helping Tyson focus on developing constructive inner resources for coping with racist situations and managing his feelings and behaviors

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(that is, agreeing to talk through problem situations w îth his parents instead of get- ting silently angry and indirectly acting out his feelings in negative ways).

Second, Karen could have turned to- ward the school context. She might have encouraged Tyson's parents to intervene on his behalf with his teacher, and per- haps the school administration. She also might have intervened directly by offering to convene a meeting with Tyson, his parents, and the teacher/principal. Dur- ing such a meeting Karen's job w ôuld involve soliciting everyone's view of the problem and validating each of these, while also supporting Tyson (and where necessary, advocating on his behalf). After hearing everyone's view, Karen might have moved things along by saying to Tyson and his teacher:

'Tou both have dififerent views, but in the end you both want the same thing—to feel respected, and to get along. [To his teacher] You're frustrated with Tyson and believe he is purposefully being difficult. [To Tyson] And you're frustrated with your teacher and believe she is mistreating you racially. I know you [to his teacher] don't believe you have racially mistreated Tyson, but he be- lieves you have. Let's try to address some of the things that leave Tyson feeling racially mistreated, and figure out what concrete steps can be taken to chainge these. And with you, Tyson, in the future, when you believe something unfair is happening, let's work out a plan for how you can deal with this in other ways than getting silently angry and acting up. This way everyone can get some- thing they want."

To work effectively with Tyson, Karen needed to be able to recognize and vah- date the role that he believed racism played in the presenting problem, even if she saw things differently. She also needed to help him directly address the problem as he saw it, which included working with his family and his teacher/school. To ac-

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complish this, both Karen and the team needed to be comfortable acknowledging £ind talking about race, including having worked through their "racial triggers" and the obstacles these created with respect to clearly seeing and nonreactively respond- ing to racial issues.

Client-Generated Racism

One of the most challenging situations for therapists is when a client directs a racially hostile or insensitive act toward them. Because of the personal nature of the assault, therapists are most likely to struggle with how to respond to such situations. Client-generated acts of rac- ism also can be directed at parties other than the therapist (e.g., toward other family members). In either case, thera- pists must be poised to respond to client comments or actions that support racism. When therapists fail to address/challenge a client's racially aggressive or insensitive acts, they unwittingly collude with rac- ism. Some of these complexities are illus- trated below:

Equal Opportunity Oppressor? The therapist, Anthony, a white male, and

the clients, Mr. and Mrs. Stevens, a white couple, initiated therapy because Mrs. Stevens felt disrespected by her husband. He frequently made comments about the fact that she didn't work (because she didn't have a job outside of the home). She com- plained that no matter what she did or how hard she tried, her husbsind never thanked her for anything, he never complimented her or took the time to say anything nice to her. In general, she felt unappreciated by him. Mr. Stevens said he didn't know what his wife was complaining about. He believed he was a good husband who provided for her. What else could she want? He didn't under- stand why she wasn't more grateful for what she had.

During the second session, Mr. Stevens began by complaining about his business and difiBculties he was having with several

/ 45

African American and Puerto Rican employ- ees. He specifically referred to them as "lazy niggers and spies who were always complain- ing about something and trying to find ex- cuses not to work." He explained that they were ungrateful for the opportunity he had given them. Anthony appeared stunned by Mr. Stevens'comment and quickly attempted to change the subject. Later during supervi- sion he expressed how flustered he felt in the session because he was shocked by Mr. Stevens' racism and didn't know how to respond. He explained to his supervisor that he felt guilty for ignoring his remarks but was confused about how he could have re- sponded in a way that would confront the client's racism but also remain relevant to the issues that had brought the Stevens to therapy.

In situations involving client-generated acts of racism, we recommend the follow- ing three-step process that is based on our VCR model (see Hardy & Laszloffy, in press):

1. Validation: No matter how egregious the ofifense, or how potentially volatile the situation is, it is important for therapists to find some aspect of their clients' disclo- sures that warrant affirmation. For ex- ample in the aforementioned case, An- thony could have validated Mr. Stevens by saying: "I admire your commitment to hard work and to running a successful business."

2. Challenging: During this step, thera- pists should begin to ask questions or make statements that are designed to encourage clients to examine critically the connections between their verbal disclo- sures, their racial ideology, and if possible, the presenting problem. For example, in the above case, Anthony might have gone on to say: "I couldn't help but notice your racially derogatory remarks about several of your employees. What role do you think your feelings toward your African Ameri-

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can and Puerto Rican employees may have upon your relationships with them?"

