Privilege and otherness: An examination of working with the experience of race-based trauma in the counselling room

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‘No therapist will deliberately harm their client, but all therapists who ignore the challenge of racism contribute to the perpetuation of racism and inadvertently contribute to the client’s pain about oppression’ (Mckenzie-Mavinga, 2016:212). The challenge of this statement and the desire to do no harm (BACP, 2018:9) was the driver for researching this topic.

The aim of this critical literature review is to look at how White privilege and the experience of being other can impact the dynamic in the counselling room, and how an awareness of difference and an ability to work with it can help clients manage their experience of race-based trauma.

Firstly, it will give a brief history of Blackness in the UK and some statistics around mental health issues for those of a non-White British background. It will then look at the client’s experience of racism as trauma. It will explore a Christian anthropological view and examine how the Bible has viewed slavery before turning to racism in the context of the Church. It will consider the issues facing therapists when working with someone from a different race or ethnicity. Lastly, it will offer some therapeutic responses for working with clients who have experienced racism as trauma.


The subject of ‘Black Lives Matter’ has been much in the news in the last few years, especially following the death of George Floyd in the United States (BBC, 2020b). Over this period, I have been counselling a Black[1] client of African-Caribbean descent who has identified trauma and identity issues in the wake of these events. Research has shown this is not uncommon, with 23% of the Black community experiencing common mental health problems in a given week compared with 17% of White British people (Burrell, 2021:200;, 2020). Eight per cent of Black or Black British adults have experienced post-traumatic stress disorder (PTSD). This is twice as many as those from White British backgrounds (Mind, 2021).

Alongside this, I have been working through my personal response to White privilege (Eddo-Lodge, 2018:86-87) and the Church’s role in, at times, disenfranchising the other (Lindsay, 2019:38). Through my client’s challenge, the intersectionality of race and ethnicity not only entered the counselling room but also my consciousness (Turner, 2021:21). For the first time, I had to recognise my own feeling of shame and guilt at my perceived powerlessness and inadequacy in the face of my client’s experience of racism (Mckenzie-Mavinga, 2016:26).

Intersectionality is a huge topic which can relate to any areas where the majority use difference to marginalise the other (Turner, 2021:18-22). The focus of this essay is race and ethnicity and what happens when this is brought into the counselling room.

Race: Black history and mental health 

A brief overview of Black history in Britain 

An overview of the history of Black people in Britain is marked by the fact that, as Maharaj notes, people of colour have been ‘pawns in the [economic/ political] game’ (2021:122), used when labour was needed, either as slaves, indentured servants or, in more recent times, low-paid workers in the making of modern Britain (2021:123).

While there is evidence of Black people in Britain as early as the first century (Olusoga, 2021:30), significant numbers of Black people are not recorded until the late 17th and early 18th century (Olusoga, 2021:76). Their presence, mainly around ports, was linked to commerce, marked by the shipping of goods and people from Africa and the Caribbean by plantation owners and slave traders (Olusoga, 2021:86). Some people of colour arrived as free citizens, others as slaves, but whatever their status the majority found themselves living in poverty (Olusoga, 2021:97).

The expansion of the British Empire into Africa and the rise of social Darwinism in the late 1800s led to a growth in white supremacy, viewing Black people as racially inferior, their dark skin and distinctive facial features marking them out as different (Olusoga, 2021:405-406).

The history of the Black community in the UK often overlooks the fact that many Africans were sent to Britain to study at university. They often stayed on as professionals, leading to the creation of a Black British middle class in the early 20th century (Olusoga, 2021:420). This runs counter to the earlier view of Black people as less mentally capable (Lago, 2006:27).

The First and Second World Wars brought a further influx of people of colour from the colonies who came to fight for the ‘Mother Country’ (Burrell, 2021:201). Following the Second World War, with high labour shortages, people from the Commonwealth were invited to come and work. Another wave of immigration began with the Windrush generation from 1948 onwards (Maharaj, 2021:121).

The 1948 British Nationality Act gave people born in commonwealth countries the ability to claim British citizenship. The Race Relations Act (1964, 1968 and 1976) and the Equality Act 2010 sought to give greater equality to people of colour (BBC Bitesize, 2021). However, the 1905 Aliens Act and the 1962 Commonwealth Immigration Act sought to restrict the types and numbers of Black people able to enter Britain each year (Olusoga, 2021:512). The 1980s use of sus law and subsequent race riots continued to highlight inequalities in the administration of law and order (Olusoga, 2021:516).

Black people’s mental health and access to services 

This section identifies the impact of being Black on people’s mental health and their ability to access services[2].

The 2016Equality and Human Rights Commission’s, Healing a Divided Britain report, highlighted the higher prevalence of poverty (EHCR, 2016:65), overcrowded housing (EHCR, 2016:60) and reported significant growth in long-term unemployment among the BAME population (Olusoga, 2021:525). These factors have been shown to have a negative impact on mental health outcomes (Bignall, Jeraj, Helsby & Butt, 2019:14).

Maharaj argues that equality of access is not possible when institutional structures still carry their colonial legacy (2021:122) and do not seek to address the culture and history of those with non-White backgrounds in the services they provide (Maharaj, 2021:123). Coupled with the perceived stigma attached to mental ill-health, this has led to people of colour not accessing services early (Rethink Mental Illness, 2021). The cultural need for silence around issues of mental health also play into this (Venson, 2020:28; George, 2018:34).

Statistics have shown that when Black people do access mental health services, they are more likely to be medicated than referred to talking therapy (Bignall et al., 2019:16). There is also evidence that Black people are more likely to drop out of therapy if their culture is not included in the counselling process (UEA, 2021). The Equality and Human Rights Commission have shown that White people have better chances of recovery having engaged with mental health services (2018:113).

