Addressing Racial Trauma in Your Clinical Practice

As a therapist, you’re going to have clients who struggle with racial trauma.

When you’re attacked or discriminated against because of something so tied to your identity and so inseparable from who you are as a human being, that pain lasts. These experiences build and change your outlook on life. They contribute to learned helplessness (Why bother trying?), deep anger, depression, anxiety, PTSD, and substance use disorders. 

Not every experience of racism is traumatizing. An incident is more likely to have a lasting effect if the racial stressor is particularly intense, if it happens frequently, or occurs at a time when your client is dealing with other emotional or physical vulnerabilities.

What is Racial Trauma?

Dr. Carla Smith (Ph.D., LCSW, LMFT) defines racial trauma or race-based traumatic stress as the mental and emotional injury caused by encounters with racial bias and ethnic discrimination, racism, and hate crime. 

These include:

• A sudden, emotionally painful, and uncontrollable racist encounter.
• Ongoing exposure to racial bias or discrimination.
• Violence against people of color.
• Racist abuse in the media.

Racial stressors can be experienced directly or they can be vicarious, like the George Floyd murder or when Asians experienced verbal and physical attacks during the shutdown because “COVID-19 came from China.”

These incidents create an environment in which a person feels unsafe because of the color of their skin and their ethnic background. 

How do you identify and recognize racial trauma? 

Our first role is to provide a safe space and a strong therapeutic alliance so healing can happen.

Asking may seem like it’s opening up a wound, but it's not. Taking about it acknowledges that it’s there.

Ask your client if they’ve experienced racism and if it plays a part in the challenges they’re currently experiencing. An accepting, open question opens the door to creating a safe space.

Especially if you’re white, you might have been conditioned to “not talk about things like that” or make it an issue. “Be colorblind.” 

But the reality is, people who are a minority for whatever reason – color, ethnicity, gender, sexual preference, etc. are always aware of what makes them different and vulnerable.

A few other reasons to ask

• The stress may be manifesting in physical symptoms like increased heart rate, headaches, and increased blood pressure, so it could be important for their physical health.
• It may be affecting their relationships and their social functioning in profound and harmful ways.
• You may need to decide with your client if you are the most ideal therapist for their healing process. Studies have shown that having a therapist who shares a similar background is important to many clients. They feel understood coming in. If your client feels it makes a difference, refer them to a therapist of color. 

Consider using an assessment to identify your client’s symptoms and severity. The Trauma Symptoms of Discrimination Scale (Williams, et al, 2018) or the Race-Based Traumatic Symptom Scale (Carter, et al, 2013) are two options of many that can help you identify the trauma and know what direction to take as you develop a treatment plan with your client.

How to Address Presenting Racial Trauma

Addressing race-based trauma requires a sensitive and supportive approach grounded in cultural humility, trauma-informed care, and evidence-based interventions. 

Understanding structural drivers of racism

Structural factors include geographic and economic elements that prevent a person and their family from the right jobs, a good school, a safe neighborhood, and ways to take advantage of opportunities. 

History is pretty blatant. We live in a country with a history of slavery, segregation, and immigration discrimination, just to name a few issues. It’s important to be aware that not only do our experiences shape us, but so do the experiences of our ancestors. That’s part of a trauma-informed perspective.

Using trauma-informed care methodology to acknowledge your client’s experience 

It’s always important to make the therapy space a safe, supportive environment that promotes healing and recovery. In the case of trauma, which is more common than we used to assume, you’re focused on building trust so  you and your client can work together to address the underlying pain behind their symptoms and behavior. 

Avoid trying to “get at the truth” or offering another interpretation. Reframing a racial trauma can be retraumatizing because it feels like you’re questioning your client’s reality or defending the perpetrator’s behavior. 

Allow the pain to be the pain.

5 Ways You Can Be an Advocate for Your Clients Who Have Experienced Racial Trauma

1. Engage in ongoing education and training to understand the impact of racism and discrimination on your clients so you can develop the skills necessary to address their racial trauma effectively. 
2. Develop a deeper understanding of the complex ways race and ethnicity intersect with other aspects of identity such as gender, sexual orientation, and socioeconomic status.
3. Treat each client as an individual whose healing requires a unique approach.
4. Be aware of your own biases and how they could impact your ability to work with clients who have experienced race-based trauma. Consider your own privilege and how it may influence your interactions with clients from marginalized communities.
5. Be an advocate for change in your community. Speak out against racism and discrimination. Advocate for policies and practices that promote equity and social justice.

Dig Deeper and Keep the Discussion Going

Do you feel like you want to explore more about trauma-informed care, cultural bias, and racial trauma? Motivo Learning offers courses on these issues and so much more—and you can earn continuing education units as you learn.