Being Black and a Clinician During 2020: A Trainee’s Perspective By Danielle McDuffie, M.A on 4/9/21 - 1:26 PM

It is now the year 2021. Vaccines have been released. People are getting vaccinated. And yet, the death toll from COVID is still staggeringly high, particularly in the United States. 2020 was a year that humbled many of us, and as a Black graduate psychology trainee, I was no exception. To say that 2020 was a “hard” year is almost facetious. The truth of the matter is, for many people, particularly those who look like me, 2020 was a series of struggles at the hands of two pandemics, one that was novel and the other that was not. To be frank, 2020 was arguably disproportionately more difficult for Black people than any other group. Black people living in the United States were hit harder than any other group by COVID-19 (1). If this were not bad enough, the main culprit of these disparities was systemic racism. While a more thorough explanation of the factors attributable to systemic racism that made Black people more susceptible to COVID-19 infections and subsequent deaths is not within the scope of this piece, it is important to note that factors such as minimized access to healthcare, food deserts, and results of housing inequality over the years contributed to this trend.

Along with the detrimental effects of systemic racism and COVID-19, the pandemic of systemic and structural racism also manifested through televised, media-streamed reports and depictions of brutality against Black people. Names and stories of individuals such as George Floyd, Ahmaud Arbery, and Breonna Taylor (among others) incited global unrest and placed a spotlight on the undervaluing of Black lives. As a Black person living in America, this was not surprising. And yet, I’d be dishonest if I said that a video of a Black man crying for his mother with a knee on his back didn’t take my own breath away.

Considering the totality of these factors, the question becomes: where does this leave Black clinicians? I identify as an African American woman, and I am currently living, learning, and working in a part of the country that has not always been welcoming or kind to people who look like me. Throughout my training as a clinical psychology graduate student, many of the training experiences I have valued the most were when working with racial/ethnic minority clients, particularly those identifying as racially Black. For me, it was interesting to see the nuances of the Black lived experience manifesting through my clients. However, 2020 very explicitly placed a spotlight on the struggles associated with these lived experiences.

In their candid ethnography-based article, Lipscomb and Ashley (2) provided a direct look into the struggles of working as a Black clinician in 2020. While it is not within the scope of this blog to give the totality of their narratives, a few important points stuck out: 1) as Black clinicians working in 2020, the authors felt overwhelmed, 2) the authors felt challenged to mitigate countertransference in providing space to validate the feelings of their Black clients while managing their own feelings, and 3) the authors felt uncomfortable at times with their White clients’ desires to share their sentiments regarding the racial injustices of 2020. While it would be unrealistic to insinuate that these authors or myself know and can speak to the lived experience of all Black clinicians working during 2020, I feel a commonality between my own experiences and those of the authors.

As a clinical doctoral trainee, the trends Lipscomb and Ashley found amongst themselves almost feel exacerbated within me. As many of the readers of this blog might know, operating as a graduate student trainee is often plagued by holding opposing positions. For our clients, we are regarded as “authorities” on mental health, though we are only students, learners, and supervisees in the eyes of our supervisors. We are encouraged to develop and cultivate our professional autonomy and identities, but are also frequently and subtly (or sometimes not subtly) reminded of the hierarchical structure of higher education. As a Black graduate student trainee, these juxtapositions often feel jarring and have felt increasingly dissonant throughout 2020, as civil unrest and health care disparities have become blindingly apparent. Admittedly, I resonate very strongly with both the COVID-19 and racial injustice pandemics. To plainly illustrate this point, I faced the unfortunate reality of losing my grandmother on the same day in May that the story of George Floyd went viral.

