Skip to Main Content
297
Views
0
CrossRef citations to date
Altmetric
Received 31 Aug 2020
Accepted 06 Oct 2020
Published online: 16 Oct 2020

ABSTRACT

I CAN鈥橳 BREATHE! Social distance! I CAN鈥橳 BREATHE! Stay six feet apart! I CAN鈥橳 BREATHE! Make sure you wash your hands! I CAN鈥橳 BREATHEEEE! When can I schedule a session? The duality of being Black in America and a mental health professional during a global pandemic is stressful enough; however, coupled with a simultaneous racial pandemic, the intrapsychic, interpersonal and professional responsibilities feel incessant. This article seeks to explore the lived experiences of two Black mental health professionals residing and providing clinical services in Los Angeles County during a dual pandemic. Utilizing autoethnography methodology, the authors will reflect upon their personal and professional experiences of being Black and a mental health provider during a dual pandemic. Special attention will be allocated to unpacking issues of systemic racism, White supremacy, White fragility, anti-racism and third space oppression while providing clinical services to White and Black clients and attempting to engage in ongoing self-care activities. In addition, the authors will explore recommendations examining the nexus between racial identity, social location and professional expectations during a dual pandemic.

Introduction

Historically, African Americans (the words African American and Black will be used interchangeably to describe the racialized, Black bodied experience) have been seen as tough or disposable enough to endure great psychological, physiological, environmental and economic injustices and harm without recognition. For centuries, African Americans have been fighting and advocating to have their voices heard as it relates to equitable human rights. This long history of inequality, systemic racism and discrimination has caused significant health disparities within the African American community. According to the Centers for Disease Control and Prevention (CDC, 2020), health and mental health care disparities continue to exist for minority populations, including a lack of access to care, limited health care coverage, and social, economic, and environmental factors. Coupled with COVID-19 and racial unrest, the perfect explosion in our society has been created. African American people have been disregarded at all levels of society due to oppression and White supremacy. At a certain point, enough becomes enough and Black Lives need to matter. African Americans are trying to stay alive and avoid two distinct illnesses during 2020 鈥 COVID-19 and racism resulting in murder at the hands of law enforcement officers across the United States. More now than ever, African American people need advocacy, allyship, community healing, physical and psychological safety. But what happens when you are African American and a mental health provider? Where does one go for psychological reprieve? This article will explore the experiences of two African American clinicians providing mental health services during a dual pandemic.

Figure 1. Emergent themes.

Literature review

COVID 19 and mental health

In March of 2020, the COVID-19 outbreak created both a global health challenge and a second wave of mental health crises. The pandemic has been a stressor for physical health, mental health and well-being (Fiorillo & Gorwood, 2020; Rajkumar, 2020). Currently, one in five American adults have a diagnosable mental illness, suicide rates are dramatically increasing while the United States has a shortage of mental health care resources and providers (Choi, Heilemann, Fauer, & Mead, 2020). In addition to the hundreds of thousands of hospitalizations and deaths among the elderly and medically vulnerable, apprehension about community spread of the coronavirus has led to stay at home orders and social distancing measures (Choi et al., 2020). There are significant psychological consequences for those impacted by COVID-19, their family members, and health care workers. Survivors of ICU treatment are at elevated risk for post-traumatic stress disorder (PTSD), depression, and sleep disturbance (Choi et al., 2020; Righy et al., 2019; Wang et al., 2019). Distress and fear about the virus triggers people with mental health conditions, resulting in relapses of depression, anxiety and panic attacks (Tsamakis et al., 2020). In addition, medical personnel involved in global outbreaks experience increased burnout, compassion fatigue, decreased job satisfaction, higher job stress and low morale (Choi et al., 2020; Kim & Choi, 2016). Thus, personal or professional involvement with health systems in the pandemic has the potential to create elevated mental health concerns.

There is also a level of psychological distress associated with grief, loss, quarantine and the social distancing methods employed to protect our communities. Risk for anxiety, isolation and loneliness is increased, and the elevated stress and fear of the virus may exacerbate symptoms or impair functioning in those with preexisting mental health conditions (Choi et al., 2020; Rajkumar, 2020). Increased loneliness and reduced social interactions are well known risk factors for anxiety disorders, obsessive compulsive disorders, trauma related disorders, schizophrenia and major depression (Fiorillo & Gorwood, 2020). Further, employment insecurity, housing instability, financial pressure, and parental responsibilities for caregiving and educating their children are ongoing stressors that contribute to mental health symptoms. Confinement orders also have the potential for increased stress, resulting in significant emotional outcomes, including irritability, depression, insomnia, fear, confusion, anger, frustration and boredom (Pfefferbaum & North, 2020). Unfortunately, these challenges create a need for ongoing support for those with mental health histories, access to service provision for new clients and mental health care for health care providers potentially experiencing vicarious traumatization or burnout (Choi et al., 2020; Smith et al., 2020).

