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When Internalized Stereotypes Impact Depression

24 Comments

There are times when a patient may internalize painful judgments and stereotypes from the world, and they might not even realize they’ve done it.

And when that patient is struggling with depression, addressing this toxic messaging can be a critical step in healing.

In the video below, Shelly Harrell, PhD, will get into why it’s important to take a patient’s experiences of discrimination into account when we’re working with depression.

She’ll also share her approach for helping patients identify and examine any painful stereotypes they may have internalized.

 

 

Click here for full transcript
Dr. Harrell: Obviously one of the things that that’s very important to me is that our clinical treatment be appropriate for diverse cultural groups. That we think very carefully about what we’re doing and is it really universal and might some ways of working be a better fit for some clients than others or even are there issues that we need to consider in working with clients of diverse backgrounds. I also think about not just cultural diversity, but also clients who are members of historically oppressed or stigmatized groups, so that it may not be ethnically or racial diversity, but people who might be looked down upon in society in some way or might be excluded from different aspects of society in some way where there’s perhaps a lot of stereotypes or prejudice, so people in the LGBTQ community, people with physical disabilities. That the notion of exclusion and stigmatization I think it’s important to to look at, with depression I think that allowing people the space to talk about those kinds of experiences is very important. Dr. Buczynski: Is there a way that your language can invite them to explore that? Dr. Harrell: To often talk about or very much speak their experiences in the world and how the world treats you, how do you think the world sees you, those kinds of questions. That people begin to be sensitized. Then later on we may talk about that issue of the inner critic, but people begin to be sensitized to what they’ve internalized in terms of messages from larger society about their value and their worth and i think sometimes depression for members of historically oppressed and marginalized groups has some relationship to those issues of internalizing those negative stereotypes or those expectations, what you’re not really capable of and those sorts of things. I think that that’s important and I think it’s also important to be very direct. I’ll ask people specifically have you had experiences with discrimination or racism or heterosexism or homophobia or whatever the relevant issue is? It’s very direct and my experience is that people find relief when you put those things in very directly what you’re saying. I’m open to talking about this I’m not afraid of it and you can share those types of experiences here. I think that that those issues feel very important to me for therapists to consider in an addition to the typical things people might think about in terms of depression, but integrating that we live in a world and what’s happening in the world affects people and that’s an important important issue to bring into there. It’s not just internal but that interaction between the external world we live in and then what we do with that internally and how our internal experience then sometimes impacts how what our experiences are in the external world. Our ability to cope with racism, I think people who are depressed and have low self-esteem have impaired ability to manage the discrimination and racism they might experience and that might have a tendency for self blame. The issue with self blame in terms of historically oppressed and marginalized groups is internalizing negative messages from society about one’s value and worth. Messages that you may not be smart enough or that that there’s something you know wrong with you. I think when people are depressed they’re more vulnerable to those internalized messages from how larger society is seeing us. Of course, we know that people are vulnerable to criticism from parents or valued adults in their lives as children and we take in what others think of us in terms of beginning to form sense of self and identity and who I am in the world. When we’re working with people who are again members of historically oppressed or marginalized groups I think it gets wider, the things we need to consider about what people are internalizing. It’s beyond sort of parents and school. It also becomes society. How do you talk about that or elicit that kind of exploration with a client? As I mentioned, I think that it’s important to be very direct to ask and use, once we give permission for that topic to be in the room, then we use our therapeutic skills to explore and help people find their voice. I guess the reason I asked it again is because I see this as different than asking, “Are you experiencing discrimination?” in that sometimes we internalize judgements from the world and we don’t even know that we’ve done that. The idea that when someone is feeling some sense of self degradation or devaluing themselves, it’s important to ask where does that come from for you? Where do you think that started? To look for the source sometimes I’ll even ask clients whose voice is that? Whose voice do you hear there to help them identify whether it is a close friend or family members voice or that they’re hearing a teachers voice. Or is it a voice that that is from the media or from politicians or from wherever that you have you gotten those messages from. Where it’s that voice that is that your voice or is that coming from somewhere else. I think that just digging and helping people begin to differentiate and discern where some of that negative self esteem or self blame may come from. I feel like those kinds of issues of understanding of how the world impacts the person, what does it mean to be an african-american in the world, what does it mean to be a woman in the world, gay man in the world, that those those issues are not only identity. Identity is important to explore as well but it’s not only identity. It increases exposure to particular kinds of stress and as therapists we need to be aware of stress exposure. Those have areas where people are experiencing stress and related to that is then what can we do to facilitate adaptive coping.