Public Health England (2019) has highlighted the need for a change in the Eurocentric approach to therapies to reduce barriers to access for those of different ethnicities. Cosford and Toleikyte (2018) see creating a level playing field for access as a ‘contentious and complex’ issue among some public health and healthcare commissioners, leading to reduced action in this area at a local level.

Experiencing racism as trauma 

 What is trauma? 

Before examining the effects of living with racism as trauma, it is important to be clear about what trauma is. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines traumatic stress as occurring in response to exposure to a traumatic or stressful event(s) where there is a risk of serious harm or death (American Psychiatric Association [APA], 2013:265).

Ellis defines trauma as ‘any stressful event that is prolonged, overwhelming or unpredictable’ (Ellis, 2021:36). Lee argues that, just as the experience of trauma is unpredictable, it can leave a sense of lack of control, a lessened sense of trust in others and a diminished sense of safety (2012:5). It can also lead to a distrust of self and one’s cognitions (Lee, 2012:5). This lack of safety and trust can lead to a state of hyper-vigilance (Welsh, 2018:4) and the use of safety behaviours to avoid perceived threats (Scott and Stradling, 2006:13) or hypo-vigilance and potential dissociation (Sanderson, 2013:38).

While much race-based trauma would not fit the DSM-5 definition of traumatic stress as the causal criteria is not met, there is a growing view that racial trauma should be included as a category of traumatic stress (Olson, 2021). In the absence of a formal entry in the DSM-5, Carter, Mazzula, Rodolfo, Vazquez, Hall, Smith, Sant-Barket, Forsyth, Bazelais and Williams developed the Race-Based Traumatic Stress Symptom Scale to provide a criterion which would allow a correlation between event and symptoms, identifying ‘race-based traumatic stress occurs [sic] from events that are sudden, out of one’s control, and emotionally painful (negative)’ (2013:2).

‘Living while Black’

The title of Kinouani’s book, Living While Black, was chosen to reflect the ‘challenges of existing, resisting and thriving within white supremacy’ (Kinouani, 2021:5-6). The designation, Black, has come from a hierarchical distinction developed in the years of the slave trade and colonialisation (Coates, 2015:7). White colonialists used blackness as a ‘physiological sign’ to highlight a ‘psychological inferiority’ (Ellis, 2021:61). It is important to note that race is a social construct (Winters, 2020:33) which has no grounds in biology (Ellis, 2021:66).

If unchallenged racism can infiltrate systems the effects of this ripple wide. Over time, unequal treatment becomes institutionalised, leading to a failure to ‘provide an appropriate or professional service’ (Macpherson, 1999). Research shows that while young Black people are more likely to access higher education, they are less likely to attend ‘prestigious’ universities or exit with high grades (Eddo-Lodge, 2018:67). They are also less likely to obtain a ‘highly skilled’ job (Roberts and Bolton, 2020:1). This is borne out by a recent survey of FTSE 100 companies that revealed only 2% of CEO roles are held by people from an ethnic minority background (Powell, 2021).

The nature of race-based trauma is widespread, being felt not only at an institutional and systemic level, but also at an individual level (Winters, 2020:6). The individual can supress the feelings and effects of racism causing a trauma response. At an interpersonal level, racism can be experienced by the individual in community (Winters, 2020:6).

For individuals and communities’ race-based trauma can also be experienced intergenerationally. In this instance, the fear generated by trauma experienced in one generation is passed on to the next (Ellis, 2021:116). Mckenzie-Mavinga refers to ‘ancestral baggage’ (2009:78), the emotional response of one generation impacting subsequent generations. Unlike other forms of ongoing relational trauma, when racism is experienced as trauma, it carries with it the weight of history as well. Mckenzie-Mavinga’s ‘baggage’ feels like an apt description for this heavy load.

Conceptualising of racism as trauma using the Waverley integrative framework

Having examined what race-based trauma is, and the lived experience of Black people, the Waverley integrative framework is now used to conceptualise its impact on the individual. It uses the six areas of functioning to examine some of the characteristics that are likely to be encountered (Ashley, 2015:152).


Coates highlights that racism is a ‘visceral experience’ (2015:10); it is felt in the body. Kinouani notes that ‘physicality’ has been used to ‘racialise’ Black people (2021:9). A difference in physical appearance has been used to create boundaries. Shadism, hair texture and the white definitions of beauty can all play into the ‘negative gaze’ (Mckenzie-Mavinga, 2016:93). Kinouani highlights the dehumanising crossing of boundaries when, for example, White people want to touch Black people’s hair (2021:19). She also comments that having a Black body marks you out in White spaces and can mean it is harder to be accepted (2021:125).

Black people report a low-level, ongoing fatigue (Winters, 2020:70; Houshmand, Spanierman and De Stefano, 2017: 205). This is related to continued secretion of stress hormones, which in turn can lead to other mental and physical illnesses (Sanderson, 2013:30). The fatigue is a deeply held traumatic stress which can pass generationally and take ‘inordinate amounts of energy to overcome’ (Winters, 2020:33).


Having highlighted how Blackness has been used as an indication of inferiority (Kinouani, 2021:9), this has led to some Black people feeling shame in who they are (Kinouani, 2021:163). The felt need to assimilate whiteness and deny parts of self can be equally as abhorrent as the feeling of shame (Kinouani, 2021:163).

Another emotion common in the experience of Black people is living with fear. Recent statistics on the use of stop and search legislation by police in England and Wales have shown that Black people are nine times more likely to be stopped than White people (, 2021). A client of the author has reported that ‘nowhere feels safe, not even home’.  He reports living in fear; a phenomenon which Winters also notes in her description of ‘place-based fear’ (2020:77).

