California State University, Northridge Certificate in LGBTQ+ Health

The Culturally and Racially Safe Practice

Delivering mental health services is first and foremost about people – those of all races, cultures, and socioeconomic statuses. To provide high quality culturally and racially safe, affective services means being attuned to three key areas: 1) being knowledgeable of the clients’ lived experience; 2) having a diverse, well-trained and supervised staff, and 3) having collaborative teams that bring their best selves to the work and display emotional intelligence.

As mental health leaders, we must acknowledge and understand the lived experience of clients and how these experiences shape beliefs and attitudes toward treatment. We also must acknowledge and understand cultural and racial differences. According to Speight et al (1991), “a system that does not consider race, culture, gender or social values does not adequately serve the people it purports to.” This means having the ability to work with everyone and making services that are accessible to all. This entails developing practical ways of supporting those whose cultures and beliefs differ from ours, and most importantly, avoiding projecting our own cultural expectations of what is therapeutic onto clients (Elder, Evans & Nizette, 2009).

In Retooling Mental Health Models for Racial Relevance (2005), Gail K. Golden, MSW, EdD notes that “people are dehumanized when we fail to develop asset-based models which incorporate curiosity and respect about the survival skills which whole communities have had to mobilize to confront genocidal affronts to their being.” She notes that credentialing, for instance – though valuable in many ways – does harm in others. Noting that it is a “gate keeping” device which can exclude people with important cultural expertise from career advancement, leadership roles as well as from participating in program and policy decisions, which can result in “impoverished and ignorant forms of treatment.” In other words, in most organizations, gatekeepers without a racial/cultural lens can blindly control access to resources and opportunities which ultimately leads to services that do not adequately meet the needs of our clients.

Dr. Golden implores us to examine our thinking. Are we able to identify the resilience and assets of clients? Do we frequently examine our rules and procedures for their impact on the population that we actually serve? Do we involve or even consider our clients when developing or altering our services?  How do we value and reward cultural expertise and lived experience within our staff?  Does our profession’s commitment to credentials hurt our ability to expand our range of services? She also notes that graduate schools in the helping professions are not graduating enough mental health professionals from diverse communities to mirror our changing demographics. The result is that many agencies serving populations of color often have staff that are predominantly white, especially in leadership roles.

Strategies for Providing Safe Racially and Culturally Informed Care

  • Recognizing that it is counterproductive to treat all people alike. There are characteristics that all people share, ones that some people share, and some that are unique to a group. This includes racial or ethnic historical conditions, such as slavery (Henderson & Primeaux, 1981).
  • Allowing clients to define themselves rather than attempting to erase the clients’ lived experiences with categories, notions of dysfunction, or simplistic theories (MacKinnon, 1993).
  • Avoiding all stereotypes and generalizations.
  • Becoming knowledgeable, sensitive and aware of clients in their cultural setting (Wright, 1991).
  • Recognizing that there is diversity within groups as well as between groups (Charonko, 1992).
  • Becoming aware of your own ethnocentrism, which is the belief that your own group is superior to others (Henderson & Primeaux, 1981).
  • Developing policies and practices that acknowledge and reward cultural expertise and lived experience
  • Recruiting, developing and retaining multi-racial/multi-cultural staff and teams.
  • Being mindful that most of us have not been trained to talk about racism across racial/cultural lines and are fearful, and thus often silent about these issues.
  • Being aware that privilege is invisible to people who have it and painfully obvious to those who don’t.
  • Being clear that many agencies unconsciously use white organizational characteristics as their norms and standards which make it very difficult to open the door to other cultural norms and standards.
  • Being able to identify and name the cultural norms and standards you want is a first step to making room for a truly multicultural/antiracist organization.
  • Understanding the constructs and intersections of racism, hetero-normativity, sexism, homophobia, transphobia and other systemic forms of oppression based on social identity.
  • Understand that the constructs of power, privilege, hierarchical rank and culture are always fundamentally a part of the individual and institutional context.
  • Learn to recognize the intersections of race and racism with gender bias, LGBTQIA+ bias, non-binary bias, class bias and religious bias (including anti-Semitism and Islamophobia) and how they impact the work environment and service delivery.

Clinical Supervision and Support

To ensure high-quality safe care, staff must be properly trained to do the work. This means having the appropriate experience, training and clinical supervision.