 
This is one of several videos we’ve shared recently as we continue to talk about antiracism in clinical practice.

What are your biggest takeaways from the video? Please let us know by leaving a comment below.

If you found this helpful, here are a few more resources you might be interested in:

Working with the Trauma of Racism

Moving from Cultural Competence to Antiracism

Working with Depression

 

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Related Posts: Antiracism, Depression, Shame

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24 Comments

  1. Lisa T., Nursing, Tampa, FL, USA says

    I love this so much! Thank you for sharing and raising awareness regarding the impacts of stereotypical behavior. After years of being in healthcare I have seen so many individuals impacted by this unjust and insensitive behavior. Your video needs to be incorporated within the annual education competencies for healthcare providers around the world. Thank you again!!

    Reply
  2. GHALIA AL ASHA, Psychotherapy, JO says

    WHERE DID THAT VOICE COME FROM: THE VOICE OF MOTHER ….

    IT IS A GREAT IDEA

    Reply
  3. Ananda Bode, Counseling, Albuquerque, NM, USA says

    Camille: You are right. Those who try and refute your statement make your point clear. It is not up to the client to be “the teacher,” or “the guide” to help white people be better people, or to strive to act in anti-racist ways. It is not up to Black people to teach white people how not to be racist or embrace racist communication. That responsibility lies with white people. And those who utilize therapy as an unending cycle of “teachable moments” are not good therapists. What is our responsibility is to utilize the constructs that we have to acknowledge and support our clients. And, from what I have observed, many white women–especially highly educated white women–have limited capacity for understanding their own racist views, resisting internalizing systemic racism, and defending anti-racist positions.

    Reply
  4. Debora Sloane, Other, Willow Grove, PA, USA says

    Such a welcoming way of expressing herself; Dr. Harrell allowed me to ease into her reasoning which I found very helpful.

    Reply
  5. Catherine F, Another Field, USA says

    I am a white woman and a psychotherapy CLIENT. I can understand why a black woman would prefer a black therapist. I can’t deny the many advantages to a therapeutic relationship with someone who can really and truly relate to your unique situation. It makes sense to choose a therapist who is the best fit for you.

    However, I believe that many many white women (especially psychotherapists) are open to LEARNING and combatting generations of bias in personal relationships. If white women don’t work with black women clients or build strong relationships with black men and women, they don’t have that chance to extinguish racism in their own lives.

    I know it’s not the responsibility of clients to educate their therapists. Clients needs are paramount. But learning and growing does occur on BOTH ends of a therapeutic relationship. I pray that therapists of all sorts work hard for many years of their life to recognize, honor, and be sensitive to the needs of black clients.

    Reply
    • F Sutherland, Counseling, Anchorage, AK, USA says

      It is entirely untrue that white people need to have clients of other races in order to confront their racism. They need to do their own work outside of session time, like every other white person who is not a clinician. It is not their time- at all. Much like, as a cis-gender, heterosexual therapist it would be abhorrent for me to use client sessions as a learning ground. All clients deserve better than that.

      Reply
  6. Anna Banning, AU says

    So illuminating how sensitive this topic is and how inadvertently we can offend. I am Jewish, born in Hungary and my parents came to Australia to escape Hitler. My uncle was killed in Auschwitz and the other uncle was put in a concentration camp and became a very disturbed, dysfunctional man. I grew up with a huge sense of shame and even believed i don’t deserve to be alive. It took me many years of therapy to overcome this and i am a psychiatrist.
    When the Black Lives Matter came out i started to repeat to myself “Jewish Lives matter”. As a child it would have made a huge difference if even a couple of people had said this to me.
    I am white and I do belong to a privileged group, but I can identify with the pain and the sense of shame.
    I hope this share adds to the conversation. I have never shared before but I felt called to do so.

    Reply
    • Sue Levy, Counseling, Agoura, CA, USA says

      Anna, I, personally, sincerely appreciate you sharing your story. You aren’t alone. Thank you for becoming a psychiatrist- a healer. I’d like to share this with you-
      My father, US Army Air Corps during WW2- (now Air Force) was one of the liberators of Dachau. He spoke to me twice when I was young, of the horrors he witnessed, yet relief he experienced in helping the Dauchau survivors. He also described a time he was on a break during the war in England, there was a bombing raid. The building next to him, full of people was completely destroyed, no survivors. His building remained standing.
      I witnessed him struggle with PTSD, survivor guilt, and shame his whole life. I became a substance abuse counselor later in my life to help others. While I have my own white privilege shame, I’ve attempted to discuss it publicly on social medi; I find some understand, some don’t. Anna, please- We do matter. Even though we don’t feel it. These are dificult times, but we’ll get through. Thanks for listening. 😉

