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Holding Up The Mirror: Deconstructing Whiteness In Clinical Psychology (Ahsan, 2020)



88% of UK Clinical Psychologists are White (BPS, 2015). This study explores how nine white, middle-class female psychologists in London understand whiteness in clinical psychology.
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
ABSTRACT: 88% of UK Clinical Psychologists are White (BPS, 2015). This study explores how nine
white, middle-class female psychologists in London understand whiteness in clinical psychology.
KEY WORDS: Whiteness, class, PoGM, complicity
Sanah Ahsan is a liberation and community psychologist. Her work centres on compassion, decolonising understandings
of ‘mental health’ and embracing each other’s madness.
Sanah Ahsan
Holding Up the Mirror:
Deconstructing Whiteness in
Clinical Psychology
“For the master’s tools will never dismantle the master’s house. They may allow us to temporarily
beat him at his own game, but they will never enable us to bring about genuine change. – Audre
Lorde (1984)
I begin this paper by asking the reader to join my attempt to “dismantle the master’s house” of
Clinical Psychology with a critical use of the “master’s tools”. I hope the reader can maintain a
curious approach to the psychological theories and academic references used, recognising that
these resources have a recursive relationship with whiteness. I also wish to clarify the terms
‘whiteness’ and ‘people of the global majority’ (PoGM).
Whiteness is the systemic rules, norms and discourses that produce (and reproduce)
the dominance of those socially racialised as white (DiAngelo, 2018). Whiteness is often
invisible to its benefactors yet remains an oppressive reality to PoGM. Nevertheless, systemic
whiteness is not synonymous with white people (who are not a homogeneous group), and
PoGM are also capable of reinforcing whiteness. I use the term PoGM instead of ‘people of
colour’ because the latter term centres whiteness as default (Lim, 2020).
The experience of whiteness
In 2020, the myth of a post-racial Britain has been desecrated by racially traumatising global
events. Institutions are forced to reckon with the extent of their racism, and the harm it
causes, and British Clinical Psychology (CP) is not exempt. CP has long been criticised for
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
being ‘white psychology for white folk’; for pathologizing PoGM; for its complicity in the
Islamophobic ‘Prevent’ scheme and for being overtly and covertly racist (Wood & Patel, 2017).
CP sits within mental health (MH) services where PoGM are more likely to be diagnosed
with schizophrenia, sectioned, treated as inpatients, restrained by staff, given high doses of
medication, and less likely to receive psychological therapies in comparison to their white
counterparts (Fernando, 2017). Nevertheless, the impact of CP’s whiteness is not limited
to service recipients. In 2019, the discipline was criticised for racism after an enactment of a
slave auction at a Group of Trainers in Clinical Psychology conference, and for its insufficient
response to the effects on black trainees (Busby, 2019).
According to latest British Psychological Society (BPS) demographics, 88% of
psychologists are white and 80% are female (BPS, 2015), a demographic which has shaped the
profession since the 1970s (Goodbody & Burns, 2010). Given the entry salary is £30,764 (BPS,
2015), a degree in psychology is a mandatory requirement and a ‘class-ceiling’ in university
access exists (Friedman & Laurison, 2019), CP can be described as a middle-class profession.
Holding up the mirror to the majority identity (white middle-class female psychologists:
WMFPs), to investigate their relationship to whiteness, is imperative.
Why are there still so many white psychologists?
White British applicants have a 1 in 5 chance of being shortlisted for interview for CP,
compared to 1 in 13 for PoGM applicants (Clearing House, 2017). Systemic barriers such as
unpaid assistant psychologist posts, a lack of belonging in elitist education, and institutional
racism are explanatory factors. The pathway into the profession is underpinned by meritocratic
assumptions; yet, rather than individual capability - time, financial privileges and support
networks are often rewarded (Wood & Patel, 2017). ‘Widening access’ initiatives aiming to
‘increase diversity and representation’ (Turpin & Fensom, 2004) assume that the presence
of PoGM trainees will neutralise systemic whiteness within the profession. Yet, despite
these initiatives existing for over three decades, PoGM psychologists remain consistently
underrepresented (Tong et al., 2019).
How does whiteness shape the ‘evidence-base’ and therapeutic approaches?
