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Care Insights: Black Maternal Mental Health with Meghan Murchison

The Positive Impact of Therapy in Maternal Care with Meghan Murchison, LPC

February 24, 2023

Getting Therapists Involved in the Maternal Healthcare Conversation

In this edition of Care Insights we spoke with Meghan Murchison, a therapist with Heading Health who is based out of Houston, Texas.  Meghan’s passion for counseling started from a desire to reduce the stigma surrounding seeking therapy, especially for Black and BIPOC people. Now, Meghan says it is her journey as a mother that continues to fuel her passion to support people in finding mental wellness.  She offered insight from her own life as well as her professional expertise on the subject of maternal mental health, what she thinks is important for pregnant people to know, and how she feels therapists and doctors can do better when it comes to helping new mothers and parents thrive. 

 

“I have a passion for maternal mental health and focusing on women and the very broad spectrum of motherhood. My personal goal is to decrease the amount of deaths related to childbirth and post childbirth,” Meghan began.

Moms Need More Than Screenings

“I would like for us all to remove the stigma attached to postpartum depression, and how people have been solely categorized as having postpartum depression and not exploring other very real things like access to resources and support, PTSD after difficult pregnancies or traumatic births, OCD, anxiety, and even psychosis which can also occur during pregnancy and after childbirth,” she offered.

 

“After having a baby you go to doctor’s office and they do this little check-off list but I personally, as someone who completed the list and have clients who have completed the list,  I don’t feel that it is thorough enough. It’s a start, but we need to do more” Meghan noted.

 

“Physicians could do better in making sure that they partner with psychiatrists and partnering with therapists, and keep those referral pathways top of mind. Women should be getting help immediately, and preferably long before this 6 week checkup because finding a therapist after you’ve had a baby is probably the very last thing on your mind.” 

 

The checklist that Meghan is referring to is a screening that typically occurs while a woman or pregnant person is in the care of an OBGYN. The American College of Obstetrics and Gynocology recommends that doctors and providers screen postpartum for depression and anxiety. ACOG also recommends screenings occur before and during pregnancy to help ensure that comprehensive follow up also happens after birth as well. While screenings are common, studies have found that OBGYNs may need to do a better job ensuring referrals and resources make it to the patient. A 2020 study concluded that screening may not be enough, which echoed Meghan statement. Rather, increasing awareness and increasing resource availability seemed to be missing pieces to supporting the over 15% of postpartum people diagnosed with depression after birth. 

 

“Screenings just aren’t enough,” said Meghan.

 

When asked what therapists could be doing better, Meghan didn’t skip a beat.

 

“Expecting mothers need help and someone who listens. And it doesn’t matter if you have five kids, two kids, or it’s your first pregnancy, it is – to me – imperative that people receive therapy throughout the entire process of pregnancy, birth, and postpartum because it’s a reeling experience. Changes in your body physically and chemically. Changes in your work and social life. Changes in your relationship, and your sex life. And so many of the activities that you used to love may not be on the table any more, or at least for a while. Not to mention pregnancy can also be dangerous for some people. So it can be a scary time,” she said.

 

Advocacy and education seem to be missing pieces according to Meghan.  Very often people don’t seek out therapy until after there is a known problem, or someone in their life suggests it. While routine and regular physical checkups with a physician or midwife are involved in pregnancy healthcare, mental healthcare checkups with a licensed therapist are not considered routine. 

Improving Outcomes for Black Women

“Advocating for seeking therapy before and throughout pregnancy is something I would love to see for all moms, but I believe it is very important for Black mothers because there is still an inequity in Black maternal mortality rates,” Meghan noted when expanding on her desire for therapy to be considered more routine in prenatal care.

 

 

“Expecting moms, especially Black women, can benefit by having a therapist who helps them develop the skills necessary to advocate for their needs during pregnancy care. As a black woman, not only do I have to worry about the fact that my provider may not listen to me, or take my needs or wants into consideration because there is still a very real bias that exists in healthcare.”

