Let’s be honest, talking about Black mental health myths in the community hasn’t always been easy. For generations, we’ve been taught to be strong, keep pushing, pray harder, and keep our business in the family. Vulnerability was often seen as weakness, and therapy? That was for “other people.”

But here’s the truth: strength is not the absence of struggle. Addressing mental health myths directly helps us break stigma and find the support we deserve.

I can’t tell you how many times I’ve heard a friend or client whisper, “I thought I was the only one going through this.” And yet, studies show that Black adults are 20% more likely than white adults to report serious psychological distress, yet we’re half as likely to receive the care we need.

Why? Because myths, stigma, and systemic barriers keep too many of us from seeking help. It’s time to change that. Let’s unpack five common Black mental health myths and replace them with truth, healing, and hope.

Myth 1: “Therapy Is for White People”

I grew up hearing this one on repeat. Therapy was often painted as a “luxury” for other folks. In many Black families, the idea of talking to a stranger about private struggles was almost unthinkable.

But here’s the reality: therapy is for everyone.

Therapists who specialize in working with Black clients understand that mental health challenges don’t mean we’re “weak”,  they mean we’re human. Whether it’s managing stress, unpacking generational trauma, or navigating everyday pressures, therapy can provide tools that our families and communities were never given.

The shift is happening, too: more Black therapists are entering the field, and more Black clients are prioritizing wellness. According to the Association of Black Psychologists, while only 4% of psychologists are currently Black, initiatives are underway to expand the workforce.

Seeking help isn’t abandoning our culture, it’s expanding our strength.

Myth 2: “If I Have Faith, I Don’t Need Therapy”

Faith and spirituality have always been the heartbeat of our communities, and prayer can be powerful. But prayer and therapy are not competitors; they’re partners.

Imagine this: you pray for healing from a broken leg, but you still see a doctor to set the bone. Mental health is no different.

A culturally competent therapist will respect your faith and, if you choose, integrate it into your healing journey. Research on culturally competent therapy shows that therapy doesn’t take you away from God; it can bring you closer; helping you process pain, strengthen resilience, and find peace without shame.

Take Action: Looking for faith-integrated therapy? Browse our directory of culturally aware providers who can honor your beliefs while supporting your mental wellness.

Myth 3: “I Don’t Have Time for Therapy”

Between work, caregiving, church, and community responsibilities, many Black families are doing everything for everyone else. We push ourselves until we’re running on fumes and convince ourselves we don’t have time to pause.

But here’s the thing: burnout doesn’t ask for permission. Neither does anxiety, depression, or grief.

Therapy isn’t “one more thing on your list”,  it’s a space to refill your cup so you can keep showing up for the people you love. And with virtual sessions and flexible scheduling, accessing therapy has never been easier.

Your healing is not a luxury. It’s a priority.

Myth 4: “I Can’t Afford Therapy”

Money can be a real barrier but it doesn’t have to be a dealbreaker.

There are more affordable options today than ever before:

• Sliding-scale therapy based on income
• Community clinics that offer free or low-cost sessions
• Employer assistance programs (EAPs) that include counseling benefits
• Virtual therapy platforms with reduced rates
• Referral networks (like ours!) that connect you with identity-affirming, cost-conscious providers

You deserve care that fits your life and your budget. Healing should not be reserved for the wealthy, and thankfully, it doesn’t have to be.

For help understanding stigma across different communities, read: 11 Organizations That Challenge Mental Health Stigma.

Myth 5: “Therapists Don’t Understand Black People”

This one is personal and for many, it’s true if you don’t find the right therapist.

Mental health care hasn’t always served Black communities well. Historically, many providers lacked cultural awareness, leaving clients feeling unseen or judged. But things are changing.

More Black therapists and culturally competent providers are practicing than ever before. Even if your therapist doesn’t share your identity, what matters most is cultural humility, a provider’s ability to listen, affirm, and adapt to your lived experiences.

