Behavioral Health Brief: Black Twitter Reveals Insights on the Significance of Race in Therapy
By Stephenie Howard, PhD, LCSW
Social Work Today
Vol. 21 No. 2 P. 32

For some students and clinicians, it can be difficult to embrace cultural competence as a necessary component of clinical services. Hearing directly from cultural group members regarding their needs and desires might foster greater agreement to support cultural competence standards.

Toward this goal, I explored tweets from Black Twitter users regarding the significance of the racial identity of their therapist. The findings highlight the salience of race in therapy and the need for cultural competence. Notably, I completed this project prior to the second wave of the Black Lives Matter movement, which means the issue of social justice was not trending at the time. This suggests that the findings can be generalized beyond the current moment.

The conclusions drawn in this paper are relevant and timely. Blacks are increasingly seeking therapy in light of shifting cultural beliefs about mental health (Bahrampour, 2013) and the continued media coverage of grave injustices against their race (Dowd, 2020).

For this project, I used Tweepy for Python to search the content of publicly available Twitter data, both current and archival. Twitter is a useful tool because it provides an unmediated glimpse into the personal perspectives and lived experiences of diverse users.

While the data in this project were deidentified, Twitter users agree to the terms and conditions of the website, which stipulate that their tweets are public domain and may be used broadly, including for research purposes. Tweepy allows users to control the search parameters and to deidentify the data. Searches were limited to tweets posted between January 1, 2013, and December 7, 2019. Retweets were excluded, meaning only unique tweets were included.

The following search terms were used: Black therapist, white therapist, white counselor, Black counselor, white social worker, and Black social worker. Once the search was completed, the data were cleaned and any remaining identifying information was removed. Tweets were coded for significant content, and themes were developed by combining related codes.

Search Results
The search of Twitter data returned 150 unique tweets. Four common themes were identified: the desire for Black clinicians, the perceived advantages of Black clinicians, the perceived relevance of race in clinical issues and services, and barriers in cross-racial clinical relationships.

The Desire for Black Clinicians
“I want a Black therapist ... let’s start there.”

“The hard part is over and done with so now it’s time to focus on healing. First step is finding a Black therapist in Atlanta.”

“I hate how hard it is to find a Black therapist.”

“I really need to find a therapist out here, preferably a Black therapist.”

By far, the most prominent theme was the desire for Black clinicians. Fifty tweets indicated that the user wanted to work with only a Black clinician, was seeking to find a Black clinician in their area or to treat their clinical issue, or desired to see more Black clinicians in their community.

The Perceived Advantages of Black Clinicians
“Having a Black counselor/advisor is so important … that connection can be the determining factor between not graduating and graduating.”

“Find a dope Black therapist; it’ll change your life.”

“When my therapist gets to talking to me like we’re home girls, that’s why it was so important for me to find a Black therapist.”

“Having a Black therapist is the best thing ever.”

Twelve tweets indicated that the users perceived Black clinicians to be generally more capable of meeting the needs of Blacks and that they had special qualities that were particularly beneficial to Black clients. They reported better outcomes, more intimate connections, and more attuned services with Black clinicians. Some users recommended that Blacks work exclusively with Black clinicians.

The Perceived Relevance of Race in Clinical Issues and Services
“Like today she fully dismissed me the moment I brought race in2 [the] mix.”

“The first therapist I had counseling with was a white woman. She said how do you feel about … seeing a white therapist. It definitely needs to be talked about in the room.”

“For a lot of us, our trauma is so interlinked with our race and racial consciousness, that we DO need to be seen by a Black therapist.”

“When I was getting therapy as a teen, my mother explicitly asked for a Black therapist who had dealt with Black kids in a PWI [predominantly white institution].”

Ten tweets posited that clinical issues and Black oppression are inherently and intimately linked and therefore should be addressed in clinical services. Twitter users felt that part of the reason they were in clinical services was because of the deleterious effects of racial oppression and historical trauma. They expressed a desire that their clinician help them to cope with race-based stress and institutional oppression. They suggested that only Black clinicians can or will address these issues in clinical services. Because of the salience of race in clinical services, one user advised that racial differences be explicitly addressed as part of the clinical process.

