Healing Requires Recognition:
The Case for Race-Based Traumatic Stress
California State University, Long Beach
Race-based traumatic stress has been studied in the literature under various names
including but not limited to insidious trauma, intergenerational trauma, racist incident–
based trauma, psychological trauma, and racism. This article reviews and analyzes R.
T. Carter’s article in this issue. The author underscores and reacts to the trauma of
racism as discussed in Carter’s article, and also highlights efforts that should be
directed to racist incident–based trauma counseling. Counselors have to be trained to
effectively conduct assessment and interventions with clients who have been victimized
by race-based traumas. In addition, counselors should be aware that intersecting iden-
tities can result in multiple traumas or forms of oppression, such as 1 client experi-
encing racism, sexism, poverty, and heterosexism. While it is important to study the
dynamics of race-based traumatic stress within the United States, as Carter compre-
hensively does, it is also essential for counselors to examine and respond to race-based
traumatic stress internationally.
In his in-depth Major Contribution, Carter (2007 [this issue]) explains
the ways in which racism can be a source of stress, trauma, and emotional
injury. For counselors to effectively address race-based traumatic stress,
they must first be educated and trained to recognize and acknowledge it
(Bryant-Davis & Ocampo, in press; Carter, 2007; Sue & Sue, 2003). Race-
based traumatic stress has been called by various names including, but not
limited to, societal trauma, intergenerational trauma, racist incident–based
trauma, insidious trauma, psychological trauma, emotional abusiveness,
and racism (Bryant-Davis & Ocampo, 2005; Carter, 2007; Carter & Helms,
2002; Daniel, 2000; Loo et al., 2001; Root, 1992; Sanchez-Hucles, 1998;
Wyatt, 1990). Race-based traumatic stress can be defined as (a) an emo-
tional injury that is motivated by hate or fear of a person or group of people
as a result of their race; (b) a racially motivated stressor that overwhelms a
person’s capacity to cope; (c) a racially motivated, interpersonal severe
stressor that causes bodily harm or threatens one’s life integrity; or (d) a
severe interpersonal or institutional stressor motivated by racism that
Correspondence concerning this article should addressed to Thema Bryant-Davis, California
State University, Counseling Psychology, 1250 Bellflower Boulevard, Long Beach, CA
THE COUNSELING PSYCHOLOGIST, Vol. 35 No. 1, January 2007 135-143
© 2007 by the Division of Counseling Psychology.
causes fear, helplessness, or horror (Bryant-Davis & Ocampo, 2005; Carter,
2007; Loo et al., 2001). To build on the arguments raised by Carter, this
reaction article will examine the need for (a) counselor training on race-
based trauma, (b) recognition of the parallels between posttraumatic stress
disorder (PTSD) and race-based trauma, (c) validation of a separate cate-
gory for race-based trauma, (d) examination of racism as an additional
trauma for survivors of other forms of trauma, (e) cultural competent
assessment and intervention for race-based traumatic stress, (f) acknowl-
edgement of the intersection between race-based trauma and other forms of
societal traumas, and (g) the need to extend psychologists’ lens to include
international cases of race-based trauma.
KEY COMPONENTS FOR COUNSELOR TRAINING
Carter (2007) notes that all counselors, including counselors in training
and those who entered the field prior to cultural competence training
requirements, need to receive education on race-based traumatic stress.