 

 

Meghan discussed not only her professional experience witnessing Black women navigate difficult pregnancies, but she shared personal stories as well, “With my second child I was so afraid. I mean you’re already afraid as a mom. You’re just worrying about each day. Let me get this baby to the next day. Let me get this baby to the next week. Let me get this baby to the next month but then when you throw in  preeclampsia or gestational diabetes it raises the bar. I was so frantic because diabetes is already something that heavily affects the Black community.” 

 

 

Statistically Black women do experience more complications during pregnancy, higher maternal and infant mortality rates. While maternal mortality rate has experienced disappointing numbers in general over the last two decades, the gap for Black maternal mortality rates has increased and seems to have peaked during the pandemic.  Additionally, Black women report, on average, less satisfaction with their care, less trust in their providers, and a larger concern about bias among providers

 

 

“And ours is a community that already experiences a lot of disparity. For many Black women just securing a job with good benefits is a really big deal. So to be able to keep that job and keep that insurance often becomes the priority rather than really focusing on getting adequate rest and care.”

 

 

“My own pregnancy was very nerve-wracking and scary. But, luckily, I had a therapist that I’d been speaking with consistently. It made a huge difference in the way I approached my prenatal appointments, the questions I asked, and, how I spoke to my doctors. Just having someone who can help you feel more confident in every appointment can really improve the experience and the health of a pregnant person,” Meghan concluded.

Empowering The Expecting

“There is a huge opportunity for mental health providers to lean towards this community,” Meghan suggested.

 

Therapy for those experiencing pregnancy for the first time is shown to reduce rates of anxiety. Meghan proposes that it may also have a positive effect on how a person feels about the care they receive during pregnancy as well, and empower them to feel strong about the role they  play in the health of their pregnancy and new baby. 


“Therapy offers an outlet, as well, as a space of accountability,” Meghan explained.


Going to therapy is a bit like going to see a trainer in the gym. You learn the moves, and practice them, and you have a coach guiding you on how it’s done. Then you go work out on your own. In the early stages of pregnancy, those tips and guidance are essential, because everything is new. The outlet [of therapy]  can be very cathartic and it helps a woman feel like she’s not alone because of pregnancy and learn how to use her voice.”


Therapy is often thought of as a place to share feelings, or examine events and how they influence responses. Cognitive behavioral therapy, for example, helps patients recognize when a thinking pattern may be faulty and influences a behavior or reaction that is unhelpful, and it is a widely used therapeutic modality for anxiety and depression. However, therapy is not solely CBT. 


Therapy also can involve reframing a narrative, or belief system, about oneself, as well as coaching for a pregnant person who may be feeling intimidated by doctor’s appointments. Using a therapy session as a training ground to practice establishing boundaries, practice speaking up for themselves at appointments or during labor and childbirth, and discussing plans, fears and desires can be a outlet to process difficult emotions in a safe space. Additionally many therapists employ mindfulness techniques, and can offer education and practices that support nervous system regulation which can be helpful during moments of anxiety including birth itself. 


“I can share from my own experience that I had a doctor that solely focused on  having a safe delivery – and my birth preferences were not really part of the discussion. ‘Get the baby out safely’. That’s fair, but I wanted to enjoy my experience. I told my therapist that I was a little concerned that my doctor wasn’t not listening to me. My therapist was able to give me the feedback I needed. She told me ‘ok you have to be assertive and you have to tell her ‘this is what I need. Where can we meet in the middle?’ She also suggested I get a doula and encouraged me to write down a birth plan,” Meghan shared.  


“I heavily encourage talking about that birth plan with your therapist. Birth can be scary, but also it’s beautiful, and more times than not that mom and baby are both healthy. A therapist can help you focus on the positive potential outcomes too, especially when you’re feeling very anxious. So talking to your therapist is helpful in gathering those plans and empowering you to speak your truth.”


When considering her bottom line and what she hopes for the future, Meghan was clear.


“I personally believe that all Black women should know that they have a right to control their medical experience specifically. In birthing and caring for a child we have a history of pain, and a story that needs to change. Dating all the way back to slavery black women often had no autonomy over their experience as a mother, many times their children were ripped away from them or they spent all their time caring for other people’s children without being able to dedicate the same time caring for their own. And so I want black women to know that they are powerful, that this is their experience, and their experience only,” Meghan concluded. 