      Reply
  7. Lindsay Smith, Psychotherapy, GB says

    Internalized discrimination

    Reply
  8. Lynetta Hagler, Psychotherapy, Fairfield, ID, USA says

    I hope my children don’t agree with you. There is a space where different experiences than yours cause one to regroup their beliefs and treatment of others. Lynetta Hagler, LCSW

    Reply
  9. Patricia Zaretzky, Counseling, Wheeling, IL, USA says

    I totally agree with Cleo. It is very disconcerting to watch that happening. I also agree that sometimes tend to attempt verbal domination. But it is interesting to see WHO we choose to dominate, and who we give space to.

    Reply
  10. Victoria Christensen, Counseling, Ashland, OR, USA says

    racism in language can be very subversive, as you point out Cleo. Our culture, being extravert oriented, and “talking” oriented, reinforces verbal domination, which can be very unconscious. This is why we need other people to help us see our blind spots and ignorance. Takes humility and a willingness to be open to constructive reflections

    Reply
  11. T D, Counseling, USA says

    I have to say I disagree as a white therapist. I’m not here to start a chain of negativity but rather highlight the positive work I have done with the African Americans I work with grappling with an array of issues. As the presenter said , it’s a whole big world out there. We have established a positive trusting relationship where growth and development has occurred. I hope this can be helpful to all.

    Reply
  12. Shelley Davis, GB says

    Great conversation thanks! One thing I would say is that if therapists ask the question about a clients experience of being in a marginalised group that they really listen to the answers and leave their own biases at the door as much as they can. If they aren’t getting something to ask the client again, much as happened here in the discussion. My experience as a LGBTQI client is that this sadly doesn’t happen. Ideally therapist should learn from the client as well as visa versa.

    Reply
  13. Renee Willis, CA says

    Thank you so much for talking on this specific topic! This is the first time I am hearing any ‘mental health professional’ talk directly about the inner pain, the dialectical internal battle that comes from the programming from society at large (as well as our family or origins) because of being in the margins and I am feeling a massive release just by this one video because I feel heard and I feel seen. With hearing more and more what it is like for our black family I am hearing that for many their minds are in the fight flight mode, the brain is hijacted into the ‘danger danger’ mode based on generational traumas and also the reality that ‘they are not safe’ now. Having C-ptsd my heart feels so sad to hear that anyone with a dark skin color can experience the pains of ‘having trauma’ daily – and my mind is also angry about it because it is unjust. What I did not expect to feel what my pushed down anger, grief and sorrow because of being a gay woman. As we engage empathy and compassion, we recruit our understanding of pain to get as close to the individual as possible, and with that during this time all the pain that I was holding / denying came full frontal. I could see the pain I had experienced in the past because I was gay, and I could see vividly the pain that light up in my brain daily because of the fear programming of going into the public, wanting to be safe / accepted, and my brain constantly ‘on’ as I adapt or have to distress and emotionally regulate (which is exhausting) simply because I am gay. And it is not right, and it angers me and also makes me sad; and I have dedicated my life to help others in pain and what has happened now, is that I am finally giving myself compassion for my own pain. There is loneliness in this truth and yet there is much work that needs to be done to heal, and educate the world at large in hope to move the needle so that others will not suffer as we are now. I no longer use the word discrimination as I find it not as effective as using the word dehumanization. When another person does something or says something that makes another person feel less / a misfit, they are ultimately saying that person is substandard human and when we believe those things we do horrible things or we tolerate horrible things, and can suffering horribly daily. Thank you.

    Reply
  14. Dorothy Mehl, Exercise Physiology, Spokane, WA, USA says

    This approach could apply to any characteristic that might set a person apart from others. As I lisened, I became aware of something in my physical appearance that was never brought up in counseling, not by me or by a counselor, but has always been a sensitive issue. Of course, this has to be handled with kindness and compassion.
    Thank you for this helpful video.

