Being a racially responsive mental health practitioner

Our Senior Participation Officer, Zoë Baum, writes on the importance for therapists to address racial injustice through exploring and understanding deeply embedded racial attitudes and practices.

“As therapists acknowledging power issues and embracing social justice, we are not free from representing one or another version of oppression or subordination” - Malin Fors

Whilst racism and racial injustice are not new phenomena, the tragic and brutal death of George Floyd in the USA has instigated a global conversation, much broader than that of American politics and police brutality.

It’s easy to brush this off as an American problem, a policing problem, a problem for racists or politicians. But at Youth Access, we believe that it is as much a conversation we need to have in the youth and mental health communities.

And it’s a tough conversation. It’s tough on white and non-black therapists and youth workers who are doing their best in a strained system – race, culture, ethnicity and identity are complex topics to grapple with. But it’s tougher, by far, on the black young people who are missing out on the support they need – especially at a time like this - if we, as the professionals who they look to for a lifeline, refuse to invest the energy in developing a racially aware practice and ignore our role in building a system that can better meet the rights of black young people.

As mental health practitioners we seek to support clients to express painful feelings such as anger, shame and guilt in a safe and contained way. We recognise the importance of trauma-informed care, understanding that “traumatic experiences can initiate strong emotions and physical reactions that can persist long after the event”. Research has highlighted, however, that these well-rehearsed roles and scripts we recite to ourselves – “I work in a multicultural setting” or “I take a trauma-informed approach to mental health care” are not enough to be able to say we’re ‘anti-racist’ or an ‘ally’.

We must go beyond mere cultural awareness by thoroughly exploring and understanding the deeply embedded racial attitudes that we hold (and yes, we do) and we must understand that trauma is of course related to culture, history, race, gender and other factors.

"It is not enough to simply be open minded. Truly understanding and connecting with people who have minority perspectives that differ from yours requires knowledge regarding individual and social biases and power structures." - Pamela Hays

As therapists and mental health practitioners there are things we can do to better understand racial power dynamics within therapeutic practice and develop cultural competency in our work. Here are some tips and suggested reading to help you to become a racially responsive practitioner:

1. Take a rights-based approach to your practice.

The Youth Access movement, made up of a diverse range of organisations supporting young people on their journey into adulthood, is built around the principles of a rights-based approach to their work with young people – whether that’s in a school, youth work or clinical setting.

A rights-based approach is built on the human rights principles of equality and non-discrimination. But equal treatment does not mean identical – it means tailoring and personalising our response so that everybody is able to access the support that works for them. And it’s vital that we are sensitive, especially at times like these, to how racism, racial injustice and racial inequalities might be playing out for the young people with whom we work, and how this might impact on their right to the best possible mental health support.

2. Understand how your own racial identity affects the therapeutic relationship

Examine how different aspects of your identity may help or hinder the therapeutic relationship you have with your clients. Which parts of you may represent a dominant culture? Which aspects of your client’s identity may represent a dominant culture and how does this play out in the therapeutic relationship?

It has been essential for me to explore how being white impacts my therapeutic work. Particularly given my experience working in settings such as the youth justice system where black children and young people are cautioned and sentenced at three times the rate (and rising) of the general population aged 10-17.

In Gill Tuckwell’s book Racial Identity, White Therapists and Counsellors, she highlights that by exploring aspects of our white identity through our own supervision and therapy we are able to give attention to issues of denial, guilt and shame experienced by white people making time to develop a ‘healthy and secure white identity’. This will in turn build our capacity as therapists to work with racial processes in the therapeutic space.

3. Don’t be silent, be an ally and use your voice to create change

The mental health sector can be guilty of a general silence around racism and this silence can make its way into the therapy room. Tuckwell discusses how this silence can play out through behaviours and attitudes such as “overprotectiveness or overfriendliness towards black clients; lack of challenge of the client’s defenses and discrepancies; and passive acceptance of the client’s progress”.

Tuckwell highlights that “to transform this silence into a racially aware practice, therapists need to find a language in which they can work more openly with racial issues at a dynamic level”. I suggest reading Tuckwell’s chapter on ‘developing a racially aware therapeutic practice’ as a great starting point to becoming more confident working with racial dynamics and issues of power and oppression in the therapeutic space. 

4. Understand different racial identity models:

Janet Helms developed a white racial identity model and a people of colour identity model which can both be used as a framework for therapists to assess their own ‘racial identity status’ and that of their clients.

In the white identity development model, Helms proposes six distinct stages through which a white individual’s ego evolves. Before reaching the final stage of ‘autonomy’ where the white individual no longer needs validation from people of colour of their identity, Helms proposes that they go through a stage of ‘immersion and emergence’. This is when a white person ‘engages in a sincere search to develop a White identity that feels right and moral and brings with it powerful emotions about how other white people deal with racial issues’ in the words of Lisa Blitz. Blitz provides comprehensive analysis of her experiences applying Helm’s white identity model in her work with clients in her article, ‘owning whiteness’. Using this anti-racist framework, Blitz provides three powerful accounts of her experiences of challenging white clients to consider their own race in the counselling room. In doing so, she challenges the notion that race is only something to explore with black clients which in turn discredits the idea of ‘colour-blindness’, that has been used to legitimise the persistence of racism.

5. Remember that there are an infinite possible number of therapeutic dyads:

The possible number of counsellor/client dyads is huge. It is therefore, essential that we don’t make assumptions about a person’s experiences because of the colour of their skin and maintain a person-centred approach, keeping an open mind to the possible implicit and explicit power dynamics that might emerge in the therapeutic encounter and responding accordingly.