At the time of my grandmother’s passing, I only shared the news with a limited number of faculty within my program, but, as things tend to do, the news spread. Whereas faculty members and some student colleagues were reaching out to me with condolences for my grandmother, hours later they were contacting me again with gingerly worded messages attempting to lend support in the wake of the civil unrest following George Floyd’s murder. While well intentioned, the onslaught of messages felt emotionally, mentally, and psychologically overwhelming. The dual pandemics also affected me as a Black trainee in my clinical work. With my Black clients, I struggled with allowing them the space to articulate their hurt, pain, and fear, while also validating them and not allowing my own feelings to seep into my clinical work. This is something that I have since become better at reconciling, but it at times felt like a hard barrier to overcome, particularly during the late summer months.

I have a client with whom I have been working for about two years. She also is a young Black woman, and we have found throughout our work that we tend to be extremely aligned personality-wise. After my grandmother died this past summer, I took two weeks to return home and be with my mother, who after the death of my grandmother had just lost her last remaining parent. What this meant is that when my client was struggling with the fallout from the death of George Floyd, I wasn’t there. When I eventually returned, despite our having a treatment goal that we were working on, I entered the virtual session (another thanks to 2020) and could see that she was visibly distressed. She began speaking about the topics we’d listed on our treatment plan, and I responded by gently stopping her and asking if she needed the space to just be Black and “feel.” In that moment, the client visibly deflated and became emotional. For 50 minutes, we spent the session with me listening and providing affirmation. I did not try to guide the session. While I’ve been taught that guided processing is an often-effective therapy tool, I did nothing of the sort. I let the client be Black, in a space with another Black woman who intimately could understand and validate what she was feeling. I won’t pretend I’m not potentially biased, but I’d argue that session was one of the most impactful sessions I have had with that client in our two years working together.

In concluding this blog, I leave a few takeaways for fellow clinicians and a quote I was particularly moved by from the Lipscomb and Ashley article.
  • For Black clinicians: It is important to create your own spaces for self-reflection and emoting. This could look like having your own mental health professionals you can engage with to process your feelings (I have one, and let me tell you, that level of being able to just “be” is unmatched).
  • In working with Black clients: As noted by Lipscomb and Ashley, “there are no words to heal the pain of systemic racism, oppression, and racialized trauma…” (2). Be kind, graceful, and validating of the lived experiences of Black people you might be professionally engaging with.
  • In working with majority group clients who might want to discuss racial injustice: One of the hallmarks of effective therapy is creating a safe therapeutic space. Fear of making mistakes, expressing microaggressions, or in some other way making blunders when discussing racial injustice could impact the ability for White clients to engage and benefit from therapy. Considerations should be made to transparently, directly, and yet compassionately, address these topics.
  • For Black trainees: Give yourself grace. Graduate school is often an isolating experience for Black trainees. Being one of the only Black people in a field that prides itself on empathy and emotional intelligence is often a hard feat, particularly during times of civil unrest. Take time to engage with your communities of support, and don’t feel bad about taking breaks from engaging in sympathies expressed by majority group colleagues and faculty.
  • For majority group individuals engaging with Black clients, trainees, clinicians, and/or colleagues: Validate. Don’t try to assuage guilt or get caught up in “saying the right thing.” Listen and affirm. Also understand that while your attention might be uniquely piqued to race issues in 2020, for Black people and other people of color, racial injustice is a generational lived reality. Your current sentiments are appreciated, but continued engagement and investment on your part to these matters would be appreciated even more.
  • For the field at large: There are no evidence-based models, manuals, or diagnostic criteria available to guide work with Black clients living through COVID-19 and exacerbated racial injustice. This places even greater importance on the role of therapists of color during these times and highlights the notion that work should be done to recruit, acquire, and retain more therapists of color moving forward.

“…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” (2).


Reference
 

(1) Yancy, C. W. (2020). COVID-19 and African Americans. JAMA, 323(19), 1891. doi:10.1001/ jama.2020.6548

(2) Lipscomb, A. E., & Ashley, W. (2020). Surviving being Black and a clinician during a dual pandemic: Personal and professional challenges in a disease and racial crisis. Smith College Studies in Social Work, 90, 221-236. doi: 10.1080/00377317.2020.1834489 


File under: The Art of Psychotherapy, COVID-19 Blogs