The reawakening of the social and political conversation around race and equality in these challenging times has upended my thinking on cross-cultural therapeutic engagement. I work as a faculty wellbeing advisor in a large metropolitan university with students in mainly one-to-one therapeutic engagement, to support a range of ‘moderate’ mental health presentations. These include but are not limited to: anxiety, depression and bereavement, which impact on personal wellbeing and hinder the students’ ability to complete their studies. The need for wellbeing services has always been great, but the global pandemic and the events of the last month around the Black Lives Matter movement have provoked a marked increase in students disclosing experiences of racial abuse, and inequality. Accordingly, those students who had already experienced seemingly moderate presentations have been further ‘traumatised’ and are seeking support to manage unquantifiable distress.
‘The need for wellbeing services has always been great, but the global pandemic and the events of the last month around the Black Lives Matter movement have provoked a marked increase in students disclosing experiences of racial abuse, and inequality.’
For any mental health practitioner, EMPATHY lies at the heart of any meaningful therapeutic engagement. As students we are taught that it is a fundamental principle of good practice that forms our ethical framework. After foundational principles, we are taught about ‘transference’. This happens when the therapist’s personal or known experience interferes with the client’s presentation to blur boundaries. Sometimes, this affects the ethical boundaries between client and therapist that are meant to protect. Depending on the level of transference, and nature of presentation, if unchecked this can compromise one-to-one relationships, limiting the clients’ right to autonomy and hindering the therapeutic process. The challenge for any practitioner, is to maintain professional boundaries and remain alert to these experiences. Through regular and ongoing professional development training, case management meetings, and group or individual supervision, we can continue to challenge and inform our practice, while improving therapeutic engagement.
However, recent events have forced me to question whether working within the ethical framework is enough to understand the complexities of living in a black skin? In my practice, students regularly disclose the psychological impact of bearing countless microaggressions (consistent insults, indignities, slights and put-downs at people of colour) and direct discrimination on campus. I am led to rethink the adequacy of higher education wellbeing services to offer meaningful engagement with people of colour that supports and makes sense of these experiences, particularly when practitioners are white. A BAME ambassador informed a recent open meeting seeking equality reform, that low ‘take-up’ from students of colour to wellbeing and counselling services was a result of students feeling ‘unheard’. She suggested that ‘practitioners could not understand the scope of their presentation’, had limited and inadequate responses to students’ disclosures and were not, she felt, equipped to support them. A lack of diversity among staff meant that students requesting similar support attempted to cope with these issues while languishing on waiting lists.
Similarly, the issue of transference in therapeutic engagement requires further scrutiny, particularly when considering ‘what belongs to whom’ when the client is black or a person of colour. Given that any non-white practitioner will have undoubtedly experienced some form of discrimination during their lifetime, is transference and secondary trauma a probable outcome of therapeutic engagement? If so, there is an urgent need for culture-competent, continuing professional development to be built into university wellbeing services to challenge where transference ends and secondary trauma begins.
It is not necessary to have lived experience to be empathetic, so it’s reasonable to expect most practitioners at least to feel comfortable working with clients of colour. To work effectively, however, requires a recognition that inequality and power imbalance can exist in therapeutic engagements, and favour those providing support rather than those seeking it.
To support students with mental health issues arising from experiences of racism and ‘microaggressive’ behaviours, all practitioners need to be professionally supported to recognise the likelihood of lived experience affecting the therapeutic relationship. For non-white staff currently engaged in support where the impact of racism is central, it is possible to recognise the emotional burden of such work. Painful memories of similar experiences, invoked in therapeutic encounters with black and other students of colour, can bring about unexpected emotional responses which escalate trauma and impact personal wellbeing.
At this critical juncture in our social and cultural history, we have an opportunity to redefine our approach to wellbeing provision, and need to work harder to support underrepresented groups of the student population. I look forward to contributing to this overdue dialogue.