Within the context of COVID-19, access to mental health services requires innovative adaptations to traditional mental health treatment. Because it is difficult to ensure that clients are adequately protected in an in-person therapy setting, virtual platforms are increasingly utilized as the primary methods of clinical intervention. Further research is needed to ensure that best practices in engagement, assessment, intervention, treatment planning and evaluation are translatable to telehealth contexts. Telehealth, training for mental health providers in utilizing telehealth effectively, insurance coverage for telehealth models, and virtual support (including substance or addiction groups) are all approaches that have been rapidly implemented to ensure that community mental health needs are addressed (Choi et al., 2020; National Alliance on Mental Illness, 2020; Smith et al., 2020).

However, while virtual and digital platforms are essential to the access and implementation of mental health service provision, the internet is also a source of large amounts of inaccurate and often inconsistent information. The anxiety generated by this 鈥渋nfodemic鈥 exacerbates uncertainty within already at-risk populations (Fiorillo & Gorwood, 2020). Anxiety serves a purpose; in this context it is an adaptive defense mechanism and prepares people for threat or danger. The biological processes involved in responding to threat are fundamental for survival, however, chronic or disproportionate fear is harmful and contributes to the development of psychiatric disorders (Ornell, Schuch, Sordi, & Kessler, 2020). While many people feel increasingly afraid of the coronavirus that initiated a global quarantine, stay-at-home orders for much of the United States, and a new culture of mask wearing, this level of anxiety may manifest in the form of panic that is both intrusive and debilitating. Further, in addition to anticipated or feared loss, many people are also losing loved ones, and having to grieve their loved ones that (given the circumstances of COVID) they are not able to memorialize.

The uncertainty of the length or course of the Coronavirus pandemic, the lack of adaptive coping mechanisms (such as socializing, exercise, shopping and dining out) pave the way for increasing feelings of powerlessness and helplessness. Conflicting or false information about virus transmission, antibodies, symptoms, geographic reach, number of those infected and mortality rates provoke high levels of fear (Ornell et al., 2020). Many people respond to this lack of control with maladaptive coping strategies (such as overeating, substance abuse and poor hygiene), defensive responses, emotional distress, or noncompliance with public health directives (Cullen, Gulati, & Kelly, 2020; Pfefferbaum & North, 2020). Uncertainty about the future can generate or exacerbate fear, anxiety and depression (Fiorillo & Gorwood, 2020). Most natural disasters, wars and international mass conflicts are limited to a certain area, a given time frame, allow people methods of escape, and have an easily recognizable enemy (Fiorillo & Gorwood, 2020). Unlike similar historical events, the novel coronavirus is nebulous, and the threat is potentially everywhere and in everyone.

Mental health providers are also vulnerable to the impact of the COVID-19 pandemic. The emotional labor of caring for loved ones while managing higher caseloads, longer work hours and decreased resource allocation can influence the amount of distress in the pandemic. Disruption of routine clinical practice, destabilization and a perceived loss of control within an indefinite time frame may provoke anxiety and depression for healthcare professionals (Tsamakis et al., 2020). The World Health Organization (WHO) has formally recognized the risk of psychological symptoms of health and social care professionals in the pandemic, indicating that more needs to be done to manage their anxiety and stress and to minimize the likelihood of depression, PTSD and burnout (Cullen et al., 2020). Prevention of vicarious traumatization or other mental health disorder symptomatology often encourages practitioners to initiate media 鈥渇asts鈥, ask for help, take frequent breaks from work, employ self-care activities, and increase their awareness of symptoms (Cullen et al., 2020). Strategies to maintain stability and psychological well-being during in an indefinite pandemic will provide mental health providers with support to sustain ongoing external distress while preventing internal self-neglect and deterioration.

COVID-19 and African Americans

Underrepresented groups are contracting COVID-19 more frequently and dying from the virus disproportionately. African Americans, in particular are overrepresented among reported coronavirus cases, hospitalizations and deaths (Milam et al., 2020; Yancy, 2020). Currently, the infection rate for predominantly Black counties in the United States is three times higher than for predominantly White counties, and the death rate is six times higher (Yancy, 2020). There are a multitude of theories accounting for the discrepancies, including health comorbidities, health risk factors, environmental elements (densely populated, lower socioeconomic status communities with the potential for increased contact and challenging social distancing), minimal or no health coverage (underinsured or uninsured), lower rates of testing, employment in essential workforce positions, and refusal to utilize 鈥渄o not resuscitate鈥 directives; however, more research is necessary to provide targeted equitable resources for the Black community (Milam et al., 2020; Shah, Sachdeva, & Dodiuk-Gad, 2020; Yancy, 2020).