“If someone makes you feel bad about speaking up for yourself, then they are not the provider for you. They are not a support person for you. You have to find another support person and not to give up on finding that person or people who will help you make your birth the best possible experience for you and baby.

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Facts About Major Depression Everyone Should Know

Facts About Major Depression Everyone Should Know

February 22, 2023

Depression is a Leading Cause of Disability

With an estimated 300 million people suffering  worldwide, depression has become a leading cause of disability. The financial toll that depression takes on an individual furthers the difficulty individuals have in maintaining stable employment and adequately being able to receive treatment. Prolonged depression that is untreated or undertreated only serves to increase the problem leaving the individual, and their families not only with health concerns, but additional financial stress that comes from being on disability and concerns regarding on how to pay for treatment. 

Adults with Depression Have over a 60% Increase in Their Chance of Developing Heart Disease

When it comes to health it is clear that mental health plays a huge role. The two-way link between heart disease and depression is multifaceted. From the impact of prolonged stress on the nervous system stimulation, to inflammation, to the influence depression has on other lifestyle factors including movement, diet, and socialization, it is obvious that the physical body suffers when the mind suffers. Mental health is health, and must be a serious part of the conversation.

Suicide is the Fourth Leading Cause of Death in People 15-29

Depression can be lethal especially for young people. More than 700,000 people die by suicide every year. Not only do these deaths have tremendous ripple effects, they are completely preventable. Education, resources, access to personalized and more effective treatments, and reducing the stigma around mental health are all important components in suicide prevention. 

Combining Therapy with Medication Often Works Better Than One Treatment Alone.

When it comes to depression, many people consider taking medication, which can be effective in symptom reduction.  However, most people with major depression respond better to a combination approach that includes psychotherapy. Treatment that incorporates both top down and bottom up approaches seems to work. While medication is addressing symptoms physically, therapy can come in to help a person develop longer term coping strategies to better navigate stress.  Increasing access to in-network psychiatrists and therapists is key in increases access to care that improves outcomes. 

Some Studies Show 10%, and Others Up to 30% of People with Major Depression are Treatment Resistant

While SSRIs and combination therapy work for some, they don’t work for all. Be it side effects that become intolerable, or simply a medication that no longer works, treatment-resistant is a term that applies to someone that has tried multiple attempts at treatment (typically medication) and is still suffering. There are many theories as to why SSRIs don’t work or stop working. However, that does not mean there isn’t hope for those individuals. New treatments like psychedelic treatments, including Ketamine therapy, have shown rapid improvement of symptoms for those who have experienced treatment resistance.

 

 

There is a 2-Way Link Between Sleep Disorders and Major Depression.

Restful sleep supports the brain, and a healthy mind promotes good sleep. Those who experience sleeplessness and insomnia are more likely to experience major depression. Additionally those who have trouble sleeping may have less success with medication as well. A tired mind and body have a difficult time healing. Bottom line, those who are experiencing sleeplessness should be talking to their mental health care provider about it, and developing strategies to get more restful sleep, and providers should be proactively asking about and addressing sleep concerns.


Changing Medications is Common and Normal, as is Pursuing Alternative Treatments and Therapies, Such as Ketamine, rTMS, and Psychosocial Interventions

It is common for a medication that has worked for years to stop working for someone with depression, and this may be for a variety of reasons both biological and related to life events. For some, switching to a new medication works. However, for others, it does not. People who are treatment resistant, which generally mean they have tried and failed to find relief from traditionally prescribed medications, may be more inclined to seek interventional treatments. While treatment resistance is difficult to treat a significant number of people with treatment resistant depression who engage in other treatments such as Ketamine, repetitive transcranial magnetic stimulation, and psychosocial interventions do find some level of relief when traditionally prescribed medications stopped working. 

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Care Insights: Sex & Therapy with Jestina Franks, LPC-S, AASECT Certified Sex Therapist

Talking Sex & Therapy with Jestina Franks, Sex Therapist & LPC-S

February 13, 2023

Psychology, Sex, and Intimacy

Whether it’s framed as a “Hallmark” holiday, or a tradition that couples around the world take seriously as a date to engage or reengage with romance, Valentine’s Day raises feelings, questions, and desires to the surface for almost everyone. When those feelings, questions, and desires feel uncomfortable, painful, or completely new, it can be the very best opportunity to talk to a therapist about sexuality, and intimacy.

