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

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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.
© 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
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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
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© 2020 The Authors. Journal compilation © 2020 Egalitarian Publishing Ltd.
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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.
Methodology
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,
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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.
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
therapy.
Table 1: Superordinate Themes, Emergent Subthemes and Quotes (continued overleaf)
Superordinate
Theme
Emergent Subtheme Direct Quotation
The White
Profession
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
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Superordinate
Theme
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
more
“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
eggshells
“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
stuff
“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
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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
therapy?
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
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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
profession?
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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(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).
Implications
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.
Limitations
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
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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
position.
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.
Acknowledgements
Keren Yeboah, Kairo Maynard, Janey Starling & Louise Goodbody - thank you for your
meaningful feedback.
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... Reflexive thematic analysis (TA) was conducted in line with the six-step guidelines from Braun and Clarke (2006, 2020Supplementary Material S3). Reflexive TA allows for identification of key themes in keeping with a 'critical realist' framework acknowledging the space for an 'ultimate reality' whilst accounting for the potential impact of the researcher's assumptions and the individual social and cultural contexts of participants (Braun & Clarke, 2006. ...
... Other studies have reported similar sample demographics (Chin, Anyanso, & Greeson, 2019;Tickell, Ball, et al., 2020;Tickell, Byng, et al., 2020;Waldron, Hong, Moskowitz, & Burnett-Zeigler, 2018) suggesting that our skewed demographics may represent a larger issue with recruitment to MBIs. Specifically, it remains difficult to know whether people of other ethnicities and demographics would feel safe enough to participate in MBCT or whether they would feel heard in terms of their individual and collective experiences, particularly with regards to racial trauma and inequality (Ahsan, 2020). Future studies would benefit from directly exploring a more diverse range of views around access to, interest in, and feelings of safety around participating in MBCT. ...
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Objectives: Mindfulness-based cognitive therapy (MBCT) is an 8-week relapse-prevention intervention designed for people who have experienced multiple episodes of depression and remain vulnerable to relapse. Previous qualitative explorations of the effects of MBCT for people in remission from depression have suggested a number of themes regarding changes arising from participating in MBCT ranging from awareness, agency, perspective, group processes, self-related change, and new ways of understanding depression. We aimed to qualitatively explore how participants in remission from depression experienced MBCT both post-MBCT and during a follow-up period. Methods: In a preference-choice trial design, 35 participants took part in qualitative interviews and assessments post-MBCT and at three time points during a 12-month follow-up. Data were analysed using reflexive thematic analysis. Results: Two overarching themes were developed as follows: (1) 'reconnection with experience, self, and others' and (2) 'acknowledging an ongoing process of change'. In theme one, sub-themes captured participants' experiences of increasing levels of awareness of their experience (e.g., thoughts, emotions, sensations, and present moment) from which they described changes in their relationship with experience describing increases in control, choice, acceptance, and calm. Participants described shifts towards reconnection with aspects of the self and relationships with others. In theme two, sub-themes reflected participants' conflict between avoidance and engagement in mindfulness practices, and the recognition of the gradual change following MBCT and long-term investment needed in mindfulness practices. Conclusions: Our findings have clinical implications in terms of facilitating MBCT and point to important themes around recognizing the ongoing process of reconnection with experiences, self, and others. Practitioner points: Participants with histories of depression may have experienced disconnection and isolation from internal experiences (e.g., thoughts and emotions), self, and others; MBCT encourages a deliberate shift towards reconnection with these experiences. Practitioners could encourage more psychoeducation and discussions around depression during MBCT to encourage reflections on the process of reconnection. Practitioners should maintain an awareness of the ongoing, gradual processes of change and potential for conflict experienced during MBCT Practitioners could provide a stronger emphasis on building awareness of body sensations during MBCT, with suggestions provided in the discussion section.
... 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.
... The pandemic has highlighted and heightened health inequalities generally, especially those experienced by ethnic minorities (Kirby, 2020). At the same time, the Black Lives Matter protests has reminded everyone, including the clinical psychology workforce of the continuing need to address systematic racism (Ahsan, 2020 Historically in the United Kingdom, many point to the work of Holland (1991) whose community work in Battersea and White City in London helped individuals and groups move from intrapsychic to social and then to political spaces. In other words, from pills to therapy, to self-advocacy and social action (e.g., Fenner, 1999 (Camilleri et al., 2020). ...
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This paper explores the personal and professional connections between clinical psychologists in the United Kingdom (UK) and critical/community psychology (CCP). Specifically, it asks how clinical psychologists define the area, how they relate to it and how they apply it in their work. Twenty clinical psychologists responded to an online survey, 12 of whom went on to take part in a follow-up telephone interview. Data were analysed using inductive thematic analysis. The results are divided into three sections: i. "describing CCP": social justice and a questioning stance are considered, ii. "relating to CCP": an interplay between lifespan events and personal responses are described and iii. "applying CCP": a dynamic between role-specific applications and reality checks that either enable or constrain is illustrated. Although the continued need for a CCP is described, the results highlight both challenges and tensions of practising CCP within clinical psychology.
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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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Background: MBCT is a relapse-prevention intervention for people experiencing major depression. Three qualitative meta-syntheses investigating experiences of taking part in MBCT and/or Mindfulness-based Stress Reduction (MBSR) across different diagnostic populations reported themes including control, choice, group processes, relationships, and struggles. As multiple studies have been published since, we aimed to update, systematically review, and synthesise the experiences of participants with depression taking part in MBCT. Methods: Four databases were searched systematically (PsycInfo, Web of Science, Medline, CINAHL) up to and including the 12th November 2021. Twenty-one qualitative studies met the review criteria. All papers were rated as fair using a quality appraisal tool. Meta-ethnography was applied. Results: Across 21 studies of participants with current or previous depression who had participated in MBCT, three overarching themes were developed: "Becoming skilled and taking action", "Acceptance", and "Ambivalence and Variability". Participants became skilled through engagement in mindfulness practices, reporting increased awareness, perspective, and agency over their experiences. Participants developed acceptance towards their experiences, self, and others. There was variability and ambivalence regarding participants' expectations and difficulties within mindfulness practices. Limitations: Many studies were conducted in MBCT-research centres who may hold conflicts of interest. Many studies did not address the impact of the participant-researcher relationship thus potentially affecting their interpretations. Studies were skewed towards the experiences of female participants. Conclusions: Our findings help to enhance participant confidence in MBCT, alongside understanding the processes of change and the potential for difficulties. MBCT is beneficial and provides meaningful change for many but remains challenging for some.
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An exploration of how owning and accepting white privilege could move psychotherapy and counselling into an era whereby truly anti-racist practices might begin to flourish
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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
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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.
Chapter
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.
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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.
Book
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.
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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.