A Call to Action: Decolonizing Clinical Practice

Theories and processes of psychology have largely been influenced by North American and European psychologists whose Western-oriented paradigms have not promoted inclusivity or recognized the strengths of ethnically diverse cultures. Western paradigms promote power, hierarchical order, and structural privilege to the detriment of the well-being and mental health of racially and ethnically diverse cultures (Goodman et al., 2014; Goodman & Gorski, 2015). This can occur through the use of visible and concealed practices aimed at socializing marginalized communities and aligning them with dominant cultural standards and experiences (Singh et al., 2020). More recently, current training practices in psychology embrace more openness and seek to provide culturally competent and culturally responsive treatments for marginalized populations seeking mental health services and also call for the decolonization of psychology. The perspective of critically questioning and disrupting inequities in institutional systems and structures is conceptualized as the practice of decolonization (Hernandez-Wolfe, 2011).

Psychology as a profession is recognizing the importance of addressing the needs of individuals with marginalized identities and individuals from diverse backgrounds. The field of counseling psychology has become a leader in shifting toward a transformative approach to decolonize all aspects of the profession. Literature has been published on methods of decolonizing clinical practice for well-established therapists (Goodman et al., 2014). Yet, there is a dearth of literature on effective strategies for students and early career therapists to effectively engage in decolonizing clinical practice. Decolonizing clinical practice places emphasis on challenging existing knowledge, engaging in critical dialogues, and sharing knowledge across the discipline to transform therapy practice (Sharma & Kivell, 2023). When examining clinical practice through a decolonial lens, it becomes imperative to dismantle educational practices that reproduce conditions of oppression by challenging hegemony, deconstructing imperialist ideologies, and developing space for diverse clients and communities (Goodman et al., 2014). Training programs should examine their curricula offerings and provide students opportunities to develop critical consciousness around issues of social justice.

The conditions of oppression reproduced by colonized clinical practices have largely contributed to the neglect and pathologizing of perspectives and experiences relevant to BIPOC and marginalized individuals and communities. Decolonization is an active resistance against the forces of colonialism that addresses the negative implications of eurocentrism and deficit-based approaches (Fellner, 2018). Furthermore, it deconstructs colonial ways by restoring community-based indigenous perspectives that are culturally relevant to individuals of racial and ethnic backgrounds (Fellner, 2018). Rather than maintaining a sole focus on culture and identity, a decolonized view shifts its attention to the power hierarchy where inequalities are embedded in systems and structures granting few privileges at the detriment of many (Goodman & Gorski, 2015).

When examining systemic inequities, psychology’s history is riddled with patterns of neglect, abuse, and a failure to address mental healthcare disparities among BIPOC populations. These disparities include poorer psychotherapy outcomes and higher rates of premature termination in marginalized client populations (Wilcox, 2023). Despite this pervasive history of disparity, numerous scholars expose minimal progress in the improvement of psychotherapy and mental health outcomes for BIPOC individuals and communities (Wilcox, 2023). Supporting this claim, a recent study conducted with queer and/or trans Black people, Indigenous people, and other People of Color (QTBIPOC) (Arora et al., 2022) suggested optimal therapy experiences are contingent on the intentional dismantling of systemic oppression in therapy. Results also suggest that therapy has potential to be ineffective or even harmful for QTBIPOC individuals when systems of oppression are not adequately dismantled in the therapy room (Arora et al., 2022). This further highlights the necessity of decolonized therapeutic work that centers non-western healing practices (Arora et al., 2022). While the findings previously mentioned are specific to QTBIPOC populations, similar findings have been found with studies examining African American, Indigenous and Latine populations and the negative effects associated with experiencing ineffective psychotherapy (Sharma & Kivell, 2023;Vazquez, 2022). Subsequently, studies have indicated better mental health care outcomes among marginalized groups when culturally relevant and indigenous healing practices are implemented in client treatment plans (Sharma & Kivell, 2023;Vazquez, 2022).

While there are studies that demonstrate a pressing need for decolonial clinical practices, there is less literature that addresses how to decolonize clinical practice, especially for students and beginning therapists. Continued attention in this area is warranted in order to continue dismantling systems of oppression to improve the mental health needs for individuals from diverse backgrounds and marginalized identities. More inclusive and effective therapeutic spaces can be created by incorporating diverse perspectives and challenging Western pedagogies and praxis.

