Psychotherapy
© 2022 American Psychological Association
ISSN: 0033-3204
2023, Vol. 60, No. 1, 39–50
https://doi.org/10.1037/pst0000435
Radical Healing in Psychotherapy: Addressing the Wounds of
Racism-Related Stress and Trauma
Hector Y. Adames1, Nayeli Y. Chavez-Dueñas1, Jioni A. Lewis2, Helen A. Neville3,
Bryana H. French4, Grace A. Chen5, and Della V. Mosley6
1
Department of Counseling Psychology, The Chicago School of Professional Psychology
Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park
3
Department of Educational Psychology and African American Studies, University of Illinois at Urbana-Champaign
4
Graduate School of Professional Psychology, University of St. Thomas
5
Independent Practice, Menlo Park, California, United States
6
The WELLS Healing Center, Durham, North Carolina, United States
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2
There is a large body of research on the importance of addressing culture in psychotherapy. However, less is
known about providing critically conscious and racially affirmative therapy for Black, Indigenous, and
People of Color (BIPOC) clients in the context of ongoing systemic racism and racism-related stress and
trauma, especially in the sociopolitical context of the United States. This article introduces and illustrates the
Keeping Radical Healing in Mind Therapeutic Approach using a sample therapy session. To contextualize
the therapeutic approach, we outline the need for antiracist and liberatory approaches to psychotherapy and
describe in detail the Psychology of Radical Healing theoretical framework. The clinical stance that
underpins the Keeping Radical Healing in Mind Therapeutic Approach includes helping clients develop,
internalize, and nurture (a) Critical Consciousness, (b) Cultural Authenticity and Self-Knowledge, (c)
Radical Hope and Envisioning Possibilities, (d) Collectivism, and (e) Strength and Resistance. To better
meet the needs of BIPOC clients, the stance requires clinicians to develop their critical consciousness of
systemic racism and interlocking forms of oppression. The clinical case of “Brenda,” a Black woman
experiencing the effects of racism-related stress while raising a young Black boy, is presented.
Clinical Impact Statement
Question: The current article explores a psychotherapeutic approach titled, Keeping Radical Healing in
Mind, developed to address racism-related stress and trauma among Black, Indigenous, and People of
Color (BIPOC) clients. Findings: Grounded in the literature, the authors introduce and describe a
therapeutic approach anchored in the Psychology of Radical Healing (PRH) theory and illustrate its
utility and applicability through a case example and clinical exchanges. Meaning: Psychotherapists are
encouraged to conceptualize interventions for BIPOC clients using PRH to support clients to internalize,
develop, and nurture (a) Critical Consciousness, (b) Cultural Authenticity and Self-Knowledge, (c)
Radical Hope and Envisioning Possibilities, (d) Collectivism, and (e) Strength and Resistance. Next
Steps: Encourage more clinicians to adopt a Keeping Radical Healing in Mind therapeutic stance when
working with BIPOC clients experiencing racism-related stress and trauma.
Keywords: liberation psychology, radical healing, intersectionality, racial trauma, racism
This article was published Online First March 10, 2022.
Hector Y. Adames
https://orcid.org/0000-0003-2169-1165
Nayeli Y. Chavez-Dueñas
https://orcid.org/0000-0002-3721-3937
Jioni A. Lewis
https://orcid.org/0000-0003-1719-4895
https://orcid.org/0000-0001-8053-0519
Helen A. Neville
https://orcid.org/0000-0002-3823-7463
Bryana H. French
Grace A. Chen
https://orcid.org/0000-0001-7279-0206
https://orcid.org/0000-0002-6404-6863
Della V. Mosley
Hector Y. Adames played lead role in conceptualization, visualization and
writing of original draft. Nayeli Y. Chavez-Dueñas played lead role in
conceptualization, writing of original draft and writing of review and editing
and supporting role in visualization. Jioni A. Lewis played supporting role in
conceptualization and writing of original draft and equal role in writing of
review and editing. Helen A. Neville played supporting role in visualization
and equal role in conceptualization and writing of review and editing.
Bryana H. French played supporting role in conceptualization and equal
role in writing of review and editing. Grace A. Chen played supporting role in
conceptualization and equal role in writing of review and editing. Della V.
Mosley played supporting role in conceptualization and equal role in writing
of review and editing.
Correspondence concerning this article should be addressed to Hector
Y. Adames, Department of Counseling Psychology, The Chicago School
of Professional Psychology, 325 North Wells Street, Chicago, IL 60654,
United States. Email: hadames@thechicagoschool.edu
39
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ADAMES ET AL.
The stress of the disproportionate negative impact of the novel
coronavirus disease (COVID-19) pandemic on Black, Indigenous,
and People of Color (BIPOC), combined with the historical and
continuation of systemic oppression on BIPOC communities, underscore the need for therapists to address the role of racism on the
health of BIPOC clients. Racism, or the system of structuring
opportunity based on the belief that one race is superior to another
(Carter & Pieterse, 2005; Helms, 2020; Jones, 2000), is designed to
exhaust and harm the health and well-being of Communities of
Color (Alvarez et al., 2016; Chavez-Dueñas et al., 2019; Williams
et al., 2019). There are various manifestations of racism in society,
including (a) institutional/systemic racism, (b) cultural racism, (c)
interpersonal racism, and (d) internalized racism, which operate to
control and dehumanize BIPOC (see Chavez-Dueñas et al., 2019;
Helms, 2020; Jones, 1972, 2000; Neville et al., 2012). Racism
pathologizes any person, group, ideology, or institution that deviates
from Whiteness. The cruel treatment and control of people based on
phenotype (e.g., skin color, facial features, hair texture) is racial
oppression (Adames et al., 2021; Chavez-Dueñas et al., 2014;
Helms & Cook, 1999, Jones, 2000).