In addition to disproportionality, African Americans are experiencing disparities in care regarding COVID-19. Yancy (2020) cites privilege as a primary factor in maintaining disproportionality and disparities. Furloughs from work, adequate wi-fi, virtual social events, telecommuting with sufficient space, access to healthy foods, and the ability to maintain social distance while working from home are all privileges that are promoted as expectations to avoid contamination, but are not always accessible in Black and Brown communities (Yancy, 2020). Another contributor may be implicit bias. Implicit biases are unconscious preferences for or against people based on presumed identity factors (typically race, gender, age and more) and may responsible for much of the disproportionality and disparities (Milam et al., 2020). In 2018, a systematic review of studies assessing implicit bias in health care providers revealed three substantial themes: a) the majority of health care providers demonstrated bias against African Americans; b) Black health care providers demonstrated lower implicit biases overall; and c) providers with stronger implicit biases were associated with worse client-provider communication (Maina, Belton, Ginzberg, Singh, & Johnson, 2018; Milam et al., 2020). Consideration of privilege and implicit bias allows for a more nuanced understanding of the coronavirus disparities while illuminating the larger social problem of healthcare inequities resulting from systemic racism.

2020 civil unrest 鈥 the dual pandemic

The high-profile deaths of George Floyd, Ahmad Arbery, and Breonna Taylor increased public awareness of the police brutality of Black Americans in the United States. While grappling with the weight of the COVID-19 pandemic, the savagery of the violent murders appeared to substantively impact the world. The killings of unarmed African Americans have led to racial tension, global protests, and exhaustive media coverage (Dukes & Kahn, 2017). Although the recent deaths may appear novel, African Americans have been dying at the hands of law enforcement for as long as we have been in this country. Black Americans are three times more likely than White Americans to be killed by the police and five times more likely to be killed unarmed, accounting for more than 40% of all police killings nationwide (Bor, Venkataramani, Williams, & Tsai, 2018). In the United States, people of color are more likely to experience both threats of and actual use of force in interactions with the police, and more likely to die at the hands of the police or while in police custody (Dukes & Kahn, 2017). Moreover, police officers who have killed unarmed African Americans are rarely charged or prosecuted. The media coverage of these deaths heightened the vulnerability of Black Americans; not only were African Americans dying at a disproportionate rate by COVID-19, but they were also being systemically targeted and murdered by the organization designed to 鈥減rotect and serve.鈥

Police killings impact their victims and their families, but also the mental health of Black Americans watching the murders on television and social media. Bor et al. (2018) found that viewing multiple media sources鈥 coverage of the consistent deaths of African Americans was associated with poor mental health among other Black Americans, resulting in increased awareness of systemic racism and inequities, fear of victimization, greater mortality expectations, increased vigilance, decreased trust in social organizations, anger, activation of previous trauma and communal bereavement (Bor et al., 2018, p. 302). These symptoms are directly correlated with psychological distress, major depression, lower levels of happiness and decreased life satisfaction (Dukes & Kahn, 2017). There are significant consequences associated with exposure to police violence and discrimination. The population mental health burden from police killings of African Americans has been estimated to be responsible for approximately 75 million poor mental health days among Black Americans (Bor et al., 2018, p. 308). However, police brutality and murder cannot be understood without acknowledgment of the historical trauma associated with government sanctioned violence against Black people. Historically, racial disparities within law enforcement and the criminal justice system have been used to terrorize, dehumanize and subjugate Black Americans, resulting in structural racism that places a lower value on Black lives (Bor et al., 2018). As a result, Black people have more negative attitudes toward police than other racial groups, and experience a plethora of emotional, cognitive and behavioral reactions that directly impact mental health (Dukes & Kahn, 2017). In this context, disproportionate use of (lethal and non-lethal) force toward African Americans by police is less of a new phenomenon and more of an issue of structural racism that has serious mental health, public health and political implications.

Racialized trauma

Viewing incessant coverage of police lynchings on media platforms is perceived by many Black and Indigenous People of Color (BIPOC) as racial trauma. Racial trauma, or race based stress, is defined as events of danger related to real or perceived experiences of racial discrimination, and include threats of harm and injury, humiliating and shaming events, and witnessing harm to other BIPOC (Bor et al., 2018; Carter, 2007; Comas-D铆az, Hall, & Neville, 2019). Police violence can be understood through a racial trauma framework that posits that vicarious traumatization from consistent media depiction of the murders of Black Americans, the invisibility of historical trauma, intersectional oppression and ongoing racial microaggressions create a cumulative racial trauma that is scarring and dehumanizing (Comas-D铆az et al., 2019). Racial trauma causes psychological distress and physiological effects. Many of these symptoms, including hypervigilance, flashbacks, nightmares, avoidance, somatic experiences (such as heart palpitations or headaches), and suspiciousness are consistent with posttraumatic stress disorder (PTSD) (Comas-D铆az et al., 2019). Despite the lack of representation of racism in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), racist events and experiences may function as traumatic catalysts and serve as exacerbating stressors even when there is no evidence of actual threat to life (Helms, Nicolas, & Green, 2010). Helms et al. (2010)refer to this type of trauma as vicarious cataclysmic events, described as witnessing of identity group others鈥 experiences of severe racism (p. 68). Thus, the dual pandemic experience of global exposure, ongoing systemic targeting, increased vulnerability, quarantined isolation, and societal devaluation creates a considerable emotional burden and a trauma catalyst for many African Americans that negatively impacts their mental health and well-being.

