African-American women: considering diverse identities and societal barriers in psychotherapy.

Abstract

Effective psychotherapy with African-American women explicitly requires cultural literacy and competence of its practitioners. Cultural literacy includes understanding the collective social plight of African-American women and the individual client in the context of the prevailing reality of race, gender, and sexual orientation bias and the interpersonal and institutional barriers that result from that bias. Cultural literacy presumes a willingness on the part of the therapist to educate himself or herself about the clients cultural background and milieu and validate the client's accurate perceptions of discrimination and bias and their impact on the client's life. Cultural competence may be seen as the appropriate level of technical skill in applying those concepts to the understanding of the client and the conduct of the psychotherapeutic inquiry. The culturally literate practitioner will acknowledge and appreciate the wide range of diversity within African-American women as a group. The individual client's intrapsychic and familial endowments and personal relationship history as they are embedded in the aforementioned context should be carefully explored and understood as well as are all relevant social factors. Finally, therapists must be willing to scrutinize their own feelings and motivations for working with African-American women. What should follow is a careful analysis of the developmental interactions of these variables, how they promote an individual's view of the world, her perceptions of her options, her strategies for negotiating institutional barriers, her relationships with other persons, as well as any contributions she makes, consciously or unconsciously, to her own dilemma. A culturally literate and antiracist therapist must begin with an understanding of the role of multiple identities and oppressions in client's lives and must have or be willing to acquire a familiarity with the clients' cultural and ethnic heritage and the role of institutional barriers in a client's life. This includes clients' varying experiences of their ethnic and cultural history. The therapist must also be willing to acknowledge each client's personal barriers and resources by exploring significant figures, relationships, and their patterns, and events in their personal lives. Having done all of this, the therapist must avoid the temptation to reduce a client's dilemma to a series of dichotomized "either-ors." Rarely is institutional oppression the sole source of all of a client's difficulties. The struggle of negotiating discriminatory barriers may at times be less painful to explore than troubled or conflicted personal histories with loved and trusted figures. It is essential to strike an appropriate balance between prematurely dismissing a client's realistic complaints about discrimination and focusing on such complaints exclusively. Similarly, exploring or exposing personal difficulties in a client's life should not be used to minimize problems that are a function of the client's oppressed status. While there are realistic racist and sexist barriers in the world that African-American women share as a group, each individual has her own unique experience and understanding of that reality, and that is what the therapist seeks ultimately to understand. The therapist must avoid romanticizing the strengths forged from African-American women's struggles with institutional barriers by neglecting to appreciate the often debilitating effects of those struggles. Furthermore, the temptation to use these struggles as an explanation for all of a client's problems must be avoided as well. Exposing or exploring the parameters of characterological difficulty or psychopathology in a client does not mean that she is to "blame" for everything that happens to her or that racism and sexism are just excuses for internal deficiencies.