Research shows that broaching,  when therapists acknowledge racial and cultural differences, strengthens the therapeutic relationship.

You deserve a therapist who doesn’t just hear your words but understands your world.

Take Action: Finding the right therapist matters. Our network includes providers trained in multicultural competence who understand the unique experiences of Black communities. You can also find support through GoodTherapy’s BIPOC therapist directory.

Shifting the Narrative on Black Mental Health Myths

Here’s what’s real:

• Your pain is valid.
• Your healing matters.
• Therapy is not weakness; it’s power.

According to Mental Health America, 19.7% of Black and African American adults experience a mental health condition each year, yet only one in three receives treatment. When we release stigma and embrace culturally responsive care, we create room for joy, resilience, and thriving.

You don’t have to carry everything alone.

Take Action: Your Path to Healing

It’s time to shift the narrative:

1. Reflect on what you’ve been taught about mental health
2. Realign your beliefs with your needs and your worth
3. Rise into healing for yourself, your family, and generations to come

Understanding the intersection of mental health challenges is crucial. Learn about related issues that affect our community: The Last Taboo: Breaking Down the Stigma of Depression.

FAQ: Black Mental Health Myths

What are the biggest barriers to Black mental health care?

The primary barriers include stigma within the community, lack of culturally competent providers (only 4% of psychologists are Black), financial constraints, and historical mistrust of healthcare systems due to past medical discrimination.

How do I find a therapist who understands Black experiences?

Look for therapists who explicitly mention cultural competence, have experience with racial trauma, or are Black themselves. Use specialized directories, ask about their training in multicultural issues, and don’t hesitate to interview potential providers.

Can therapy work alongside my faith?

Absolutely. Many therapists integrate spirituality into treatment when clients request it. Faith-based therapy can strengthen your spiritual connection while providing professional mental health support.

What’s the difference between feeling sad and clinical depression?

While everyone experiences sadness, clinical depression involves persistent symptoms lasting weeks or months that interfere with daily functioning. These may include sleep changes, loss of interest in activities, feelings of hopelessness, and physical symptoms.

How much does therapy typically cost?

Therapy costs vary widely, from $50-200+ per session. Many options exist for reduced costs: sliding-scale fees, community mental health centers, employee assistance programs, and some insurance plans cover mental health services.

Is virtual therapy as effective as in-person sessions?

Research shows virtual therapy is equally effective for many mental health conditions. It also increases access for those in areas with limited providers or those facing transportation barriers.

Finding the right therapist doesn’t have to be overwhelming. Our referral network connects you with culturally responsive, identity-affirming providers who understand the unique challenges and strengths of Black communities.

It’s human nature to want to feel validated in your feelings and experiences, and therapy is a great avenue for feeling understood. Yet, our unique perspectives, cultures, and outlooks often impact our emotions and struggles, which means therapy must also be personal. Culturally competent therapists better understand the qualities and identifiers that make you unique, such as race, gender, sexual orientation, religion, and more. Below, we dive into the importance of culturally competent counseling and how you can take advantage of it.

Read More: Not Sure How to Get Started on Your Therapy Journey?

Cultural Competence Explained

You might feel like other people don’t understand your values, beliefs, or experiences. This is where cultural considerations come in. Cultural competence is a set of knowledge, skills, and attitudes that someone, like a mental health provider, can apply to effectively respond to and work with people with diverse backgrounds.
When used appropriately, cultural competence has a place in nearly every industry, from healthcare to education to business to social work. In therapy, a culturally competent therapist can be key in helping you feel safe and supported, especially when sharing vulnerable feelings or emotions. For some people, culturally competent care might mean understanding experiences through a lens of race or sexuality. For others, it might mean considering regional background or spoken language during care. Regardless of your unique identifiers, these elements can impact your communication approaches, attachment styles, triggers, and emotional responses.