3. Request: Finally, therapists pull all of the issues together in a comprehensive way and make a request. Hence, in the case example, Anthony might have said to Mrs. Stevens: "I've noticed that your hus- band is a very hard-working man and he expects the same from those around him. But his lack of respect for people of color and women seems to undermine his abil- ity to establish and maintain positive rela- tionships with certain people, like his employees of color, and you for example. I think that before we can move forward he will need to explore his feelings toward people of color and women in greater depth and how these shape how he treats members of these groups."

The goal is for therapists to begin by affirming their clients, followed by present- ing a challenge that invites further dia- logue and exploration of one or several related issues. Finally, therapists pull is- sues and themes together and make a request that translates this information into a concrete direction for where to proceed next.

Therapist-Generated Racism

Racism can also infiltrate the therapy process in the form of therapist-generated actions. Therapists of all races can commit acts of racism in therapy. It is important for therapists to be aware of this potential and the ways in which they can challenge it.

White therapists: White therapists have a responsibility to challenge the devaluing perceptions and sense of superiority they may have internalized toward people of color. If such feelings are not explored, the entire process of therapy can be compro- mised. It is impossible to not have one's beliefs and biases shape the therapy pro- cess. Hence, white therapists who do not painstakingly and repeatedly question

FAMILY PROCESS

their racial socialization and how it in- forms their interactions with others (both within and outside of therapy), are at risk of committing (albeit unintentionally) acts of racism against people of color.

Even when a white therapist is working with a white client, it is possible to commit acts of racism. While these acts may not target or hurt a particular person of color directly, they do reinforce a racist system that hurts all people, especially those of color. For instance, a white therapist work- ing with a white client can commit a racist act by denigrating a racial minority group. While the therapist's statement does not directly assault an individual person of color, it reinforces a harmful ideological system.

The following is an example of a how a white therapist engaged in an uninten- tional act of racism while conducting therapy with a biracial family.

Knowledge and Knowing The parents, both white, had two adopted

teenage daughters, one white and one black. During the second session the therapist met with both daughters and engaged them in a dialogue about their dating experiences. Diir- ing the discussion, the daughters revealed that they had each dated extensively cross- racially. Upon learning this, the therapist turned to the white daughter and innocently begsui to question her about why she had chosen to date cross-racially. The therapist never asked the black daughter why she also had chosen to date cross-racially. Later when questioned about this by her supervision team, she explained she did not question the black daughter because she felt she already understood her dating decisions—and then seconds later, her jaw dropped as she real- ized the implications of her statement. "Oh my goodness," she exclaimed, "I didn't ask her why she dated cross-racially because I had unconsciously assumed that she obvi- ously did it to improve herself"

This case highlights the ways in which covert, often unintentional racism can un-

LASZLOFFY and HARDY

dermine the work of white therapists. It is incumbent upon white therapists to en- gage in critical introspection and identify the ways in which their racial socializa- tion may lead them to engage in uninten- tional acts of racism.

Therapists of color: Therapists of color also have a responsibility to challenge their racial socialization that teaches them to devalue themselves and to overvalue whiteness. In the absence of such resis- tance, therapists of color are susceptible to committing offenses against other people of color that are not substantially different from those committed by their white counterparts. This is most likely to occur among therapists of color who suffer from internalized oppression whereby they project their self-hatred toward their sym- bolic selves (that is, other people of color). Internalized oppression occurs when the oppressed "learn" to hate themselves— either their literal or symbolic selves. In either case, the underlying dynamic is the same: disavowal of self.

Therapists of color who perceive clients of color as "white identified," and therefore as "sell-outs," are susceptible to racism in therapy. The strong negative feelings that are engendered by encountering another person of color who appears to "to think and act white" can easily lead to therapist- generated acts of racial hostility in therapy.

Are You My Sister? The therapist, Michelle, was a dark-

skinned Dominican American female, work- ing with a couple, Sylvia and Angela, both light-skinned Cuban American females. The supervisor who was watching the first ses- sion on videotape was an Afirican American female. As she watched, the supervisor be- gan to identify places in the session where Michelle had failed to respond in an appropri- ately empathic manner to the clients. At one point, the supervisor noted that Michelle was fiddling with her watch in plain view of the clients, almost as of to say: "When will this be over?" At the end of the session, while

/ 47

Sylvia was crying over the death of her mother, the therapist interrupted by saying, "Well, we're out of time today. Let's schedule a time to meet next week." The supervisor noted that Sylvia seemed stunned by the abrupt end to the session. As she wiped her eyes and gathered her composure, Angela tried to talk with Michelle to find a meeting time for the following week, and agreed to cancel a doctor's appointment to meet during the only time Michelle said she had available next week. The supervisor later discovered that Michelle eventually canceled the ap- pointment at the last minute.

