CBT and Anti-Racism: Healing Racism Through CBT

By Norman Cotterell, PhD, Beck Institute Senior Clinician & Dara Friedman-Wheeler, PhD, Beck Institute Faculty

In recent months, many of us have committed or recommitted to our personal anti-racism work. Such books as Ibram X. Kendi’s How to Be an Antiracist and, perhaps particularly for those of us who are health-care providers, Jonathan Metzl’s Dying of Whiteness may form a part of this work. Both texts provide important insights into racism as it functions in American society today, including reminders about the structural and institutional nature of racism in the U.S. 

Definitions of racism have changed over time. Patricia Bidol-Padva in her 1970 book, Developing New Perspectives on Race defined racism as prejudice plus power. Kendi redefines racism as 1) a tendency towards over-generalization, to generalize from the individual to the group, whether attributed to genetics or environment, and 2) a tendency towards labeling, to stamp cultural differences and adaptations as dysfunctional. There is nothing wrong with people of any race other than the idea that there is something wrong with people of any race. Therefore, as much as possible, we need to resist over-generalizing: People aren’t racist; ideas are racist. A single individual in a single speech may provide both racist and anti-racist ideas. Cognitive Behavioral Therapy provides tools by which an individual may assess the accuracy and function of such ideas. 

Personal or political change

Kendi, Metzl, and other prominent authors suggest that working on racism at the individual level is ill-fated, and perhaps even a poor use of time and energy. They regard racist ideas as impervious to the typical solutions of white self-sacrifice, black success (“uplift suasion”), and educational persuasion. Rather, they argue, changes in policy are the pathway to ideological change. Policy changes people.

In addition, Tiffany L. Green and Nao Hagiwara (2020) point out that research on the effects of implicit bias training is mixed at best. They, too, suggest that we focus on institutional and systemic problems — rather than targeting individuals’ non-conscious beliefs. 

Reminders to work on racism from a policy/systems perspective may be particularly important for those of us who are trained as psychologists, as we tend to (understandably) focus more on intra-individual factors. And targeting implicit biases directly may not yield the desired results. But should we forego work on racism at the individual level altogether? (Davis, 2017) People create policy. People support or protest policy. And people change policy. 

To be clear, we agree that we must all work for institutional, systemic, and policy change if we are ever to mitigate the harms to people of color, and we believe psychologists can play an important role in effecting changes at a systemic level. But might we also, when we have clients in our offices, do well to apply what we know about adjusting cognitive distortions to racist thoughts and ideas? 

Individuals as a point of intervention

Perhaps this type of intervention, at the individual level, could complement the work for policy change that is so desperately needed, by resulting in more voters who might be inclined to support such changes, or at least not to oppose them so vehemently. Indeed, the APA Ethics code calls on psychologists to “safeguard the welfare and rights of those with whom they interact professionally and other affected persons.” One could argue that we have a moral obligation not to stay silent, when oppressive ideas are presented in therapy.

What might this look like? 

Suppose your white client comes into session furious because they did not get into the college of their choice. In learning more about their anger, you investigate what it means to them that they did not get in. 

“It’s because of stupid affirmative action,” they spit out. 

Perhaps taken aback, you ask them to explain. 

“Everybody who’s anything other than white has a leg up. They all get the spots, and then there’s no room for white people. It’s totally unfair.” 

Perhaps this triggers automatic thoughts in you, and you feel blood pressure go up, as you think, “I’d better get away from politics.” 

But should we? Or could we ask the client if they are willing to investigate the thoughts they just shared further?

Perhaps this is not the moment. Perhaps it is more critical right now to validate the person’s frustration and disappointment, and to see if this incident is activating a core belief such as “I’m not good enough.” 

But ultimately, you might come back and say, 

“Yes, I agree that this is an important issue. And I can see that it hurts you deeply when things are unfair. Can we look into that together?” 

Perhaps in session, or perhaps as part of their action plan, the client could do an Internet search on affirmative action to see its definition and how it’s supposed to work. They could then look up statistics about the proportions of students of different backgrounds who attend the school in question and compare those to the proportions of students of those backgrounds in the broader population. Fairness may be a core value for the client, and this may be a way for the client to act in accordance with that value.

In this case, since the thoughts were associated with significant negative affect (and perhaps even related to the client’s therapy goals), this may not seem so far-fetched. It is, of course, possible that clients will report racist thoughts that do not conflict with their values, and that don’t have an obvious link to their goals for treatment. We maintain that we have an ethical responsibility to relieve suffering, and to address the ideas that lead to suffering. And in doing so in a supportive manner, we may even reduce the harms associated with racism.

Do we focus on the wound or the arrow? The wounded or the archer?

Scholars have begun looking at ways in which Cognitive Behavioral Therapies, including Acceptance and Commitment Therapy (ACT), may help oppressed groups cope with the stress of discrimination. Of course, helping these individuals may be our first priority. But might we be able to do some good on the other end, too, by inviting others to think critically about their own racial biases? 

We don’t have the data, at present, to say one way or the other. But we suspect that, as with so many public health issues, interventions at multiple levels (individual, community, systems) may complement each other in the fight against racism. And, given that we regularly engage individuals in conversations about their thoughts, perhaps this is one way that CBT therapists are particularly suited to contribute to anti-racist efforts. 

References:

Banks, K.H. & Stephens, J. (2018). Reframing internalized racial oppression and charting a way forward. Social Issues and Policy Review. 12(1) Referred from https://spssi.onlinelibrary.wiley.com/doi/10.1111/sipr.12041

Bidol, P.A. (1972). Developing new perspectives on race: An innovative multi-media social studies curriculum in racism awareness for the secondary level. Detroit MI: New Perspectives on Race.

Davis, D. (2017, November). Why I, as a black man, attend KKK rallies. [Video File] Referred from https://www.ted.com/talks/daryl_davis_why_i_as_a_black_man_attend_kkk_rallies?language=en

Green, T.L. & Hagiwara, N. (2020). The Problem with implicit bias training. Scientific American. Retrieved from https://www.scientificamerican.com/article/the-problem-with-implicit-bias-training/

Kendi, I. (2019). How to Be an Antiracist. New York: One World.

Metzl, J.M. (2019). Dying of Whiteness: How the Politics of Racial Resentment is Killing America’s Heartland. New York: Basic Books.