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Black Anxiety: How to Talk to Your Therapist About Racism

Tips to address race and racism-induced stress in therapy.

by Sojourner Ahebee
July 7, 2020 | Health

Imagine a tightness spreading across your chest. Your heart rate surges. Thoughts and images of the most recent police killings of Black people play backward and forward in your head. 

As recent news accounts of violence against people like Dominique "Rem'Mie" Fells, Breonna Taylor and George Floyd swept the nation, I started to experience these anxiety symptoms, and I reached out to my therapist for help. 

These were all sensations I had felt before, after being racially profiled while shopping in a clothing store or watching from the passenger seat as my mom was pulled over by the police. 

At the time, I didn't have the language to describe what this particular kind of anxiety was doing to my body. New research is helping to change that.

What is biological weathering?

According to Arline Geronimus, a research professor at the University of Michigan's Population Studies Center, the stress response I experienced is all too common for Black people who live, grow and develop in a racist society. She describes the accumulated damage of racism on Black people's body systems as "weathering."

For the average person, stress is a normal and healthy response to danger. When you're anxious, blood travels to your muscles and heart, blood pressure rises and other parts of the nervous system are suppressed. This response isn't a problem if it happens for a few minutes every once in a while. 

However, Geronimus said the prolonged, chronic stress Black people experience as a result of living in a racist society poses a serious threat to the immune system, organs, tissues and other body systems.

"When this happens over years, these systems just get completely worn out," she said. 

"All of these diseases, that on average Black people die from more and at younger ages than white (people), are all things that at a minimum weathering contributes to."

In addition, Geronimus noted that chronic stress within Black communities often involves a sustained cognitive and emotional engagement that goes way beyond the normal stresses of everyday life.

"That could be something as big as social injustice, but it could also be fighting with your landlord to turn the heat on in your apartment," she said.

According to Doris F. Chang, clinical psychologist and associate professor at NYU's Silver School of Social Work, when you ask Black Americans about their physical experience with anxiety, they will not report higher rates than their white counterparts.

"But, if you measure it empirically, you will find elevated rates of stress hormones," she said. "Their body is registering the stress, but their mind is like, 'This is just what it's like to be in my body, it's just normal.'"

Why racism is so hard to talk about with your therapist

I've often struggled to bring up race and racism when working with therapists who are not Black. I've noticed a pattern of writing off Black people's experiences with racism as an overreaction. And the labor of having to withhold salient aspects of one's identity as a Black person in therapy is stressful in and of itself.

But, in the wake of the recent acts of police brutality, I needed my therapist to acknowledge the way my identity intersects with my anxiety.

According to Dr. Chang's research, therapists — particularly white clinicians — have an extremely hard time discussing race with clients of color. Therapists report feeling anxiety around these conversations, even though most of the clients in Chang's studies want the topic of race to be broached.

"(Clients of color) were acknowledging the power difference and the sense of white fragility that made it kind of dangerous for them to be the one to raise it," Chang said.

What can Black people do to seek culturally competent therapists?

Therapy session
Take time to speak with several different therapists to find the right fit for you.  |  Credit: Adobe

Dr. Allison Thompson, clinical associate professor of psychiatry and behavioral science at Stanford University, said race is one of the first things she discusses with new patients.

"For example, I am an African American woman," she said. "If the patient is also African American, I ask them, 'What does that mean to you that we share this one identity?'"

Finding a culturally competent therapist for yourself can be quite the challenge, so Dr. Thompson recommends the following tips to help navigate your search for the right provider.

  1. Do a preliminary phone interview with a few different potential providers: “My suggestion is always to ask if you can do a 5- or 10-minute conversation with them by phone or video to get a sense of who they are and your comfort level working with that person,” Thompson said. 
  2. Ask about their experience working with Black clients: "It's really helpful to ask about the provider's experience working with people from your cultural background," Thompson said. Asking providers about what challenges they have run into while working with clients who share your racial background will give you a sense of how they may approach some of the issues you want to address in your own therapy sessions.
  3. Don’t commit to the first person you call: It’s important to give yourself the agency to consider many different people before making your decision. “I know that I'm not going to be the right fit for every kind of patient,” Thompson said. “You don't want to end up working with someone where you feel like there are all these things going on in your world and in your life that you can't bring up because the other person is going to be uncomfortable.”

As white supremacy continues to wage war on Black people's bodies, a truly anti-racist mental health model must develop language to acknowledge the effects of structural racism, including the distinct ways that stress, anxiety and depression emerge for Black people.

Stress is a feeling that can have very serious bodily consequences, in some cases leading to the premature death of Black people. I am reminded of the late, great Nina Simone, who said, "Freedom is a feeling, freedom is no fear."

If we are to take Simone seriously, imagine the consequences of freedom replacing fear in the bodies of Black people. What would that look and feel like? What new possibilities would unfold for Black life when our bodies are no longer queued for fear?

Sojourner Ahebee
Sojourner Ahebee is a Philadelphia-based writer and audio producer. Her work has appeared in The Atlantic, WHYY, The Philadelphia Tribune, WITF and elsewhere.
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