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
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.
WHERE DID THAT VOICE COME FROM: THE VOICE OF MOTHER ….
IT IS A GREAT IDEA
Such a welcoming way of expressing herself; Dr. Harrell allowed me to ease into her reasoning which I found very helpful.
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.
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. 😉
Internalized discrimination
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.
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
As a black woman who has had a lot of experience with therapy, I would simply say, avoid white therapists at all costs. They do more damage than good and it’s not worth it. So, seek out black therapists. They exist and it’s worth the search. There’s also the option of peer counselors where money is tight, but stay the heck away from white women and men. White women especially. They’re so used to being the center of all things that if you talk about your traumatic experiences of racism they seem to think it’s about them and then they project all their insecurities and garbage onto you and that can really complicate the emotional distress you are already suffering. They can’t relate and don’t really want to. Stay away. Better no help than ‘help’ from a white counselor.
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.
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
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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…
She clearly mentioned women as an example, so yes.
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.