Importance of Addressing Internalized Racism in Clinical Practice (SCP Diversity Committee)

Racism against Black Americans has a long history in the United States, but it is getting worldwide attention due to recent tragedies, including the death of George Floyd at the hands of the police. Psychologists, businesses, and the government have all responded to the current movement to address racism. The public responses have been focused on overt racism that is visible, including discriminatory hiring/promotion practices and re-occurring police brutality, but ignore more subtle forms of racism including internalized racism. Internalized racism occurs when a racially marginalized group believes the negative stereotypes and labels placed upon them from the majority.

Clinical psychology is one of the few specialties that can directly address internalized racism, but overt racism tends to be the focus in clinical practice. Psychologists are increasingly in tune with many microaggressions that are experienced daily by their Black patients and the impact on their well-being (Wong et al., 2014). Psychologists’ strategies for intervention are typically focused on external racism as if racism is a disease that solely affects an individual from external events (e.g., withheld opportunities due to discrimination). However, it is important to also realize that racism can be internalized (e.g., believing one is less qualified or deserving based on his/her race). This internalized racism is sometimes ignored as a potential problem or is simply not realized. This is because systemic racism is pervasive in one’s daily life and normalized by the environment so that one can develop racist views of themselves that continue to degrade one’s humanity.

Recently, Gale et al. (2020) published a meta-analysis of 29 studies on the impact of internalized racism on health-related outcomes. Internalized racism experienced by Black Americans has a direct association with poor mental health, including depression and anxiety, and physical health outcomes, including obesity and hypertension. Black Americans are taught about health, beauty, professionalism, decorum, and inherent self-value from a Eurocentric perspective, all of which can be reinforced by their peers, their family, society, marketing, employers, and even mental health professionals, including psychologists. Gale et al. (2020) advocated for psychologists to assess the level and salience of internalized racism so that it can be addressed in session. They hypothesized that the physical health of people of color may be impacted by their mental health and sense of agency to operate outside of the imposed stereotypes upon their race/ethnicity. Gale et al. (2020) encouraged psychologists to focus on healthy racial development when working with people of color and be involved in policy development to affect change in the systems that perpetuate internalized racism. In session, psychologists should take notice of negative self-perceptions and beliefs about the person’s inherent value. Psychologists can help patients understand the root of these beliefs in order to help shape positive and lasting change.

Main Points

  • Internalized racism can be subtle but may have a negative impact on our patient’s mental health.
  • Internalized racism may affect our patients’ self-perception, self-esteem, and daily stress.
  • Addressing manifestations of internalized racism in therapy and helping the patient define their own value has the potential to reduce or even eliminate internalized racism.

Discussion Questions

  • What potential examples of internalized racism have you observed in your patients?
  • What impact has internalized racism had on your patients’ daily stressors?
  • Pick a characteristic of yourself of which you internalized the stigma imposed by society and examine how it affects your personal experience and behaviors.

About The Author

Sheehan D. Fisher, PhD is an Assistant Professor and clinical psychologist at Northwestern University. His research focuses on perinatal mental health, with the inclusion of father’s mental health and contribution to the family. He is an alumni of the Chicago Urban League’s IMPACT Leadership Program that trains Black leaders to support their community and Northwestern University Change Makers program that teaches leaders to create change for inclusion in their institution.

References Cited

Gale, Michael M., et al. “A Meta-Analysis of the Relationship Between Internalized Racial Oppression and Health-Related Outcomes.” The Counseling Psychologist 48.4 (2020): 498-525.

Wong, G., Derthick, A. O., David, E. J. R., Saw, A., & Okazaki, S. (2014). The what, the why, and the how: A review of racial microaggressions research in psychology. Race and social problems, 6(2), 181-200.

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