CP presents itself as an objective ‘science,’ regardless of its history rooted in colonialism, eugenics
and empiricism (Patel, 2003). This ‘science’ is shaped by an ‘evidence-base’ disproportionately
representing WEIRD (Western, Educated, Industrialized, Rich, Democratic; Henrich et al.,
2010) populations, who constitute 5% of the global population (Arnett, 2016). This research
is often presented as scientific and value-neutral, and informs courses and training resources
commonly delivered by white lecturers. WEIRD research informs NICE guidelines which
recommend psychological therapies for clinical practice. Therefore, Eurocentric, psychocentr ic
models of distress grounded in individualism (e.g. Cognitive Behavioural Therapy), dominate
the profession (Rimke, 2016), obscuring systemic, racial and political trauma as explanations
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
of distress. Locating distress within individual psyches places responsibility for recovery solely
on individuals and individual coping mechanisms (Afuape, 2016). Psychological approaches
centring systemic oppression in understanding distress, which emphasise collective healing
(e.g. liberation psychology; Afuape & Hughes, 2015) are not mandatory to UK training
courses, whereas CBT is.
The concept of therapist neutrality may offer a ‘professional’ justification for silence
rather than engagement in social-justice informed practice. How psychologists use their
formulations holds great power. It is unlikely psychologists would suggest a woman with
a history of sexual abuse participate in a therapeutic space with nine men. Contrastingly,
PoGMs with racial trauma are placed into white-dominated spaces (Griffiths, 2020). When
people can no longer tolerate therapy, their departure maybe ‘formulated’ by the therapist
through a Cognitive Analytic lens of ‘reciprocal roles’ (e.g. abandoned becomes abandoner),
instead of acknowledging racism. Racial trauma is commonly pathologised (Fernando, 2017).
As Menakem (2017) describes: “Trauma decontextualized in a person looks like personality. Trauma
decontextualized in a family looks like family traits. Trauma in a people looks like culture.
Study Rationale
Lipsitz (2006) states that attention must be focussed not only on those harmed by systemic
processes, but also toward the majority who benefit from the resulting inequities and whose
identities are often deemed invisible: a shift from the position of researcher to researched.
It is therefore imperative to understand the viewpoint of the dominant group in CP. To date,
there is no UK research explicitly exploring experiences of whiteness from the professional
majority group perspective.
Nine participants (self-identified WMFPs), were recruited using opportunity sampling from
responses to an advertisement in the BPS Psychologist magazine. Inclusion criteria required
training in the UK and current or previous employment in London NHS Trusts. The focus on
London was due to its racially diverse population, somewhat reflected in MH services (Turpin
& Coleman, 2010). Face-to-face semi-structured interviews were conducted (range: 58 - 88
minutes) in 2019, focussing on participants’ understandings of whiteness, how it operated in
therapy, as well as in the wider profession.
Verbatim transcripts were analysed using Interpretative Phenomenological Analysis
(IPA), following Smith, Flowers & Larkin’s (2009) recommended process. Grounded in
phenomenology, this approach offers an ‘insider perspective’ of a systemic process. Through
line-by-line coding and commentary, analysis moved from descriptive to interpretative,
identifying patterns and distinguishing between emergent and superordinate themes.
Additionally, IPA’s double hermeneutic approach enables a consideration of one’s own
difference and interpretational lens as a PoGM researcher on the outcome of analysis. However,
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
to reduce researcher bias and ensure consistency across findings, themes and collated data, a
WMFP academic supervisor linked to the research was involved in naming and identification
of themes.
Three interrelating superordinate themes emerged from interview data: ‘the white profession’,
‘therapy is a white idea based on white peoples’ experiences’ and ‘we don’t see ourselves
as white.All three theme titles are direct participant quotations. Table 1 below illustrates
the themes and uses example quotes with anonymised identifiers to illustrate participants’
personal relationship to whiteness and experience of whiteness in the profession and in
Table 1: Superordinate Themes, Emergent Subthemes and Quotes (continued overleaf)
Emergent Subtheme Direct Quotation
The White
This white bubble “I really want the profession to be more diverse, but I
don’t want it to happen at the expense of really good
potential white psychologists. - Becky
“It is a profession created by white people..there’s a
power to create what a clinical psychologist looks like”
- Jane
It’s not to do with
individual merit
“Almost exclusively the people who applied for our
voluntary assistant post were white middle class women.
It struck me that they were in a position where they
could” - Julie
I applied ve years and faced kind of, a lot of rejection.