Read More: The Relationship Between Culture and Communication Is Closer Than You Think

Why Culturally Sensitive Therapy Matters

Your therapist’s main goal is to help you feel validated, understood, and equipped to manage your emotions with the right tools. Culturally competent therapy means providing an added level of consideration and context to your sessions. Every person’s experiences are different, but below are some examples of what culturally sensitive care might look like:

• When your therapist seeks to understand terms and words you use from your culture that are not considered Standard English
• Helping you unpack microaggressions you’ve experienced because of your race or sexuality
• Validating your perspective on a topic through the lens of your gender expression
• Discussing what a mental health condition means to you, depending on your religion or culture

How Intersectionality Meets Therapy

People’s emotional or difficult experiences can be layered and involve more than one element of identity – this is called “intersectionality.” Understanding intersectionality is important for both you and your therapist because acknowledging people’s unique identifiers and experiences promotes improved policies, health approaches, self-care practices, and resources. There are many examples of intersectionality and how that relates to mental health, but the following are just a few examples:

• You might be feeling like your coworkers are treating you unfairly because of your race. You might also be afraid to speak up to your manager because you’re a woman and assume it’s better if you stay quiet. Your identities as a black person and a woman blend together to create this unique experience.
• You are a trans woman in college who is also Muslim and wears a hijab to cover your hair because of your religious beliefs. You might feel uncomfortable at school because some classmates tease you for wearing a hijab and also misgender you often. Your identities as a trans woman and a Muslim person impact your personal challenges in this setting.

Finding a culturally competent therapist who understands you on multiple levels is crucial to helping you address your layered mental health needs and feel safe during your sessions. The right therapist will talk you through different self-reflection practices to address your unique identities and backgrounds. When choosing a therapist, be sure you ask them their areas of expertise, test out how you feel when you unpack certain topics with them, and ask meaningful questions during the initial intake sessions to be sure you can build an effective relationship. 

Read More: Not Sure How to Find the Right Therapist? Start Here With Three Steps.

GoodTherapy Makes Finding Your Ideal Therapist Easy 

Finding a therapist you trust can be difficult, but GoodTherapy makes it easier. Our search filters help you find professionals who understand your background and apply culturally competent care to your conversations. Simply filter your search with information like:

• Location 
• Treatment type
• Telehealth or treatment center
• Therapist speciality

Plus, you can use our Therapy for BIPOC Individuals page to find a therapist who understands your different layers and experiences. We’re committed to providing inclusive resources for BIPOC individuals to get the help they deserve.

Getting the help you deserve doesn’t have to be complicated. Our licensed, highly-rated professionals are prepared to offer you personalized, culturally-informed care so you can be the best version of yourself.

Read More: Not Sure Which Type of Therapist Is Best for You? Explore Your Options 

Clinical supervision can offer a myriad of benefits, including professional growth in the realms of clinical skills, listening skills, ongoing verbal feedback, and keeping track of agreed upon goals between you and your supervisor. It also assists with ensuring client welfare, serving a gatekeeping function in the provision of clinical services to the larger community and the public (Bernard & Goodyear, 2009).

From a diversity perspective, the American Psychological Association states that competencies in supervision include working with different worldviews and backgrounds of the supervisee, supervisor, and clients on an ongoing basis. While I discuss the potential benefits of clinical supervision, I would be doing this article a disservice if I did not acknowledge the inherent power differential and hierarchical nature of supervision, wherein supervisors may have more room to acknowledge the nature of such a relationship when delivering feedback (APA, 2014).

So what does all of this mean when selecting your supervisor and making the most out of supervision?

Benefits of Clinical Supervision: Acknowledging Diverse Identities

I had the fortune to interact with supervisors who were sensitive to the power differential in the supervisory relationship and who also had the expertise to delve into different aspects of intersecting identities, values, and the collectivistic worldview that I carry as a woman, woman of color, and woman from a collectivist culture. I am fortunate that the first few supervision sessions with some of my supervisors focused on the sociocultural identity wheel exercise that highlighted my cultural preferences, values, and the ways they intersect with my communication style, theoretical orientation, and approaches as a clinician.