 

In this edition of Care Insights Jestina Franks shared her perspective as a counselor and sex therapist on why talking about sex in therapy is an important conversation for deepening personal understanding, and life satisfaction – whether you’re coupled up or not. 

 

So, we talked about sex.

Jestina works with Heading Health, and is a LPC-S and AASECT Certified Sex Therapy who offers virtual therapy to patients in Texas. To kick off the conversation about sex and therapy, Jestina thought it was important to set a baseline understanding of why sexual intimacy is such an important topic even though it’s often ignored or skimmed over in therapeutic settings.

 

 “Sex is an important part of who we are.  We see many images in social media and think this is what my sex life should look like and this is how I should feel when I have sex.  Those images can be further from the truth and can create anxiety.  It’s important to talk with your therapist about these concerns,” Jestina offered.

 

Sex and Satisfaction Beyond Biology

Discussing sex in the world of psychiatry often stops with conversations of physical performance, as mental illness itself and some medications prescribed to treat mental health disorders can negatively impact a patient’s sex life. Be it medication side effects or the impact of long standing stress, mental health takes a toll on intimacy and sex.  Finding a balance between effective management of concerning symptoms of anxiety and depression can come with a trade off. 

 

“There can be some psychological barriers that can impact our sexual functioning. Also some psychiatric medications can have side effects that can affect your sexuality.  It is important to educate yourself how medications can affect your sex life, and ask questions,” suggested Jestina.

 

“While some issues with sex and intimacy may have physical causes, very often psychological causes are at the core. Sexual dysfunction can be caused by anxiety, self-confidence issues, and trauma. These are things that are not just affecting life inside the bedroom, but also everyday. So proper screening can shed light on deeper issues that could easily be overlooked if the right questions aren’t asked.” Jestina shared.

 

The door also swings both ways as well, and collaboration between mental health care and physical health care providers is crucial for optimal care. “Mental health professionals need to collaborate with physical health providers too to ensure that sexual health issues are not medical, “ she noted. “Sexuality is a part of who we are as humans, and it’s not a one size fits all. It’s a unique part of who we are and it’s different from everyone else.  Our sexual health contributes to our overall wellbeing.”

Seeing a Therapist who Specializes in Sexual Health

However, it’s not always that simple as stigma around sex is still a large barrier. Jestina sees a parallel between sex and mental health in the way that culture, and the medical system, has been slow to invite an open dialogue. 

 

“Sex is so taboo. It’s a part of ourselves that we keep hidden and don’t talk about. Mental health was just like that at one point, and still is in a lot of ways. But, what a lot of patients, and even many providers, don’t consider is that sex therapy is a specialization within behavioral health that is focused on sexuality and sexual functioning. While you can talk to your therapist or psychiatrist about sex, getting referred to a provider with specialized training in sex therapy offers tremendous benefit – especially for those who have experienced sexual trauma, or are seeking support surrounding their sexual orientation, sexual identity, or have had a major life experience that has impacted their experience of sex and intimacy” 

 

The conversation can also be much more fluid when speaking with someone trained in sex therapy because the elephant in the room isn’t being ignored; it’s front and center. “Sex therapists are there to educate on communicating openly and honestly with your partner, find the root of sexual issues or challenges and move towards a fullfling, and pleasurable sex life.”

 

Something that many people are surprised to find out is that this work is not just for couples. 

 

 

Sex therapists very often work with individuals, especially when someone is working through a history of abuse or trauma, or when someone is  seeking support for issues of sexual preference, orientation, or identity, or experiencing a big life change like dating after divorce, medical illness, or another large life transition.  “Having a therapist who is sex positive, knowledgeable, compassionate, and empathetic empowers people to take control of their sexual health and wellness, and you don’t have to wait until you’re having sex with someone else or partnered up,” encouraged Jestina.

