Evidence has overwhelmingly shown that those who identify with marginalized groups in society may experience mental health-related issues at heightened frequency and with greater symptomatology. This is attributed to minority stress theory, which highlights the additional everyday stressors (such as microaggressions) that minority populations experience (Singh, 2020). Furthermore, intersectionality, which refers to the systems at play in marginalization wherein an individual may have multiple minoritized identities (PettyJohn et al., 2020), lays the framework for the power and privilege an individual is afforded based on their relative position of status in society (PettyJohn et al., 2020).
Several therapist factors play a role in the treatment context of minoritized individuals. For instance, when working with individuals who identify with minoritized identities, providing affirmative care is often viewed as the gold standard; however, providing such care requires cultural competence and humility (Lange, 2020). Although providers are encouraged to utilize minority stress theory to guide their work, providers might receive inadequate training on how to effectively work with diverse clients (Singh, 2020). Providing an environment where the client feels validated to process their discriminatory experiences should be paramount (Cheng & Mallinckrodt, 2015). Similarly, the use of evidence-based relationship variables (EBRVs) is a central focus when working with minoritized populations (Lange, 2020). Due to this, it is essential to establish a strong therapeutic alliance grounded in stability, trust and safety before engaging in trauma processing with minoritized individuals (Lange, 2020).
To provide a safe, stable therapeutic environment, therapist transparency is essential in terms of addressing the power and privilege dynamics that may be present within the relationship due to differing therapist-client identities (PettyJohn et al., 2020). As such, therapists are encouraged to gain training and consultation, as needed, so that they can question how intersectionality may play a role in conceptualizing clients and providing effective services (Viehl et al., 2022). To further foster a therapeutic environment of safety, the client should be encouraged to give feedback to the therapist (PettyJohn et al., 2020). Similarly, therapist disclosure is recommended to be a purposeful act and should not be utilized to ease the therapist's anxieties surrounding cultural differences. Cultural humility should be an ongoing process through continued professional development and training efforts (PettyJohn et al., 2020; Singh, 2020). A therapeutic stance of curiosity and cultural humility should be fostered to communicate unconditional positive regard and empathy, whilst acknowledging the fact that another’s lived experience is unique (PettyJohn et al., 2020; Singh, 2020).
Taken together, research and psychoeducation on the therapist's part will strengthen the client's trust and willingness to engage in therapy. Resilience might be a key aspect to address in the causal chain when conceptualizing clients using an intersectionality perspective (Meyer, 2015; Singh, 2020). Additionally, empathy is a core foundational aspect when working with minoritized communities to prioritize culturally sensitive conversations surrounding intersecting therapist-client identities as the therapeutic alliance accounts for the most variance in treatment satisfaction (PettyJohn et al., 2020; Singh, 2020). On a related note, more research on culturally sensitive interventions should be conducted to combat the lower treatment-seeking rates in some minority communities (Cheng & Mallinckrodt, 2015).
In conclusion, interventions must occur on a societal-based level to fully allow trauma survivors from marginalized communities to reap the benefit from psychotherapy. Affirmative, trauma-informed care can help to validate clients’ experiences through a cultural lens (Viehl et al., 2022). Additionally, therapist factors could be an area of future research to understand how therapists might play a role in perpetuating or easing minority stress (Owen et al., 2018). The impact of minority status on identity, development and relationships cannot be disregarded among mental health care providers. In fact, mental health care providers can play a critical role in dismantling a system of oppression and stigmatization. Recognizing and accepting the experiences of those with a minority identity, the trauma of recurrent discrimination can be validated and normalized.
About the authors
Abigail Dopico, MS is currently in her third year of her clinical psychology doctoral program at Nova Southeastern University (NSU) in Fort Lauderdale, FL. Abigail has primary clinical interests in treating traumatic stress in adults and is currently in her clinical practicum rotation at the Trauma Resolution and Integration Program (TRIP) at NSU. Abigail has a passion for expanding the field of research surrounding effective treatments for trauma in specialized populations.
Luca Hartman (she/her), MS, is a third year doctorate student in the PsyD Clinical Psychology program at Nova Southeastern University (NSU). She is completing her second practicum rotation at the Trauma Resolution and Integration Program (TRIP), which specializes in providing trauma-informed, affirmative care to those with histories of complex trauma. Her clinical and research interests include the effects of interpersonal trauma across the lifespan, especially among those with a minority identity.
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