The top five reasons Black people don’t go to therapy

For many mental health issues, Black individuals experience similar rates of challenges compared to their counterparts. However, the severity of the challenges comes at a much greater cost for Black people due to compounding issues such as racism and discrimination. Furthermore, mental health issues that were once thought to be “White” concerns have cast a large shadow over the lives of Black people (e.g., suicide). The good news is that Black individuals that participate in therapy have the highest rates of success. So the question becomes if Black people are struggling with greater severity when experiencing mental health issues, but reap the most benefit, why are they the least likely to go to therapy? This post explores five reasons why Black people don’t go to therapy including: chronic mistrust, a lack of professionals of color, limited access, fear of misdiagnosis, and concerns about confidentiality.

Mistrust: For generations, the exploitation of the Black body as well as the pathologizing of the Black experience has contributed to a significant mistrust of medical professionals. Stories of medical tests and procedures, such as the Tuskegee experiment, being conducted on Black people have been passed down through the generations communicating a lack of value for Black life, health and healing. Additionally, ever since the first African stepped foot on American soil, Black individuals have fought to thrive and not just survive the atrocities of slavery, second class citizenship, and legal discrimination. However, at every turn, those Black individuals who have fought for freedom and equality have had their experience reduced to an abnormality that has been quantified in diagnoses such as Drapetomania (unrealistic desire to be free) and Protest Psychosis (unrealistic desire to be equal).

Lack of professionals of color: When individuals are experiencing issues related to mistrust, seeing someone that looks like you in the profession can serve as a bridge towards a trusting relationship. However, Black people are significantly underrepresented in the mental health field. For example, in the field of psychology less than 5% of psychologist are Black. The process of therapy requires individuals to exist in a space of ongoing vulnerability. However, Black people are less likely to inhabit this space if the therapist in the room is a reflection of racial oppression and is unaware of their complicity in the system.

Limited Access: Due to the transition of many mental health professionals to private pay practices, many Black individuals are priced out of mental health services. Instead, these individuals are forced to navigate large mental health systems with potentially long waits for services or seek temporary help via emergency services. This experience leaves Black individuals in a bind where they can’t afford quality services with a clinician who has potentially fewer clients and a faster turnaround time in a private practice. Instead, they must settle for less frequent care with a clinician who has a considerably higher case load in a larger mental health system. Black people who are already mistrustful of the system and observe a lack of professionals that look like them are further frustrated by an inaccessible system as they attempt to seek the services they need.   

Fear of Mis-diagnosis: There is power in mental health diagnoses. These diagnoses can open doors to much needed services and deeper understanding. However, the diagnoses can also close doors and increase stigma. For Black people, receiving a mental health diagnosis can compound the stigma already associated with the Black experience. Furthermore, mental health professionals are not immune from the negative narratives associated with Black people. Terms such as the “angry Black woman,” “scary Black man” or “defiant Black child” influence the way mental health professionals view and understand mental health issues facing Black people.

Concerns about confidentiality: The mystery that surrounds the process of therapy as well as the inherent mistrust that many Black people have about therapy create a space where individuals are unsure of how their narratives are received and recorded. By law, mental health professionals have one of the highest standards for protecting information shared during therapy. However, this fact is often not communicated well and leaves individuals to figure out for themselves the difference between talking with a friend (where the limits of confidentiality are based on the strength of the relationship) and talking with a therapist (where the limits of confidentiality are based on legal mandates).  

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