To say that 2020 has been a “hard” year is almost facetious. The truth of the matter is, for many people 2020 has been a series of struggles at the hands of two pandemics, one that was novel and the other that was not. In being frank, 2020 was arguably disproportionately more difficult for Black people than any other group. African Americans in the United States had (and likely continue to have) more infections, hospitalizations, and subsequent deaths from COVID-19 than any other racial/ethnic group (Milam et al., 2020; Yancy, 2020). Predominantly Black communities had a three times higher infection rate and a six times higher death rate from COVID-19 than predominantly White communities (Yancy, 2020). Among the explanations accounting for these disparate outcomes is that of the second pandemic affecting 2020: structural racism.
One of the biggest factors affecting COVID-19 outcomes is access to healthcare, which is lower among minority groups (Laughland, 2020). About 27 percent of Black Americans live below the poverty level compared to only about 10.8 percent of non-Hispanic Whites (U.S. Census Bureau, 2016). Feasibly, poverty can be linked to overcrowding, poorer living accommodations, and lowered access to care. These are all factors that have historical roots in the systemic oppression of African Americans. Concurrent with its detrimental effects in conjunction with COVID-19, the pandemic of 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.
Among Black people, these dueling pandemics had the potential to contribute to adverse mental health outcomes. Negative mental health implications of living throughout the COVID-19 pandemic include higher susceptibility for triggered states of depression, anxiety, and panic attacks among those with a history of mental illness (Tsamakis et al., 2020), along with isolation, loneliness, anxiety, and potential grief from losing a loved one (Choi et al., 2020). Consistent with structural racism, Black Americans could be struggling with effects of racialized trauma. Racialized trauma, defined loosely as danger related to real or perceived racial discrimination, has been found to present in a manner consistent with Post-Traumatic Stress Disorder (i.e. avoidance, hypervigilance, flashbacks)(Comas-Díaz et al., 2019).
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 (2020) 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 iterate 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 Psychology doctoral trainee, the trends Lipscomb and Ashley (2020) 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, which is a sentiment shared by Lipscomb and Ashley. 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 done better at reconciling, but it at times felt like a hard barrier to overcome, particularly during the late Summer months.
In concluding this blog, I leave a few takeaways and a quote I was particularly moved by from the Lipscomb and Ashley (2020) article.
- For Black clinicians: It is important to create your own spaces for self-reflection and emoting. Both Lipscomb and Ashley, in their narratives, noted having their own mental health professionals they could engage with to process their feelings.
- In working with Black clients: As noted by Lipscomb and Ashley (2020), “there are no words to heal the pain of systemic racism, oppression, and racialized trauma…”. 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: 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” (Lipscomb & Ashley, 2020).
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. https://doi.org/10.1080/00377317.2020.1834489
- As clinicians, how has your work with Black clients been affected by cultural implications of COVID-19 and racial injustice in 2020?
- For Black mental health workers: how have you been engaging in self-care and self-kindness during 2020 with the dual pandemics of COVID-19 and racial injustice?
- How can mental health institutions and training programs better support Black clinicians and mental health trainees?
- For non-Black clinical psychologists, how have you been engaging with colleagues of color, particularly Black colleagues, in light of the dual pandemics of 2020? Have you played a more active role in reaching out to colleagues of color, or taken a step back? Why?
About the Author
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
Comas-Díaz, 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
Laughland, O. (2020, August 5). ‘Death by structural poverty’: US south struggles against Covid-19. The Guardian. https://www.theguardian.com/world/2020/aug/05/us-deep-south-racism-poverty-fuel-coronavirus-pandemic
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
Milam, A. J., Furr-Holden, D., Edwards-Johnson, J., Webb, B., Patton, J. W., III, Ezekwemba, N. C., Porter, L., Davis, T., Chukwurah, M., Webb, A. J., Simon, K., Franck, G., Anthony, J., Onuoha, G., Brown, I. M., Carson, J. T., & Stephens, B. C. (2020). Are clinicians contributing to excess African American COVID-19 deaths? Unbeknownst to them, they may be. Health Equity, 4, 139–141. doi:10.1089/heq.2020.0015
Tsamakis, K., Rizos, E., Manolis, A. J., Chaidou, S., Kympouropoulos, S., Spartalis, E., Spandidos, D. A., Tsiptsios, D., & Triantafyllis, A. S. (2020). COVID-19 pandemic and its impact on mental health of health- care professionals. Experimental and Therapeutic Medicine, 19, 3451–3453.
United States Census Bureau. (2016a). Income and poverty in the United States: 2015. Retrieved from https://www.census.gov/library/publications/2016/demo/p60-256.html
Yancy, C. W. (2020). COVID-19 and African Americans. JAMA, 323(19), 1891. doi:10.1001/ jama.2020.6548