This education needs to include definitions of race, racism, and race-based
traumatic stress, as well as assessment needs, effects, and intervention
strategies for race-based traumatic stress (Bryant-Davis & Ocampo, in
press). Education on cultural competence needs to include not only self-
awareness, knowledge of cultural traditions, and skills for culturally appro-
priate interventions, but also an understanding of power, privilege, and
racial oppression (Sue & Sue, 2003). A grasp of these concepts is critical to
a counselor’s ability to recognize, acknowledge, and address race-based
ADDRESSING FEAR OF PATHOLOGY
BASED ON PTSD AFFILIATION
In his Major Contribution, Carter (2007) and other scholars (Bryant-
Davis & Ocampo, 2005) have noted some resistance to an association
between racist incident–based trauma and PTSD for multiple reasons. One
of the concerns is that a PTSD diagnosis will lead to victim blaming and
pathologizing (Carter, 2007). It is important to note the following: (a) PTSD
is one of only a few diagnoses that by definition is precipitated by an event (a
traumatic experience) versus other diagnoses such as depression and anxiety;
(b) no one who experiences a trauma should be pathologized—postracism
136 THE COUNSELING PSYCHOLOGIST / January 2007
distress is a normal response to an abnormal experience or a sane response to
an insane stressor (Greene, 2004); and (c) calling a trauma by another word
such as injury will not prevent those who seek to blame victims from blaming
victims; therefore, avoiding an association with the concept of PTSD does
not truly address the problem. Only education, prevention, intervention, and
justice can work against the insidious and tenacious nature of racial oppres-
sion, victim blaming, and pathologizing. As scholars and researchers, psy-
chologists can become distracted by debates over labels and linguistics
while the traumatic experiences of racism are themselves sorely neglected.
It is important for counselors and researchers to find a necessary balance for
all psychologists working in the trauma field; this balance is the cognitive
space between understanding individual factors that moderate the relations
between traumatic experiences and their effects while avoiding the pitfalls of
While trauma and PTSD are not synonyms, researchers and counselors
often merge the two, assuming that a person has only experienced a trauma
if, as is noted in the diagnostic criteria for PTSD, he or she has experienced
a physical violation. This view of trauma is unnecessarily narrow and dis-
regards the severity of such stressors as nonphysical violation experiences
of sexual harassment, partner/spousal abuse, and racist incidents.
CASE FOR RACE-BASED TRAUMATIC STRESS
Although it is important to recognize the parallels between racism and
other forms of trauma (Bryant-Davis & Ocampo, 2005), one can also make
a convincing argument for a specific conceptualization of race-based trau-
matic stress (Carter, 2007). I would like to agree with and extend the case
built by Carter for race-based trauma, although I do diverge from the
premise that nonphysical stressors cannot be traumatic. A stressor does not
require physical contact for it to be severe or traumatizing. Instead, the case
for the concept of race-based trauma is that it provides a more precise
description of the psychological consequences of interpersonal or institu-
tional traumas motivated by the devaluing of one’s race. There is actual
precedent for giving a specific trauma that may result in PTSD a more spe-
cific classification. An example of this is rape trauma syndrome, which
describes specific psychological manifestations of sexual assault. In this
same vein, race-based traumatic stress conceptually gives greater depth of
understanding to a trauma that, while sharing some commonalities with
other traumas, is also quite unique (Bryant-Davis & Ocampo, 2005).
Bryant-Davis / HEALING REQUIRES RECOGNITION 137
RACISM AS AN ADDITIONAL TRAUMATIC STRESSOR
As Carter (2007) significantly observes, it is important to recognize the
multiplicative effect race-based traumatic stress can have on survivors of
other forms of trauma. Examples of this multiplicative effect include the trau-
matic race-based and class-based neglect experienced by Hurricane Katrina
victims as well as race-based trauma experienced by ethnic minority rape vic-
tims in their encounters with the judicial system. It is, therefore, imperative
for counselors to be cognizant of the potential for additional race-based trau-
mas facing racially marginalized survivors of other severe stressors such as
war, domestic violence, and assault. Given the vulnerability and violation
already affecting these survivors, it is particularly vital for trauma counselors
such as those working with rape crisis centers, veterans’ hospitals, domestic
violence shelters, and emergency response workers to be trained in race-
based trauma assessment and intervention. In other words, counselors and
researchers must consider the impact of being raped physically, and then
being emotionally “raped” by systems and institutions that devalue members
of one’s race, or of being shot, but the impact of this violation being mini-
mized or ignored because of one’s race. These race-based violations can add
and in some cases multiply the traumatic stress of survivors.