Recommendations for Psychology Trainees and New Therapists

1. Approach clinical practice with a commitment to decolonization, recognizing the impact of historical and cultural factors on mental health.
2. Seek professional development and continuing education opportunities to expand knowledge in anti-racism and liberation psychology approaches
3. Incorporate an advocacy and social justice perspective when working with clients
4. Build a network of mentors who prioritize cultural competence and cultural humility to help create a supportive community for ongoing dialogue and learning
5. Redefine diagnosis, treatment, and assessment from a decolonized and liberation-focused approach. An essential component of decolonizing psychology is breaking down systems that focus solely on cultural differences and do not pay attention to the dismantling of systematic privileges (Goodman & Gorski, 2015).
6. Develop a culturally responsive clinical practice that engages cultural humility and a deep understanding of the interaction between therapist and clients’ privileged and marginalized identities (Comas-Díaz, 2012).
7. Understand the influence and role of cultural capital (Yosso, 2005) which includes utilizing cultural strengths to avoid focusing on negative aspects of culture and build on the positive ones. Practicing cultural capital in sessions may allow the practitioner to help empower the client (Yosso, 2005). For example, if family or community is essential to the client, encouraging the client to bring in individuals may help with the healing process. Another example is if the client values spirituality or religion, encouraging the client to discuss religion or spirituality in sessions. Research shows that discussing religion or spirituality in sessions creates a more comforting atmosphere, allowing clients to build rapport (Terepka & Hatfield, 2020). Lastly, if the client values food sharing within their culture, allowing the sharing of food within sessions could also increase the comfortability and rapport in sessions (Warren, 2009)
8. Understand the consequences of racism on mental and physical health outcomes (Iradukunda & Canty, 2023).
9. Supplement colonized knowledge of psychology through models such as The Black History Knowledge (BHK) model (Chapman-Hilliard & Adams–Bass, 2016). This model provides a framework for utilizing history to inform practice. Understanding the history of oppression and colonization in psychology can better inform students in practice (Chapman-Hilliard & Adams-Bass, 2016). Models such as the BHK model can be effective in decolonizing psychology by increasing understanding of the history behind intelligence tests and personality assessments. Many tests and assessments were created with one group in mind. Making this group the standard by which behaviors, intelligence, personality, and knowledge of other groups is measured can be detrimental. It is important to understand the impact this may have on clients.

Recommendations for Training Programs to Support Psychology Trainees and Students

1. Supervision and mentorship are essential in training student therapists. A goal of supervision should be to help students shift perspectives and make social justice and advocacy central to their professional functioning (Goodman et al., 2014).
2. Addressing decolonization in training programs is accomplished by incorporating multicultural and social justice perspectives throughout the curriculum, and hiring and retaining faculty (Goodman et al., 2014). It is essential to increase diversity in hiring faculty and ensure that incoming faculty value and promote the decolnization of clinical practice (Goodman et al., 2014; Cartwright et al., 2021).
3. Incorporating community engagement opportunities throughout the curriculum of training programs (Iradukunda & Canty, 2023; Goodman et al., 2014). These opportunities assist trainees and students in engaging with the community prior to internship and practicum experiences. For example, Henderson et al., (2019) noted that counseling education curriculum should include a community psychology course focusing on projects that create partnerships in the community to help uncover community needs and assist with building relationships. Community psychology courses or other experiential learning courses can help students engage in leadership roles, expand their understanding of community needs, and gain practical skills in the field early in the curriculum. Students and trainees often do not engage with the community until their final years of training (Goodman et al., 2014).
4. Recognizing the impact of social determinants on mental health outcomes is vital to making meaningful changes in clinical practice. Acknowledging and advocating the need for change in social and governmental systems may help empower clients (Alegría et al., 2018). For example, utilizing empathy with clients who may suffer from social determinants rather than holding them accountable for systemic imbalances can be effective.
5. Theoretical frameworks, such as the Psychology of Radical Healing (PRH) and The Keeping Radical Healing in Mind Therapeutic Approach (Adames et al., 2023), as well as approaches such as Comas-Diaz’s (2016) Racial Trauma Recovery approach should be included in training programs to help trainees and students gain a better understanding of how to engage and support healing in the BIPOC community.