It’s not what they’re looking for. My friend of colour
got on the rst year, when no one else got in. She joked
at her own expense, about it being the fact that she was
black” - Becky
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
Emergent Subtheme Direct Quotation
Therapy is a
white idea
You’re not gonna get this
cos your white
“I have a young person in front of me who has black
skin, explaining to me why she doesn’t want dark skin. I
can see her choosing words carefully and feeling like she
needs to explain it, that although I’m not really gonna
understand, they almost have to be apologetic that it’s
their fault that they could bring something outside of
my range of experience. There’s an inadequacy, like I
wish I could be black right now and give you a different
experience” - Sophie
White middle class
families end up getting
“White, middle-class are not going to be the kind of
families who’d ever end up being referred to social care...
there is a sense of knowing how to use your power and
an understanding of how the system works. - Amy
We dont see
ourselves as white
Not wanting to identify
with it
“We don’t see ourselves as white, do we really? I don’t
think we’re forced to look in the mirror. It is never really
pointed out to you. Whereas if you are black or brown,
your experience is- you are reminded of it” - Abi
“I think I feel quite bad. And then probably like it stops
me from really getting into conversation like I probably
think there is that resistance if I am honest. - Jo
I’m often treading on
“I nd it hard to talk about these things. I nd it
anxiety-provoking” - Julie
“I have been conscious of not wanting to say something
that is discriminatory” - Anne
I am committed to keep
on thinking about this
“We shy away from power and the responsibility that
comes with that. We have the knowledge to stick heads
above the parapet for some things, but not this. We need
to do more. - Hannah
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
Exploring the Themes
How do WBMF clinical psychologists understand whiteness?
Participants’ sense-making of whiteness focussed on both a racialised, individual level of being
white, as well as wider understandings of structural whiteness. Participants had rarely ‘been
forced to look in the mirror’ (e.g. Abi), and reflect upon being racialised as white, as captured
by the superordinate theme ‘we don’t see ourselves as white.
Conflict arose for participants in the subtheme ‘not wanting to identify with it’,
resulting in emotional manoeuvres in response to whiteness which may be understood as
white guilt (Rasmussen & Garran, 2019). A psychoanalytic framework suggests anxiety about
owning one’s own part in negative social processes triggers unconscious defensive reactions
(e.g., denial, splitting). Acknowledging one’s privileges requires confronting the de-idealized
self: split off parts of the self previously projected onto the ‘other’ become relocated inside
oneself (Segal, 1977). Unconscious defensive reactions against these processes create self-
imposed limits to engaging with one’s white embodiment and, as participants experienced,
can result in fearful paralytic silence(e.g. “It stops me from getting into conversation” - Jo), rather
than justice (Kinouani, 2020).
Participants identified supervision and therapy (and the interview itself), as spaces that
help raise unconscious behaviour into consciousness. Pendry (2012) highlights the importance
of the client-psychologist-supervisor triad in working with whiteness, and the supervisor’s
ethical responsibility in prioritising this.
The statement, ‘I am committed to keep thinking about this stuff,’ highlights
participants’ awareness that professional power comes with the responsibility of anti-racist
work. An awareness of ‘difference’ without challenging individual and structural whiteness
is mere ‘verbalism’ (Afuape, 2016), reflected in participants’ simultaneous awareness and
complicity (e.g. “We shy away from the power and responsibility” - Hannah). For psychologists
cultivating social justice-informed practice, an interactive relationship between action,
willingness and awareness is vital.
How do WBMF clinical psychologists understand how whiteness might inuence
The subtheme, ‘I’m often treading on eggshells’ demonstrates participants’ fear when
addressing whiteness with clients, often couched in an unwillingness to compromise
neutrality, make assumptions or make things worse (e.g. “...not wanting to say something that is
discriminatory” - Anne). Several participants understood being white as a barrier to therapeutic
work, underpinned by assumptions that the client had negative perceptions of this. For some
participants, black therapists were idealised as being more competent in racial matters (e.g.
“...I wish I could be black right now and give you a different experience” - Sophie). Perhaps both good
and bad projections are made onto black psychologists to alleviate intrapsychic tensions and
the responsibilities WMFPs carry when working with the complexities of race-relations in
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
therapy. Participants’ varied references to blackness in particular may align with reports of
anti-blackness within the profession (Paulraj, 2016).
‘Therapy is a white idea’ showed participants’ awareness of therapy propagating
psychocentrism (Rimke, 2016) and erasing indigenous healing knowledge, whilst being
complicit with the political notion that social problems can be treated through individual
behaviour change (Afuape, 2016).
