Black Parents and the Importance of Cultural Competence in Therapy

When Grace W.’s son Denzel began acting out in class, the New York City-based copy editor was immediately concerned. Denzel, then aged eight, had always been a stellar student. In the gifted program at school, he had never gotten into trouble.

“He was also starting to have a lot of nightmares, and his teacher was calling every week to say that he was disrupting class,” Grace says. “This was not the Denzel I knew. We needed help.”

When Grace contacted her company’s Employee Assistance Program (EAP) for a referral to a mental health provider, she had a few requirements. “I wanted a child psychologist, someone with a practice near enough to go there after school easily, and I wanted them to be Black.”

Finding the first two items on her list was relatively easy, but locating a Black therapist proved much harder. After combing through the list of providers supplied by the EAP, Grace was dismayed to discover that none were Black. “I felt a Black counselor would be a more comfortable fit for Denzel and me,” she says. “I had to insist.” Grace called the administrator of the EAP directly. “The person I spoke with was Black and understood what I wanted,” she says. “It took some doing but we eventually found a Black woman in our area.”

Finding a Black therapist isn’t easy. According to the 2022 Black Mental Health Workforce Survey, within the United States, only about 5% of psychologists, 7% of marriage and family counselors, 20% of social workers, and 11% of professional counselors are Black. And locating a Black child psychiatrist, specifically, can be even harder. Of the 10,500 child and adolescent psychiatrists currently practicing in the United States, “just 1% are Black,” says Christine M. Crawford, MD, MPH, an assistant professor of psychiatry at Boston University and an adult, child, and adolescent psychiatrist. “If you’re looking for a Black child psychiatrist, especially if you live in the South, Midwest, or a rural area, you’re looking for a unicorn.”

Despite the difficulty, recent research shows that, like Grace, many in the Black community have a strong preference for mental health professionals who look like them and share their cultural beliefs.

A new study conducted by the Child Mind Institute in partnership with the Steve Fund, surveyed 1,000 Black parents seeking care for their child and 500 young Black adults seeking care for themselves. The goal of the study was to garner insight into the experiences and views of Black families and youth around mental health within the United States, as well as identify the key barriers they continue to face. Nearly half of participants (both parents and young adults) said that they trusted a Black mental health professional over one who is white or a non-Black person of color.

“There’s a comfort level that parents get from a Black provider,” says Rhonda Boyd, PhD, associate director of the Child and Adolescent Mood Program at the Children’s Hospital of Philadelphia. “When they feel like they’re understood and can, in turn, understand where the provider is coming from, it can make doing the assessment and understanding the treatment plan easier.”

There are many in the Black community who still view health care with suspicion. From the Tuskegee syphilis study to the forced sterilization of Black women and girls to the unauthorized harvesting and use of Henrietta Lacks’s cells, there’s a long history of mistreatment and outright racism in the health care system.

“There’s a reason why some in the Black community may not trust the medical establishment,” says Ruth C. White, PhD, MPH, MSW, a diversity trainer and former clinical associate professor in social work at the University of Southern California. “Historically we haven’t been treated well.”

For many, seeing a Black mental health professional can make it easier to put aside these concerns.

As a Black clinician, Dr. Crawford has seen firsthand how her presence affects patients. “There’s a look of relief on the faces of Black parents and caregivers when they meet with me for the first time,” she says. “There’s this sense that they can trust me, that there’s an understanding and an assumption that the diagnosis I provide won’t be rooted in bias or racism.”

This is particularly true when it comes to mental health care for children and adolescents. “There’s often a concern that if your kid were to express any mental health challenges or talk about difficult interactions that they might have with their parents, Child Protective Services is going to be called with that information,” Dr. Crawford says. “That’s how Black families are walking into their encounters with brand new mental health providers because of their life experience.”

Dr. White notes that Black parents may also be wary that receiving counseling for their children may expose them to systemic racism. “It’s important to understand that, historically, Black kids who were reported to have behavior problems were shunted to programs and tracked,” she says. “Parents may resist therapy because they don’t want their kids to get labeled.”

Nearly half of the participants in the Child Mind Institute study stated that white and non-Black POC mental health professionals often misunderstand or underestimate the effects racism can have on mental health. “Experiencing microaggressions and racism can lead to racial trauma which, in some people, can elicit symptoms that meet diagnostic criteria for PTSD,” Dr. Crawford says. “When a clinician minimizes or invalidates their experiences, it can create a barrier to wanting to engage in treatment.”