How to Pick a Sex Therapist

Not every therapist is going to be able to offer the same level of skill as a therapist who has specialized training. For those who feel that their therapist may not able to provide support Jestina suggested asking for a referral. Jestina also empowered people looking for a sex therapist to consider the qualities that would support them best, “Sex therapists are trained to help process concerns such as low libido, mismatched libidos, lack of desire, pain during sex, erectile dysfunction, sexuality and identitiy, and alternative relationships such as polyamay or open relationships and a host of other sexual health or wellness concerns,” Jestina explained.

  

“I would encourage people to ask questions and advocate for yourself. You can ask about a therapist’s education and qualifications. For example some sex therapists are AASECT certified which means they have gone through extensive training. You also will want to know if the therapist has had experience working with a population similar to yours.” 


Cultural sensitivity and community experience can have a positive impact in building rapport, and people may with to seek out sex therapists within or allies of the LGBTQIA+ community, have experience working with people who have a history of sexual abuse, or  people experiencing issues with sex and intimacy post divorce or loss, and  aging populations may want a therapist who has insight in maintaining a positive sex life in their golden years. According to Jestina sex therapy needs to be culturally sensitive, and inclusive, otherwise it will completely miss the mark.


“There’s a need for therapists who want to get more training in sex and intimacy. For those interested in the field I would encourage them to check their bias at the door. What appeals to a client may not appeal to you, but it’s not your job to judge. Those unique desires and preferences may be key pieces to that individual’s overall identity and experience of the world. It’s a sex therapist’s job to guide and support the healthiest and most authentic experience of sex and intimacy for the person they are helping,” concluded Jestina.


And, for those still nervous to talk about sex during therapy, or unsure of the benefits, Jestina had this to say, “Seeking professional help can give you the tools and resources to process what you have experienced. [Sex therapy in particular] will give you a safe space to process your trauma, learn coping skills, explore ways to feel safe in your body, learn how to create and set boundaries, and use positive communication skills.”

Important skills for everyone – no matter their relationship status. 


For those interested in learning more about sexual health, sex education, and sex therapy, the American Association of Sexuality Educators, couselors, and Therapists has resources for patients and providers at AASECT.org

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Care Insights: Community Health & Black Mental Health with Shaunae Tolson, LPC

Therapy Insights: Community Health & Black Mental Health with Shaunae Tolson, LPC

February 6, 2023

Black Mental Health & Black History Month

In this Care Insights we spoke with Shaunae Tolson, LPC.  Shaunae is a counselor who offers virtual therapy services to Texas, and is part of the care team at Heading Health.


Shaunae shared with us her inspiration for entering the field of mental health, her perspective on providing mental health care and receiving mental health care as a Black woman, and what she feels is the duty of the medical system and those in health care when it comes to not only serving individuals but also being the change she hopes to see for all patients.

February is Black History Month, a month that serves to recognize the contributions and achievements of Black individuals, with special focus on sharing important stories of the people and moments in Black history that have and continue to play a central role in U.S. history, and offers a powerful reminder that Black culture is American culture.  In our conversation with Shaunae, she shared what this month means to her and how Black Mental Health should be part of the conversation, this month and every month.

 

 

“Well, obviously, being a Black woman I grew up black with all the challenges that come with growing up Black. And for me, and many people in my community,  mental health was not mentioned or talked about or acknowledged. The closest thing you get to counsel is ‘go to church’, ‘give it to God’, or you’re told to pray or talk to the pastor,” Shaunae reflects.

 

 

“I think that’s why it’s important to talk about Mental Health when we talk about Black History.”

 

 

Mental Illness, PTSD and Survival

Shaunae grew up in what she called a ‘rough, inner city neighborhood’, and recognized that most people in her community were experiencing significant challenges. Now, as a therapist she is able to empathize with her clients who have been raised in similar circumstances. Shaunae shared that she feels that what may be labeled as ‘mental illness’ is often survival mechanisms and habits for coping.  The impact of living under extreme stress for a prolonged period of time often creates mental and physical health symptoms that aren’t always obvious, because surviving becomes another part of daily living.