The purpose of this article is twofold. One, provide a detailed
outline of the Psychology of Radical Healing (PRH), a newer
theoretical framework in the field and one of the few that considers
the cultural and systemic mental health concerns of BIPOC people
and explores the connection between individuals and community
healing. Two, illustrate how clinicians might begin using the PRH in
psychotherapy. To achieve this goal, we (a) outline the need for
antiracist and liberatory approaches to psychotherapy, (b) describe
how resisting self-blame for racism is healing, (c) describe the PRH
as a viable option to conceptualize clients and guide treatment, and
(d) provide a case of a Black woman struggling with symptoms
related to racism-related stress. The article includes clinical case
content and the therapist’s reflection on the psychotherapeutic
process using a therapeutic approach the authors introduce and
describe as, Keeping Radical Healing in Mind.
The Need for Antiracist and Liberatory
Approaches to Psychotherapy
Take a day to heal from the lies you’ve told yourself and the ones that
have been told to you (Angelou, n.d., para. 1).
Doing healing work requires us to question our professional
training and socialization, which has been grounded in a Eurocentric
understanding of human behavior (see American Psychological
Association [APA], 2021; Guthrie, 2004; Katz, 1985; Neville
et al., 2021). The work also requires us to embrace the invitation
to unlearn how psychology and psychiatry systemically uphold
racism (see Guthrie, 2004; Katz, 1985). For instance, the Diagnostic
and Statistical Manual of Mental Disorders (DSM-5) defines a
person’s mental condition as a “syndrome or pattern that occurs
in an individual” (American Psychiatric Association [APA], 2013),
suggesting that suffering originates from a damaged self—a central
organizing principle that guides the actions of many practitioners.
This stance alone can be invalidating and harmful to BIPOC clients
when used as a rigid framework to make sense of clients’ presenting
problems (for an ethical perspective, see Pope et al., 2021).
Recently, APA’s governing body, the Council of Representatives,
adopted and issued a public apology for its longstanding contributions to systemic racism (APA, 2021). The resolution states:
The American Psychological Association failed in its role leading the
discipline of psychology, was complicit in contributing to systemic
inequities, and hurt many through racism, racial discrimination, and
denigration of People of Color, thereby falling short on its mission to
benefit society and improve lives. APA is profoundly sorry, accepts
responsibility for, and owns the actions and inactions of APA itself, the
discipline of psychology, and individual psychologists who stood as
leaders for the organization and field (APA, 2021, para. 1).
There is a long history of BIPOC scholars and therapists advocating for and recognizing the need to develop psychotherapeutic
approaches designed to address the impact of racism on people’s
lives. In their classical book, Helms and Cook (1999) introduced
theories to explain the importance of providing racially conscious
and culturally responsive treatment to BIPOC clients. Helms and
Cook’s work centered on understanding and being therapeutically
responsive to clients’ culture and race.
At the turn of the 21st century, several treatment approaches
specifically addressing racism-related stress and trauma have been
developed. One of the most cited treatment approaches is BryantDavis and Ocampo (2006) Treating Racist-Incident-Based Trauma
therapeutic approach. Their method centers on the importance of
helping BIPOC clients name and process racist incidents in a safe
environment, mourn the losses associated with racism, examine
shame and internalized discrimination, and advocate for equality.
Similarly, Comas-Díaz (2007) Ethnopolitical Approach seeks to
foster “healing and transformation through the development of
critical consciousness and sociopolitical action” (p. 254). More
recently, Intersectionality in Psychotherapy (Adames et al.,
2018), the Healing Ethno And Racial Trauma (Chavez-Dueñas
et al., 2019), Community Healing and Resistance Through Storytelling (Chioneso et al., 2020), and (Chavez-Dueñas et al., in press)
are some of the latest evidence-based approaches to addressing
racism-related stress and trauma among BIPOC clients. These
approaches underscore the importance of enhancing the client’s
self-care and overall well-being. They are also grounded in methodologies and practices developed by and for BIPOC communities.
The Psychology of Radical Healing
“Wisdom consists of the art of discovering hope and liberation behind
the pain” (Marcos, 1996, para. 9).
Building on liberatory and strengths-based approaches created by
BIPOC researchers and clinicians, French et al. (2020) developed the
Psychology of Radical Healing (PRH) theoretical framework, which
also pays attention to how BIPOC heal from racism-related stress and
trauma. One of the unique features of the PRH is its integration of
four foundational theories from different disciplines, including
Liberation Psychology (Comas-Díaz & Torres Rivera, 2020;
Martín-Baró, 1994), Ethnopolitical Psychology (Comas-Díaz,
2007), Black Psychology (Thompson & Alfred, 2009; White,
1970), and Intersectionality Theory (Collins, 2000; Combahee
River Collective, 1995; Crenshaw, 1989). Table 1 provides descriptions of the foundational theories that inform the PRH. Several other
distinctive hallmarks of the PRH is its equal emphasis on BIPOC
envisioning and working toward collective liberation while resisting
oppression (see Ginwright, 2010; Neville, 2017) by supporting
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RADICAL HEALING IN PSYCHOTHERAPY
Table 1
Descriptions of Foundational Theories and Resources That Inform the Psychology of Radical Healing
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Foundational theories
Description
Resources
Intersectionality
Intersectionality theory, an analytical framework introduced by Black
Queer Women and Black feminist activists and scholars, was created
to specifically name and illustrate how systems of oppression (e.g.,
racism, sexism, cissexism, heterosexism, ableism, ethnocentrism)
intersect and produce interlocking forms of inequities. More recently,
intersectionality is being used in practice with clients.