The subtheme ‘white middle-class families end up getting more’ reflects the perceived
racialised, class-defined identities of clients as influential to clinical outcomes, particularly in risk
assessment and referral. This aligns with literature reporting the unconscious primitivisation of
black service users in particular, manifested by greater sectioning, restraint, entry through the
criminal justice system and over-medicating (Kilomba, 2008). White professionals assessing
risk may see more of themselves reflected in white clients (Lowe, 2018), perceiving less risk
in the familiar. Psychodynamic manifestations of both love and hatred for the self are, however,
complex; participants’ frustration at the privileged expressions from white people may be
understood as a projection of the unwanted parts of the self.
Finally, the subtheme ‘you’re not gonna understand this because you’re white’
encourages reflection on the reported benefits (e.g., diversity of cultural knowledge), of
having greater representation in the profession (Gibbs et al., 2019). Individuals with strong
racial preferences reportedly benefit from being ethnically matched with a psychologist
(Cabral & Smith, 2011). However, with evidence of PoGM trainees ‘losing themselves’ to
fit into the landscape of whiteness, entrenched structural whiteness in the profession may be
more influential than the number of PoGM bodies physically present (Martinot, 2010).
How do WBMF clinical psychologists understand the inuence of whiteness on the
The theme ‘the white profession’ highlighted participants’ awareness of structural whiteness
in the profession, as well as the dominance of white bodies (e.g. psychology teams, clinical
training, assistant posts). Some participants understood this lack of diversity to be un-
representative of client perspectives, whereas others found comfort amongst white
professionals viewing diversification as a potential threat (e.g. “I don’t want this [diversication]
to happen at the expense of white psychologists” - Becky). Dalal’s (1993) group psychoanalytic
ideas suggest safety is strengthened in the white in-group via the unconscious processes of
marginalising the out-group.
The subtheme ‘this white bubble’ highlights participant awareness of structural
processes upholding the status quo, including gatekeepers (e.g. white interviewers, white
lecturers) and dissemination of ideologies of the dominant group such as through white
resources and knowledge (e.g. “It’s a profession created by white people” - Jane). White psychologists’
unconscious investment in this status quo may mean they identify themselves as positive and
legitimate knowledge sources, colonising the subjective consciousness of PoGM as negative
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Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
(Fanon, 1963). From a Kleinian perspective, a depressive stance recognises that PoGM may
be (un)consciously both desired and feared; therefore, fear of, and desire for, diversification in
the profession perhaps co-exist.
The subtheme ‘it’s not to do with individual merit’ demonstrated that most participants
understand pathways to the profession afford access to an elite group of socio-economically
privileged, often white, communities. Yet, some participants understood that being white is
a disadvantage in accessing the profession, believing that specifically black applicants benefit
from the need for diversification acknowledged by the BPS (Turpin & Fensom, 2004). This
is perhaps another participant reference to anti-blackness, and can be described as ‘white
victimisation’: a psychological defence against the unconscious realities of white privilege
(Lipsitz, 2006).
Structural shifts must be led by the professional organisations and universities to address
the issues discussed. Academic and clinical recruitment practices must prioritise PoGM
representation across lecturers and staff, as well as white psychologists working to relinquish
power and offer PoGM leadership and voice. Access to the profession could be improved by
valuing lived over clinical/academic experiences in short-listing; mandatory PoGM interview
panel representation and interview questions exploring experiences of oppression and how
these might inform psychological practice. Anti-racist teaching (e.g., white psychologists
holding spaces to dismantle whiteness together) must be threaded through training, rather
than tacked onto UK training courses. PoGM must have the power to consume, construct
and produce their own knowledge during training and post-qualification. Therefore,
diversification of the curriculum (e.g. mandatory reading by PoGM authors) and inclusion
of liberation and indigenous psychological approaches in training is crucial. Furthermore,
legitimising non-academic knowledge through PoGM music, poetry and arts may facilitate
further deconstruction of whiteness.
On an individual level, psychologists must move past processes of complicity,
intellectualisation, avoidance, denial or silent paralysis and centre their discomfort. A key
question for psychologists is: how can discomfort (in self-confrontation) be normalised rather
than avoided or enacted? The analytical space of reflection and intellectual debate may be
more familiar than the embodied experience of confronting whiteness, as somewhat reflected
in participants’ intellectual responses. Part of the psychologist’s anti-racist work is becoming
embodied: staying with the tightening throat and chest, recognising that this is a healthy place
to return to meet an opening for change.
There are several limitations to the sampling in this study. Focusing on white identity risks
emphasising that which is already centred, and risks centring the individualised psychology of
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
racist identities rather than systemic processes. However, it successfully addresses criticisms of
critical race theory for ignoring the lac k of individual agency in systemic processes. Recruitment
methods may have attracted psychologists already engaged in thinking about whiteness.