And sometimes the issue is really a lack of cultural awareness. “Clients have told me when they’ve tried to talk about racism with a non-Black provider, it seemed to make the clinician very nervous.” Dr. White says. “And often, clients feel like, now I have to educate my therapist, that’s not what I came here for.”

That’s the situation Danielle D., a paralegal in East Orange, New Jersey, found herself in when she began seeing a white therapist she found through her school. “I remember telling her a story about my mom, and she reacted more stunned and enchanted to hear certain stories about growing up in a Caribbean household,” Danielle says. “She wasn’t derogatory or condescending, but I needed her to act like my therapist and not like a student I was teaching about my culture.”

Instead of being supported, Danielle felt let down. “She ​​really couldn’t understand anything with regards to my family’s background, so I spent most of the time giving in-depth explanations about things a Black therapist would just get,” she says. “I met with her a handful of times before I stopped going and focused on finding a Black therapist.”

And after conducting a lengthy search, Danielle found a Black therapist near her. “Finding someone I can relate to and who could relate to me was key,” says Danielle. “With my other therapist, I just felt like I wasn’t being seen.”

Locating a Black therapist may feel challenging, but there are some resources and strategies you can use to simplify the process. A good first step is to leverage your workplace resources, such as your company’s EAP. “It doesn’t hurt to ask them for help identifying Black clinicians,” Grace says. “Don’t overlook your health insurance company,” adds Dr. Boyd. “Ask if there are Black therapists available under your plan.”

If you don’t have access to an EAP, check out websites that provide directories of Black therapists. The following list is a good place to start your search:

• The Association of Black Psychologists
• Black Therapists Rock
• Clinicians of Color
• Inclusive Therapists
• InnoPsych
• Melanin & Mental Health
• Therapy for Black Girls

Once you decide that you’d like your therapist to be Black, it helps to think about what else you’re looking for. For instance, after Danielle narrowed down her search to a Black woman, she also looked for who saw clients in person and who was located within reasonable travel distance from her home. Then she began to comb through directories and asked friends for recommendations.

And if you know of a therapist who might not be right for your situation — say they specialize in couples counseling and you need someone who works with children — consider asking them for a recommendation. Clinicians often have a professional network and can guide you toward trusted practitioners. “Black Therapists Rock has over 20,000 members on its Facebook page,” says Dr. White. “People post saying they are looking, say, for a therapist who deals with Black adolescents in the Washington D.C., area, and members are happy to post referrals.”

But given the deficit in Black mental health professionals in the United States, the best option may be a carefully chosen non-Black therapist. “I tell folks, do not let the color of your clinician’s skin be the barrier that keeps you from getting the help that you or your child needs,” says Dr. Crawford.

So, if you’re unable to find a Black provider, try to find a non-Black one who is inclusive and culturally sensitive. Changes in the way mental health professionals are taught and trained over the past decade are making this easier. “As someone who oversees the training programs for licensed mental health counselors, psychologists, and psychiatrists, I can tell you providing culturally competent care to people who aren’t of your same background is a required part of training,” Dr. Crawford says. “They’re trained on how to ask questions coming from a place of curiosity, rather than making assumptions or judgments about a patient based on the color of their skin.”

When meeting with any clinician for the first time, it can be helpful to come prepared with questions about their approach to therapy and what you can expect from a typical session. And when dealing with a non-Black therapist, asking about their experience in treating Black patients is key. “Ask explicitly if they are comfortable talking about race and racism and any issues that are important to you, and notice how they react,” says Dr. White. “If the question makes them squirm, if it gives them pause, if they display discomfort, then they may not be the right person for you.”

Dr. Crawford says when it comes to evaluating a non-Black therapist for your child, consider the artwork in the office, what books are on the shelves, and the color of the dolls in the room. “Ask yourself if this is an environment that communicates that all are welcome.”

Once you’ve chosen a clinician, remember those initial sessions with any mental health provider, no matter their race, can feel uncomfortable. “They’re asking a lot of questions and prying into very personal information in a way that may make you feel uneasy,” says Dr. Boyd. “It’s important that you give it a chance.”

Check in with your child regularly about their comfort level with the provider and schedule regular meetings with the provider to make sure everyone is on the same page. And after some time, if you feel like your kid doesn’t feel comfortable, you’re not seeing progress, or you’re unhappy with your interactions, have an open conversation about whether they’re still a good fit. “Therapists are trained to navigate these conversations,” Dr. Crawford says. “And parents should feel empowered to be active participants in their child’s mental health treatment.”