Cole (2009), Collins (2000), Combahee River
Collective (1995), Crenshaw (1991), Lewis
and Grzanka (2016), and Lewis and Neville
(2015)
For intersectionality in psychotherapy see
Adames & Chavez-Dueñas, 2021, Adames et
al. (2018), Adames et al. (2020), ChavezDueñas et al. (2019) and Chavez-Dueñas and
Adames (2021)
Black Psychology
Black Psychology is a field of study that focuses on the thoughts,
behavior, feelings, beliefs, attitudes, interactions, and overall wellbeing of Black People. Black Psychology has four components,
including (a) Is strengths based, (b) represents the voice of Black
People, (c) belongs to Black People, and (d) made accessible to the
community.
Neville et al. (2008), Parham (2009), Parham
et al. (2010) and White (1970)
Liberation Psychology
Liberation Psychology is an emancipatory approach to understanding
and addressing oppression among individuals and groups and
embodies four main acts of resistance, including (a) members of
oppressed groups, view their oppression as a collective assault
requiring a unified response, (b) clinicians conceptualize problems and
interventions within a social-historical context, (c) treatment goals are
designed to promote self-determination, and (d) action toward change
explicitly targets institutions and systems that create and maintain
oppression.
Comas-Díaz and Torres-Rivera (2020), MartínBaró (1994) and Utsey et al. (2001)
Ethnopolitical Psychology
Ethnopolitical psychology is an articulation of Liberation Psychology
that “encourages healing and transformation through the development
of critical consciousness and sociopolitical action : : : . [it] aims to
decolonize people of color, reformulate their ethnic identity, and
promote racial reconciliation, personal transformation, and societal
change” (Comas-Díaz, 2007, p. 92).
Comas-Díaz (2000, 2007) and Comas-Díaz et
al. (1998)
BIPOC individuals to recognize and challenge the unjust conditions
they face. The PRH also fosters a sense of hope and possibilities in
the future. To this end, the PRH is defined as:
Being able to sit in a dialectic and exist in both spaces of resisting
oppression and moving toward freedom. Staying in either extreme—the
despair of oppression or the imagination of possibilities—could be detrimental. On one end of the spectrum, one could get lost in an overwhelming
sense of disempowerment. On the other end, only focusing on dreaming for
a better future removes oneself from current reality. We believe it is
essential that radical healing includes both acknowledgment of and active
resistance from oppression and a vision of possibilities for freedom and
wellness. Moreover, the act of being in that dialectic is, in and of itself, a
process of healing (French et al., 2020, p. 24).
The PRH is grounded in five anchors including (a) Critical Consciousness, described as a person’s capability to critically reflect and act
upon their sociopolitical conditions; (b) Cultural Authenticity and SelfKnowledge honors ancestral wisdom, cultural knowledge, and selfdefinition instead of being defined by oppressors or what liberation
psychology theorists describe as the recovery of historical memory (see
Comas-Díaz & Torres Rivera, 2020; Martín-Baró, 1994; Tate et al.,
2013); (c) Radical Hope and Envisioning Possibilities centers on
imagining future existence for BIPOC individuals, one where courage
is needed to improve the collective human existence; (d) Collectivism
underscores the power of being connected to and having a sense of
belonging to one’s culture to create counter spaces for validation, joy,
and healing; and (e) Strength and Resistance aims to foster a commitment to living joy-filled lives despite a critical awareness of racism and
other forms of systemic oppression.
The concept of radical healing is not new. In 1851, Augusto Vidal
utilized the notion of radical healing in the title of his book to
describe a medical treatment for varicocele (French et al., 2020;
Vidal, 1851). Vidal purposefully used the concept of “radical” to
advocate and communicate the importance of creating change at the
root level of a problem to generate innovative solutions. Figure 1
illustrates and describes the genesis and development of radical
healing through the decades. In this paper, we discuss how antiracist
and liberatory approaches to healing must also include resisting selfblame for racism and oppression.
Resisting Self-Blame for Racism and Oppression
Is Also Healing
We have to talk about liberating minds as well as liberating society
(Davis, n.d., para. 1).
Racial oppression adversely impacts all individuals that are
part of an oppressive system. For BIPOC people, one of the
harmful consequences of racial oppression is accepting and
believing the negative depictions of their racial groups. Such
portrayal injures Communities of Color and fragments the inner
world of BIPOC individuals. To some extent, considering some
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ADAMES ET AL.
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Figure 1
Genesis and Development of Radical Healing Through the Decades
Note. Ballentine (1999), French et al. (2020), Ginwright (2010) and Vidal (1851).
of the dehumanizing narratives about one’s community is challenging
for BIPOC people to avoid, if not nearly impossible. The need for
BIPOC people to free ourselves from such toxic and racist narratives
is vital for our wellness.