Another emotion which is common in the context of racial trauma is what Mckenzie-Mavinga refers to as ‘Black rage’ (2016:51). Anger at unfair systems and unequal treatment can simmer below the surface. It is often suppressed due to a fear of the repercussions. The ‘brutal, unforgiving’ White response to civil unrest is an example of this (Ellis, 2021:208). The fear of being labelled with a mental health problem can also lead to internalising anger (Mckenzie-Mavinga, 2016:72). Keeping rage hidden because it feels dangerous can lead to depression. One key role of therapy is to provide a safe place for exploring emotions (Mckenzie-Mavinga, 2016:73).


In the rational area of functioning one can see mental fatigue. There is a need to shut down feelings, and thoughts of injustice are not given voice, which can lead to silencing (Mckenzie-Mavinga, 2016:33).

Kinouani comments that in her work as a psychologist, she does not feel she has ever worked with a client of colour who has not been experiencing injustice of some type (2021:59). This can lead to a sense of lack of safety and disconnection with the world, an ‘ontological insecurity’ (Kinouani, 2021:58). These thoughts are not just for the individual, but also extend to the family. There is often concern for the safety of children as they venture out into the world (Ellis, 2021:121). The fact that there is a need for ‘the Talk’ to ready children for the experience of racism in the outside world, with particular reference to authority figures and the need to stay safe, can be alarming (Kinouani, 2021:192). There is a recognition that this step away from the ‘normalcy’ of the general parenting experience needs to be grieved (Kinouani, 2021:111).


Thinking leads to behaviour and the need to assimilate can be found in the way Black people can often feel the need to adopt two personas. In the world of work there is a different way of dressing, a different style of language so that the Black person can be accepted in the White space (Kinouani, 2021:122).

The concept of ‘Black excellence’ (Kinouani, 2021:103) and the need to be doubly good to succeed is prevalent in behaviour (Kinouani, 2021:123). The need to work twice as hard can lead to long-term stress. Failure or mediocrity can confirm racial bias, and this can play into the emotion of shame for self, family and community (Kinouani, 2021:162; Turner, 2021:51).

Ellis notes the delicate balancing act between action and speaking out against racism and the desire to stay quiet and be safe. This is part of the daily dilemma of living for those who are Black (Ellis, 2021:5).

Mckenzie-Mavinga highlights the destructive behaviours that can result in internalised oppression. The fact that one stays silent can cause the individual to act against themselves and can lead ‘to low self-concept and feelings of powerlessness’ (2016:16).


This leads into the spiritual area, which Kallmier describes as the place where we discover within ourselves ‘security… self-worth and… significance’ (2011:78).

As we have examined the other areas of functioning, there has been a felt lack of security (Kinouani, 2021:58); self-worth, with the ‘low self-concept’ described by Mckenzie-Mavinga (2016:16) and significance, the need to try harder and conform to fit in (Kinouani, 2021:122). This could indicate challenges owing to racism in the spiritual area of functioning.

There is also the dichotomy of holding the Christian faith, a religion with links to a colonial past, which has in itself ‘created barriers to faith’ for some (Lindsay, 2019:xxvi) and the expression of culturally relevant faith, which was frowned upon (Burrell, 2021:202). This has led to the setting up of Black majority churches (BMCs) outside the mainstream denominations (McLean, 2020:36). It is interesting to note that BMCs are now the fastest-growing denominations in the UK (Maiden & Daley, 2021).

Winters states that faith has been one of the main ways Black people have endured racism (2020:91). While Winters is writing about US culture, there is likely to be some correlation with UK experience. For example, in the 2011 UK census African-Caribbean and Black Africans who described themselves as Christians ‘ranked religion as the third most important factor in their lives’. This compares with White Christians who seldom valued ‘religion as central to their identity’ (Thompson, 2018).


In the relational aspect of the model, the attention turns from the internal aspects of self to ‘‘the self’ in… dialogue with the ‘outside world’ (Ashley, 2015:152).

Kinouani describes connection as being fundamental to human relationships, but racism creates the opposite of this – the breakdown of relationship (2021:21). Siegel (2011) describes the need to feel positivity about ourselves as being based in a sense of connection with others. There can be a sense of cultural homelessness for second-generation immigrants. They are neither part of their parents’ culture nor are they accepted by their native culture. This can lead to a sense of disconnection (Kinouani, 2021:64).

A Christian perspective on racism 

Christian anthropology 

From a Christian anthropological perspective, the foundational premise of creation is one of equality. Scripture views all of humanity as being created in the image of God (Genesis 1:27). This is carried through in the Abrahamic promise that all nations will be blessed through Abraham’s children (Genesis 22:15-18). This promise is fulfilled in Christ ‘the seed’ of Abraham (Galatians 3:16). Moreover, the New Testament places an emphasis on the equality of all people, ‘neither Jew nor Gentile, neither slave nor free’ (Galatians 3:28). This is radical inclusivism (Wallis, 2016:8). Lindsay argues Jesus’ message is essentially one of ‘equality and reconciliation’ (2019:xxvi; John 3:16).

However, this is not homogeneity, as there are diverse groups (Mckenzie-Mavinga, 2016:92) who make up the picture of heaven where ‘every nation, tribe, people and language’ (Revelation 7:9) will worship God together. Each person is unique, with distinct characteristics, and all are equally welcome in God’s kingdom (Lindsay, 2019:21). McLean comments that undermining or devaluing this concept ‘is an offence to God’ (2020:39).

The Bible and slavery 

Against the view of the equality of all people outlined in the previous section, historically, the Bible has been used to condone slavery.

