Well Balanced

How to make therapy more inclusive

February 21, 2022 Balance Season 1 Episode 16
Well Balanced
How to make therapy more inclusive
Show Notes Transcript

In honor of Black History Month, psychiatrist Dr. Stephanie Stewart joins Ofosu and Leah to discuss how she is working to make therapy better for Black patients — and what her experiences can teach us about building a more inclusive world.

We want to know what you think of our show! Please share your thoughts and enter to win a $25 Amazon gift card in our survey at https://www.balanceapp.com/survey

[Theme up and fade under]

OFOSU: Hi, I'm Ofosu Jones-Quartey.

LEAH: And I'm Leah Santa Cruz. We're the meditation coaches on Balance. 

OFOSU: And this is our weekly show -- Well Balanced.

OFOSU: So before we dive into today's chat, here's a little announcement. We want to hear your thoughts about our show. So we put up a survey@balanceapp.com slash survey, and you can actually just click the link in the show description, but please y'all head over there and let us know what you think.

LEAH: Yeah, we want to make this podcast as good as it can be for you. So thank you for sharing with us. Let's get going.

OFOSU: Let’s do this. Alright. So Leah, as you know, it is black history month, and I think it's really important that we take time to celebrate black people who are helping to make this entire world of wellness more accessible, relevant and useful for people of color. From my own experience, I know that the community of wellness and mindfulness and mental health practitioners has not always been super inclusive to people of color and it still has a way to go, but there are definitely glimmers of hope that exist within the community right now.

So I'm excited to be able to highlight those more and keep working in that direction. So I know you brought an amazing friend, that's doing some very cool work to fight racism in the mental health profession.

LEAH:  Yeah.  Today I asked my good friend, Dr. Stephanie Stewart to come on. She's a psychiatrist who's done a lot of great work from being one of the first to practice tele-psychiatry, to working with incarcerated people and founding her own practice, Worldwide Wellness.

She does a ton of work in educating psychiatrists and therapists on how to take better care of their black patients. And that's what I'm really excited to dive into with her today. 

OFOSU: That is super awesome. I feel like we need a clap track when we bring these amazing guests on. So I will just like, you know, do an imaginary one [claps] and welcome Dr. Stewart to our show.

[Transition Sound Effect]

LEAH: Hey, Stephanie!

DR. STEWART: Hi!  Thank you for having me and thank you for doing this series. It's so important. And I think you know, wellness is becoming, um, a little bit more sought out in the black community.

Um, part of that, I think as black folks were kind of reaching a tipping point where we just have to take matters into our own hands. And, you know, living as a black person in America is just stressful and not stressful like I have a lot of things to, you know, on my plate. I mean like toxic stress that affects your body.

It affects your physical health, your mental health, but surprisingly, even with all of the compounding factors that we're dealing with, our rates of mental illness are actually less than are on par with white people. So we're still resilient folks. 

And I think that's why this wellness movement is really important because we can begin to take matters into our own hands and do some of the deeper work that even if you do get into the system, the system's not really equipped to handle because the practitioners aren't trained.

You know, I started helping the other therapists in my group because none of them had really ever had a single conversation about race and all of this unexamined bias. This is coming out in the therapy rooms and causing harm. 

OFOSU: Yeah. It brings to mind a very personal situation aside from my own experience as a black man who has a therapist and has been on my own therapy journey and having some really just crazy racist things said to me, in, in, uh, in therapy sessions, that therapist who thought they meant, well, obviously we're causing harm. Where it really strikes home for me is that, you know, I have a teenage daughter who happens to be trans and finding the right therapist for her as she is in the process of really coming into her identity as a human being, as a trans person, as a black young woman, all of those things. And as an adolescent, you know, there are so many convergences that offer significant challenges.

And so we've been on a therapy journey for her. And the first two or three - just going back to what you're saying is like, these are people who say that they're qualified and tell you that yes, oh absolutely, I think I'd be a great fit for your daughter, but they have no background of working with someone where these various identities intersect.

Maybe they've worked with LGBT youth before. Maybe they've worked with black youth before, but have you worked with a black trans child before we've had therapists who have mis-gendered her, we've had therapists who just were so oblivious to how her blackness makes her situation in life, that much more specific.

And that requires a specific approach. So we are so thankful that we have found the right therapist for her now that she has reported that I feel safe with this person. But you know, there was a point where she was like, I don't want to do this anymore because what we gathered that it was making her feel that there's something fundamentally wrong with her, that she was untreatable.

And so, yeah, I think it's a really important point to pause and think, and just go back to your point that there are some people who believe that they're qualified end up coming into the therapy room and causing more damage. 