The supervisor challenged Michelle about her apparent lack of respect and consider- ation for the clients: though her hostility was subtle, it was nonetheless apparent. As the supervisor probed, eventually Michelle ac- knowledged her disdain for the clients. "Cu- bans are worse than some home-grown white folks. They're people of color who try to pass for white. I've never known a Cuban who didn't try to pretend they were white and wouldn't sell out other folks of color just to get a leg up."

The supervisor gently challenged Michelle about the unfairness of her position and encouraged her to appreciate how her mis- treatment of Sylvia and Angela made her no better than what she imagined them to be. This was a revelation for Michelle. "I never thought of it that way I just have so many bad memories from growing up. It never occurred to me that my position with Angela and Sylvia was basically the same thing that I feared in them—turning on other people of color instead of supporting each other."

In this case, Michelle was reactive and extremely hostile toward the clients be- cause they were Cuban American, and she had had painful experiences growing up with Cubans who had aligned themselves with whites against her. Her unfortunate personal history left her with a general- ized sense of mistrust and anger toward all Cuban people. It was only with the guidance of her supervisor that Michelle

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was challenged to appreciate the unfair- ness of her position, and the irony of it.

Since racism at the individual level can occur in either direction, therapists of color, in response to having been repeat- edly victimized by racism, can be racially aggressive toward white clients as well. While never justified, it is important to understand that these aggressions are a response on the part of therapists of color to being consistently devalued and mis- treated by whites. Moreover, when thera- pists of color racially mistreat whites, such interactions always occur within broader social and institutional contexts that ultimately privilege whites and disad- vantage people of color, even while in their role as therapists.

A critical distinction also exists between a therapist of color who is racist toward a white client, versus one who is acting defensively out of fear that she or he will be racially scorned by the client. A lifetime of experience with being the target of white racism, inevitably predisposes some therapists of color to respond to white people with a certain level of healthy cultural paranoia (Boyd-Franklin, 1988; Grier & Cobbs, 1980). As a result, some therapists of color initially may assume a cautious stance in relation to white cli- ents, which is not the same as acting racist. Initially, they may approach the relationship with trepidation, fearing that white clients will either have assumed they were white, and/or will have doubts about their competence.

When clients sense uncertainty and sus- picion from their therapists, it compro- mises the establishment of an effective £ind secure therapeutic relationship. Thus, therapists of color must find ways of bal- ancing healthy feelings of suspicion to- ward whites, with a level of openness and goodwill that is necessary for any success- ful therapeutic experience. Ultimately, as is the case with white therapists, it is

FAMILY PROCESS

important for therapists of color to be racially self-aware. They must tune into the ways in which their personal "racial triggers" may lead to racist acts in therapy. Self-knowledge and a good supervisor/ supervision team are the best resources that therapists have to deal effectively with their own potential to perpetrate acts of racism in therapy.

SUMMARY

Despite our desires and best intentions, therapy cannot be cleansed of racism as long as racism occupies such an integral place in our everyday lives. The implica- tions of racism for therapy are wide- spread. Since much of therapy takes place in private, it is possible for acts of racism to occur "innocently," routinely, and with little detection or accountability. One of the most significant steps therapists can take to prevent racism from infiltrating therapy, is to examine carefully "what we say," "what we do," and, most importantly, to ask ourselves: "What is it that we really believe?" Only through this kind of critical self-examination can racism can be exor- cized from our lives, our clients' lives, and the work we do together.

REFERENCES Adebimpe, V.R. (1981). Overview: White norms

and psychiatric diagnosis of black patients. American Journal of Psychiatry 138: 279- 285.

Brantley, T. (1983). Racism and its impact on psychotherapy. Amer/can Journal of Psychia- try 140: 1605-1608.

Boyd-Franklin, N. (1989). Black families and therapy. New York: Guilford Press.

Casimir, G.J., & Morrison, B.J. (1993). Rethink- ing work with "multicultural populations." Community Mental Health Journal 29: 547- 559.

Falicov, C.J. (1983). Cultural perspectives in family therapy. Rockville MD: Aspen Publica- tions.

Fernando, S. (1988). Race and culture in psychiatry. London: Croom-Helm.

LASZLOFFY and HARDY / 49

Flaherty, J.A., & Meagher, R. (1980). Measur- ing racial bias in inpatient treatment. Ameri- can Journal of Psychiatry 137: 679-682.

Garretson, D.J. (1993). Psychological misdiag- nosis of African Americans. Journal of Multicultural Counseling and Development 21: 119-126.

Gerrard, N. (1991). Racism and sexism, to- gether, in counseling: Three women of color tell their stories. Canadian Journal of Counseling 25: 555-566.

Goodman, J.A. (ed.). (1973). The dynamics of racism in social work practice. Washington DC: National Association of Social Workers.

Grier, W.H., & Cobbs, P.M. (1980). Black rage. New York: Basic Books.