Internalized Racism
Internalized racism or “the individual inculcation of the racist
stereotypes, values, images, and ideologies perpetuated by the
White dominant society about one’s racial group, leading to feelings
of self-doubt, disgust, and disrespect for one’s race and/or oneself”
(Pyke, 2010, p. 553) is related to a range of adverse mental and
physical health outcomes in BIPOC individuals (Gale et al., 2020).
For instance, a recent longitudinal study examining the association
between racial discrimination and anxiety symptoms found a positive association between internalized oppression and anxiety (Sosoo
et al., 2020). These results reflect previous studies documenting the
negative impact of internalized racism on health, including significant (a) reduction in personal self-worth, psychological well-being,
and life satisfaction (David & Okazaki, 2006; Utsey et al., 2015), (b)
increased feelings of hopelessness and stress (Cort et al., 2009;
Garcia et al., 2019; Lewis et al., 2020), and (c) physical ailments
such as obesity and vascular disease (Butler et al., 2002; Chae et al.,
2010; Chambers et al., 2004). Thus, internalized racism is detrimental to the health of BIPOC individuals.
Resisting Self-Blame for Racism
Resisting self-blame for racism is an antidote to the harmful effects
of racial oppression. We define resisting racism as the process by which
individuals reject blaming themselves for experiencing symptoms
because of living in a racist and oppressive society (see Adames &
Chavez-Dueñas, 2017). Creating curiosity in therapy to support BIPOC
clients in (a) questioning and deconstructing harmful racist narratives
and (b) naming racism and oppression as the problem rather than a
deficiency within the self is life-affirming and healing (Adames &
Chavez-Dueñas, 2017; Semmler & Williams, 2000).
When BIPOC clients reject self-blame for the challenges they
face due to living in a culture of White supremacy, they can better
contextualize the source of their distress (e.g., racism, sexism,
gendered racism, racialized heterosexism, cissexism, ethnocentrism,
racialized ableism; see David, 2014: David et al., 2019; Turner &
Neville, 2020). In turn, when BIPOC individuals resist self-blame
for oppression, they are better equipped to recognize the problematic
nature of systems, institutions, and ideologies organized to harm and
dehumanize their existence (Adames & Chavez-Dueñas, 2017;
Adames et al., 2018). They can also direct their energy to heal,
connect, and build community as ways to resist oppression (Mosley
et al., 2020). Moreover, rejecting self-blame for racism can aid in
developing a sense of racial pride, a key component of racial
socialization that can buffer the deleterious effects of racism for
BIPOC (Neblett et al., 2008; Wang & Huguley, 2012; Wang et al.,
2020). It is healthy for BIPOC people to actively create ways to
reject self-blame for the profound and harmful impact of living in a
White supremacy culture.1
1
The language of White supremacy is often associated with explicitly
racist, extremist individuals and/or groups (e.g., White nationalists), and
often remains disconnected from the experiences of everyday White people.
Thus, to connote the shared behaviors and ideologies that are pervasive under
a system of White dominance, we use the term White supremacy culture
(Okun, 2001) throughout the paper (Adames et al., 2021, p. 30).
RADICAL HEALING IN PSYCHOTHERAPY
Keeping Radical Healing in Mind: A Therapeutic
Approach
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Rarely, if ever, are any of us healed in isolation. Healing is an act of
communion (hooks, 2001, p. 215).
Psychotherapy works for various presenting problems, including
stress and trauma, an assertion that is empirically supported
(Campbell et al., 2013; Lambert, 2013; Wampold, 2007, 2015).
Several actions of effective therapists include: (a) providing an
acceptable and flexible etiology of the client’s distress, (b) developing
a treatment plan that is congruent with the etiology provided to the
client, (c) not avoiding complex and challenging content in therapy,
(d) being aware of the client’s demographics and context, (e)
therapists being aware of their internal processes (Wampold, 2011,
para. 14; Wampold, 2015), and (f) the therapeutic alliance between
clients and therapists (Norcross & Lambert, 2018; Wampold &
Budge, 2012). However, most psychotherapy research fails to explicitly center healing from the wounds of racial oppression. Instead, there
is an imbalance in our practice. For instance, although most theories
of psychotherapy and counseling pay attention to how people’s
internal subjectivities impact their functioning (e.g., assessment of
functioning in social, educational, and occupational spheres of life),
they often fail to contextualize how the external world and its
structures impact people intrapsychically. Although research in this
area is underdeveloped, empirical evidence demonstrates the effectiveness of individual psychotherapy and community-based treatment
approaches to address racism-related stress (Brondolo et al., 2009;
Conway-Phillips et al., 2020). Additionally, treatment approaches
that use intersectionality in psychotherapy are emerging (see Adames
et al., 2018, 2020; Chavez-Dueñas & Adames, 2021; Chavez-Dueñas
et al., 2019). Intersectionality in psychotherapy provides a lens for
BIPOC clients and therapists to understand how overlapping systems
of oppression impact their everyday lives. It also supports BIPOC
clients to generate ways of resisting self-blame for experiencing
symptoms that result from interlocking systems of oppression
(Adames et al., 2018). Consistent with what we know about
successful therapeutic relationships from psychotherapy research,
we argue that the PRH is a viable theory to address racism-related
stress and trauma in psychotherapy.
To make psychotherapy a healing space where BIPOC clients can
learn and explore how racism-related stress and trauma impact their
lives, a racially conscious and systems-centered treatment approach
centering the PRH as a practice and praxis, titled Keeping Radical
Healing in Mind—A Therapeutic Approach, is provided in Figure 2.