DR. STEWART: Absolutely.  When I started having these conversations with other therapists, they would kindly open up and share these vulnerable truths that they really had never come across a black person until they were in the chair across from them.

And they are supposed to, you know, what they saw as ‘fix’ them and just clueless of any of the issues. Um, or complexities clueless that they were even going on. Yeah. And I think 80 plus 90% are white of the providers in therapy spaces, but it's not a topic that white people talk about, period. And that's part of what white privilege is, is that you have the privilege of race - it just doesn't have to be on the table because you're not racialized. You're the norm. And so just clueless as to even begin how to have these conversations when they've literally never had them.

OFOSU: So by that extension, we know that you've made it a goal to teach your peers about being better equipped to treat their patients of color.

Was there a moment, was there like a final straw moment that made you think that okay. You know, I really need to step out front and be on the front lines of creating change in this space.

DR. STEWART: Well one thing that comes to mind was a sort of an email thread that was going around. And typically we present a patient and we say, their age and their race and their gender when we're referring to someone and that's standard across all of medicine, but the comment back was, well, why are we mentioning race here at all? Why don't we just mention race if it's clinically relevant.

And that just kind of blew me away that when is it not clinically relevant to be black in America? I mean, if you don't interact with the education system, that's clearly racially biased, a pipeline to prison, your children are part of that - um, policing, just driving around being black and the stress of that. You're just listening to the radio and bam, the lights come on behind you.

And you don't know if you're going to get out of this incident with your freedom or even your life. And there's little to no recourse for that. There's just so many ways that you're impacted that you have to handle being black - being followed around in a store. I mean, it's, it's almost constant. Yeah.

So I was saying this email about being only when it's clinically relevant, that was kind of when I had to kindly respond that that's a big definition of white privilege, right? Like that you don't have to talk about race, deal with race, see race. Until you choose to do so until that would make that clinically relevant for you.

LEAH: I'm curious, like with such a completely systemic issue, it seems like such a mountain to tackle. Like how did you even begin to enter into that to begin to teach that to others?

What did that look like when you started? 

DR. STEWART: Well, I think a lot of people just don't even know that that is going on for black people. I think people misunderstand that racism, it's not necessarily just like one individual being mean to another individual based on the color of their skin.

Certainly that can be, but honestly, that's the least of my worries. I’m worried about equality, um, and an equal opportunity for my sons coming out to live in the world, jobs, et cetera. And I think that they really didn't even see it through that lens. It's very scary for some people to call out that word, to use the word racist, to describe something as racist.

LEAH:  People get really defensive. They're like, oh, that's not me. I’m a good person.

DR STEWART:  Oh my goodness. I'm a good person. And that's the thing is yes, that is one level of it. But that's the more minor level. The major thing is that we are swimming in it. We are like fish in that ocean and racism is in every single one of us, even black folks, you know, the internalized racism is real, and, you know, getting into some of the psychological barriers around that self-worth image.

What's considered beautiful. What's represented in the media. Who's successful? You've got to overcome all of that being internalized. 

OFOSU: Yeah. Just to arrive at a baseline, not to achieve, not to rise, not to explore, but just to arrive at a baseline of humanity, you know, you've got to come up through all of these different, uh, systemic barriers that are deeply internalized from the moment that we enter the world. I'm curious. Can you paint a picture for us? What does it look like when you are teaching your colleagues about this? 

DR. STEWART: Yeah, it's casual. I mean, that's just my style too. I want to create a safe place for people to bring me their dumbest questions, you know? Be able to be real about it and to not inflict that guilt back because then people shut down.

So I just try to keep it as informal as possible. And the objective basically is to educate and make people aware because you know, what comes at you passively is. Well, I don't even know if it's still on TV, but I don't watch TV, like the show Cops, right. Where they're just showing black people in very unattractive lights.

Let's say even the news. Right. But what you're going to see if you see it passively is not good. 

LEAH: It's subliminal. 

DR. STEWART: Yeah. I think I'm calling out those messages and helping people see that those have been what they've been ingesting all their life.

And that they're not true. When's the last time you ever saw what it even looks like for a little black boy to be joyful and to play. Right. We don't see that. That's why little, 12 year old children with a toy gun are shot and called menacing. So it's like really examining that implicit bias.

But I think when you see the picture painted in the way that it is, then some people are like, wow. And I really have to give credit to the individuals at my clinic. The Well Clinic in San Francisco, shout out great work.

[OFOSU: shout out!]

They have taken this on and they are going deep and they are doing their own personal work as therapists to look at this because they recognize that this system is in place. This is real. The bias is baked in, and if they don't do anything, they are continuing to perpetuate and to benefit from this system.