The pro-slavery ideology of the late 18th century had its roots in the Eurocentric interpretation of Genesis 9:24-27, where Noah, on waking from a drunken slumber, condemns the actions of his youngest son, Ham, and curses his descendants to a life of servitude to his brothers (Lindsay, 2019:40). Those who uphold this view see the descendants of Ham being identified as Black Africans (Olusoga, 2021:55).

The New Testament writings of Paul encourage ‘slaves, [to] obey your earthly masters’ (Ephesians 6:5; Colossians 3:20) even when they are harsh, which is used by those who condone slavery to argue that the New Testament is not speaking against slavery. Masters are equally encouraged to ‘provide for your slaves’ (Colossians 4:1). This interpretation has upheld the practice of slavery as biblical and, with it, the treatment of Black people as other. On the other hand, the use of Scripture explored in the earlier section on Christian anthropology has been used to counter this view, condemning slavery by painting a different picture of the uniqueness and equality of all people from God’s perspective.

The Church and racism 

As much of theology has grown out of European schools of thoughts, the Church could be accused of whitewashing the Gospel (Lindsay, 2019:55). The historical context for the biblical story was the Middle East and Africa and yet pictorially it has been represented by White people, ‘the blonde-haired, blue-eyed Jesus’ being the antithesis of reality (Lindsay, 2019:55). Kinouani argues that a white version of Christianity was used to advance ‘imperial and colonial agendas’, justifying enslavement and the supremacy of the White master (2021:166).

Dalal’s 2002 research into the usage of the words ‘black’ and ‘white’ in the Bible demonstrate that white was associated with purity and goodness. Through time this symbolism became associated with people’s skin colour; by default, the opposite becomes true and black is linked with evil and sinfulness (Ryde, 2009:48).

Some would argue that racism has become institutionalised, not only in society, but also within the Church (BBC News, 2020a). The emergence of the Black Church in the 1950s in the UK was a direct development out of a lack of acceptance by the established Church of immigrants, whose spirituality was expressed in more ‘vibrant’ and ‘expressive’ ways (Burrell, 2021:202).

Part of arriving at a Christian worldview around race involves the disentangling of Scripture from the socio and political agendas that it became tied to in the rise of colonialism. Kwon argues that sadly the Church provided the ‘moral cement for the structure of racism in our nation’ (Lindsay, 2019:47). Isaac (2020) is reported as saying that in the face of the Black Lives Matter movement, many church leaders ‘are staying quiet or withdrawing’ (Fung, 2020:43), potentially an avoidance strategy in light of not knowing how to respond. Turner argues avoidance can come from ignorance, or through a ‘wilful unwillingness to admit to [its] existence out of… shame’ (2021:37).

Lindsay talks about ‘the white supremacy iceberg’ (See Figure 1) where the tip of overt racism is viewed as unacceptable within the Church context. However, what is below the surface: racial bias, acceptance of White privilege, colourism, etc can be held as socially acceptable. He maintains that when these behaviours go unchallenged, they reinforce systemic racism (2019:11). Something, which on balance, if challenged, the Church would not want to be aligned with.

Figure 1: White supremacy iceberg (Lindsay, 2019:12)

Just as Lindsay talks about the Church having a ‘colour-blind mentality’, seeing everything as ‘race neutral’ (2019:21), this could be equally true of Christian counsellors. This is a key area for self-inquiry when working with people of a different ethnicity to ensure complacency on the part of the counsellor does not make the discussion of race-based trauma a no-go area for the client (BACP, 2018:15).

For clients who have experienced barriers to integration within the Church because of their colour, finding a Christian counsellor who can recognise racism for what it is can be a helpful part of the reconciliation process within themselves and then with the wider Church (Lindsay, 2019:30).

As Winters says, the ‘Black church is a place of refuge where you know your Blackness is unconditionally accepted’ (2020:116). The Church can be a place of spiritual and socio-economic support (Winters, 2020:91). Faith often plays an important part in helping clients facing difficult or traumatic events, providing support and resilience (Alleyne, 2011:127; Watson, 2011:26). Kinouani cites The Royal College of Psychiatrists’ report that those patients with a spiritual practice have better outcomes (2021:166). ‘The sense of hope and peace of mind’ engendered through spiritual practice can help with integration and the ability to live with the issue while working for change (Kinouani, 2021:166-167). Lago recommends that transcultural therapists understand and appreciate the importance of faith and spirituality in their client’s lives (2011:177).

Intersectionality: Privilege and otherness 

Intersections are many layered. Ablack describes intersectionality as ‘what happens when our multiple, identifying processes overlap’ (2021:150). This section will examine the challenge of working with white privilege and otherness in the counselling room. It is important to note that the ethical framework within which counsellors work emphasises the need for equality, inclusion and the valuing of diversity (UKCP, 2019:4; BACP, 2018:15; ACC, 2004:5).

Power dynamics 

Privilege is neutral. It is how privilege is used that determines whether it is oppressive. It can be used to create a power advantage over the other or exercised with humility to build relationship with the other (Turner, 2021:31).

Tuckwell highlights that historically ‘whiteness’ has become the measure against which other things and people are judged (2002, cited in Ryde, 2009:46). It is viewed as neutral (Ryde, 2009:39) and consequently, Blackness is regarded as a deviation from the norm (2009:38). The writer agrees with Hook, Davis, Owen and DeBlaere (2017:47) that the normality of whiteness can mean that for the White person it feels invisible, a taken-for-granted aspect of privilege. As such it can create an ‘unintentional and unconscious’ bias (Sue, Capodilupo, Torino, Bucceri, Holder, Nadal & Esquilin, 2007:280) and be used for the oppression of the other (Turner, 2021:30).