This approach aims to assist therapists working with BIPOC clients to
offer strength-based, culturally relevant, and racially responsive treatment whereby clients are viewed not only as oppressed people but also
as beings with strengths, agency, who have, are, and will flourish. In
the same way radical healing is about existing in both spaces of
resisting oppression and moving toward freedom, so does our conceptualization of BIPOC clients. For instance, if our understanding of the
client is on either extreme (i.e., only focusing on the client’s oppression/viewing them solely as victims or only centering hope and
liberation for the future without also paying attention to how oppression is impacting clients), we will miss the opportunity to create a
therapeutic space that contributes to healing (supporting clients to
balance both ends). Therapists can use the treatment approach to
supplement any theoretical orientation by developing a formulation
43
that considers the impact of racism and oppression on clients’ lives and
provides interventions to address racism-related stress throughout
psychotherapy. Through the therapeutic process, the approach aims
to (a) support clients in developing, internalizing, and nurturing the
five anchors that stem from the PRH (i.e., critical consciousness;
cultural authenticity and self-knowledge; radical hope and envisioning
possibilities; collectivism, and strength and resistance), and
(b) develop or strengthen awareness of clients’ complex existence
that moves from being unidimensional to multidimensional beings.
Keeping Radical Healing in Mind requires a therapeutic stance of
curiosity, unassuming openness, and responsiveness to the interlocking ways BIPOC clients are oppressed—a more effective
practice than simply matching therapists and clients by race and
ethnicity (see Ancis, 2004; Knipscheer & Kleber, 2004). To
illustrate, a meta-analysis conducted by Cabral and Smith
(2011) examined ethnic and racial matching among Asian American, African American, Latinx, and European American clients
and therapists on three variables, including (a) preference for an
ethnic and racial matched therapist, (b) client perception of
racially or ethnically matched and unmatched therapists, and
(c) the therapeutic outcome in racially and ethnically matched
and unmatched treatment. The results indicated that BIPOC
clients prefer a therapist of their own race and that those matched
with a therapist of the same ethnic and racial background stayed
in treatment longer. However, ethnic and racial matching
between the therapists and the client did not account for better
treatment outcomes (Cabral & Smith, 2011; Smith & Trimble,
2016); instead, what accounts for a better outcome is the therapists’ cultural competence and responsiveness to clients’ social
demographics including their ascribed race. Working from this
clinical stance requires therapists to understand the impact of
their racial socialization on their clinical work with BIPOC
clients and develop an antiracist identity.
BIPOC clients working with therapists using the Keeping Radical
Healing in Mind approach are likely to benefit from treatment
regardless of ethnic and racial matching in the dyad. This work
also requires us to move beyond multicultural competence in practice.
As described by Adames et al. (2018), “focusing on multiple identities
in culturally responsive psychotherapy is important; demarginalizing
strong intersectionality, a compass that may help psychotherapists
explicitly consider how systems of oppression impact clients, is
equally vital” (p. 78). Hence, while the therapeutic approach is
understood as a cyclical and ongoing process co-constructed
between therapists and their BIPOC clients, we describe Critical
Consciousness as the beginning anchor in the process. It is
essential for therapists to develop their critical awareness of
the systemic nature of racism and oppression and assist their
clients on this radical healing journey adequately. Scholars in
Black Psychology and Liberation Psychology posit that as clinicians, we cannot change society and be a healing presence in
people’s lives without recommitting daily to help dismantle
oppression (Comas-Díaz & Torres Rivera, 2020; French et al.,
2020; Parham et al., 2010; Martín-Baró, 1994). Thus, Keeping
Radical Healing in Mind has no endpoint; instead, it is a practice
that gains strength the more therapists and clients use and nurture
it together in treatment. This liberatory and racially affirming
stance facilitates acknowledging, understanding, and accepting
what racism invokes in BIPOC clients without self-blame or
blaming Communities of Color. This therapeutic approach also
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ADAMES ET AL.
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Figure 2
Keeping Radical Healing in Mind—A Therapeutic Approach
Note. Analogous to a compass, Keeping Radical Healing in Mind—A Therapeutic Approach
helps BIPOC clients navigate living in a White supremacy culture by resisting self-blame for
racism and interlocking forms of oppression directed at them and their ethno-racial group. It also
supports clients to internalize, develop, and nurture the five anchors of the Psychology of Radical
Healing. In turn, BIPOC clients will be able to heal from racism-based stress and trauma while
finding ways to maintain joy and meaning in their lives despite living in a world that dehumanizes
their communities and existence.
helps clients name the various sources of stress (i.e., resisting
self-blame for racism and oppression), which may help protect
BIPOC clients from internalizing and owning ideologies and
practices designed to devalue, shame, and destroy them. Finally,
Keeping Radical Healing in Mind creates space in and outside of
therapy for clients to envision and work toward a liberated future.
Keeping Radical Healing in Mind: A Case Example
The following clinical exchange demonstrates how to keep
radical healing in mind when considering multiple marginalized
identities, systems of oppression, and how they impact the lives of
BIPOC clients. We echo Adames et al.’s (2018) assertion that “the
task requires that the therapist stay close to the client’s experience
while considering both their internal subjective experience and the
impact of external structural systems of oppression on the client’s
well-being” (p. 74). Keeping Radical Healing in Mind recognizes
the clinical value of paying attention to what is happening in the
world AND what is taking place inside people’s minds (both clients’
and therapists’) AND the interplay between both.