And thus other people are being oppressed for their benefit. So they're doing the work to get in there, not only on their own bias, but to also talk to legislators and make actual changes that have to be made on a legal level because this stuff is in the laws. 

I'm curious for those of us who are not therapists or directly in the wellness community, what do you think is a viable takeaway from this kind of conversation? 

DR. STEWART: Well, I think takeaways are the little things that we're talking about, these stereotypes coming across as microaggressions, all of this existing in the system that has the power, the way that they do it impacts lives for real. Yeah, it actually matters if you're slurring jokes, because these are what create this implicit bias and perpetuate this implicit bias. And in healthcare, you're going to be kind of written off as a drug seeking person if you complain of pain and school, if you're coming across as a kid, who's acting up or having fun, that is going to be viewed as aggressive behavior.

So in all these ways, They're not little and they have real consequences for these bottom line numbers like health care outcomes, rates of imprisonment. And so just being aware that that's not okay. And for people to believe the lived experience of black people who are saying, yeah, this may be about race.

And at that point don't defend your right to inflict pain or assert your intention? Oh, I didn't mean anything by it. I didn't mean it that way is again about you.

LEAH: It's not really accepting responsibility. 

DR. STEWART: Absolutely. And not acknowledging the hurt that you're causing. 

OFOSU: Yeah. [sighs]

LEAH: Well, thank you, Stephanie. This has been a really enlightening conversation. It's given me food for thought, you know, as a white woman who didn't grow up, having to think about these things, you know, I recognize in myself times that I might've been not meaning or intending to cause harm. And maybe when I did.

So I think that this is a good thing for all of us to consider, like how are we walking with compassion and trying to understand people that come from a different background than us so that we can be the change that we really want to see in the world. Thank you for being that change. 

OFOSU: Yeah, legitimately being that change. Thank you so much, Dr. Stewart, the nervous system difference when you're talking to someone who is acknowledging your lived experience is so palpable that it's hard to explain. So I just really appreciate that we were able to have this experience talking with you and feel seen and to feel heard and understood.

So thank you so much and wish you so much success in your work. It can't be easy. So please just remember to take care of yourself too, while you're out there on the front lines for all of us. 

DR. STEWART: Thank you both. I really, I love that you're here talking about this, being here to support people. Um, yeah, the app is fantastic.

OFOSU: I love that. 

DR. STEWART: So thank you both. 

OFOSU: Thank you.

[Transition Sound Effect]

LEAH: Well, I think it's important for, when you're in a community of people who aren't experiencing prejudice or the racism that another group of people are - It can be so easy to say, oh, you know, I care for everyone. I don't want to harm anyone. But if you are ignorant about these conversations, if you're ignorant about what they're going through, then that's perpetuating, contributing to the harm.

OFOSU: Yeah. And it's in a passive way. And, you know, I have compassion for people who have been ignorant of these realities because you know, what is the impetus to learn? You know, that's the whole idea of being privileged. It's like, there's nothing that's calling you to learn more, but once you are made aware of that there's a wider and more nuanced and a lot of times harmful experience happening in the world and perhaps within your particular sphere, then I do feel like, you know, folks have a responsibility to continue to educate themselves and to not deny the realities that exist. You know, I think it's really great that we just heard from somebody that, you know, a lot of people don't get to hear this perspective and don't get to really highlight and celebrate.

But it also makes me think how many other doctors stewards there are that might not even be doctors that might be a school counselor or going back generations, just that empathetic black person who was caring for their community, advocating, or that safe person who has helped them. I want to acknowledge all of the unsung black practitioners of wellness, whether traditional or non-traditional, who have absolutely existed throughout time and who have helped all of us get through what is, you know, unquestionably a very difficult situation of being a black person, a person of color in the Western world. So shout out to all the on song ancestors and practitioners of wellness in the black community that we know exist and existed. Yeah. And a huge shout out to Dr. Stewart for being an extension of that legacy. 

LEAH: Thank you unsung heroes.

[Sound effect - ringing bowl]

OFOSU: Well, thanks everybody for joining us. What a special show we had. Leah, I appreciate you as a sister and a friend and an ally. 

LEAH: I appreciate you too, and also thank you to Dr. Stephanie Stewart for her insight. You can check out the work she and her colleagues are doing at the Well Clinic at wellsanfrancisco.com.

OFOSU: And yeah, if y'all already follow us on your favorite podcast app, you know that we bring you new episodes every Monday. So if you don't follow us yet, it is that time. Be sure to subscribe on whichever app that you prefer so we can let you know when our next episode goes live 

LEAH: And we'll be back with another conversation next week until then have a beautiful day. 

OFOSU: Don't forget to be kind to yourself. Y'all take care. Bye-bye

LEAH: Bye.

[Theme up and out]