I also carry shifting identities that come from the ongoing process of acculturation⁠—adapting values and preferences from multiple cultures depending on the context in which I interact. I am fortunate that the first few supervision sessions with some of my supervisors focused on the sociocultural identity wheel exercise that highlighted my cultural preferences, values, and the ways they intersect with my communication style, theoretical orientation, and approaches as a clinician.

I was able to integrate my cultural self into my clinical approaches when working with clients. More importantly, I was culturally aware and informed as a clinician. This also increased my self-awareness of what kinds of professional resources and support I was looking for, be it conferences, workshops, training opportunities, or ongoing mentorship.

Addressing the Challenges of Clinical Supervision

I can also reflect on some challenging aspects of clinical supervision. I had a few supervisors who identified as feminists and emphasized a concrete and specific structure for supervision. I have learned a great deal from the measurable and tangible aspects of supervision, but it came at the expense of my cultural self and the part of my identity that preferred an added layer of process to supervision.

I picked a supervisor whose style was concrete and specific without any cultural context. This was a very challenging experience for me because culture is critical to my identity, and my supervisor was unintentionally unaware of the cultural differences inherent in our supervision sessions. It was also one of my most valuable learning experiences in supervision. Looking back, it was a mismatch between supervisor and supervisee, and the challenge came from not openly acknowledging and learning from our differences.

For Supervisees: Tips for Successful Clinical Supervision

Now that I have reflected on the positive and challenging experiences of supervision, here is what works for me. In sharing what works, my hope is that you are able to try some of these ideas based on your own work style and values.

• Set up an informational meeting with your supervisor to talk about your work style, values, cultural needs, and multiple identities, if applicable. Ask your supervisor what their experiences are with intersecting identities, what their work style is, and what values inform their role as a supervisor.
• If your supervisor does not engage in ongoing feedback, and if this is one of your preferences, respectfully state that where possible, you’d prefer ongoing feedback that includes examples from your work so you can more clearly understand and apply the feedback.
• At the onset of supervision, discuss with your supervisor how you would typically approach any ruptures in the relationship. My hope is that your supervisor would also be able to initiate this discussion on an ongoing basis.
• If you are seeking a certain supervisory style, look for components of that style in your supervisor. For example, if your style in supervision is exploratory and concrete, clarify this with your supervisor. You might want to delve into your identities and how they interact with that of your client’s, then balance this with concrete references for clinical strategies.
• If the structure of supervision is important to you, let your supervisor know so they can address your preferences early on.
• Talking about strengths is as important as talking about vulnerabilities. If you have trouble acknowledging either as a supervisee, let your supervisor know at the outset so they can be mindful of this—it can be a critical part of the ongoing feedback and evaluation you receive.
• Before you start supervision, ask your training director, coordinator, or the person in charge (if applicable) what policies exist should you need to switch supervisors. This can be a good option if efforts to recover from a ruptured relationship have proven unsuccessful.
• The process of becoming aware of your personal, professional, and cultural self is ongoing. My recommendation is to visit and revisit the sociocultural wheel of identity consistently as you transition into different roles and/or experience personal and professional transitions in your life. This may give you increased clarity about which sets of preferences are malleable and contingent on the changing landscape around you, and which values are core, unchangeable, and inform your personal and professional working style.

The above is a bird’s eye view of what to look for in supervision and of how important it can be to reflect on what each experience has taught you. It has certainly taught me, in terms of increased awareness, about my own preferences for supervision, as well as increased my knowledge of my own style as a supervisor. It’s taught me about my blind spots and the skillset of balancing exploration and process with strategies and concrete resources as a supervisor. Improving skills in the field of supervision while building awareness and knowledge is certainly a lifelong process for me.

To find a qualified clinical supervision in your area or online, start here.