Methods

Autoethnography

Autoethnography methodology is a continuum of ethnographic research approaches that seek to interpret, describe, explore, analyze and enhance phenomena in fieldwork research studies 鈥 it is akin to case studies (Anderson, 2006). However, this form of methodology ventures away from the traditional ethnographic research in that, (1) the researcher鈥檚 intrapersonal perspective is the focus of the research; (2) it evolves through a reflexive process that occurs through creative writing and other arts-based techniques; and (3) it maintains that transformation occurs through active engagement with the material, rather than from generating external discussions and generalizations in a broader context (Chang, 2008). The authors sought to immerse themselves in a reflexive process as well as a position as a scholar-clinician-practitioner. This encourages the authors to be agile enough to vacillate between various professional, personal and cultural realities simultaneously and honor multiple experiences. The authors believe that this method provides more of a personal context and illuminates how we authentically express ourselves in our multi-dimensional intersectional experiences of the world around us.

Positionality

Lipscomb, A. Over the past 15聽years working in community-based mental health agencies (in Los Angeles and Greater Los Angeles County area), I have seen the impact of police induced trauma on Black people. My identity as a Black male, clinician and researcher serves as a unique catalyst in positioning myself to explore this new era that we are living in with COVID-19 and civil unrest due to racial injustices being committed on Black bodies across the United States. I have spent the past decade and a half learning and receiving clinical training on providing anti-oppressive and affirming mental health treatment to Black families of African descent in the United States. I have studied extensively the psychological effects of trauma and oppression on the African American/Black community. I have collaborated with many Black familial survivors of traumatic grief and loss experiences (i.e. within their family systems and often times within the larger community). It from this lived experience and lens that I bring to this body of work to gain a deeper understanding utilizing critical self- reflection on ways to navigate the times that I am currently living in as a Black male clinician and academician. The goal for me is to not be broken but rather brave enough to take a multi-dimensional look at surviving these times.

Ashley, W. I am a Black woman, with a biracial heritage. Others鈥 opinions of my identity provoke questions regarding my credibility as a woman of color. I have spent 50聽years of life and 25聽years as a social worker learning to trust myself and letting go of justifying my Blackness and learning how to lead with my lived experiences rather than external cultural expectations. My identity positions me well to connect with the universal experience of not belonging, of being a cultural imposter, of not feeling enough. Colorism, racism, sexism, and police brutality are all real elements of my history that reside in my body and impact my relationships. My clinical practice, scholarship, teaching and research are focused on connection, validation and healing within an anti-racist context. I am passionate about supporting identities, addressing trauma, acknowledging losses, navigating relationships, managing oppression and developing vulnerability with my clients, my students and my colleagues. My training has come from my personal experiences, years of working with White, BIPOC and multi-racial communities, and years of academic study. My research has the primary objective of empowering the invisible identities that are typically not represented in traditional research, and to have their narratives, stories and experiences included in academic literature. I am passionate about changing the climate of our individual, interpersonal, institutional and political systems to one of equity and social justice. And for Black lives to really matter.

Auto-reflections

Lipscomb, A. The day was May 27th, 2020 and I woke up nervous and afraid, afraid to go out 鈥 afraid to breathe due to George Floyd鈥檚 murder by law enforcement two days prior. I had five psychotherapy sessions scheduled that day and I could not move. It was difficult for me to even think of having sessions that day given the emotional state I was in. I decided to reschedule three out of the five clients scheduled for that day. The first client I saw was Black, and it was clear they needed to talk about George Floyd鈥檚 murder by law enforcement officers. The following session was with a White male client in his early 30s. During the session 鈥 toward the middle of the session he said, 鈥淚 just wanted to say how it really sucks with everything going on with Black being murdered by police 鈥 it鈥檚 not right.鈥 He proceeded to say, 鈥淚 can鈥檛 even imagine what it must be like for you.鈥 At that moment I froze during our virtual session. While I understood what he meant and wanting to empathize with me as a Black male in the United States, it came across as sympathy and it 鈥渟ucks鈥 to be you. I was also concurrently receiving multiple e-mails and text messages from friends and colleagues checking in and wanting to support, learn and be an ally for Black people. Albeit positive, it still began to be overwhelming. Following the sessions, I needed to take a break and was feeling overwhelmed with emotions related to the weight of the racialized trauma. Within the next week, my mood shifted slightly when I started to witness the amount of people in the streets protesting in solidarity with Black Lives Matter. It was refreshing to see a coalition of allyship support. The day had finally come when across not just the United States but around the world folks were actively and unapologetically demanding justice for Black bodies. I thought to myself, 鈥淔inally people are seeing what has been the plight of Black folks for centuries.鈥 I have to admit that there were some days when I felt frustration that it had to come to witnessing a Black man dying with a police officer鈥檚 knee on his neck for 8聽minutes and 46聽seconds for there to be action and global responsiveness. So much was being thrown at me and my way that I could not hold it all together; I finally decided to reach out to my own mental health therapist for psychological care. Thankfully, my therapist was humble, supportive, affirming and validating. The session I had with her was both restorative and healing. I able to center my psychological and emotional experiences with all that was going on 鈥 unpacking the pandemic and most importantly to me 鈥 the racial injustices experienced by Black people.