    Reply
  15. Daniel Kolos, Coach, CA says

    When Shelly Harrell asked ‘what is the source’ of my self-negation? My parents? My teachers? The media? I went there.
    I, like everyone else, was born with the joy of life, but, like everyone else, was subjected to stress where my needs were not met. Stress put me, as an infant, into survival mode. This survival state pulled me away from this joy of life, separated me from my authenticity, my emotional self.
    This separation was traumatic. It is this trauma that I carry throughout my life: separation from my authentic self. Everything that has happened to me where I was emotionally hurt reactivated the pain of this separation. That separation was the source of the trauma that I eventually interpreted as not being good enough, not being worth it.
    It is true that my father supplied the necessary words from which I had built my negative self-image. Approaching my own healing, I now see that my father, also, lacked self-worth and unconsciously projected it onto me. That was the source for the language of my trauma.
    What did that child I was, need? Like every other child in the world, I needed to be held with love and compassion. What is available to me now? Relational holding either by a therapist or from myself. A therapist who had not experienced their own relational holding, not faced their own pain as a child, cannot authentically take me there. As a therapist, I have to work on my own healing and begin to resolve my childhood trauma.

    Reply
  16. F Sutherland, Counseling, Anchorage, AK, USA says

    I think it’s also important for clinicians who are not from marginalized communities to be aware that these may be topics a person from a marginalized group may not wish to speak about with a person who has a privilege they do not. As a clinician from a racial minority group, I’ve seldom had to dig to get a client to talk to me about feeling discriminated against the way she describes. It’s a vitally important topic- but we still need to follow our clients lead. Even if that means we aren’t the place they receive that support. Even if it means all we do is facilitate getting that support where they feel comfortable (and not bringing an additional power dynamic into the room that might limit freedom of sharing).
    Also important not to presume race or other marginalization must play a part in people being critical of themselves or depressed.

    Reply
    • Karen Abbo, Another Field, Lewiston, NY, USA says

      Although I do not have a degree in counseling, I think that your last statement is a very important one to take into consideration. I’m currently speaking with a family member who is going through the painful realization of what/who has contributed to their feeling of self-loathing and worthlessness. It is heartbreaking to me to hear of their pain, and of the trauma that has caused much of this pain. They are in therapy currently, however I don’t know if this is being addressed as well as it could be, even though this therapist is a very well respected one. Or maybe it is being addressed well and that is why these thoughts, memories, feelings are now surfacing. And no, we are not a minority race. But we are women, so in that regard, I guess we could say that we are not seen as powerful as some others are in our society. I have/am working on my own issues also, and for the most part feel great about myself. But it’s taken a while to get to this point. I feel strong and confident, know what i want out of life and have been able to assert myself when needed, yet in a humble and kind manner. I have hope for those that still have a long way to go that they, too will find their authentic voice/self.

      Reply
  17. Swati Desai, Psychotherapy, Los Angeles, CA, USA says

    Someone who is already depressed, their brains are more susceptible to negativity bias. What they remember from the upbringing is the times when they heard the judgment. So internalizing the negative messages becomes their identity even when there may have been plenty of good caregiving or good experiences in the environment. So depression and internalization of negative messages may be chicken and egg. Would it be important to tease it out? Otherwise the client may get into the endless loop of being a victim and having no power to change anything.

    Reply
    • Eva, Other, So Cali, CA, USA says

      People who are born in marginalized and oppressed groups are victims in a society. It is not just internalized ideas, but it is the truth. Marginalized and oppressed group of people are quite possibly going to be victimized for the rest of their lives at different degrees so long a society at large does not change, which one has little control over. After healing from PTSD which often includes depression, one might go on to participate in activism, but this has to be a choice and desire that has to come from the one who has resolved PTSD symptoms and has built resilience to face such traumatizing circumstances without developing PTSD again only to repeat therapy. I think it is detrimental to even imply that one could do something to stand against oppression and marginalization in the early stages of trauma therapy. One can possibly invite a “suicide by the police” situation. Participation in activism often invites harsher criticism and violence from the community that they live in. If one is not well equipped to handle and manage added stresses that inevitably come from participating in such activities, one cannot start to heal. Just my honest opinion.

      Reply
  18. lisa maddox, Other, Miami, FL, USA says

    This would be as applicable to sexism as it is to racism. I hope you apply this kind of thinking to women’s issues. It would resonate with a large population: 51% of humanity is born female…

    Reply
    • F Sutherland, Counseling, Anchorage , AK, USA says

      She clearly mentioned women as an example, so yes.

      Reply
    • Cheryl Confirm, Coach, DC, WA, USA says

      But it’s interesting how when racism is discussed, a white woman’s first instinct is often to center the spotlight on her oppression. This confirms what one of the earlier posters said about white women making issues all about them. In the wake of the Black Lives Matter protests, I’ve gotten all kind of calls from white friends and even acquaintance who want to talk about their pain at discovering that racism against African Americans exists and is for real. Coming from some who have for years denied that racism exists, this is rich indeed.

      Reply

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