Brenda2 is a 32-year-old African American cisgender woman who is
affectionately attracted to men. She sought treatment for symptoms
related to anxiety, which she has experienced on and off since her early
20s but worsened in the past year during the COVID-19 pandemic.
She discussed constantly being worried, unable to concentrate, and
“always feeling on edge.” Also, Brenda reported difficulty falling
asleep, loss of appetite, and having frequent stomach aches. Her
primary care physician encouraged Brenda to seek therapy since her
physical exam and lab work were unremarkable.
Brenda lives with her mother and her 6-year-old son Chad who
has been attending school remotely for the past year. During this
period, Brenda’s themes centered around her need to project an
image of strength. The following is an exchange between the client
and the therapist (Hector Y. Adames), an AfroLatinx man.
Sessions often started with Brenda discussing feeling annoyed
with her mother. For instance, Brenda described being bothered by
her mom’s “obsession with watching the news.” When Brenda
2
The names, identifying information, and specifics of the case have been
deidentified and disguised.
RADICAL HEALING IN PSYCHOTHERAPY
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discussed her mom and her affinity for the news, she would often
comment by saying, “I know the world is awful right now, but who
needs all that energy in the house” or other similar statements. The
following reconstruction is an amalgamation of sessions in longterm therapy (2 years) with a good working alliance. Brenda sat
down, released a long sigh, and said, “Oh my god, you won’t believe
this—Chad is now taking after mom. He has all these questions
about the damn news—I just can’t take it.”
Therapist:
I believe it. Children are so inquisitive. I am wondering what comes up for you when Chad asks you
questions about the news?
Brenda:
(Releasing a deep sigh) I don’t know. The news is so
disturbing; I don’t want to think about it.
Therapist:
And unlike the news, you can’t turn off his questions.
Brenda:
Oh my god, yes! They’re nonstop. I just don’t want
Chad exposed to all that stuff and worrying.
Therapist:
Brenda:
Therapist:
Brenda:
You know, all that negative energy—the police violence, the killing of Black people, the damn pandemic.
Nahh : : : I don’t have time for feelings (shifts in her
chair). I have a Black boy to raise, and the world is a
hot mess—know what I’m sayin?
Therapist:
Yeah, that’s a lot for anyone to deal with, especially a
child.
I hear you. Allowing yourself to feel can be overwhelming, especially as the mother of a Black child.
Brenda:
Yup, and I can’t afford to break down and get sick, you
know.
Can you say more about the stuff, Brenda?
Therapist:
We live through such a disturbing time when it seems
that there is so little that brings people joy and laughter.
Brenda:
this may help facilitate a therapeutic relationship in which the psychotherapist is intentionally open to both cultural content and structural
racism existing in and outside of the therapy room (Adames et al.,
2018, p. 76).
Quiet is good Brenda : : : the silence reminds me of
your wish to silence all of the noise, turmoil, and
negative energy in the world : : : silence can allow us
to connect to our feelings like how the pressure from
oppression can make us feel distressed.
Exactly, he’s so young, he should be playing and doing
kids’ stuff, you know—playing, laughing, having fun.
Therapist:
grounded in critical consciousness. To foster this stance, the therapist
validates and connects (a) what Brenda is discussing in session to
what is taking place out in society (e.g., We are living through a
disturbing time), and (b) how oppression can be a source of distress
for both her (e.g., it must be a lot for you, Brenda) and her son (e.g.,
That’s a lot for anyone to deal with, especially a child). The PRH
framework anchors our conceptualization of Brenda’s presenting
concerns stemming from racism-related stress. In turn,
Therapist:
Brenda:
Brenda:
45
So true.
And it must be a lot for you, Brenda. (long silence)
Sorry, I got quiet : : : it’s just been rough.
In this clinical exchange, we understand Brenda’s desire to avoid
the news as a way for her to protect herself and Chad from the racial
trauma that can result from repeated exposure to violence against
Black people. Research suggests youth with greater exposure to online
traumatic events such as police killings of Black people are related to
youth experiencing more significant levels of depression and posttraumatic stress disorder (PTSD) symptoms (Maxie-Moreman &
Tynes, 2022; Tynes et al., 2019). Using tenets of the PRH framework,
we view Brenda’s decision to limit her news intake as a form of
self-protective coping (see Lewis et al., 2013), strength, and resistance
against constant messages that highlight how systems perpetually
dehumanize BIPOC, particularly Black people in the United States.
The clinical stance we are advocating for in this article has this
particular way of developing curiosity about different ways to make
sense of the content BIPOC clients bring into the session. At the same
time, clients and therapists share their curiosity and mind—this is one
way to build critical consciousness.
Using the Keeping Radical Healing in Mind therapeutic approach
calls for practitioners and clients to become curious together and codevelop a shared account of the presenting problem—one that is
In this exchange, we observe the psychological toll of racism on
Brenda. The therapist provides emotional support by recognizing how
Brenda’s lived experiences and the sociopolitical environment (e.g.,
racism) are overwhelming and impacting her life. We also notice the
intersection of racism with other systems of oppression, such as sexism
or gendered racism (Essed, 1991; Lewis et al., 2017), showing up for
Brenda. For instance, the stress and worry of raising a young Black boy
in the context of police violence (Thomas & Blackmon, 2015) along
with the pressure she faces related to the Strong Black Woman schema
(e.g., a schema where Black women internalize cultural expectations to
project an image of strength, an intense motivation to succeed, suppress
their emotions, and adopt a caretaker role; Watson-Singleton, 2017;
Woods-Giscombé, 2010) are some of the unique ways we are making
sense of how gendered racism uniquely impacts Brenda.