Ashley, W. If I am honest, I admit that I generally avoid the news. My jobs providing therapy in my practice multiple hours in the day, teaching anxious new clinicians, maintaining a marriage and parenting my two kids are about as much as I can handle on a daily basis; and the pandemic has rendered my ability to generate the space I need to adaptively cope and recover nonexistent. Additionally, the emotional labor of watching media coverage of racialized atrocities and the ongoing trauma of the dominant society鈥檚 attempts to blame Black people for the violence is sickening and overwhelming, so I keep my distance. On May 25, 2020, I heard about the death of George Floyd through one of my Black clients. My initial response was to contain my internal discomfort and to support the outrage and hopelessness of my client. On my lunch break, I scrolled through social media and news coverage to read the reports. I purposely didn鈥檛 watch the video- when Philando Castile was murdered by law enforcement in 2016, I was sick for several days after watching the video that I couldn鈥檛 stop watching. I went back into the rest of my sessions, both that day and the next couple of days in a fog of numbness. I was able to talk about the murders with clients and support their reactions, but I was aware that I wasn鈥檛 allowing myself the space to feel my own feelings. When my 14-year-old son brought up the murder at dinner the next day, I broke down in tears, realizing why I had compartmentalized my feelings. Having to discuss WHY this can happen to my children made me aware of how terrified I was for myself, for my husband and for them. That night I watched the video, and wept again. In the next few weeks, acknowledgment of the deaths of Ahmad Arbery and Breonna Taylor were added to the growing levels of rage and consternation. I noticed distinct differences in how my Black clients addressed their feelings versus my White clients. When my Black clients would bring up their distress, their hurt and their fear, it came up early in the sessions. They were vulnerable, intense and activated. They struggled with the onslaught of support from White allies and felt frustration that these deaths were experienced as novel, while our reality reflects an extensive history of similar stories. With these clients, I wanted to drop into my own feelings and commiserate. I was aware this was truly a problem I had no ability to fix. It was challenging to stay clinically grounded, to acknowledge how this trauma triggered previous racialized and other traumas, and to support them in identifying adaptive coping strategies. With my White clients, they were tentative in bringing it up. They asked me how I was doing, in vague and general terms. When they did address the civil unrest, they were clearly uncomfortable, making jokes about their privilege or minimizing their perspective. I struggled not to take care of them; not to tell them I was fine, because I wasn鈥檛. I also wanted to initiate dialogue about the deaths and to push them to be direct in what they were asking about. It seemed impossible to talk about anything else in the context of both COVID-19 and the murders. I wanted to encourage them to stop worrying about me and worry about their own allyship and advocacy. I am pretty proud of how I navigated these challenges. I utilized my own therapist as a source of support, I remained grounded in the clinical work and I allowed the process to move from reactivity to self-examination to strategizing. And I watched as my clients modeled for me how to effectively utilize therapy to grow, become empowered and initiate anti-racist actions.

Autoethnography themes

There were three salient themes that emerged from the narrative reflections provided by the clinicians 鈥 (a) feeling overwhelmed, afraid and soul wounding; (b) challenge with holding clinical space for African American/Black clients as a Black clinician; (c) and discomfort with White clients wanting to share their sentiments as it relates to the racial injustices(Figure 1). This information is useful in gaining insight as to the psychological and emotional plight of Black clinicians providing clinical services in a dual pandemic.

Black individuals: feeling over whelmed, afraid and soul wounding

It was apparent that being Black in America has had a profound impact on both of us. The feeling of being overwhelmed highlights the emotional burden of being Black bodied during these turbulent times. The emotional labor of racialization, consistently navigating stereotypes, implicit bias and ongoing oppression is heavy; managing this weight juxtaposed with the coronavirus pandemic, the isolation of quarantine and media portrayals of multiple murders results in overwhelming fatigue and wounds to the soul. We felt pressure to respond to friends, family, colleagues and clients, we wrestled with questioning if we were okay or not okay following the murders of Ahmad Arbery, Breonna Taylor and George Floyd, and wondered if we could vulnerable enough to admit it if we were not. Almost simultaneously, we asked ourselves what to do about it. Is there hope? Will we rise up? Will we do this individually or collectively as a community 鈥 or as a global society? Maintaining hope in the current socio-political climate in the context of a global disease pandemic was challenging, at best. At worst, we feared for ourselves, our children and our families.

