Understanding Cultural Competence and Becoming an Antiracist Therapist

In a society that is warped and damaged by racism and inequality, behavioral health professionals need to have a strong understanding of cultural competence. 

However, cultural competence is not a simple concept that can just be adopted overnight. It takes a conscious effort to rid ourselves of the biases and prejudices that are baked into our culture. It takes conversation, education, training, and commitment to become an antiracist clinician.

What is cultural competence, and how can behavioral health professionals create safe spaces for clients to talk about, process, and heal from racism and other forms of oppression?

What Is Cultural Competence?

Systemic racism has been a part of our society since long before the field of mental health emerged. So, it’s no surprise that behavioral health clinicians, who are often white, create unintentional barriers to accessing care for some Black, Indigenous, and people of color (BIPOC) clients. 

That’s why clinicians need to understand their own biases and approach their lives and practices through an antiracist lens.

Antiracism in Therapy

In this excellent series of articles in Psychology Today, Lyrica Fils-Aime, LCSW-R, RPT-S, explores the work of clinicians who are working to be antiracist and anti-oppressive in their practices. She explores topics such as

• The harm of “respectability politics” in practice. This post explores how therapists’ beliefs and unconscious biases can affect practices.
• The promise and limitations of cognitive behavioral therapy (CBT)
• Decolonizing therapeutic modalities by applying anti-oppressive strategies and dismantling the racist history of psychology
• Recognizing ancestral trauma, which is the trauma passed from generation to generation, especially in people of color
• Creating racial stress recovery plans with clients who are distressed and exhausted with the constant struggle to respond to racism

These are just a few aspects of cultural competence that behavioral health professionals are grappling with.

Busting the Myth of Colorblindness

In this Psychology Today article, Naomi Torres-Mackie EdM, PhD, writes: “Many therapists never ask, ‘What is it like to be Black?’ ‘To be white?’ ‘To be biracial?’ or ‘What prejudice have you experienced (or not experienced) because of your race?’

One of her top suggestions is to bring up race in the very first session with clients. Ask them about their racial identity when you are getting to know them. That way they understand that talking about race is not off limits: it is welcomed and encouraged as part of the healing process.

Color blindness (or claiming to “not see race”) is a harmful misconception that was cultivated in elementary schools around the country in a misguided attempt to wish away our country’s painful history of racism.

In the Connecticut Women’s Consortium training, Racism and the Myth of “Colorblindness, Mara Gottlieb, PhD, LMSW, provides some context and valuable insights for behavioral health professionals who want to understand more about the ways that race affects our day‑to‑day lives, the history of race and racism and how it has shaped our identities, power structures, and institutions, including the criminal justice system.

Learning to name bias in ourselves, in our culture, and in our society is a step toward cultural competence.

Tips for Anti-Racist Counselors

The American Counseling Association’s Anti-Racism Toolkit offers a tip sheet with some advice for behavioral health professionals.

1. Be open and accurate. Be open to discussing community trauma surrounding the killing of Black, Brown, and AAPI people, and choose your words intentionally. Using words like incident, event, or misunderstanding can be interpreted as victim blaming. Use active voice (“A police officer killed an unarmed Black person.”  instead of “An unarmed Black Person was shot.”) Use accurate words like killings, murder, or death.

2. Be aware of microtriggers, microagressions, and invalidating clients’ experiences. For example:

   • Not responding to clients’ inquiries based on demographics
   • Taking a “color blind” approach
   • Asking clients to explain their cultures
   • Questioning whether a client’s experiences are related to racial identity
   • Questioning the desire for a therapist who shares their racial background

3. Seek out supervision and consultation. That can mean getting advice from:

   • Peer consultants who can help behavioral health professionals identify biases and open the door to honest conversations about race and identity
   • Counselors who specialize in diversity and inclusion

Practicing Cultural Humility

Antiracist educators believe that a first step for behavioral health professionals is to approach our lives and our practices with a sense of cultural humility. 

That starts with listening to our clients’ stories and experiences—and honoring the strength and wisdom they already possess.

Too many harmful stereotypes have made their way into treatment practices because of implicit bias. Disparities in the mental health system mean that people of color are less likely to seek out and receive high-quality mental health care.

When clinicians embrace cultural humility instead of centering on themselves and their cultures, treatment spaces become forgiving, empowering, and transformational.

Exploring Liberation Psychology

Liberation psychology takes the notion of cultural competence and cultural humility deeper, fully embracing oppressed minorities and acknowledging the ways societal structures harm them.

When working with populations of people who have experienced the trauma of racism, liberation psychology is an approach that seeks to understand and liberate people from the structures and forces that hold them back.

It shows great promise for clinicians whose clients identify as LGBTQIA+ or BIPOC, people whose very existence runs up against white supremacist and oppressive structures. 

Liberation psychology was developed in the 1970s in parallel with liberation theology. It was promoted by scholars, priests, and nuns in Latin America who believed that activism on the part of the poor and oppressed was their core mission. The man credited with pioneering liberation psychology was a part of a troubled chapter in the history of US aggression. Ignacio Martín‑Baró, a Jesuit priest and psychologist, was born in Spain and lived most of his life in El Salvador. In 1989, soldiers from the Salvadoran Army murdered Martín-Baró along with five other Jesuits and the caretaker’s wife and daughter.

Clinicians are following in the footsteps of the martyred Salvadoran Jesuits by doing intersectional and antiracist work. They are cultivating cultural humility, recognizing privilege, and seeking to understand the contexts for mental and behavioral health challenges.

Practices like The Liberated Us in New York City and Liberate Therapy in Los Angeles practice psychotherapy using the lens of liberation psychology. They tend to focus on serving BIPOC communities, immigrants, LGBTQIA+ individuals, artists, and activists. 

A Continuing Journey

There will not be one moment when we declare ourselves “culturally competent.” Instead, behavioral health professionals will continue to learn and grow in the journey to become antiracist clinicians whose practices are welcome, healing spaces for all.