From this exchange, we understand Brenda as someone who has
critical consciousness (e.g., the world is a hot mess) while also being
emotionally taxed (e.g., I don’t have time for feelings) and thinking
of ways to be of support to her child (e.g., I have a Black boy to
raise). In concert with the Keeping Radical Healing in Mind
approach, the therapist continues to make the connections between
systemic oppression and its impact on Brenda (e.g., silence can
allow us to connect to our feelings, like how the pressure from
oppression can make us feel distressed) as a way to help the client,
not to internalize oppression.
Therapist:
Tell me what it’s like to raise Chad amidst all that is
going on.
Brenda:
It’s so hard. I love my little Chad; I can’t imagine
anything happening to him. I just can’t.
46
Therapist:
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Brenda:
ADAMES ET AL.
The thought of something happening to Chad must be
terrifying : : : just more pain and loss like what Black
people have always gone through. No wonder you
don’t have time for feelings.
(remains silent and becomes tearful)
Therapist:
Your love for Chad perhaps makes it especially hard
to face all the racism in our society and the constant
hate directed at Black people : : : it is indeed rough.
Brenda:
Yeah, so rough : : : I know I am not the only one who
has to worry about their child’s safety. But damn, it’s
exhausting to hear about another officer-involved
shooting of Black people. They are just babies (tears
flowing down her cheeks).
Therapist:
As I hear you, I keep thinking of how the burden of
racism is too heavy to carry on your own. Are there
any spaces in your life where you can connect with
other Black mothers who worry about their children’s
safety?
Brenda:
I have my supportive mom : : : I wish there were more
spaces to do that, but we are all just getting by.
Therapist:
You, Chad, and all Black people deserve more than
just getting by. A world where Chad can play, where
you and your mom are held and valued, where the
news is not about the constant murders of Black
people.
Brenda:
Therapist:
(becomes tearful)
You deserve to be valued and not just live in constant
fear.
Radical Healing also calls for the therapists to listen to moments
when BIPOC clients bring up personal difficulties (e.g., It’s so
hard. I love my little Chad, I can’t imagine anything happening to
him) and use this opportunity to validate how anti-Blackness
exhausts (e.g., hard to face all the racism in the society constantly),
generates fear, and hijacks the life chances or potential possibilities
of Black people (e.g., the thought of something happening to Chad
must be terrifying : : : just more pain and loss like what Black
people have always gone through). In this exchange, naming and
connecting Brenda’s challenges to systems of oppression may
have facilitated her recognition of how racism is a collective
traumatic experience for the Black community (e.g., I am not
the only one who has to worry about their child’s safety). The
therapist was attuned to Brenda’s indirect description of her
collectivistic worldview and used it as an opportunity to become
curious about ways for Brenda to collectively heal (i.e., emotional
and social support), which aligns with a PRH stance (e.g., the
burden of racism is too heavy to carry on your own. Are there any
spaces in your life where you can connect with other Black mothers
who worry about their children’s safety)?
Brenda:
Mom is on another level : : : I don’t know how she
does it; she’s been through so much (period of
silence), and yet she never loses faith.
Therapist:
As I hear you, I’m envisioning your mom holding on to
faith as she watches all the atrocities in the news.
Brenda:
I wish I could be more like her : : : it honestly feels
hopeless.
Therapist:
Difficulty maintaining hope in the face of endless
racial cruelty makes a lot of sense, Brenda—and
I’m also hearing your wish to be more like your
mom. Say more about that.
Brenda:
I don’t know. I remember her being honest with me
about how unfair and cruel this world is, and she
taught me about the beauty of Black people.
Therapist:
And this is the world and future you want for Chad.
Brenda:
Yeah : : : I wish I were better at doing this with Chad. I
am so afraid of what this world can do to him.
Therapist:
Racism is painful stuff, Brenda.
Brenda:
(soft voice) You’re telling me.
Therapist:
There is a loss when we face the reality that we can’t
protect Black children from hatred, but your love for
Chad and the lessons you learned from your mom can
create space for him to love himself. This will help him
find ways to take care of himself while keeping the faith
just like your mom does.
Radical Healing calls for therapists to help clients develop
strategies to recognize and resist self-blame for racism and other
forms of oppression while envisioning new possibilities and moving
toward psychological and sociopolitical liberation (i.e., internalizing). Therapists can listen to moments when BIPOC clients directly
or indirectly mention longing for hope and change (e.g., I wish I
could be more like her) and a sense of defeat and discouragement
(e.g., it honestly feels hopeless). Therapists can listen for these brief
and subtle moments to normalize the hopelessness while connecting
it to racial oppression, as we see the therapist do in this exchange
with Brenda (e.g., difficulty maintaining hope in the face of endless
racial cruelty makes a lot of sense, Brenda). Similarly, the therapist
affirmed Brenda’s yearning to be like her mom, which we understand as an opportunity to help Brenda envision new possibilities for
her and Chad. This exchange illustrates how the client and the
therapist created a space to discuss and sit in the dialectic between
experiencing racism and envisioning future possibilities for Brenda
and her son. It is also an example of standing in solidarity with
clients during the session. For example, the therapist helped Brenda
recognize the models of resistance and hope she had in her own life.