 

 

“I was an inner city kid. And I feel like a lot of inner city kids suffer from PTSD. For me, having family members that have gone through the legal system, we suffered, but we had to suck it up. No one really talks to inner city kids about the exposure they have had to really difficult circumstances, and what impact witnessing these things is having on them”

 

 

“What I know now about PTSD, as a counseling professional, is that it’s just survival tactics really.  You’re often forced to learn them and sometimes just don’t have a choice in the matter. It can come with aloofness, a numbing, pretending like you’re unbreakable, or coming across as standoffish or disrespectful. But what people need to realize is that at the end of the day – basic needs always win. You do what you think keeps you safe.” Shaunae shares.

 

 

Shaunae’s personal experience concerning the difficult nature of mental health diagnoses, and even misdiagnoses, when dealing with trauma echoes broader issues of racial disparity in mental health care. A 2018 study from Rutgers University compared the diagnoses given to over 1600 people and concluded that very often Black men with a diagnosis of schizophrenia were much more likely than non-Black individuals with a schizophrenia diagnosis to also qualify for a diagnosis of major depression and PTSD. Yet, the screening for mood disorders and diagnosis of major depression was often not given.  Discussion of this study also noted the finding suggests a bias towards screening Black individuals for psychotic symptoms over mood disorders.

 

 

Undertreated major depression is significant, as it is a misdiagnosis of schizophrenia, in both instances the potential for inappropriate treatment or undertreatment comes with significant health risks.

 

“You know with police brutality, lack of opportunity, crime, and a lot of what happens in rougher neighborhoods relates to people doing what they know to do based on the demands of their environment. And it takes time and perspective, and really the ability to step away, to realize that sometimes coping techniques are dysfunctional, and understand that your feelings do matter.  But it’s hard to form that sort of perspective if you’re stuck or you’re unsafe. You have to survive first. Mental health or emotions are not going to be seen as a priority, because they’re emotions. They don’t feed you, put clothes on your back or keep the electricity on.”

 

The challenge of offering support to an individual when societal factors play a large role in a patient’s suffering is an aspect of her job that Shaunae embraced, ”I think that’s why it’s such a  passion of mine. The work is complicated because I’d often have to say to someone, ‘You’re right, you still have to survive, unfortunately, because of the cards that you were dealt and the situation that you’re dealing with’.” 

Doing Healing Work In a Broken System

The resilience of the people Shaunae supported in her time in community mental health stoked a passion for her career in counseling. When Shaunae reflected on her time in community mental health she shared that one of the most difficult aspects of that work was not being able to change the environment she was sending people back into after their session, but that community centers were the heart of change for neighborhoods like the one where she raised.

 

 

“I’m a huge advocate of community centers,” Shaunae shared excitedly.

 

“I worked in community mental health. So, I dealt with, you know, America’s true people. And I’ve heard a lot of things, and witnessed a lot of emotion that stem from really horrible experiences. Even though I couldn’t necessarily change their experiences or what they were going through, I  saw the impact of just being heard, and having a safe space for letting it all out,” Shaunae remarked.

 

 “We can’t fix the situation. Most times we have to send them back to where they came from and they have to continue to survive. But I don’t think people understand the impact of just having a brief moment of not having to worry.”

 

Community centers are often frontline areas of support for low-income people who live in inner city environments. While the American Affordable Care Act did begin to close the insurance gap, Black individuals still trail behind in coverage, and are much less likely to have private insurance making access to quality mental health care difficult and cost prohibitive. Safe spaces where counseling, support groups, social services, and recreation, become centrally important in providing low cost and zero cost access to meaningful access.

 

 

“When you’re worried about basic needs emotions are not going to be a priority. But there can also be some acknowledgement and support. And that goes a long way. Just a space for releasing is impactful.”

Need for Black Mental Health Professionals

When asked about her perspective on receiving mental health counseling for someone of the same race, Shaunae’s response was nuanced and thoughtful. It was clear this is a topic she’s considered often in her own life and in her career. 

 

“I have a mixed perspective. It’s not always necessary for your therapist to look like you, but sometimes it can help. Some of the greatest therapists I saw were white women. I never felt like they couldn’t help me because they didn’t understand my struggle or that I couldn’t meet with them, but I also will add that at the time I was already studying this work. So I had some awareness. But, in reflecting back, the biggest reason I was able to navigate [having a white therapist] was because growing up my mom always made a way to ensure we were able to go charter schools. I was not a stranger to being in predominantly white environments.”