References:

1. American Psychological Association (2014). APA guidelines for clinical supervision in health service psychology. Retrieved from https://www.apa.org/about/policy/guidelines-supervision.pdf
2. Bernard, J. M., & Goodyear, R. K. (2009). Fundamentals of clinical supervision (4th ed.). Upper Saddle River, NJ: Pearson Education.

English tends to provide a robust variety of descriptions for mental health issues, whether they’re represented in the DSM or not. For the most part, we can talk about trauma, adverse childhood experiences, anxiety, and depression and trust that other people understand the feelings and sensations we describe.

But sometimes clinical terminology may not fully convey our emotions. Or perhaps we are experiencing so much at once that we have to use multiple concepts to describe our emotions.

Other cultural traditions may describe mental health issues through a spiritual lens that honors centuries of traditions and customs. Some terms have fallen out of use, but others live on in different languages and healing practices. Learn more about how people around the world conceptualize mental health issues we may have never felt or perceived.

Multicultural Concepts of Mental Health Issues

1. Maladi Moun

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A Haitian concept that means “humanly caused illness,” maladi moun is a label that may be applied if it’s suspected someone has been harmed through another’s ill will. Also called “sent sickness,” it explains many medical and mental health issues in Haiti. It is believed feeling envy and malice toward another can cause harm in the form of depression, academic or social failure, psychosis, or an inability to perform daily life activities.

Because personal gain is assumed to be linked to another person’s loss in some way, economic success, high social status, intelligence, attractiveness, and good health are all seen as factors that can make someone vulnerable to attack. In other cultures, a similar concept has been called the “evil eye:” mal de ojo in Spanish and ma’occhiu in Italian.

2. Khyâl Cap

Khyâl cap, a Cambodian term that means “wind attacks,” centers on the idea that khyâl, or wind, rises in the body with blood. It can cause symptoms such as panic attacks and psychosis, as well as a range of somatic experiences. Physical health issues that may occur include tinnitus, dizziness, difficulty breathing, palpitations, and cold hands and feet.

The experience of khyâl cap may closely resemble a panic attack. Khyâl attacks might have a trigger like being in crowded spaces or some other stressful situation. But they may also happen without warning.

3. Kufungisisa

Learning about other cultures can help us increase our knowledge around mental health concepts and expand the vocabulary we use to describe mental health issues. This can help us increase our acceptance of others and broaden our worldview.

Many of us can likely relate to the experience of “thinking too much.” This concept is described in various ways across many different cultures, countries, and ethnic groups. The Shona people of Zimbabwe call this kufungisisa. It is seen as a cause of many concerns, including physical distress. For example, a person might say, “My heart is hurting because I think too much.”

Related mental health concerns include anxiety, panic, irritability, and depression. Ruminating on thoughts related to upsetting social situations, marital woes, or financial difficulties may lead to excessive worry. If a person cannot perform typical tasks due to this state of worry, they might also refer to kufungisisa as “brain fog.”

4. Taijin Kyofusho

Taijin kyofusho, which means “interpersonal fear disorder” in Japanese, is a form of social anxiety related to feelings of inadequacy or low self-esteem. Someone with taijin kyofusho might avoid interpersonal situations because they believe their appearance or actions are offensive or intolerable to others. They might be concerned about their level of body odor, level of eye contact, bodily movements, facial expressions, or blushing. Because these are physical concerns, taijin kyofusho sometimes encompasses aspects of body dysmorphia.

5. Nervios, Attaque de Nervios:

People of Latin descent, in both Latin America and the United States, may use nervios to describe general distress. Generally, it is a response to stressful life experiences or circumstances that make one vulnerable. Symptoms of nervios include both emotional and somatic distress, such as irritability, nervousness, difficulty sleeping, head and neck pain, dizziness, and stomach problems.

Attaque de nervios is a more acute form of nervios. This term describes a “fit” or episode of intense emotional upset. Anger, grief, anxiety, dissociation, and even suicidal ideation may be elements of this experience. A person might also experience physical symptoms such as fainting or seizure-like spasms. Variations on these experiences are echoed in Greek, Sicilian, Appalachian, Haitian, and other cultures.

