How to talk about racism in therapy when you practice in a culture that denies it

I have to admit that as a therapist located in the Dominican Republic, I struggle to talk about this topic. Although I understand that I am not the most knowledgeable person, I don’t want this to be an excuse as to why not do it. When we talk about psychology, we have to understand that a person is a conglomerate of identities that directly impact their experiences around mental health. And it is our responsibility as therapists to consistently create safe spaces to talk about any topics that are relevant to our patients.

 

The first thing that we need to understand is that racism is prevalent in the Dominican Republic. It is not an experience that is separate from our country.

The people who say that racism does not exist, usually find themselves in the group that perpetuates the oppression of the group that struggles to accept that they are on the side of the oppressed. I believe that both experiences are valid. If we are not taught about privilege or oppression, we can sometimes struggle to identify them or label them in our lives.

However, in our country, we see again and again, how we have a system that is anti-blackness.

Whether it is with experiences around our hair, comments about how we can “better the race,” which people are found more attractive or with higher SES, or even to hear concepts of “negrito fino” o “negrita fina” (a concept used to label individuals who have dark skin but “white features” such as eye color or straight hair). All of this can be called covert racism. Regardless, there are many individuals in our country that experience mover blatant or overt comments of rejection and denigration.

As therapists, it’s crucial to let our patients know that therapy is a space in which we stand as witnesses to these experiences.

Patients need to have a space in which to process them, and it is our duty as therapists to have these conversations. Even when it might be uncomfortable for us.

What we fail to address in therapy sends a message loud and clear to our patients that we do not find it “as relevant” as other themes.

Now, a lot of you might be thinking, “But how do I know if it’s relevant in the patient does not bring it up?” Easy! Bring it up yourself. Let’s remember that experiences around racism are consistently questioned, invalidated, forgotten, ridiculed, or excused in our society. And, usually, patients don’t always feel comfortable taking the initiative because they don’t want to reexperience this silencing. Due to this, we, as therapists, must take the initiative and the responsibility to create the space. And to allow clients to talk about these experiences if they choose to do so.

So, how do we start these conversations in therapy?

 

1) Inform ourselves around our own prejudices and work on them. Like it was once said, “We cannot remove the splinter in someone else’s eye without noticing the beam of wood that we have on our own.” It is impossible to live a life without prejudices, even as therapists. The importance is to accept this and to question it actively. Some of the questions that we can start making ourselves are:

• Why am I uncomfortable talking about this topic?
• What fears do I hold around making others uncomfortable? What do I fear about feeling myself uncomfortable?
• In my training as a therapist, have I allowed myself to read books from non-white authors? How many Black therapists or authors do I follow, read, or study? How many podcasts do I listen to that are created by Black folks?
• What experiences might I be failing to address due to not wanting to talk about race and ethnicity with my patients and colleagues?
• What have been my own experiences around race?

 

2) Address it with your patients when you do their clinical history. It can be as simple as: “I see in your clinical history that you identify with X nationality. I also wanted to ask you if you identify with any other groups such as Black, Afro-Latinx, Mixed, etc”. And call those identities by their names! They are not bad words, and we should start feeling comfortable with them.

 

3) Make it a topic of conversation in therapy. As therapists, a lot of times, we express that we are scared of silence during our sessions. And even though silence can be precious, we could also consider that this can be a perfect topic to bring up! And it can be done the following way “Today I thought it might be interesting to talk about different aspects that make us who we are. As a therapist, I understand that my life experiences are not the same as my patients’. This is why today I want to bring up certain elements and hear your version”. Include elements such as sexual orientation, gender, weight, race, ethnicities, etc. Bringing up these topics can facilitate such interesting and relevant conversations. And we should always remember the importance of LISTENING and showing genuine interest without trying to categorize these experiences in good or bad.

 

4) Look up activities that help to create narratives around your patients’ lives. Create exercises that lead to reflection around the patient’s life stories and the messages of acceptance or rejection that they have received throughout them. An activity that I love to do with my students (because I also teach a course at a university) is to write an essay where they explore different aspects of their identities. Then, they have to write about how they became aware of these various aspects and the messages that they have received regarding them. In my experience, those essays always talk about race. Writing also creates enough distance while maintaining intimacy, which can help to process specific experiences that our patients struggle to vocalize.

 

These topics will feel uncomfortable in the session.

I still struggle with them. And the truth is that many curriculums at our bachelor’s and master’s programs in Psychology fail to address it in the Dominican Republic.

But as therapists, we need to learn how to witness and stay with the discomfort without trying to fix it. Many times, we want to “fix” it for our own sake and not our patients.

Part of our responsibility is to model to patients how they can experience relationships that are both curious and compassionate. Also, we need to reinforce the idea that every aspect of their lives is important and deserves attention. Lastly, we need to be an example as to how to have difficult conversations and how to manage them. These topics are draining, and so is racism. But I promise you that talking about it is so worth it and necessary. It is the therapy, and the quality in mental health, that therapists and clients deserve.