It has been recognised that the psychotherapy relationship can be unequal, with the therapist having role, societal and historical power (Proctor, 2017). Drawing on Lago and Thompson (1989, cited in Lago, 2006:38) one of the challenges for the White therapist is being aware of the ‘myriad of disadvantaging mechanisms that exist… [for] black people’. They caution against the re-enacting of the White supremacist power dynamic in the counselling room; the White counsellor taking on a superior role to that of the Black client. Williams also raises the need for White people to be willing to give up power and for Black people being given the opportunity to take on their own agency (Jackson, 2020:23).


Sue et al. (2007:273) highlight the use of microaggressions as, ‘brief everyday exchanges that send denigrating messages to people of color because they belong to a racial minority group’.  The impact of microaggression is reinforced by Kinouani’s research experience from several social media polls conducted in 2017. While the sample size was small, 563 participants, over 85% of participants found covert racism more challenging than overt and 36% of responders described the impact of subtle racism was akin to ‘losing one’s mind’ (2021:61). Disbelief and gaslighting by White people were a common experience when Black people tried to share their concerns (2021:60).

Turner agrees with this finding, highlighting the fact that microaggressions are often unrecognised by the privileged whereas they form ‘a sea of daily hatred through which the other swims’ (2021:48). The lack of understanding around the effort needed for survival in this milieu can impact negatively on the therapeutic relationship, with the effect that the client is not seen.

One form of microaggression is ‘colour blindness’ [sic] (Williams, 2021:175). All people are seen as equal, colour is not important. While this might seem an admirable approach, Winters (2020:192) gives a convincing challenge that by not seeing Blackness, the person of colour is made invisible, and as such racism is ignored. For her this is a ‘sublime… ignorance’ (2020:30).

Research by Houshmand, Spanierman and De Stefano demonstrated that the lack of recognition of microaggressions experienced by the client can lead to a breakdown in the therapeutic relationship (2017:204). They also found that where counsellors exhibited microaggressions towards their clients it not only influenced the client’s view of the counsellor’s competence, but, according to Constantine, the impact was perceived to be more harmful than those perpetrated by people outside the helping professions (2007, cited in Houshmand, Spanierman and De Stefano, 2017:205).

For the White counsellor being willing to sit with the discomfort of difference and articulating it in the room can form the basis for successful transcultural therapy (Jackson, 2018:10). On the other hand, Ziffo maintains that by attending to the political ideology which shapes the racism debate, the counsellor can be in danger of viewing the client ‘through the prism of my ”white fragility”’, leading to an inability to meet the client as a unique individual (2020:12-13).

Can a White counsellor work effectively with a Black client? 

Bearing in mind the subtle undertones of power and microaggression, the question of whether a White counsellor can work effectively with a Black client needs to be addressed. 

A variety of studies have been conducted over the years into the benefits or otherwise of ethnic matching in the process and outcome of therapy. Karlsson’s 2005 study considered analogue, archival, direct measure and outcome, and qualitative studies that were available. He surmised that the evidence for benefits in ethnic matching were inconclusive as there was not enough empirical evidence to support this conclusion (2005:124). From the perspective of his study there were too many variables and lack of common definitions around words like ethnicity and culture, which made the comparison of studies difficult (2005:125). Karlsson saw shared values, language, level of acculturation and ethnic identification as having greater impact on the effectiveness of therapy than solely outward ethnic matching (2005:122-123).

Farsimadan, Khan and Draghi-Lorenz argue that what Karlsson sees as insurmountable variables are the elements that make up ethnicity; without them there is only a comparison of physical features. The separating out of aspects of ethnicity to compare studies was unhelpful (2011:19). Farsimadan et al. responded to Karlsson’s work with their own study in which they also considered analogue, archival, direct measure and outcome, and qualitative studies from the 1980s onwards. Their conclusions contradicted Karlsson’s findings, as they found evidence that matching ethnic dyads had beneficial impact in terms of higher uptake of therapy, lower dropout rates during therapy, longer duration of working and greater post-therapy effectiveness (2011:18-19).

They went on to argue that the facets most likely to affect the therapeutic process were the preconceived assumptions of either party and a lack of understanding of the others’ culture, values and experiences (Farsimadan et al., 2011:20). They also argue that the level of acculturation of the client can in some respects offset the ‘cultural incompetence’ of the therapist (2011:19).

McLeod argues that client and counsellor matching at a cultural or ethnic level can never be a complete solution. While the dyad may share common aspects of ethnic origin, there will be other layers where their experiences do not intersect (2018:40). For example, this creates a dilemma for people who want to choose a counsellor who shares their faith and their cultural background and experience. Statistically Black counsellors are in the minority (York, 2020:4) and within that number those that are, for example, Christian, will form an even smaller cohort, meaning that the client could be left with the choice between someone who shares their ethnicity or someone who shares their faith.

Turner talks about how Black people feel the need ‘to kill off, a part of ourselves’, in effect wearing a mask to be accepted in society (2021:79). This raises a question for the therapeutic process: if a Black client is working with a White therapist are they able to bring their full self to the therapeutic process or is there a need to hide parts of self? (Dos Santos and Dallos, 2012:62). If there is an element of titrating self, then therapy may not be as effective.


Turner suggests that whiteness is not the problem, but the intersection of privilege and supremacy that can be attributed to it (2021:41). As such the White counsellor working with the Black client needs to be acutely aware of their own potential prejudice, for this will come into the therapeutic space (Turner 2021:49). The development of self-awareness then becomes critical for the counsellor in relation to working with Black clients.

The need for the counsellor to be aware of themselves as a racial and cultural being, recognising the stereotypes and assumptions that influence their worldview is key (Sue et al., 2007:280). Ryde notes that ‘every individual is embedded in their culture’ (2009:192) and as such the White therapist needs a clear understanding of their own culture to understand areas of difference when working with a client of colour.