Although including White-British participants was necessary to ensure a representative sample
of the dominant group in the profession, experiences of being ‘white other,‘white-passing’
or working class have their own complex differences, which were beyond the focus of this
research (Bueno-Hansen & Montes, 2019). Additionally, the relationship between whiteness
and differing racialised groups is only touched upon in the data analysis and requires further
research, especially given that black people are the most disadvantaged by systemic whiteness
(e.g. Tangel et al., 2019).
There are challenges to taking a critical approach to phenomenological data.
Furthermore, it is difficult to predict what my race, professional position and gender meant
to participants. My racial difference may have evoked greater self-awareness and sensitivity
for participants, however, the honesty in responses suggests otherwise. Through regular
supervision with a WMFP supervisor and keeping a diary throughout the research process,
I managed my emotional responses to the research as encouraged by IPA’s critical realist
The spectrum of racism
Menakem (2017) describes all people racialised as white as existing on a spectrum of racism
from devout to complicit. The nine participants in this study were aware of the operation of
whiteness in the profession, yet remained complicit. Participant responses indicate that the
question CP needs to be asking itself is not if racism is taking place in the profession, but
how is it taking place? The discussion above draws on psychological theories to help critically
examine behaviours attached to whiteness, and highlights some of the processes through
which harm can occur.
As Eula Biss (2020) states, “You might be stuck on this team, but you don’t have to play by
its rules. WMFP committed to dismantling the ‘rules’ of structural whiteness must actively
engage with their own and each other’s embodied discomfort and resist defensive manoeuvres
(e.g., intellectualisation). The stakes are too high for PoGM and individual practitioners to
rely on voluntary engagement in deconstructing whiteness. Structural changes must be driven
by professional bodies including the BPS to show that anti-racist praxis is a core competency
for psychologists, rather than an intellectualised debate or an optional ‘reflective’ exercise.
Keren Yeboah, Kairo Maynard, Janey Starling & Louise Goodbody - thank you for your
meaningful feedback.
© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
Journal of Critical Psychology, Counselling and Psychotherapy, Vol. 20, No. 3, 45-55
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Journal of Psychology, 47(3), pp. 280-291.
... This creates a narrative by which predominantly White academic institutions 'gift' places to racially minoritised individuals, rather than placing emphasis on their need to acquire diverse knowledges and perspectives (Cullen et al., 2020). Colonial power structures are replicated when a small number of racially minoritised individuals are brought into spaces where pervasive racism exists, and this can encourage assimilation to White, middle-class culture (Ahsan, 2020). Racially minoritised students may feel a burden to educate others and act as a spokesperson for their demographic group (Cullen et al., 2020), and as a consistent stressor this can detract from the learning experience (Claridge et al., 2018). ...
... Newcastle University Clinical Psychology Programme has been a predominantly White academic institution, with trainees and trainers identifying as White. Clinical Psychology as a profession has been criticised for the disproportionate predominance of White, middle-class females (Ahsan, 2020). Following the Group of Trainers in Clinical Psychology Annual Conference in 2019 in which a slave auction was re-enacted (BPS, 2019), the Newcastle Clinical Psychology Programme was forced to confront the professions complicity in oppressive and racist structures which exacerbate the marginalisation of racially and ethnically minoritised individuals . ...
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There is a long history of human rights violations in healthcare and those perpetrating such human rights violations have included healthcare professionals, including clinical psychologists (Soldz, 2008; Balfe, 2016). Furthermore, individuals who have been subject to human rights violations which can include torture, discrimination, war, genocide, abuse, and trauma to name a few, are more likely to come into contact with mental health services and as a result, with clinical psychologists. Therefore, clinical psychologists have an ethical responsibility to critically engage with and examine issues pertaining to human rights, as well as their own positionality in respect of this (Patel, 2003). To support this examination, Doctorate in Clinical Psychology (DClinPsy) training programmes should include opportunities for exploration and engagement with Human Rights violations as part of the training of clinical psychologists, however this is not currently consistently the case. In this paper the authors outline and examine the delivery of Human Rights Based teaching to trainee clinical psychologists using pedagogical, participatory and experiential learning techniques. The authors offer qualitative and quantitative feedback from four cohorts of trainee clinical psychologists on the impact of the Human Rights based teaching on their sense of self, their sense of others, their practice, and their ability to critically reflect on clinical psychology as an oppressive structure. The authors present some of the challenges and opportunities of embedding a Human Rights based framework in the teaching and education of trainee clinical psychologists and the implications of this on the practice of clinical psychology. The authors make a case that training institutions which embody principles and values connected to human rights and just psychology are likely to foster a psychological workforce that is attuned with ethics, justice and privilege.