How Do These Concepts Impact Mental Health Care?

Learning about other cultures can help us increase our knowledge around mental health concepts and expand the vocabulary we use to describe mental health issues. This can help us increase our acceptance of others and broaden our worldview. But these concepts and terms are not standalone issues relevant only to certain cultures. Differences in the ways people understand mental health and experience distress can have a huge impact on the way they search for care, as well as the relationship they develop with care providers.

Stigma and lack of access to health care continues to disproportionately affect cultural minorities. In addition, people of color and other members of marginalized populations may be more hesitant to seek help when they are in distress. There are many reasons someone might shy away from pursuing mental health treatment. Among them may be the fear that therapists may not understand (or even try to comprehend) the nature of their concerns through the lens of their culture or heritage.

Therapists can better serve minority communities, especially those for whom English is a secondary language, by studying mental health concepts from other cultures, such as the ones listed above. Racial minorities, particularly older adults, tend to approach health care with different expectations of care providers, treatment preferences, and understanding of causes of mental health concerns. Many psychotherapists may not be aware these differences exist, let alone have an idea how to address these discrepancies during treatment. Accommodating these values is key to providing quality care for all people seeking help.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
2. Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & Alegría, M. (2012). Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry, 20(6), 533-542. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3258470
3. King, W. (2016, January 20). Inequality lingers in mental health treatment for minorities. GoodTherapy.org. Retrieved from https://www.goodtherapy.org/blog/inequality-lingers-in-mental-health-treatment-for-minorities-0120162

Complex posttraumatic stress, known as C-PTSD for short, is the result of prolonged series of traumatic experiences at the hands of someone the victim has a personal relationship with. The most common cause of C-PTSD is child abuse by a parent, stepparent, or other primary caregiver. However, it can result from a range of situations, including abusive relationships, abusive forms of imprisonment, and exploitative prostitution. C-PTSD has similar symptoms to posttraumatic stress (PTSD), but these are entwined with negative self-image, inability to control emotions, and certain personality disturbances.

The Rise of Cultural Competency

One of the most interesting aspects of working in the field of C-PTSD is the interface between cultural competency and complex trauma. Cultural competency has been a major trend within the mental health profession and, indeed, the health care field as a whole. The trend started as response to a number of studies in the 1970s which demonstrated that members of minority and marginalized communities were both less likely to seek out therapy for mental health issues and less likely to have successful treatment outcomes if they did so. While it had been naively thought that psychological research had revealed the nature of the universal human mind, experience demonstrated that many of its conclusions were highly culture contingent. What worked with people raised and acculturated in a Western cultural milieu did not always work with people from different cultural traditions.

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In response to growing awareness of this deficiency, the mental health care industry began promoting cultural competency initiatives designed to educate therapists in the cultures and mores of different minority groups. For example, learning about the differences between honor-shame societies and guilt societies allowed therapists to more effectively help people of Asian origin deal with anxiety and depression. With the expansion of culturally competent mental health services, many people gained access to effective psychotherapy for the first time and we came closer to the goal of a mental health system that serves all Americans.

However, there were two problems with the first wave of cultural competency activism, one logistical and the other more profound. The first is that the sheer diversity of human culture and the internal complexity of each branch of civilization makes it impossible for any one individual to become truly competent in all but a tiny fraction of them. True familiarity with even one culture is the work of years, even a lifetime. In short, training psychologists to achieve cultural competency in all the cultures present in a diverse country like 21st century America, then distributing them everywhere they are needed, is an impossibly complicated—not to mention expensive—task.

In practice, cultural competence training combines elements of both approaches: imparting a basic level of specific knowledge about cultural traditions that a given psychologist is likely to come across in their work so as to avoid likely pitfalls and, at the same time, cultivating a general attitude of flexibility and willingness to explore.