Black clinicians working with Black clients: challenges with holding space for Black clients

We felt both fulfilled and emotionally drained in providing clinical spaces for Black clients to share their pain. There are no words to heal the pain of systemic racism, oppression and racialized trauma resulting from media coverage. Unique to this dual pandemic was the cultural and racial countertransference we experienced in providing clinical services to Black clients. We used the connection, the shared experiences and our own activation to inform our clinical lens during this time. There are no diagnostic criteria nor evidenced-based models that guide us as Black clinicians working with Black clients during these unique unprecedented times. We were able to utilize the shared therapist/client cultural and racial experience to co-create a collective understanding and validation around the pain experienced in the present day. Naming, expressing and honoring their truth without denying, questioning or ignoring their pain was clinically significant during these sessions. As a result, we observed our clients unpacking their defenses, which allowed us to see and validate their pain, and collaboratively identified strategies for connection, coping, safety and healing.

Black clinicians working with White clients: sharing sentiments around racial injustices

Black clinicians working with White clients in a context of racial injustice is a nuanced endeavor. As evidenced in the auto-ethnographies, White clients may struggle to even bring up these issues with Black therapists, for fear of saying the wrong thing, committing a microaggression or offending them with their perspective. This significantly impacts clinical efficacy; therapeutic space is best utilized when it is safe for unfiltered self-examination. However, this becomes complicated because in a culture seeped in White supremacy, White Americans need to be accountable for their power and privilege in society. It becomes thought-provoking to consider whether therapeutic spaces with Black therapists can accommodate White clients in authentically exploring their feelings around race without censorship.

Further, it is equally important to explore the response of the Black clinician to the White client struggling to address race-based content and dynamics. Racialization has primed Black people to protect themselves in relation to White emotion; thus, Black clinicians may need to examine their own responses to White vulnerability, discomfort or fragility, especially when directed toward them. The same level of fear internalized from viewing decades of police brutality and systemic racism is unconsciously a part of most Black Americans. Black clinicians must be aware of their own defaults with White clients, including humor, avoidance, disconnection, caretaking, rescuing or educating, which may have the undesired consequence of shutting down pathways to awareness, action and white accountability.

Discussion

Reflections from the auto-ethnographies suggest that the burden of navigating a dual pandemic while practicing clinical work can be emotionally exhausting and cumbersome for Black clinicians. Due to the unique sociopolitical history of race relations in the United States coupled with the racial injustices occurring in 2020, this can longer be glossed over as has been done in the past. Shifting from a position of not racist to one of anti-racism requires awareness, action and accountability. Ibram X. Kendi (2019) describes this shift as a 鈥渞adical choice requiring a radical reorientation of our consciousness鈥 (p. 23).

Within therapeutic spaces, Black therapists maintain power in their identities as therapists, while simultaneously identifying as members of potentially multiple historically oppressed groups. The findings from these auto-ethnographies suggest that this dynamic has a number of implications for the clinical work that Black therapists are providing during this time. According to Comas-D铆az and Jacobsen (1995), 鈥渋ntrapsychic dynamics, reality-based circumstances, and societal racial dynamics鈥 (p. 94) all have a profound impact on therapy. This supports the finding that both intra and inter-racial therapeutic relationships such as Black therapists working with White client(s) or Black therapists working with Black client(s) creates a unique nuanced dynamic during these times that must be explored. Black therapists, nor their Black clients can escape the pain and racialized trauma that result from witnessing the murders of unarmed Black Americans. However, White client acknowledgment and reactions to media depictions of racialized violence and systemic racism are unfamiliar and potentially destabilizing for Black clinicians. Thus, countertransference reactions to both Black and White clients is an essential consideration. Exploration of the meaning of COVID-19 and the racialized murders of unarmed African Americans from the clients鈥 perspective, and self-reflection regarding our own perspective is critical to unpacking individual responses to the dual pandemic (Helms et al., 2010). Further, self-examination and accountability promote containment and healing, allowing Black clinicians to be present for clients without activating the inherent powerlessness that comes from identities of marginalization and oppression. Clearly, Black therapists and their clients are trying to manage and navigate these times the best they know how.