ASSESSMENT AND INTERVENTION
As argued in Carter’s (2007) Major Contribution, attending to issues of
assessment and intervention with persons who have been targeted by racism
is essential. Societal traumas such as racism receive insufficient attention in
assessment and treatment (Scurfield & Mackey, 2001). Counselors need to
address race-related traumas and race-related positive experiences, particu-
larly when the client is a member of a racial or ethnic minority group
(Scurfield & Mackey, 2001). Culturally competent and ethically responsi-
ble counselors respond to reports of racist incident–based trauma with val-
idation, competence, and compassion, as they should to any other trauma
(Bryant-Davis, 2005). To conduct effective assessment and intervention,
counselors need to create a therapeutic environment that is safe for clients
to disclose racist experiences (Goodman et al., 2004). Clients are disserved
by counselors who minimize or avoid attending to experiences of racism.
Scurfield and Mackey (2001) attributed the minimal attention given to
racist incident–based trauma to both confusion about and discomfort with
dialogue centered on traumatic experiences of racism. Resisting silence and
risking discomfort, counselors should assess for and explore race-based
138 THE COUNSELING PSYCHOLOGIST / January 2007
traumas as well as any of their lasting psychological effects (Wyatt, 1990).
Assessment for race-based traumatic stress, according to Bryant-Davis and
Ocampo (in press), can be accomplished by (a) creating a trusting and safe
therapeutic relationship; (b) establishing counseling as a safe place to
process difficult experiences such as race-based traumas; and (c) inquiring
directly about the client’s full trauma history, including race-based traumas,
through the use of either a standard structured interview or standardized
assessment tools or surveys. During assessment, the counselor should
attend not only to the trauma history, but also to the impact of the trauma(s)
on the client’s current functioning; particular attention should be paid to
reports of intrusive thoughts, hyperarousal, numbing, intense emotional
reactions, difficulty concentrating, difficulty with memory, feelings of
destructiveness toward self or others, as well as psychosomatic reactions
(van der Kolk, McFarlane, & van der Hart, 1996).
Regarding counseling interventions themselves, Comas-Diaz (2000)
called for psychologists to adopt an ethnopolitical approach when working
with ethnically marginalized clients; such an approach recognizes the impact
of oppression and racism. Comas-Diaz argued that counselors must take an
antiracist stance in their therapeutic work, which is to say the counselor
should never minimize, ignore, or intellectualize racism. Bryant-Davis and
Ocampo (in press) recognized that a number of therapeutic modalities have
been found effective when working with trauma survivors. These evidence-
based treatments include, but are not limited to exposure therapy, eye move-
ment desensitization and reprocessing, supportive group psychotherapy,
psychopharmacology, and cognitive therapy. Regardless of the theoretical ori-
entation or therapeutic approach, Bryant-Davis and Ocampo suggested that
counselors working with victims of race-based traumas explore and address
the following themes: acknowledgement of the trauma, sharing the trauma,
safety and self-care, grieving the losses, shame and self-blame/internalized
racism, anger, coping strategies, and resistance strategies.
Carter (2007) outlines the major effects that a racist incident may poten-
tially inflict on its targets. To delve into further detail, as with other trau-
mas, it is theorized that race-based traumatic stressors have the potential to
affect victims cognitively, affectively, somatically, relationally, behav-
iorally, and spiritually (Bryant-Davis & Ocampo, 2005). Cognitive effects
may include difficulty concentrating, remembering, and focusing. Affective
effects may include numbness, depression, anxiety, grief, and anger. Somatic
Bryant-Davis / HEALING REQUIRES RECOGNITION 139
complaints may include migraines, nausea, and body aches. Relationally, vic-
tims may demonstrate distrust of members of the dominant group or, in cases
of internalized racism, distrust of members of their racial group. Behaviorally,
victims may begin to self-medicate through substance misuse or other
self-harming activities. Spiritually, victims may question their faith in God,
humanity, or both. There has been evidence of race-based traumatic stress
resulting in intrusive thoughts, hypervigiliance, and avoidance (Loo, Singh,
Scurfield, & Kilauano, 1998). Other effects may include external locus of con-
trol, dissociation, and a sense of foreshortened future or hopelessness.