The second problem is that the first-wave approach to cultural competence is based on an artificial model of the world as divided into discrete, self-contained cultural units. This is an oversimplification for two reasons. First, cultural units are, in reality, composed of different subcultures. One may learn, for example, about “Chinese culture,” but there are profound differences between the culture of people from the Dongbei or Huanan regions. Similarly, the rhythms of life in Georgia and Montana are substantially different even for people who share the same ethnicity, religion, or politics. Within these subcultures, too, there are substantially different “sub-subcultures” all the way down to the level of a local town or even family. Decisions about where to draw the line between one “culture” and another are often based on arbitrary or political considerations rather than objective criteria.

Secondly, the static culture model ignores the reality of cross-cultural fertilization and the ability of individuals to cross cultural boundaries. Cultures are not static entities but dynamic, constantly evolving, compound forms, which develop precisely because individuals are able to transcend their cultural origins and incorporate new elements from others or of their own invention. Putting these two considerations together forces us to reimagine our concept of culture as a sort of spectrum, making the task of cultural competence as infinitely complex as the human experience itself.

In response to both practical and philosophical objections to the static model of cultural competence, a new approach known as cultural flexibility was developed. Instead of emphasizing specific forms of knowledge about specific cultures, the emphasis came to be placed more on openness and awareness about questioning assumptions. Instead of being a barrier to communication, with the right attitude and approach, cultural differences can be used as a tool to help the development of an effective therapeutic relationship between therapist and person in therapy. In practice, cultural competence training combines elements of both approaches: imparting a basic level of specific knowledge about cultural traditions that a given psychologist is likely to come across in their work so as to avoid likely pitfalls and, at the same time, cultivating a general attitude of flexibility and willingness to explore.

Cultural Competence and Complex Trauma

One of the most difficult and fascinating areas within the field of culturally competent psychology is the issue of trauma—and complex trauma in particular. While there are many things that are so horrific that virtually anyone would be traumatized by experiencing them, it is clear there is a great deal of cultural variation in what is considered traumatic around the world, as well as how this trauma affects people. To take a superficially extreme example, among the Mursi people of Ethiopia, about a year before marriage, which often takes place as young as 15, a young woman will have an incision of about half an inch made in her lower lip, usually by her own mother (and, of course, without anesthetic). A wooden chip will then be inserted into this incision, which is replaced with successively larger objects until, finally, a clay disk of up 20 centimeters in diameter is inserted in time for the wedding day. It is safe to assume that a typical Western adolescent would find this experience at the very least somewhat traumatic. It is also apparent that, whatever we may think of their views on the relationship between the sexes, the Mursi women are not traumatized by this procedure, or, at least, do not display the typical symptoms of traumatization.

It is of course unlikely that an American psychologist will work with a person sporting a lip plate. If it were to happen, however, it would raise many interesting questions about the nature of childhood trauma. Child abuse exists in every culture and, presumably, the Mursi are no exception, but in dealing with such a case, a therapist would have to be extraordinarily careful not to project their own culturally modulated impression of what constitutes a traumatic experience. Complex trauma represents one of the most delicate and sensitive areas for cultural competence training, and more research is needed to guide best practices regarding the universality and cultural subjectivity of potentially traumatic experiences.

References:

1. Berman S. L. (2016). Identity and trauma. Journal of Traumatic Stress Disorders and Treatment 5:2. doi:10.4172/2324-8947.1000e10
2. McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9(1), 3–10.
3. Tummala-Narra, P. (2014). Cultural identity in the context of trauma and immigration from a psychoanalytic perspective. Psychoanalytic Psychology, 31(3), 396-409. Retrieved from http://dx.doi.org/10.1037/a0036539
4. Wilson J. P. (2007). Cross-Cultural Assessment of Psychological Trauma. New York: Springer.

I was recently talking to a colleague about the topic of therapist self-disclosure and when it’s appropriate to reveal versus withhold certain details regarding personal information. My colleague referenced the term “broaching,” saying, “There is a difference between self-disclosure and broaching.” This piqued my curiosity, as I was unfamiliar with the term.