Figure 2: The cycle of White awareness (Ryde, 2009:50)

Ryde has developed a helpful model, ‘the cycle of white awareness’ (Figure 2). Working through this model enables the White counsellor to face their own ‘complicity in racism’ but also to relate in a ‘less defensive way’ (2009:52). She challenges the necessity of staying open to ‘painful and confusing feelings’ so that a process of integration is possible (Ryde, 2009:141). Another useful tool for the counsellor in identifying ‘normalised’ racism is Lindsay’s ‘white supremacy iceberg’ (2019:12, Figure 1 above). The application of this model can help grow self-awareness and aid recognition of when covert racism is in effect.

Sue et al. identify willingness to discuss colour as one of the keys to creating a therapeutic alliance (2007:281). Zhang and Burkard’s research has shown that counsellors who are willing to discuss colour difference are seen as ‘more credible’ and able to create ‘stronger working alliances’ with their clients than those who are avoidant of this subject (2008:77). McLeod cites Dos Santos and Dallos’ research into cross-cultural therapy between White therapists and clients of African-Caribbean descent, drawing attention to the ‘awkward conversations’ that evolve when the subject of race or colour is avoided (2018:40).

Jackson notes that transcultural therapy is most successful where the ‘white therapist is comfortable with difference’ (2018:10). Tuckwell (2006:207) suggests that developing a ‘secure sense of white identity’ that is not identified with power from its colonial history needs a willingness for deep introspection and internal work on the part of the counsellor, something which must be acknowledged as essential for those working in this area.


Most counselling theories were developed in the West with a subsequently Eurocentric bias (Lago, 2006:82). They were developed in the era of the industrial revolution with its emphasis on autonomy and individuation. Consequently, theories focused on an ‘I’ culture (Lago, 2006:84). This is often out of step with Black cultures with their emphasis on the importance of the collective and ‘we’ culture (Sue et al., 2007:281). As a result, training courses that have been developed historically reflect the Western roots of the founding fathers of psychotherapy. Watson argues that training should reflect the multicultural society in which we live. She emphasises the need for transcultural issues to be integrated within the course rather than addressed as a ‘one-off’ teaching (2011:19).

Mckenzie-Mavinga (2011:31) highlights the importance of trainers grappling with their own cultural awareness to deliver courses that meet the needs of working in a multicultural society. When the tutor is confident and competent, students feel supported to explore cultural diversity and develop their self-awareness (Jackson, 2021:21). This ensures they are qualified to practice competently with clients of different ethnicity and backgrounds. An ability to address this as a primary aspect of teaching, with practical examples, gives space for students to learn how to address this issue and be confident in broaching it with clients (Mckenzie-Mavinga, 2011:33).

Lago (2006:126-130) outlines three aims for training. Firstly, to examine ‘beliefs, attitudes and awareness’ so that students can understand their own stereotypes, value others’ ‘psychological and cultural frameworks’, and learn to use their observing self to check their attitudes while working with clients and recognise when they are trying to impose ‘their own frame of reference’. Secondly, he recommends gaining knowledge so that students are transculturally literate. Lastly, developing skills which include the ability to ‘tolerate ambiguity’ and ‘manage anxiety’ when working with difference.

From the perspective of Black trainees, there is often a sense of participating in the course to pass but having to titrate oneself to not overwhelm White students (Cousins, 2020:21; Venson, 2020:19). Watson’s research reports that Black students experienced their training as an ‘unsafe place… to explore issues of ‘race’’ (2004:190).

The future development of training needs to ensure that participants can learn from each other’s experiences in a safe way (Jackson, 2021:22). Cousins talks about the ability to ‘hold boundaries while staying curious’ (2020:21). This feels like an important skill to learn.

With the discussion around Black Lives Matter there has been an increase in focus on training and ensuring that diversity and inclusion is woven through the whole of learning, not just an add-on module. The creation of the Diversity and Inclusion Coalition, drawn from eleven professional bodies and associations, is to help training institutions develop the tools to tackle this area more effectively in their teaching (Jackson, 2021:24). This feels like a significant step forward in countering a piecemeal approach to training in cultural relevance.

Lastly, it is important to recognise that the challenges around training also apply to supervision (Ryde, 2011:142). Just as the trainer needs to be competent to work with issues of difference in the training room, the supervisor needs to be robust and courageous to bring it into the supervision space (Ablack, 2021:149). Mckenzie-Mavinga has begun a transcultural supervision group to give a space to express and normalise the powerful feelings evoked by racism (George, 2020:29). The group is open to all in recognising that skirting around racism as an issue does a disservice to counsellors and their clients alike.  

Towards a therapeutic response 

In this section suggestions for a therapeutic response for the client who is facing race-based trauma are explored. Moodley, Lago and Talahite highlight how Carl Rogers’ 1977 counselling videos of working with a Black client in the Right to be Desperate and On Anger and Hurt are still used as a starting point for teaching when working with race in the counselling room (2004:viii-ix). Their ground-breaking book sought to address the deficits and benefits of Rogers’ work, offering alternative responses based on the research and experience gathered in the 25 years that had passed since the videos had been produced. While acknowledging their valuable contribution to this discourse, Turner draws attention to the ongoing progress that has been made in working therapeutically in this area (2020:35). Learning from the experience of those that have been ‘othered’ can be an important part of understanding how to work effectively with Black clients. Entering their world feels like an appropriate place to start when working from a stance of cultural humility (Hook, Davis, Owen and DeBlaere, 2017:9).

