The recent online discussion surrounding Brené Brown has sparked a much-needed conversation within the field of mental health. These discussions have highlighted the importance of incorporating diversity and cultural competency, as well as the importance of having a solid understanding of intersectionality and how it shows up in the clinical work we do with clients.
While Brown herself is not the focus of this article, in my experience as a therapist, I’ve come across dozens of Brené Browns within the mental health space. Her situation sheds light on the fact that our understanding of these deeper intersectional concepts (or lack thereof), and how they manifest, does have an impact on the clients we serve!
As a therapist who works with predominantly Black and BIPOC clients on issues related to “body image” and their relationship with food, I often cringe when I attend trainings led by colleagues who may be very well-meaning, but quite frankly, lack diverse perspectives and an ability to deeply explore how topics, such as the way we view our body show up quite differently for clients who look like me!
These trainings often heavily miss the mark and can be overly reliant on basic cognitive behavioral therapy (CBT) based techniques that may inadvertently inflict feelings of guilt, shame and blame by insinuating that the way Black people have been made to experience their bodies is somehow our fault! Our thoughts and behaviors are labeled as “maladaptive” and our feelings are deemed invalid!
These well meaning, but often ill-informed trainings fail to explore the deeper roots of clients’ experiences and the role that decades of systemic racism, anti-Blackness, Race-Based Traumatic Stress, as well as acculturative stress, or the external pressures to conform into what the dominant culture deems as acceptable, plays in shaping how Black clients, and clients from historically marginalized groups have been taught to see ourselves. This includes how we’ve been taught to view our bodies!
In fact, while working with client’s from historically marginalized groups, in my opinion, it’s not only harmful, but misguided clinical practice to ignore how these deeper social justice issues intersect with client’s clinical concerns. This means that using CBT to simply “treat” a diagnosis like Body Dysmorphic Disorder, without assessing for the possible deeper reasoning as to why these symptoms show up, especially for Black clients, is not only missing the mark, but often prevents effective treatment.
Historically marginalized clients are often inundated with external messages that are ultimately rooted in racism and anti-blackness. These messages constantly tell us that the way we biologically show up in the world is somehow not good enough! These messages can also be internalized, so what appears to be Body Dysmorphic Disorder on the surface, can in fact be the results of internalized racism or behaviors related to the external pressure to conform into what’s seen as more acceptable in order to meet one’s basic needs.
If society constantly sends Black men and women external messages about our bodies that are shrouded in racism (i.e. our natural hair is “unkept and unprofessional”), and that same society actively operates to oppress us in the workplace, it is basic human behavior to feel a need to assimilate oneself by attempting to adapt a more “acceptable” form, in order to meet one’s basic needs, provide for one’s self and ultimately feel safe, free from physical or emotional dysregulation.
As clinicians, there are steps that we can take to ensure we are providing culturally competent care! Clients seeking therapy can also use the following measures to make sure their therapist is implementing a culturally informed approach.
1. Conduct a Culturally Competent Intake Assessment:
When working with Black, BIPOC or traditionally marginalized clients, it’s important to start by conducting a culturally competent assessment that takes into account the client’s cultural background, identity, and lived experiences. Work with the client to explore how factors such as race, ethnicity, gender, sexual orientation, socioeconomic status, cultural values, experiences related to systemic racism and interpersonal racism all intersect to shape how the client views their body.
2. Develop an Intersectional Understanding:
It’s important that clinicians recognize and validate the intersectional nature of how Black and BIPOC clients often view their bodies and understand how external influences contribute to these views. Understand that body image concerns may be influenced by complex factors that include societal beauty standards, historical trauma, racism, colorism, texturism, featurism, cultural expectations, and other experiences of oppression.
3. Offer Culturally Informed Interventions:
Finally, explore tailoring your interventions to be more culturally informed, taking into account the client’s background and lived experiences. Interventions such as narrative therapy can be a helpful tool in allowing clients to explore their stories from external perspective that is separate from their own identity. This allows the client to better to explore how oppressive systems have influenced their behaviors while reducing feelings of self blame. Additionally, therapeutic approaches like Dialectical Behavioral Therapy can be extremely helpful due to its heavy incorporation of emotional validation, is acknowledgment of the role that experiencing invalidating environments has on emotional dysregulation and overall mental health, as well as its use of radical acceptance and identifying situations that may be outside of our current control, but learning how to navigate within those situation.
Do you need guided support surrounding healing from disordered eating and body shame that are the result of systemic racism and acculturative stress? The Mindfulness Space is here to help!
Stefanie Lawson is a licensed therapist with nearly a decade of clinical experience and owner of The Mindfulness Space therapy in Greensboro North Carolina, where she maintains specialized education and training in treating the underlying depression, anxiety, stress or unresolved trauma that often leads to eating disorders and issues concerning body image dissatisfaction (i.e. Body Dysmorphic Disorder) in adults and transitional aged teens (older teenagers who are transitioning into adulthood).
Schedule your free 30 minute consultation call with The Mindfulness Space today to learn more about how we can help you!
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