When Myisha Holley, a mother of three living in St. Paul, went through a divorce, she looked for a therapist that could help her and her daughters work through their trauma.
She was clear about what she wanted from a relationship with a mental health professional. “I needed to feel like I could build a relationship with my therapist … like talking to the homegirl, without the judgment,” she said.
For her daughters, Holley wanted a therapist who could be a role model while also supporting her while she parented. She wanted her daughters to have help processing the divorce in a positive way. “I didn’t want my daughters to have a negative image of Black men and negative emotions or a negative perspective of the community, but I also didn’t want my girls to go through the same things that I went through.”
As she would soon find out, this would be a tall order to fill.
Diversified staff for diversified supports
In the mental health industry, people of color are not represented proportionally to the populations of the metro area and therefore are not as accessible as their white counterparts. A study of demographics of the Minnesota mental health workforce revealed that 92 percent of licensed social workers, 88 percent of psychologists, 95 percent of mental health counselors, 92 percent of alcohol and drug counselors and 89 percent of marriage and family therapists identified as white.
With such discrepancies, mental health workers of color carry a significantly higher load. As they try to meet the immense demand for culturally-specific mental health services, they become more susceptible to burnout and compassion fatigue. The lack of racial diversity in the field limits its ability to provide support for people of color, particularly in relation to historical trauma and oppression, and the intersectionality of identities.
Laura Anne Copley Ph.D., professor of Counseling and Education Psychology at Pennsylvania State University, discusses the effects that high levels of work can have on mental health professionals. Copley argues that the tendency to attach personal responsibility to the therapeutic development of clients can be damaging for new therapists.
Often, therapists empathize with clients, and they become overly impacted by the stress of the client. This stress diminishes their effectiveness, while also wearing on their emotional state. The tendency to empathize causes them to be overly impacted by the situations that are presented in sessions; this problem is especially common with larger caseloads.
There have been efforts to increase the number of mental health professional of color, with minimal results. Such efforts include scholarships through the Department of Human Services to cover the financial costs of supervision and the cost of the licensing exam, and “grandfathering in” professionals of color with five years of experience. However, there are those in the community who remain skeptical that this trend will change in the near future.
Sunday Olayinka is the director of operations for Metro Social Services in St. Paul, which provides a variety of culturally-specific mental health services including child therapy, family counseling and respite care. He believes that although there are grants and other resources to address this disparity, the intentions are not matching the outcomes.
A Licensed Independent Clinical Social Worker must complete 360 hours of training in various areas including biopsychosocial assessment, normative development and evaluation methodologies.
A master’s degree in social work license requires completion of an approved graduate social work program, completion of Association of Social Work Board Exam, and 100 hours of supervisions for every 4,000 hours of non-clinical practice and 200 hours of direct supervision for every 4,000 hours of clinical practice.
At a cost of $100 per hour for supervision, Olayinka states that although there are people of color interested in the mental health field, it is inaccessible for them.
Youa Mor, an independent therapist and clinical supervisor for MSSI who has spent three years serving the Frogtown area of St. Paul and Brooklyn Center, agreed with this assessment. “The State [Department of Human Services] has good intentions, but what we have to do to get to the resources is too difficult. In order to access the various resources to get licensed, you have to have knowledge of the system that has continuously kept people of color out.”
Such barriers directly affect the low numbers of mental health professionals of color and limit the availability of culturally-specific services to communities of color in the Twin Cities.
The lack of mental health providers puts a strain on not only the organizations but also the individuals seeking services. Repeated failures to find effective support may sour individuals to mental health services. This is particularly true when services are mandated rather than voluntary. “By the time that they get to us, a lot of people don’t trust the system anymore. They have been sent from place to place, and that makes the work of our people that much harder,” said Olayinka.
Smaller organizations who rely heavily on state referrals for income are more inclined to take these cases, as refusing them could lead to a significant financial loss. He also believes that this directly affects turnover, as staff work twice as hard, often for less money.
Olayinka also states that the relationship between local government agencies and social service agencies led by people of color is fragile. In describing the relationship, he said “Sometimes, it’s almost like there is an expectation of failure – even when you have a contract, referrals don’t come in that often, and when they do, it’s a case that no other organization wants to take, and often require more services and supports.”
Therapy strategies are not culturally universal
Holley was not satisfied with her initial experiences with therapy. Her experiences with the therapists did not create the relationships that Holley felt were necessary for her and her family; there were gaps in cultural understanding, and she experienced microaggressions from her therapists.
Comments about her voice, communication style and dismissal of her experiences as a black woman created more tension in the relationship with her therapist and disintegrated trust. These types of experiences reinforce negative perceptions of mental health in communities of color, with many believing that it is something for white people, with no bearing on any other culture.
However, alternatives exist to the dominant style of mental health practice. Dr. Hei Kyong Kim, Counseling & Support Clinic Chief Psychologist at the Indian Health Board, provides therapy in a “decolonized” way – decentering the Eurocentric understanding of mental health. She differentiates the decolonized approach in that it values different cultures meaningfully, rather than seeing those experiences as deviations from a white American norm. As evidenced in Holley’s case, the Eurocentric approach can set up a tumultuous relationship where the individual is forced to adhere to standards that do not necessarily fit their worldview and experience.
The decolonized practice is also different in its method of treatment. The Eurocentric method of treating mental health focuses on eliminating behaviors or responding to stimuli, often through behavior management strategies or prescription medications.
In her practice, however, Dr. Kim promotes the use of traditional medicines and practices related to the individual’s culture and focuses on identifying the trauma that leads to problematic behaviors. “It is important to create a space for people to listen and reflect; there needs to be less analysis, and more connecting with feelings, triggers and experiences,” she said.
Kim does not use the Westernized “fix it” model that is interested primarily in behavioral modification within established time frames but supports her clients in doing the emotional work of growth and development.
In this approach to mental health, therapists measure success in changes in body language, conversation and outlook, not simply in the decreasing of negative behaviors that are symptoms of the issue, but not the root cause. Mental health services in this approach seeks to empower individuals to take control of their emotions and ownership of their healing and growth.
Olayinka believes in the need for structural changes. He advocates for a vision of comprehensive healthcare for mental health services for communities of color via a coordinated service provision model, “a system where, as a mental health agency you are a one-stop shop, helping the people to find transportation, helping fill out forms, identify services, etc.”
For Holley, who began her search for a therapist of color in 2009, comprehensive healthcare means not needing five years to find someone to provide culturally-responsive mental health services. Comprehensive healthcare means not navigating microaggressions from the person who is supposed to be providing support; it means not driving 25 miles with three children to have an appointment cancelled.
It means not having to explain and relive trauma several times only to be referred to another organization/mental health professional. Once she found that person, she received therapy that has been effective for both her and her children.