Multicultural orientation framework 

While recognising the value that multicultural counselling competencies (awareness, knowledge, and skills) explored in Lago’s work (2006:138-141) have brought to the therapeutic world, Hook et al. point to deficits in the research in measuring their effectiveness. They highlight difficulties with accuracy of measurement strategies and question whether in fact competencies are the best measure of success in clinical practice (2017:22). Working with intersections further complicates matters and, in light of this, they have developed a multicultural orientation framework (2017:21). This moves the focus from the ‘ways of doing’ to the ‘ways of being’ with the client (2017:9).

They recommend three ways of practising in a multicultural context: working from a stance of cultural humility, making use of the opportunities presented by the client and the importance of practising from a place of comfort.

Davis, DeBlaere, Brubaker, Owen, Jordan, Hook and Van Tongeren’s research, involving 128 participants, demonstrated that humility on the part of the therapist can give better therapeutic outcomes and be effective in healing ruptures (2016:483). With a knowledge of one’s own cultural values it is possible to be open to a different perspective, working with ‘respect, lack of superiority and attunement… [to the others’] cultural beliefs and values’ (Hook et al., 2017:29). Mckenzie-Mavinga asserts that a lack of awareness of oneself as a ‘racial and cultural being’ can impair working with those from a different background (2016:20).

When opportunities to explore the client’s cultural identity, values and beliefs are presented, these should be examined (Hook et al., 2017:32). Zahid (2021:113) encourages the ‘broaching’ of difference when it is presented as it can be validating for the client. It can create a safe space to examine the hurt caused by racism. Ignoring the opportunity and maintaining silence on this issue can speak of collusion, widening the gap of difference rather than drawing closer to understand (Wright, 2021:41).

Having a high level of cultural comfort means that the therapist can manage conversations around areas of difference while maintaining a sense of ease and calmness (Hook et al., 2017:37). The client, sensing this, is then able to share their experience without fear of judgment or rejection. This is backed up by research that shows lower dropout rates for therapists able to express cultural comfort with their clients (Hook et al., 2017:37).

Having recognised the benefits of working from a multicultural orientation framework, it is important for the counsellor to be humble enough to learn from the Black person’s lived experience, but knowledgeable enough that the person of colour is not expected to educate the counsellor. This is a tightrope which needs to be navigated with empathy and a willingness to learn (Jackson, 2020:21).

Body, mind and heart 

According to Ellis, racism impacts three areas: body, mind and heart (2021:160). As such, a therapeutic response to race-based trauma needs to work in these areas with the client. 


Coates describes racism as being primarily visited on the body. It is the visible identity which marks one out as Other (2015:10). Van der Kolk and McFarlane raise the need for trauma treatment to, amongst other things, re-establish ‘a sense of safety’ in the body (1996:17).  Fisher highlights research that has shown the link between PTSD and ‘autonomic dysregulation and unresolved physical responses’. She argues that a somatic focus is needed alongside established therapeutic practice when working with trauma (2019:2).

Merleau-Ponty sees ‘the body as a conduit to the unconscious’ (1962, cited in Turner, 2021:12). Talking therapies can help manage secondary symptoms (Fisher, 2019:7) but working with the body provides a way of connecting with the internalised trauma experience that has become ‘stuck in the body’ (Menakem, 2021:178; Caldwell & Leighton, 2018:21). Ellis, drawing on Caldwell, highlights the point that if the body has been the cause of discrimination, the body can be objectified as the source of harm and thus no longer listened to (Ellis, 2021:176).

When working with race-based trauma, Shraboni offers the useful question: ‘how do you carry your racial and ethnic identity?’ (Ellis, 2021:253). Noticing the somatic response to this can begin to unravel where trauma has been held.  Allowing the client to experiment with different ways of moving and being can start the creation of a different narrative (253).

Menakem’s five anchors for working through pain are a helpful tool, especially for grounding when exploring areas of discomfort and distress (2021:167). The anchors are somatically based and involve (1) quieting self, (2) noticing what is happening within the body, (3) recognising discomfort and staying with it, (4) allowing self to move through the experience and (5) releasing the remaining energy through physical activity (2021:168-172). His assertion that ‘healing does not happen in your head. It happens in your body’ (2021:175) is a powerful reminder when working with trauma. His body and breath practices are useful in both calming and activating the body, depending on whether trauma has left an impact of hyper- or hypo-arousal (2021:141-146).

Cornell maintains that in the West people no longer listen to their bodies (1996:8). He argues the body contains the wisdom for healing if the client allows themselves the time and compassion to stop and listen (1996:8). Gendlin suggests using the ‘felt sense’ to explore how the sensations held in the body can elucidate the feelings that are held below the surface (Nada Lou, 2003). Gently questioning the ‘felt sense’ with curiosity and openness can begin to ‘shift’ the ‘stuck’ feeling and enable a different relationship with the experience (, 2022). Menakem’s body scan (2021:157) would be a good access point for this.

There are benefits of integrating traditional healing practices with African and Caribbean clients (Kinouani, 2021:157) in which movement and body focus play a significant role. Zahid recommends using body-based techniques in therapy as ‘a bridge’ between the two cultures in the room (2021:108).

One note of caution when working in this area is to ensure that the client remains within their ‘window of tolerance’ (Siegel, 1999, cited in Ogden & Fisher, 2015:48). Being within this space with a little discomfort, the challenge of feeling ‘safe, but not too safe’ (Ogden & Fisher, 2015:48) can allow the client to ‘remain reflective and compassionate’ while also feeling secure enough to work (Ellis, 2021:7).