Brenda’s healing journey was evidenced by the client’s increasing
ability to become aware of the complexity of her existence as a
Black woman (i.e., self-knowledge) and hold both the harm oppression causes and knowledge of her community strengths and cultural
authenticity (e.g., I don’t know. I remember her being honest with
me about how unfair and cruel this world is, and she taught me
about the beauty of Black people). Over time she discussed
experiencing more hope for her and her son’s future.
The exchange provided in this article focused primarily on helping
Brenda internalize, develop, and nurture five anchors of the approach,
47
RADICAL HEALING IN PSYCHOTHERAPY
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including critical consciousness, strength and resistance, collectivism,
and radical hope. The Keeping Radical Healing in Mind Therapeutic
Approach does not require that therapists address all five anchors of
the PRH in each session with a client; instead, it can center the anchors
connected to the content that BIPOC clients bring into therapy as
illustrated in the exchanges. In our discussion, we also described the
role of the therapist. It is essential for the therapist to develop critical
consciousness while keeping radical healing in mind throughout the
therapeutic process. Essentially, therapists must constantly challenge
themselves to consider structural issues as they manifest themselves
in clients’ lives and provide space to name, explore, and resist
self-blame for these concerns.
Conclusion
In this article, we highlight a clinical case example of Brenda, a
Black woman experiencing the racism-related stress of hearing
incidents of police brutality in the news while trying to raise a
young Black son, to illustrate how to apply the PRH in psychotherapy. Given the increased attention to systemic racism, police
brutality, and police violence due to the racial uprisings in Summer
2020, clinicians need to develop an increased awareness about the
impact of systemic racism, racism-related stress, and trauma on the
lives of BIPOC clients. The clinical exchange presented in this
article highlights the benefits of keeping radical healing in mind
when working with a Black woman client to name and challenge the
harmful messages she has been told about herself and her community. For example, rooted in experiences of gendered racism, Brenda
had internalized the Strong Black Woman schema, which made her
feel like she had to suppress her own emotions while serving as the
caretaker and projecting an image of strength. In this example, the
therapist’s ability to keep radical healing in mind further assisted
Brenda in sitting in the dialectic between experiencing interlocking
systems of oppression and envisioning future possibilities for herself
and her Black son. It is vital for therapists to take a racially conscious
and strength-based approach in working with BIPOC clients
experiencing racism-related stress or trauma.
When therapists are applying the PRH to their clinical work by
keeping radical healing in mind, they are helping their clients do
more than merely cope with racism-related stress; they provide their
clients with the tools to heal and thrive in the face of systemic racism
(see Brondolo et al., 2009; Conway-Phillips et al., 2020). Specifically, therapists could help their clients internalize, develop, and
nurture radical healing as a multisystemic approach grounded in the
five anchors of the PRH framework. The therapeutic process is
viewed as cyclical, ongoing, and coconstructed between therapists
and their BIPOC clients. However, in this article, we highlight
Critical Consciousness as a core anchor for therapists to develop.
Thus, therapists need to develop their capacity to critically reflect
and act upon their sociopolitical conditions (Comas-Díaz, 2007,
2020; Watts et al., 2011) before assisting their clients in increasing
their critical consciousness. As we saw with Brenda, the therapist
validated her desire to turn away from distressing news while
helping to face it in session by acknowledging the reality of racial
terror. It is also crucial for therapists to help their clients develop
Cultural Authenticity and Self-Knowledge, which honors ancestral
wisdom, cultural self-knowledge, and self-definition. In the clinical
exchange, it was healing for Brenda to be reminded of how her
mother raised her and maintained a sense of hope in the face of
oppression. Thus, Radical Hope and Envisioning Possibilities was
also an essential component of healing for Brenda because she could
begin to imagine future possibilities for her Black son to live in a
more socially just world and engage in a joy-filled life. When
therapists keep radical healing in mind, they also encourage their
clients to develop collectivism and lean on their support networks to
nurture a sense of belonging, create counter spaces, and receive
validation from their community as a source of healing (Grier-Reed,
2010). Lastly, therapists need to foster strength and resistance in
their BIPOC clients, which helps clients to see that they have
inherent strengths and skills to survive and thrive in the face of
systemic racism. The therapist encouraged Brenda to draw on her
mother’s teachings and love for her son as a source of strength and
resistance. We hope that therapists will embrace this liberatory and
racially conscious approach to working with BIPOC clients in the
context of racism-related stress and trauma.
An assumption of the Keeping Radical Healing in Mind therapeutic
approach is that it requires clinicians to (a) know history, and an
understanding of the client’s culture, (b) develop a deep understanding of what their ascribed race means to them and what it represents in
a White supremacist culture, and (c) how power and oppression
operate in society and clinical settings. Although the therapeutic
approach presented in this article does not guide clinicians in
developing in these three areas, there are several helpful resources,
including the Multiracial/Multiethnic/Multicultural Competency
Building Model (White & Henderson, 2008) and the Academics
for Black Survival and Wellness (Mosley & Bellamy, (n.d.) immersion training that Black and non-Black clinicians can explore.
In closing, we hope that using the Keeping Radical Healing in
Mind therapeutic approach can be a compass that therapists and
BIPOC clients use to affirm the words of the Black poet, Chapata
(2019), who reminds us that
There are parts of me that I didn’t know exist, that are still healing. I’m
still learning my wounds. I’m learning that healing comes in stages. I’m
learning that wounds need air to heal. I’m learning to release fear and
welcome growth : : : I affirm it (p. 50).
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Received May 14, 2021
Revision received November 15, 2021
Accepted February 8, 2022 ▪