 

One important aspect of reducing stigma and improving care and access for the Black community relates back to a greater need for diversity in the mental health field in general. The APA reported that as of 2015 the field of psychology was less diverse than the nation as a whole, and that only 4% of professionals in the psychology field identified as Black. While beneficial care is not reliant upon racial, gender, or sexual orientation matching between patient and provider, there are real benefits to care when a patient feels more comfortable building a rapport with someone of their own background. 

 

In Shaunae’s own therapy journey, connecting with a therapist who was a Black woman made a difference for her. She shared, “When I got my first Black therapist, that shifted things for me. I can’t even pinpoint the exact shift, but it took my treatment to a deeper level. Having that connection of culture was significant. A lot of the things that I explore with my current therapist, who is a Black woman, are also things that I explored with white therapists. However, now with that shared connection I’ve been able to revisit those topics and process the experiences more deeply. Her understanding of the Black experience, and being able to ask certain questions about the Black experience and being a Black woman especially, helped.”

 

Rapport is a significant indicator of therapeutic success, even more so than a specific theory or modality used in session. Research on cultural competency and its relationships to therapeutic outcomes is gaining more traction though a precise definition of what it means to offer culturally competent care is still difficult to pinpoint. But, research shows that providers can unintentionally contribute to increased racial and ethnic disparities in care, and on the whole the system needs improvement. Though the fact remains that racial and ethnic minorities are less likely to receive psychological care than the white majority, and in order to meet the need more BIPOC are needed and white providers need to become more immersed in providing care to a culturally diverse patient population.

 

“For Black people who may be resistant to therapy, or nervous to talk, having someone that they immediately feel like they can trust and relate to might make a big difference. Someone of a different race, who’s just very textbook, just not aware and simply feeding what CBT told you to say if a client says a certain thing – that’s a turn off.”

 

 

Given that the overwhelming majority of psychology professions are white there is a tremendous need for learning and education around what it means to offer culturally competent, sensitive, and relevant care. Shaunae shared, “Clients who have come to me after experiencing a white therapist or someone who just wasn’t culturally aware said it was off putting and it made them quit there because to them it’s like, ‘I don’t need you to tell me what the textbook said or to watch calming soothing videos, I don’t need that, I need you to hear me and know what I’m talking about.’”

How Mental Health Practices and Providers Can Support Change

“When it comes to changing Black Mental Health I think first of access. Access provides the opportunity for a powerful trifecta: Awareness, Perspective, and Trajectory. Awareness comes through psychoeducation and therapy to unlock the path to psychological freedom. This leads to a shift in perspective, and that unlocks hope. Hope is needed in order to change the trajectory of one’s life; a life that may have seemed unattainable.”


Facilitating space for hope can be a change with insurance gaps, and difficulties in access – even with the advent of virtual therapy.  When asked what she thinks mental health practices and providers could do to influence systemic change and promote greater access, Shaunae had very concrete ideas of what she’d like to see.


“Educational assistance, and medicaid. I don’t know the logistics behind convincing more companies to accept medicaid, or how to improve the care that comes with it, but when I was working in community mental health accepting Medicaid was huge. Unfortunately when it comes to medicaid, people don’t always get the best care, and we need to change that too. I believe mental health practices and providers have a responsibility to figure it out.”


In the short term, Shaunae challenged practices and providers to align and support organizations already offering care to those who need it. 

“I remember when I was growing up in the projects there was a community center. It was just a place for us to escape. It had recreational activities, and people we could talk to if we needed. Simple things like that. Mental health care practices should support the places in the community that are already doing the work. Centers are monumental because there’s no transportation barrier, and financial barriers aren’t there. Growing up, I didn’t know what yoga or Pilates or meditation was. Community centers are starting to bring some of these things that we, even I, preach to our clients.”


From Shaunae’s perspective an action everyone who cares about improving mental health care equity can do is to find ways to support safe spaces, “We need places where at least you get a break, because we all need a break.”

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