Hardy, K.V., & Laszloffy, TA. (1994). Decon- structing race in family therapy (pp. 5-34). In R.V. Almeida (ed.). Expansions of feminist family theory' through diversity. Binghamton NY: Haworth Press.

Hardy K.V., & Laszloffy, TA. (1998). The dynamics of a pro-racist ideology: Implica- tions for family therapists (pp. 118-128). In M. McGoldrick (ed.). Re-visiting family therapy: Race, culture, and gender in clinical practice. New York: Guilford Press.

Hardy K.V., & Laszlofiy, TA. (in press). Dying to be saved: Strategies for addressing adoles- cent violence. New York: Guilford Publica- tions.

Helms, J. (1984). Toward a theoretical explana- tion of the eflfects of race on counseling: BlackAVhite interactional model. The Coun- seling Psychologist 12: 153-165.

Jackson, A.M. (1983). Treatment issues for the black patient. Psychotherapy: Theory, Re- search, and Practice 20: 143-151.

Jenkins-Hall, K., & Sacco, W. (1991). Effect of client race and depression on evaluations by white therapists. Journal of Social and Clinical Psychology 10: 322-333.

Jones, E.E. (1985). Psychotherapy and counsel- ing with black clients (pp. 173-179). In P. Pedersen (ed.). Handbook of cross-cultural counseling and therapy. Westport CT: Green- wood Press.

Katz, J.H. (1985). The sociopolitical nature of counseling. The Counseling Psychologist 13: 615-624.

Korchin, S.J. (1980). Clinical psychology and

minority problems. American Psychologist 35: 262-269.

Lindsey K.P, & Paul, G.L. (1989). Involuntary commitments to public mental institutions: Issues involving the overrepresentation of blacks and assessment of relevant function- ing. Psvc/zo/o^ica/Su//efin 106: 171-183.

Lopez, S. (1989). Patient variable bias in clinical judgment: Conceptual overview and methodological consideration. Psychological Bulletin 106: 184-293.

Lopez, S., & Nunez, J.A. (1987). The consider- ation of cultural factors in selected diagnos- tic criteria and interview schedules. Journal of Abnormal Psychology 96: 270-272.

Loring, M., & Powell, B. (1988). Gender, race, and DSM-III: A study of the objectivity of psychiatric diagnostic behavior. Journal of Health and Social Behavior 29: 1-22.

Malgady R.G., Rogler, L.H., & Constantino, G. (1987). Ethnocultural and linguistic bias in mental health evaluation of Hispanics. American Psychologist 42: 228-234.

McGoldrick, M. (ed.). (1998). Re-visiting family therapy: Race, culture, and gender in clinical practice. New York: Guilford Press.

Pinderhughes, E. (1989). Understanding race, ethnicity, and power. New York: Free Press.

Pakov, TW., Lewis, D.A., & Lyons, J.S. (1989). Psychiatric diagnosis and racial bias: An empirical investigation. Professional Psychol- ogy: Research and Practice 20: 364-368.

Ridley C.R. (1984). Clinical treatment of the nondisclosing black patient. American Psy- chologist 39: 1234-1244.

Ridley, C.R. (1995). Overcoming unintentional racism in counseling and therapy. Thousand Oaks CA: Sage Publications.

Snowden, L.R., & Cheung, FK. (1990). Use of inpatient mental health services by mem- bers of ethnic minority groups. American Psychologist 45: 347-355.

Solomon, A. (1992). Clinical diagnosis among diverse populations: A multicultural perspec- tive. Families in Society 73: 371-377.

Stevenson, H.C., & Renard, G. (1993). Trusting ol' wise owls: Therapeutic use of cultural strengths in African American families. Professional Psychology: Research and Prac- tice 24: 433-442.

Sue, D.W., & Sue, D. (1990). Counseling the

Fam. Proc, Vol. 39, Spring, 2000

50 /

culturally different: Theory and practice. New York: John Wiley & Sons.

Suman, F. (1984). Racism as a cause of depression. International Journal of Social Psychiatry 30: 41-49.

Sykes, D.K. (1987). An approach to working with black youth in cross-cultural therapy. Clinical Social Work Journal 15: 260-270.

Teichner, V., Cadden, J.J., & Berry, G.W. (1981). The Puerto Rican patient: Some historical, cultural and psychological as-

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pects. Journal of the American Academy of Psychoanalysis 9: 277-290.

Thomas, A., & Sillen, S. (1972). Racism and psychiatry. New York: Brunner/TMazel.

Wade, J. (1993). Institutional racism: An analysis of the mental health system. Ameri- can Journal of Orthopsychiatry 63: 536-544.

Manuscript received April 27, 1999; revision submitted December 6, 1999; accepted Decem- ber 7, 1999.

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