Reading a broad range of literature on this topic will help to broaden perspectives of how racial issues can be explored in therapy. We have included an extensive suggested reading list the end of this blog to help you to get you started!

6. Look critically at training programmes, which have a responsibility to be racially responsive

Despite anti-discrimination policies and legislation, experiences of oppression operate on a covert level, which means that therapy training and development programmes must seek not to simply promote self-awareness, but to challenge trainees to actually understand systemic racism and how our social-political roles play into that. Moreover, we need to also be actively looking to build the skills we need to promote social and racial justice in both our individual counselling work and our community/advocacy work.  

Training programmes must demonstrate a commitment to social justice in their policies and practices, and provide avenues for racial dialogue. Likewise, service managers and leaders must be looking to support the development of their staff teams in this area and looking critically in the gaps in their skill sets, understanding and service model. 

7. Recognise that understanding racial identity development is a life-long process

There isn’t a certificate or qualification you can have to say “I am now a culturally responsive and racially aware therapist”. Understanding racial identity is a life-long process and as therapists we have a responsibility to guide others through that process as well as continually examining and responding to our own conscious or unconscious bias and prejudice. Clinical supervision and training and development opportunities can support us as practitioners to further develop our awareness and understanding of racial issues.

In order for us to understand and respond to contemporary racial issues, it is important to have a broad perspective of the historical development of race and racism. We must continuously educate ourselves on the historical and cultural context in which we are working – from world-changing historic events such as slavery and colonialism which have embedded white dominance into social and institutional structure, through to the everyday news cycle and social and political events.


This is a life-long journey, and it will be tough and uncomfortable at times, but only once we’ve addressed racial injustice in our own practice and within our own services can we address the gross inequalities that see black young people so poorly underserved by a mental health system that they need.

If your organisation offers services with a focus on BAME communities and you want to discuss this and other issues with like-minded practitioners, please complete this expression of interest form for our Member Community that we will soon be launching. And finally, if you have any Black clients whose mental health has been impacted by the events of recent weeks, my colleague Safiyyah has written an excellent blog on supporting your mental health as a young Black person.


Suggested resources

Diane M. Adams (2015) The Unbearable Lightness of Being White, Women &Therapy, 38:3-4, 327-340

Bilodeau, S. Bleuer, J. Carr, M. Dokter, D & N Sajnani (2016) British Association of Dramatherapists:  Intercultural Good Practice Guidelines; UK

Blitz, L.V. (2006) Owning whiteness; Journal of Emotional Abuse.  6 (2-3) pp.241-263.

Carr, M & M. Andersen-Warren (2012) A research interview: dramatherapy and cross-cultural awareness; Dramatherapy, 34 (2) 92-100

Carter, R.T. (1995) The Influence of Race and Racial Identity in Psychotherapy: Toward a Racially Inclusive Model. New York; John Wiley & Sons, Inc 

David, E.J. R (ed.) (2014) Internalized Oppression: The Psychology of Marginalized Groups. New York: Springer Publishing Company

Eleonora Bartoli, K. et al. (2015) What do white counsellors and psychotherapists need to know about race? white racial socialization in counselling and psychotherapy training programs. Women & Therapy. 38(3-4) pp.246-262. 

Fors, M. and American, P.A. (2018) A Grammar of Power in Psychotherapy: Exploring the Dynamics of Privilege. Washington, D.C: American Psychological Association

Gaiwani, R., Parsons, H., Birchwood, M., & Singh, S.P. (2016) Ethnicity and detention: Are black and minority ethnic (BME) groups disproportionately detained under the Mental Health Act 2007? Social Psychiatric Epidemiology, 51 (5), 703 – 711

Hays, P.A. (2001) Addressing Cultural Complexities in Practice: A Framework for Clinicians and Counselors 1st ed. Washington, DC: American Psychological Association

Helms, J. E. (1995). An update of Helm’s White and people of colour racial identity models. In J.G Ponteroto, J. M Casas et al. (eds) Handbook of Multicultural Counselling (pp.181 - 198) Thousand Oaks: Sage Publications

Jones, P (2009) Rethinking Childhood: Attitudes in Contemporary Society; London: Continuum Books

Lago, C. and Thompson, J. (1996) Race, Culture and Counselling. Maindenhead: Open University Press.

Lammy. D (2017) The Lammy Review; UK

Morgan, H (1998) Between Fear and Blindness: The white therapist and the black patient, in F. Lowe (2013) Thinking Space: Promoting Thinking About Race, Culture and Diversity in Psychotherapy and Beyond; London:Karnac Books

Mayor, C. (2012) Playing with race: A theoretical framework and approach for creative arts therapists. The Arts in Psychotherapy. (39) 214-219

Moleiro, C. et al. (2018) ‘Integrating diversity into therapy processes: The role of individual and cultural diversity competences in promoting equality of care’, Counselling & Psychotherapy Research, 18(2), pp. 190–198.

Phinney, J. S. (1992). The Multigroup Ethnic Identity Measure: A new scale for use with diverse groups. Journal of Adolescent Research, 7, 156-176.

Sajnani, Tomczyn, Bleuer, Dokter, Carr and Bilodeau (2016) Guidelines on cultural response/ability in training, research, practice, supervision, advocacy and organisational change, Drama Therapy Review: (2) 1: 141-147

Sue, D. W., Arredondo, P. and McDavis, R. J. (1992) ‘Multicultural Counseling Competencies and Standards: A Call to the Profession’, Journal of Counseling & Development, 70(4), pp. 477–486.

Tuckwell, G. (2002). Racial Identity, White Counsellors and Therapists; Open University Press.