... There has been increasing interest in decolonising clinical psychology curricula, however, without diversifying institutions there is a risk of 'speaking for' marginalised communities rather than amplifying their voices and thus replicating colonial power structures (Cullen et al., 2020). Perpetuation of power structures by bringing a small amount of racially minoritised applicants into spaces permeated by a legacy of racism raises ethical concerns and can encourage assimilation to 'White middle-class' culture (Ahsan, 2020) which is overwhelmingly normalised in clinical psychology. This can be seen by aspirant and trainee psychologists code-switching and adopting a reluctance to raise issues pertaining to race. ...
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There is a longstanding history of psychological services being inaccessible for individuals from a racially minoritised background, including continuing to pathologise individuals from these communities (Fernando, 2010). There has been significant evidence that clinical psychology continues to perpetuate racism, discrimination, and marginalisation, with Pilgrim and Patel (2015) stating that clinical psychology remains 'anything but for all'. A further exploration into the theory and practice of neuropsychology highlights a history of systematic and scientific racism which includes the inappropriate use of 'race' in neuropsychological assessment and testing to further marginalise, infantilise and create a narrative of individuals from racially minoritised backgrounds as 'inferior' (Hiermeier & Verity, 2022). In this article the authors explore the experiences of navigating neuropsychology as racially minoritised individuals. The authors reflect on their experiences of witnessing and navigating racism in the practice and application of neuropsychology. The paper also highlights that due to the significant evidence of scientific racism in neuropsychology that Whiteness, power, racism and colonisation should be a core and compulsory component of the training of clinical and neuropsychologists. As a result, there is a need to move away from centring conversations on equality, diversity and 'cultural competence' with a clear focus on equity, justice, Whiteness and racism.
... Such initiatives have received criticism (e.g. Patel, 2010;Ahsan, 2020), but are increasingly acknowledged as honest attempts to address challenges related to the inequity of access to the profession. ...
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There has been increasing recognition that clinical psychology is not representative of the diverse populations it serves. The Our Stories project was led by a working group of trainee and newly qualified clinical psychologists, and ACP-UK members. It sought to better understand the experiences of those from a range of minoritised backgrounds in a series of focus groups.
Introduction Clinical Psychology has long been criticised as a profession that is rooted in coloniality, that preserves whiteness as the norm through its practices. Arguably, this has led to many racial disparities in the mental health outcomes for racially minoritised groups living in the UK. In more recent years, clinical psychology training courses (DClinPsy) have focused their efforts to develop Equality, Diversity and Inclusion initiatives, leading to changes in the curriculum. Aims The aim of the current study is to explore how trainee clinical psychologists (TCP) understand racial equity and decolonisation in relation to the DClinPsy curriculum and research practices. Also, to explore whether trainees have experienced any changes in relation to racial equity and decolonisation agendas and what changes would they like to see in the future. Method Three focus groups were conducted with TCPs across various DClinPsy courses, which were analysed using a thematic analysis. Results The data presented four themes: ‘defining and enacting racial equity’, ‘the DClinPsy course content’, ‘structural and societal barriers’ and ‘the future’. Conclusions The findings highlight the various complexities and dilemmas that surround DClinPsy courses. The results also show key areas of progression, development, and recommendations to enhance the racial equitability of the DClinPsy curriculum and research practices, in the hope of improving the mental health service provision and outcomes for racially-minoritised groups.
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Background: Care home staff working during the COVID-19 pandemic experienced higher levels of stress and increased workloads. People from diverse ethnic backgrounds were disproportionately affected by the COVID-19 pandemic. This study explored the identity experiences of care home staff from diverse ethnic backgrounds in the context of working during the COVID-19 pandemic. Methods: Fourteen semi-structured interviews were conducted between May 2021 and April 2022 with ethnic minority care home staff in England, who worked during the pandemic. Participants were recruited using convenience and theoretical sampling. Interviews were conducted via telephone or online platforms. A social constructivist grounded theory methodology was utilised in analysing the data. Findings: Participants described five key processes which facilitated or hindered the impact that their experiences had on their identity: dealing with uncertainty and transitioning into a COVID-19 world; difficult emotions; experiences of discrimination and racism; the response from care home and societal systems; and the personal vs collective responsibility. When participants' physical and psychological needs went unmet by support structures within the care home and/or society, they experienced a sense of injustice, lack of control and being unvalued or discriminated against by others. Conclusions: This study highlights the importance of recognising the unique needs of staff from diverse ethnic backgrounds working in care homes and adapting working practices to improve impact on identity, job satisfaction and staff retention. Patient and public involvement: One care home worker was involved in developing the topic guide and helping to interpret the findings. This article is protected by copyright. All rights reserved.