Recommendations

We must start off by acknowledging that Black individuals cannot escape the racialized trauma inherent in witnessing the murders of unarmed Black Americans while also trying to stay safe, healthy and alive during a pandemic. This type of trauma is described as vicarious cataclysmic events (Helms et al., 2010). Despite the debilitating impact of racism-based trauma, being forced to reckon with the ills of our country rooted in White supremacy is helping Black Americans learn to unite as a community and larger society for equity and social justice. The key to managing the unknown nature of a dual pandemic is to allow oneself to feel without denying or ignoring their feelings. Black people are notoriously stoic (Watkins & Neighbors, 2007; Wyatt, 2008) which provides protection, but may also impede support and connection. Self-care practices for Black individuals must include centering themselves prior to centering anyone else. Allowing themselves space to grieve, cry or be afraid, and honoring those feelings is crucial to managing the emotional fatigue of the dual pandemic. Equally important is connecting with communities of support that ground, restore and heal Black people from the racial injustices that continue to take place in America. It is important to note that Black people can only heal as much as the larger society allows for them to; as long as injustices continue, Black individuals cannot fully heal.

Black therapists must practice self-care by balancing clinical work with personal life. While it is important to provide clinical services during this time 鈥 it is also crucial that Black therapists actively practice self-care, and know when to turn toward their support systems (i.e. family and community). The emotional labor of managing internal activation, supporting client containment, validation and growth, and navigating their own families is a recipe for burn out. The notion that it is possible to do it all and hold it all seamlessly does not promote wellbeing and clinical sustainability.

The current research illuminates the challenges of Black therapists providing clinical services in a dual pandemic. With regard to race, racial injustices and clinical work this study highlights that race plays a vital role in clinical spaces, and that Black therapists cannot avoid micro and macro concepts of race, privilege and racial injustices in therapy. Future studies might include examining the relationship between Black therapists and self-care practices during a racial crisis; explorations of race in teletherapy contexts with Black and White clients; and deeper examination of the nature and type of racist events that occur outside of therapy and how they present in clinical spaces with Black therapists.

Disclosure statement

No potential conflict of interest was reported by the authors.