The most helpful trainings are those that combine didactic and experiential methods to focus on the meaning of cultural and racial identification for the clinicians and client; the experience of clinicians and clients with social service institutions related to their cultural, racial, gender identity, their sexual orientation, and immigrant status; and provide guidelines and support for addressing these issues in the workplace.

Anti-Racist/Oppressive Supervision

Bernard and Goodyear (1998) defined supervision as an evaluative relationship between a senior and junior member of the mental health profession whose purpose is to “enhance the professional functioning” of the supervisee. Their definition defines the supervisor as directing and nurturing the development of the supervisee’s skills and professional identity. Therefore, an essential feature of supervision would include the supervisor’s ability to raise and guide analyses of Race, Culture, Rank and Privilege with the supervisee as part of the process of honing the supervisee’s ability to address these issues in treatment and with colleagues. This includes any issues, or even perceived issues, involving race and racism in the treatment or regarding the supervisee.

It enables supervisees to review and debrief approaches to practice, ensuring that service delivery is safe for clients and following anti-oppressive best practice standards.

Cross-Racial/Cultural Teams

Research indicates that staff working together in cross-racial teams help to overcome racial and cultural bias; diversifying alone is not sufficient.

At Stanford University, psychology professor Claude Steele has studied how stereotypes shape intellectual identity and performance. Since, research indicates that race indeed does matter, it is our work to prevent bias from damaging career opportunities for People of Color in the workplace and ultimately racially/culturally safe services to clients. Decades of research has shown that cross-racial teams can increase acceptance among people of different racial and cultural groups.

According to Dr. Ann W. Battencourt, of the University of Missouri, research shows that people generally experience positive feelings toward each other when working cooperatively toward a shared goal; as people work cooperatively, they can come to value their different perspectives. In other words, working intimately across racial lines can greatly reduce stereotyping, which is the root cause of implicit bias.

Cross racial/cultural teamwork can also: enhance the quality of service; increase productivity; enhance staff satisfaction; improve retention; and improve organizational accountability.

“Emotionally Savvy” Teams

More work is being done in teams. According to Cross, Rebele and Grant (2016) teamwork has increased by 50% or more over the past 20 years. The most successful teams are diverse and collaborative, with a heightened sense of awareness of the other members. Research by Druskat and Wolff (2001) indicates that teams are more creative and productive when they can achieve high levels of participation, cooperation, and collaboration among members.

They also noted that the success of a team is more likely when members engage wholeheartedly, with three essential conditions: trust among members; a sense of group identity and pride in the group; and a sense of group efficacy – the belief that they are more effective working together than apart.

They concluded that “group emotional intelligence is about small acts that make a big difference. It is not about in-depth authentic discussion of ideas; it is about asking a quiet member for his thoughts. It is not about harmony, lack of tension, and all members liking each other; it is about acknowledging when harmony is false, tension is unexpressed, and treating others with respect.”

According to Relly Nadler Psy.D., M.C.C. (Leading with Emotional Intelligence, 2017), “teamwork is a necessity in organizations, but it is an unnatural act that takes a strategy, discipline and practice.” Emotional Intelligence is the ability to understand and manage yourself and understanding and managing others. Nadler offered the following insights:

  • Motivating average performers to be great contributors takes knowing their strength, weaknesses, and motivations.
  • Emotions are stirred up in social interactions. Anger, frustration, impatience, disappointment, rejection, betrayal, injustice and isolation all happen in groups. How they are experienced and regulated are critical for top performance.
  • Google studied teams and teamwork and found psychological safety was key factor for top performing teams. Is it safe in your team to push the envelope and bring up conflicting and opposing ideas?
  • Power mutes empathy. Research shows that the higher up in an organization and more power a leader has, the less they feel they need to listen to others. The lack of empathy can decrease the psychological safety and limit the production of creative ideas.
  • To raise the Emotional Intelligence of the team, honor the process of the conversation. Are all ideas and people heard, are ideas left on the table, are decisions really understood, digested and moved to actions?

The key is to learn to have difficult dialogues in a non-shaming, non-blameful, non-judgmental collaborative manner that tackles the challenging questions, engages the difficult discussions in a transparent style, and brings everyone’s authentic voice to the table.

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