This report was originally published on the BiPP Network website ( ) on 9 July 2021. This study reports the process of using the FOI Act to access diversity data on applicants to the DClinPsy programme for 2020 entry, the challenges faced and recommendations for courses given the context of increasing representation and anti-racist practice.
Background: Women are predisposed to maternal depression due to childbirth difficulties and parenting responsibilities, leading to long-term negative consequences on their children. The uptake of mental healthcare by British mothers of African/Caribbean origin is low due to the lack of access to culturally appropriate care. Methods: A mixed-methods randomised controlled feasibility trial was adopted to test the appropriateness and acceptability of Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) for treating maternal depression compared with Psychoeducation (PE). Mothers (N=26) aged 20-55 were screened for depression using the Patient Health Questionnaire (PHQ-9). Those who scored >5 on PHQ-9 were further interviewed using the Revised Clinical Interview Schedule to confirm the diagnosis and randomised into LTP+CaCBT (n=13) or Psychoeducation (n=13) groups. Assessments were carried out at baseline, end of the intervention at 3-months and 6-months post-randomisation. N=2 focus groups (LTP+CaCBT, n=12; PE, n=7) and N=8 individual interviews were conducted (LTP+CaCBT, n=4; PE, n=4). Results: The LTP+CaCBT showed higher acceptability, feasibility and satisfaction levels than the PE group. Participants experienced the intervention as beneficial to their parenting skills with reduced depression and anxiety in the LTP+CaCBT compared to the PE group. Conclusions: This is the first feasibility trial of an integrated online parenting intervention for British African and Caribbean mothers. The results indicated that culturally adapted LTP+CaCBT is acceptable and feasible. There is a need to study the clinical and cost-effectiveness of LTP+CaCBT in an appropriately powered randomised control trial and include the child's outcomes.
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Critical research, such as that involving the deconstruction of monoracialism, aims to empower and elevate the voices of marginalized populations. When we engage in critical research, whether it be quantitative or qualitative, scholars must recognize how our own lived experiences might shape each stage of the research process. The purpose of this paper is twofold. First, we present scholars with a structured method using a conceptual mapping of social identities combined with written reflection and regularly scheduled debriefings to begin their own explorations of identity. Second, we present our experiences negotiating with monoracialism as we worked to understand our identities as Asian scholars. Through this process we discovered new perspectives on how we, along with our participants, have grappled with socially imposed notions of who we are as Asians.
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A growing body of evidence exposes the persistence of racism and inequality within the psychological professions and this has led to a re-commitment across all professional bodies to address this as a matter of high importance. This study aims to illuminate therapists' views and understandings of the social construct and term "whiteness" within anti-racist practice. A short, mixed-methods survey conducted in the United Kingdom sought therapists' views and from a purposive sample of 150 and fifty were returned. Quantitative data were statistically analyzed and Reflexive Thematic Analysis (RTA) was utilized to explore qualitative data. Results suggest that respondents believe that the terms "whiteness" and "white culture" reflect a dominant, yet often invisible, force in the field of race, and culture. Dialogue inclusive of the meaning and power of whiteness needs to be addressed in anti-racism training and education. A central organizing concept "Heart of the Work" was the connecting principle between four key themes: The Dominance of Whiteness; Ambivalence, Complexity and Uncertainty; The Importance of Education; and Understanding the Wider Context. Findings from this survey indicates that discussions about whiteness, privilege, and racial identity could enhance anti-racism within psychotherapy. There is a real concern about the re-traumatization of racially-minoritized members of therapy training groups, and the requirement for reflexivity and skilled facilitation is highlighted.
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This article describes how and why Black trainee and assistant psychologists responded to the limited ethnic diversity within the profession, by creating a ‘community-based network’, offering tailored support and a ‘safe space’ for Black aspiring clinical psychologists.
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Understanding unconscious dynamics of racism is essential to considering some of the challenges inherent in providing therapeutic services when differences abound. Beyond ideas of cultural competency, this paper theoretically explores the possible dynamic interactions that occur below the surface of conscious efforts to help. Using the film Get Out as a case study, concepts of consciousness, double-consciousness, projection, projective identification, envy, and splitting illustrate a rich and complex unconscious dyadic interchange. The implications for various aspects of therapeutic involvement – from therapy to supervision to agencies practices – are explored.