    References

  • Anderson, L. (2006). Analytical autoethnography. Journal of Contemporary Ethnography , 35(4), 373395. doi:10.1177/0891241605280449 [Crossref], [Web of Science ®],聽
  • Bor, J. , Venkataramani, A. S. , Williams, D. R. , & Tsai, A. C. (2018). Police killings and their spillover effects on the mental health of Black Americans: A population-based, quasi-experimental study. The Lancet , 392(10144), 302310. doi:10.1016/S0140-6736(18)31130-9 [Crossref], [PubMed], [Web of Science ®],聽
  • Carter, R. T. (2007). Racism and psychological and emotional injury: Recognizing and assessing race-based traumatic stress. The Counseling Psychologist , 35(1), 13105. doi:10.1177/0011000006292033 [Crossref], [Web of Science ®],聽
  • Centers for Disease Control and Prevention . (2020, July 19). CDC health disparities & inequalities report (CHDIR) . Retrieved from
  • Chang, H. (2008). Autoethnography as method . Walnut Creek, CA: Left Coast.
  • Choi, K. R. , Heilemann, M. V. , Fauer, A. , & Mead, M. (2020). A second pandemic: Mental health spillover from the novel Coronavirus (COVID-19). Journal of the American Psychiatric Nurses Association , 1(4). doi:10.1177/1078390320919803 [Crossref],聽
  • Comas-D铆az, L. , Hall, G. N. , & Neville, H. A. (2019). Racial trauma: Theory, research, and healing: Introduction to the special issue. American Psychologist , 74(1), 1. doi:10.1037/amp0000442 [Crossref], [PubMed], [Web of Science ®],聽
  • Comas-D铆az, L. , & Jacobsen, F. M. (1995). The therapist of color and the white patient dyad: Contradictions and recognitions. Cultural Diversity and Mental Health , 1(2), 93106. doi:10.1037/1099-9809.1.2.93 [Crossref], [PubMed],聽
  • Cullen, W. , Gulati, G. , & Kelly, B. D. (2020). Mental health in the COVID-19 pandemic. QJM: An International Journal of Medicine , 113(5), 311312. doi:10.1093/qjmed/hcaa110 [Crossref], [PubMed], [Web of Science ®],聽
  • Dukes, K. N. , & Kahn, K. B. (2017). What social science research says about police violence against racial and ethnic minorities: Understanding the antecedents and consequences鈥攁n introduction. Journal of Social Issues , 73(4), 690700. doi:10.1111/josi.12242 [Crossref], [Web of Science ®],聽
  • Fiorillo, A. , & Gorwood, P. (2020). The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. European Psychiatry , 63(1), 12. doi:10.1192/j.eurpsy.2019.3 [Crossref], [PubMed], [Web of Science ®],聽
  • Helms, J. E. , Nicolas, G. , & Green, C. E. (2010). Racism and ethnoviolence as trauma: Enhancing professional training. Traumatology , 16(4), 5362. doi:10.1177/1534765610389595 [Crossref],聽
  • Kendi, I. X. (2019). How to be an antiracist . One world.
  • Kim, J. S. , & Choi, J. S. (2016). Factors influencing emergency nurses鈥 burnout during an outbreak of Middle East respiratory syndrome coronavirus in Korea. Asian Nursing Research , 10(4), 295299. doi:10.1016/j.anr.2016.10.002 [Crossref], [PubMed], [Web of Science ®],聽
  • Maina, I. W. , Belton, T. D. , Ginzberg, S. , Singh, A. , & Johnson, T. J. (2018). A decade of studying implicit racial/ethnic bias in healthcare providers using the implicit association test. Social Science & Medicine , 199, 219229. doi:10.1016/j.socscimed.2017.05.009 [Crossref], [PubMed], [Web of Science ®],聽
  • Milam, A. J. , Furr-Holden, D. , Edwards-Johnson, J. , Webb, B. , Patton, J. W., III , Ezekwemba, N. C. , 鈥 Simon, K. (2020). Are clinicians contributing to excess African American COVID-19 deaths? Unbeknownst to them, they may be. Health Equity , 4(1), 139141. doi:10.1089/heq.2020.0015 [Crossref], [PubMed],聽
  • National Alliance on Mental Illness . (2020). COVID-19 (coronavirus) information and resources . Retrieved from
  • Ornell, F. , Schuch, J. B. , Sordi, A. O. , & Kessler, F. H. P. (2020). 鈥淧andemic fear鈥 and COVID-19: Mental health burden and strategies. Brazilian Journal of Psychiatry , 42(3), 232235. doi:10.1590/1516-4446-2020-0008 [Crossref], [PubMed],聽
  • Pfefferbaum, B. , & North, C. S. (2020). Mental health and the COVID-19 pandemic. New England Journal of Medicine , 383(6), 510512. doi:10.1056/NEJMp2008017 [Crossref], [PubMed], [Web of Science ®],聽
  • Rajkumar, R. P. (2020). COVID-19 and mental health: A review of the existing literature. Asian Journal of Psychiatry , 52(102066), 102066. doi:10.1016/j.ajp.2020.102066 [Crossref], [PubMed],聽
  • Righy, C. , Rosa, R. G. , da Silva, R. T. A. , Kochhann, R. , Migliavaca, C. B. , Robinson, C. C. , 鈥 Falavigna, M. (2019). Prevalence of post-traumatic stress disorder symptoms in adult critical care survivors: A systematic review and meta-analysis. Critical Care , 23(1), 213. doi:10.1186/s13054-019-2489-3 [Crossref], [PubMed],聽
  • Shah, M. , Sachdeva, M. , & Dodiuk-Gad, R. P. (2020). COVID-19 and racial disparities. Journal of the American Academy of Dermatology , 83(1), e35. doi:10.1016/j.jaad.2020.04.046 [Crossref], [PubMed], [Web of Science ®],聽
  • Smith, A. C. , Thomas, E. , Snoswell, C. L. , Haydon, H. , Mehrotra, A. , Clemenson, J. , & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of Telemedicine and Telecare , 26(5), 309313. Advance online publication. doi:10.1177/1357633X20916567 [Crossref], [PubMed], [Web of Science ®],聽
  • Tsamakis, K. , Rizos, E. , Manolis, A. J. , Chaidou, S. , Kympouropoulos, S. , Spartalis, E. , 鈥 Triantafyllis, A. S. (2020). COVID-19 pandemic and its impact on mental health of healthcare professionals. Experimental and Therapeutic Medicine , 19, 34513453.[PubMed], [Web of Science ®],聽
  • Wang, S. , Meeker, J. W. , Perkins, A. J. , Gao, S. , Khan, S. H. , Sigua, N. L. , 鈥 Khan, B. A. (2019). Psychiatric symptoms and their association with sleep disturbances in intensive care unit survivors. International Journal of General Medicine , 12, 125. doi:10.2147/IJGM.S193084 [Crossref], [PubMed], [Web of Science ®],聽
  • Watkins, D. C. , & Neighbors, H. W. (2007). An initial exploration of what 鈥榤ental health鈥檓eans to young black men. Journal of Men鈥檚 Health and Gender , 4(3), 271282. doi:10.1016/j.jmhg.2007.06.006 [Crossref],聽
  • Wyatt, J. (2008). Patricia Hill Collins鈥檚 Black sexual politics and the genealogy of the Strong Black Woman. Studies in Gender and Sexuality , 9(1), 5267. doi:10.1080/15240650701759516 [Taylor & Francis Online],聽
  • Yancy, C. W. (2020). COVID-19 and African Americans. JAMA , 323(19), 1891. doi:10.1001/jama.2020.6548 [Crossref], [PubMed], [Web of Science ®],聽