Traumatic events are often repeated over and over in the mind. They are frequently accompanied by thoughts and feelings of shame and low self-worth, perpetuating themselves in a negative spiral from which there appears to be no escape (Welsh, 2018:44). Ellis recommends the use of mindfulness to connect what is happening in the body with the cognitive aspects of processing trauma. Mindfulness allows the processing of thoughts in a non-judgemental way. Working with the present experience in the ‘here and now’ can help bypass the tendency to get stuck in the negative cognitions of the past or thoughts for the future (Ellis, 2021:160). Ellis claims that allowing the focus on the present can be ‘enough to bring a different perspective to our experience’ (2021:161).

However, he also cautions that mindfulness can be seen as a Western concept, so framing it in the right way can be an important part of presenting it to Black clients. The focus is on being with oneself, which he acknowledges is not necessarily easy (Ellis, 2021:165). Menakem recommends grounding techniques when dealing with issues that are discomforting so that they do not become overwhelming (2021:146).

Magee (2019) encourages the use of mindfulness to help in the understanding of both what is going on in the mind and emotions, which in turn can enable the client to become more self-compassionate and emotionally resilient.


According to Mckenzie-Mavinga, ‘Self-esteem can only be raised if we increase self-love and love who we really are’ (2016:154). These challenging words speak to the essence of working with the heart in race-based trauma. Working at this level means learning self-compassion. For the therapist this involves ‘witnessing and acknowledging’ but without the need to respond. It moves beyond empathy, moving from feeling ‘with’ the individual to feeling ‘for’ the individual, experiencing ‘warmth, concern and care’ with the desire to enhance the client’s wellbeing (Ellis, 2021:186-187).

Ellis recommends a compassion practice alongside mindfulness in working with race-based trauma (2021:187). This allows the recognition of suffering and aids the client in extending compassion to themselves in the same way they would to other people (Neff, 2011:10). Mckenzie-Mavinga talks about ‘feeling it in our bones’ (2009:39). The sheer depth of feeling expressed in this statement needs to be witnessed and validated in the processing of trauma.

Kinouani describes self-care by the client as essential to cushion the effects of race-based trauma (2021:196). She has developed the Blackness-centred compassion therapy model, which seeks to address the lack of focus on the felt unsafeness of those who have experienced racism, examining the interrelatedness of the ‘here and now’ and the ‘there and then’ exposure to racism (2021:221-225).

The affect regulation system model may also be also helpful in this context (Gilbert, 2013:24). For people who have experienced trauma their ‘threat and self-protection system’ is of necessity highly activated. Helping clients to bring their ‘soothing and contentment system’ online can help counter this. As this system becomes effective, feelings of safety and connectivity become possible (Gilbert:2013:25-27).

‘We’, not ‘I’ 

Kinouani acknowledges the importance of the African concept of Ubuntu, the interdependence of community in which self is discovered that has often been lost in the face of acculturation (2021:205). Also, Lago comments that the individuation of Western therapeutic approaches can be at odds with the ‘we’ culture of Black clients, who place emphasis on kinship systems and the importance of family and community (2006:126). It is vital that therapists working with Black clients can respect and understand non-Western culture (Ryde, 2009:128).

In the therapeutic context, sharing with others and the involvement in support groups can be beneficial for the client (Winters, 2020:93). Just as racism is experienced individually and collectively, there is also a sense in which healing needs to come at both an individual and community level. Winters’ example of Safe Black Space Community Healing Circles is a powerful model of how the mix of African cultural practice, mindfulness and self-care have been integrated into a space where trauma can be explored at a group level within the Black community (2020:93).  

In summary, working from a position of cultural humility with those who have experienced race-based trauma can open the door to efficacious work in this area. This ensures that the therapist is not guilty of ‘perform[ing]’ whiteness on the client (Ryde, 2009:128). 

Concluding reflections

Turner asks the question, ‘can, or even should, [therapy] divorce itself from the cultural construct it is always operating within?’ (2020:36). I believe the answer to this is no. Racism is still an issue within our culture and addressing the counselling needs that arise from this are an essential part of the therapist’s tool kit.

Through the process of writing, I have learnt about my own lack of awareness of the lived experience of the Black community and how creating a culture of acceptance, equality and awareness in the therapeutic space is essential. Recognising difference from the outset can be helpful in establishing and developing therapeutic relationship.

My personal experience as a White therapist working with a Black client firstly challenged my ignorance in this area. It then taught me that this is a place for humility and continuous self-examination. It has helped me to develop my own sense of self regarding my culture and values. And lastly, I recognise that while this article has given me the opportunity to learn and grow in this area, it will continue to be a subject for ongoing professional development.

In conclusion, I have wrestled with the knowledge that my White heritage gives me a privilege that others do not have. As Turner rightly observes, ‘Difference is difficult. It is complicated. It is nuanced. That is why it is so important’ (Turner, 2021:21).


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About the author

Liz Doré BA (Hons) Counselling

Liz is an integrative counsellor who trained at Waverley Abbey College and runs an online and in-person private practice from Shaftesbury in North Dorset. She has a background in HR having worked mainly in the Christian charity sector. In addition to her counselling, Liz is a leader at her local church.

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Copyright 2023 Liz Doré

[1] I have chosen to use the term Black in my essay to refer to the mainly African Caribbean community experience being explored. I have chosen to capitalise the words Black and White when referring to people and race. This gives equal treatment to both groups, which feels important in the discussion of privilege and otherness. I have used BAME (Black Asian Minority Ethnic) only when it has been referenced for statistical purposes, as whilst an often-used acronym, it carries the danger of putting ‘everyone who is not white into a singular category’ (McLean, 2020:38) when there are clear distinctions of culture, language and experience for those of different ethnic groups.


[2] In some instances, statistics relate to the BAME community, as published statistics do not always separate out Black, Asian and Minority Ethnic groupings.

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