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Examining Whiteness and racism in psychology and sociology
As a black woman I have found myself in various settings where as the only person of colour, speaking of my experience of the world has led to hostility, occasionally to violence, and, more frequently to disorientating silencing attempts. As a therapist working specifically with people of colour, clients have approached me, ashamed, often terrified, describing these familiar walls of impenetrable defensiveness bolstered by gagging manoeuvers their voices meet, when attempting to articulate racism within all social structures. This collective experience of silencing, as illustrated by Eddo-Lodge’s words, is of critical significance for group processes and social dynamics and thus group work practice. This article aims to illuminate the functions of racism related silencing in groups and to offer some formulations of the same in the hope of supporting the profession to make space for those whose voices and perspectives it is still by and large to integrate. This article will present my reflections on silence, silencing and power in groups, primarily from a black perspective. It will mainly engage with formulations and theoretical explorations of racialized dynamics personally experienced, witnessed or reported to me. It will argue that silencing is a mechanism that protects the white psychic equilibrium and the racially stratified social order. It will be further posited that acts of racial silencing as remnants of intergenerational trauma, reproduce and are borne out of power relations and, that they may be enacted within group analytic therapy.
This chapter focuses on the role that demographic diversity plays in team science and identifies potential areas of future research. The growth in collaborative research and diversity within the scientific workforce are distinct yet connected trends. The range of twenty-first century health challenges is increasingly complex, and both collaborative efforts and diverse perspectives will be required to meet these challenges. Successful science teams, particularly those involving scientists from different disciplines and backgrounds, hinge upon effective team integration strategies and approaches (cite other chapters in team science book). The two areas of scholarship overlap and may benefit from a more coordinated approach to integrate both concepts and approaches.
Objective Racial and ethnic disparities in obstetric care and delivery outcomes have shown that black women experience high rates of pregnancy-related mortality and morbidity, along with high rates of cesarean delivery, compared with other racial and ethnic groups. We aimed to quantify these disparities and test the effects of race/ethnicity in stratified statistical models by insurance payer and socioeconomic status, adjusting for comorbidities specific to an obstetric population. Study Design We analyzed maternal outcomes in a sample of 6,872,588 delivery records from California, Florida, Kentucky, Maryland, and New York from 2007 to 2014 from the State Inpatient Databases, Healthcare Cost and Utilization Project. We compared present-on-admission characteristics of parturients by race/ethnicity, and estimated logistic regression and generalized linear models to assess outcomes of in-hospital mortality, cesarean delivery, and length of stay. Results Compared with white women, black women were more likely to die in-hospital (odds ratio [OR]: 1.90, 95% confidence interval [CI]: 1.47–2.45) and have a longer average length of stay (incidence rate ratio: 1.10, 95% CI: 1.09–1.10). Black women also were more likely to have a cesarean delivery (OR: 1.12, 95% CI 1.12–1.13) than white women. These results largely held in stratified analyses. Conclusion In most insurance payers and socioeconomic strata, race/ethnicity alone is a factor that predicts parturient outcomes.
This book examines the deep roots of racism in the mental health system. Suman Fernando weaves the histories of racial discourse and clinical practice into a narrative of power, knowledge, and black suffering in an ostensibly progressive and scientifically grounded system. Drawing on a lifetime of experience as a practicing psychiatrist, he examines how the system has shifted in response to new forms of racism which have emerged since the 1960s, highlighting the widespread pathologization of black people, the impact of Islamophobia on clinical practice after 9/11, and various struggles to reform. Engaging and accessible, this book makes a compelling case for the entrenchment of racism across all aspects of psychiatry and clinical psychology, and calls for a paradigm shift in both theory and practice.
In discussing 'Whiteness', a context is provided as to current issues facing British clinical psychology, with an overview of the history of clinical psychology in the United Kingdom, and a particular focus on how issues of immigration, diversity, and racism have been addressed. Following this, the constantly changing training context of clinical psychologists within Britain is explored, with lacunae evident around confronting institutional racism and Black trainee experiences. The history of addressing this issue within the University of East London's clinical psychology training programme is outlined, as well as the recent introduction of workshops to focus on 'Whiteness' and 'decolonising' the profession, in response to consistent trainee concerns. This is integrated with respect to focusing on the sorts of psychologists that might be needed to advance and transform the profession positively in the current global political climate.