In addressing an issue that is often overlooked, Carter (2007) acknowl-
edges the importance of examining race-based trauma within the context of
people’s lives, given their multiple identities. In taking a more complex
view of culture and cultural oppression, scholars have begun to examine the
realities of those individuals who live at the margins of society as a result
of more than one aspect of their demographic background (Suyemoto &
Kim, 2005). This has been referred to as multiple identities, intersecting
identities, intersectionality, and the multiplicative effects of oppression
(Crenshaw, 1994; Suyemoto & Kim, 2005). Carter (2007) acknowledges
this important concept in his review of Essed’s (1991) work on gender and
class oppression. In addition, Daniel (2000) has examined race-based
trauma specific to African American women, and Greene (2003) has exam-
ined the intersection of racism and heterosexism. Societal traumas include
not only racism but also sexism, poverty, heterosexism, and religious intol-
erance. While in-depth, separate examinations of each of these issues is
necessary, it is also important for scholars and counselors to recognize that
many clients are confronted with multiple traumas based on their multiple
identity markers. Counselors need to be sensitive to the potentially trauma-
tizing impact of all forms of societal oppression.
INTERNATIONALIZING AND EXPANDING OUR SCOPE
As Carter (2007) extensively explains, it is imperative for counselors
to acknowledge, assess, and respond to domestic instances of race-based
trauma. It is also critical for psychologists to study and intervene in cases
of international race-based trauma. The United Nations hosted a World
Conference to address racism, discrimination, xenophobia, and related
140 THE COUNSELING PSYCHOLOGIST / January 2007
intolerances (Bryant-Davis, Okorodudu, & Holliday, 2004). These traumas
include, but are not limited to, the treatment of the Dalit in India, the Aborigine
in Australia, the Indigenous Peoples of the United States, women and children
trafficked globally, and Blacks in South Africa, as well as Islamaphobia and
anti-Semitism. Healing the wounds of race-based trauma requires acknowl-
edging them nationally and globally. An issue that calls for immediate study
and intervention by culturally competent counselors is the genocide and mass
rape of Black Africans in the Darfur region of the Sudan by the Arab militia.
Researchers and intervention developers must examine the psychological con-
sequences of racially motivated mass violence in the context of consistent
global racial devaluation that results in silence and disregard for the well-being
of people of color. What does it mean for one’s safety to not be in the interest
of those with the power and resources to intervene? How does one heal the
scars of a global racial hierarchy that places you and your children at the
bottom? These questions and issues appeal to the consciousness of counselors
committed to resisting racism. They require individual and institutional inter-
vention, as well as just practice and policy.
As Carter (2007) notes, although there is much literature written about
the social, economic, and political effects of racism, much more is needed
in understanding and acknowledging the psychological effects of racism.
The need for this awareness is seen not only in the United Sates but also on
a global level, particularly when one considers the role of psychologists at
the United Nations. The American Psychological Association, among other
psychological nongovernmental organizations (NGOs), has representation
at the United Nations. The role of the psychology representatives at the
United Nations includes educating governments and other NGOs about the
mental health consequences of issues such as racism that are usually pri-
marily examined economically, legally, and medically (Bryant-Davis et al.,
2004). There is a need for psychologists working in various capacities, edu-
cators, counselors, researchers, and advocates to come to a greater under-
standing of the potentially traumatizing nature of racist incidents; this
knowledge must then be disseminated globally to protect and improve
public mental health.
Carter (2007) provides an in-depth exploration of the impact of racism.
Building on this important issue in the context of counseling, research, and
advocacy, he outlines ways in which the trauma of racism can be extended.
Comas-Diaz (2000) called for an ethnopolitical approach to counseling; in
Bryant-Davis / HEALING REQUIRES RECOGNITION 141
that vein, it is important for culturally competent counselors to adopt a
framework of liberation psychology. Liberation psychology requires the
counselor to attend to issues of social justice, cultural context, action
research, and resistance (Watts & Serrano-Garcia, 2003). With this frame-
work, which is evidenced in feminist psychology, Black psychology, and
Latin American psychology, counselors prioritize transformation of indi-
viduals and institutions. The healing of psyches necessitates the disman-
tling and healing of the source of societal wounds of oppression; active
perpetrators and passive privilege recipients of racial hierarchy require redress.
As with all interpersonal traumas, individual recovery is not sufficient; collec-
tive acknowledgment, justice, and prevention are critical.
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