She explained how broaching is a vital and culturally competent tool and went on to give the following examples: Telling a person in therapy I am from the East Coast and not the South, thus there may be references to Southern culture I am not familiar with; pointing out I was born in the United States, therefore conveying I may not have a full understanding of the experience of someone who immigrated from China; or asking a black individual what it is like to work with me, a white therapist.

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As she listed these examples, I was happy to realize this was a concept I was actually very familiar with and trained in. Despite not previously being aware there was a term for it, broaching is something I’ve found to be incredibly important in my work.

Broaching, as defined by Day-Vines (2007), “is more than consideration or acknowledgement of racial and cultural factors; it refers to the counselor’s explicit efforts to both initiate and respond to the sociocultural and sociopolitical concerns during treatment.”

Broaching involves the therapist mentioning their awareness of race, ethnicity, culture, and other obvious differences as a way to build rapport, invite open communication about diversity, and let people in therapy know that nothing is off the table. By broaching otherwise overlooked or unmentioned subjects, therapists demonstrate there is value in talking about all perspectives and aspects of various experiences and issues.

While I had excellent training in multiculturalism during my graduate program, I didn’t fully appreciate the importance and positive impact of broaching until I utilized the technique with someone during my internship. While working with a young African woman, I listened as she expressed frustration with an experience in trying to buy a car. She described how she felt taken advantage of by the salesman due to being young and female.

If you are a therapist who finds it difficult to use broaching or one who lacks strong training in multicultural issues, consider getting training in this area. If you are an individual in therapy and have found yourself holding back about important aspects of your life due to fear your therapist will be offended or unable to understand, take a chance and go there.

At one point in the conversation, I nodded in agreement and said, “And there may have been some racism going on, too!” Her eyes lit up and she exclaimed, “Thank you for saying that! Yes! I didn’t want to mention that because I was afraid of offending you or that you wouldn’t understand.”

This led to an important conversation about how I may be able to relate to some aspects of her experiences, but I could never truly understand it fully, especially in regard to what it is like to be an immigrant or a woman of color in our society. I invited her to always feel comfortable bringing up issues of race and our differences, and I acknowledged the reality that things like racism and prejudice are a huge part of her existence and worth talking about. It was incredibly powerful and eye-opening to see how broaching strengthened our relationship and allowed this individual to permit herself to go deeper in her work by sharing every aspect of her various experiences.

Mentioning differences and pointing out the “elephant in the room” makes uncomfortable, awkward, or taboo topics less of an issue, barrier, or obstacle in treatment. It is vital that therapists consider how cultural factors play a role in the experiences of people seeking help. While it can feel awkward to do so, it is the job of therapists to open the door for the people we work with to feel safe and comfortable enough to talk about the important aspects of their world. When done in a genuine, appropriate, and respectful way, initiating these conversations can help individuals to feel more comfortable and can lead to some rewarding interactions that further the treatment.

Broaching has the power to help individuals to feel safer, more respected, better understood, and more empowered. People tend to feel more comfortable with people similar to them, believing they will be better able to relate and understand; however, more important than sharing the same traits is the therapist’s attitude toward recognizing and acknowledging similarities and differences in things like age, generation, race, ethnicity, culture, gender, sexual orientation, disabilities, and socioeconomic status.

If you are a therapist who finds it difficult to use broaching or one who lacks strong training in multicultural issues, consider getting training in this area. If you are an individual in therapy and have found yourself holding back about important aspects of your life due to fear your therapist will be offended or unable to understand, take a chance and go there. You deserve a space where you can be authentic and 100% transparent about your experiences. If your therapist does not demonstrate an ability to handle broaching, it may be worth finding a provider who is a better fit.

Reference:

Day-Vines, N.L., et al. (2007). Broaching the subjects of race, ethnicity, and culture during the counseling process. Journal of Counseling & Development, 85, 401-409.