Barriers in Cross-Racial Clinical Relationships
“I realized that it’s because I’m from a Black family that I don’t understand what my therapist means by ‘take care of yourself by any means necessary.’”

“My white therapist helped me never relax.”

“It’s hard to trust people who, when the subject of race comes up, can claim to be color blind or ‘not political.’”

“They can only go so deep. When race was brought up with my white therapist, it was so awkward, it was like, ‘Oh I’m so sorry you had to go through that.’ Like they just can’t relate.”

Ten tweets indicated that there were barriers in cross-racial therapeutic relationships. Black Twitter users expressed having difficulties with separating their feelings about whites from their clinical experiences with white clinicians. A few even reported that white clinicians triggered their race-based traumas.

Some Twitter users indicated they were uncomfortable discussing their feelings and personal issues—especially those related to oppression—with white clinicians. Others reported feeling misunderstood and minimized by white clinicians. One advised against color-blind racial attitudes—the perception that race should not and does not matter. Racial differences and the minimization of racial issues were described as barriers to seeking treatment and linked to pretermination and attrition.

Making Sense of the Research
The project revealed that it is not uncommon for Black people to have strong opinions about the racial identity of their mental health clinician. Black Twitter users perceived Black clinicians to be better suited to meet their needs and thus preferred working with them for clinical services. Because their Black therapist understood their cultural material, they believed they were better able to relax and act in a natural way during sessions.

While the tweets convey a general sentiment in favor of Black clinicians, it should not be concluded that being Black is a necessary or sufficient condition for therapeutic success with Black clients. Indeed, the tweets suggest that Black clients feel most comfortable and confident in services when clinicians demonstrate a familiarity with Black culture and a nuanced understanding of their experience as a Black person.

It cannot be assumed that a Black client and a Black therapist share the same beliefs, values, or experiences. Nor can it be assumed that a non-Black therapist cannot empathetically engage race-based issues. Both non-Black and Black theorists should work to understand the range and scope of the Black experience and how to sensitively engage Black clients and address race-relevant factors.

To achieve cultural competence, clinicians should seek out tailored and targeted trainings and educational programs. They also should stay informed and up to date on events and social issues affecting Black communities, particularly in their local area. It may also behoove clinicians to engage in Black culture—read works written by Black authors and watch Black movies and television shows centering on the lives of Black people—to become more familiar with and knowledgeable about Black culture.

An overview of culturally competent services with Black clients is beyond the scope of this Twitter research. However, it is worth noting that cultural competence does not mean assuming that all observations about a Black client are culturally significant. Rather, it means using cultural competence information as “a beginning hypothesis,” an explanation for a clinical observation made on the basis of limited evidence, and as a starting place for further investigation (Boyd-Franklin, 2003, p. 4). This approach helps to avoid making rigid assumptions and acting on beliefs about Black people and Black culture that do not apply to the client.

This research has demonstrated that Black clients perceive race to be a salient factor in clinical services. Clinicians have an ethical and professional responsibility to ensure that they are meeting the needs of Black clients. Therefore, clinicians should be prepared to address race-relevant factors and to engage culture in a sensitive way. Continued education and training as well as active engagement in Black culture are key to meeting this goal.

— Stephenie Howard, PhD, LCSW, is the founder and president of Communities in Power, a nonprofit organization committed to supporting and empowering Black communities through community outreach and development and cultural competence trainings and consultation. She is also an assistant professor for the School of Social Work at Norfolk State University. 

References
Bahrampour, T. (2013, July 9). Therapists say African Americans are increasingly seeking help for mental illness. The Washington Post. https://www.washingtonpost.com/local/therapists-say-african-americans-are-increasingly-seeking-help-for-mental-illness/2013/07/09/9b15cb4c-e400-11e2-a11e-c2ea876a8f30_story.html

Dowd, T. (2020, June 19). Black therapists have been working overtime since the police killed George Floyd. VICE News. https://www.vice.com/en/article/dyz3xq/black-therapists-have-been-working-overtime-since-the-police-killed-george-floyd

Boyd-Franklin, N. (2003). Black families in therapy: Understanding the African American experience. New York, NY: Guilford Publications.