White privilege, hospice, and a ton of unanswered questions

It doesn’t feel like the time for me to be talking; there are BIPOC voices that need to be elevated at this moment and I want to be someone who elevates those voices. That being said, it also feels important to interrogate the ways in which social workers work within a system of white supremacy. And it feels important to acknowledge how tricky it can be to balance the work of anti-racism and social justice while also building rapport and offering support to our clients with unconditional positive regard.

Easy stuff!

I’ve worked in hospice for six years in a city that is racially and ethnically diverse but also often clearly segregated. The neighborhoods I visit vary wildly, both socio-economically and racially. And the demographics have changed over the years, as all neighborhoods change. In fact, that’s the racism I encounter from my patients and their families. It’s not racial slurs or explicit hatred; that would maybe be easier to address. Instead, it’s the insidious, widespread, casual stuff. For instance, the white family who says, “We moved because the neighborhood started changing, you know.” The white patients and families I see feel safe using coded phrases like that because I’m also white. And in those moments, as an ally, as a social worker, as someone who wants to be Helpful and Brave, what am I supposed to do?

With a friend or a family member, perhaps I would be brave. Hopefully I would be brave and address those statements. But with a patient or their caregiver, I must confess: I am not brave. Instead, I am complicit. In six years I have not figured out how to manage the twin asks of doing my job and doing the bigger work of anti-racism. At best in those moments, I make my face go stone and change the subject. I don’t think that’s enough. But I honestly don’t know what else to do.

One of my supervisees and I spent a solid amount of time talking about this and we didn’t end up with the Big Answer. The closest I can get is that we have to work in the role we choose. Which is not to say there’s never an opportunity to push back in a therapeutic relationship. The questions are when and how to do it. As my supervisee wisely pointed out, is it fair or reasonable to ask a person to examine their racism and their prejudice as they are dying? Will it do any good? Further, do I do my Black patients a disservice by not acknowledging the racism they face in the healthcare system I represent? How do I start that conversation? And when? Will it be welcomed or will it also be considered harmful?

Lots of questions I don’t have any answers for. There’s more for me to learn, clearly: more reading to be done, more discussion with others, more self-reflection. One place I’ve started is with this Medium post by H. C. Dawes; I hope you’ll check it out: https://elemental.medium.com/an-invitation-to-white-therapists-a04cc93b1917

Thanks for reading.

Racism, anxiety, and discomfort

This was a difficult subject to tackle; I’ve started and restarted it a few times. It certainly isn’t a deep dive into race relations or cultural competence in therapy. It’s just one experience that I keep turning over in my mind. What follows is the best I can do and I’m afraid it’s still not a perfect evaluation. Still, it is with me and I just have to keep talking about it.

The other day, a doctor gave me a referral for a patient suffering from anxiety and depression. She has a long psych history and mostly needed to be reconnected to care. Simple enough. But when we met and started talking about her increasingly anxious feelings, a lot more came pouring out than I was prepared for.

I want to be respectful of my client’s right to privacy so I’m not going to write the details of what she told me about. The basics are these: she is a young black woman with sons and she struggles with anxiety about how they will be treated in the world. She faces racism daily, in big ways and small. She knows that her sons will face it too, especially as black men. She is afraid to send them on the bus; she is afraid to call the police if she’s been the victim of a crime; she is afraid.

Lots of my clients suffer from anxiety. They tell me about fears they have that keep them up at night, about the pervasive nervousness that is with them all the time. Generally, we focus on utilizing some CBT and a little bit of mindfulness practice. I teach them strategies to examine their thoughts and worries and use their more rational brain. I teach them deep breathing and some basics of mindfulness, telling them that stress can be controlled. But in this case…what can I do when my client’s fears are not irrational? And also, am I the right person to help her?

I’m white. I was raised in an upper-middle class household and I live firmly in the middle class now, with a lot of privilege. There is no way I could totally understand my client’s experiences as a black woman and as a black mother. I validated her feelings, of course; I explored with her how watching the news increases her anxiety, how some people are unaware of or do not believe in the micro aggressions she and her sons experience on a daily basis. But I cannot truly understand those experiences, not at the cellular level that she does. And honestly, I can’t help her examine her fears for irrationality because racism exists.

I referred her to another therapist, because her mental health history demanded a more intensive therapy than I can provide in my current role. But I keep thinking about her. I keep thinking about what it must be like to fear for your children, in a very different way than I fear for mine, because the dangers they face are different than the ones my kids will face. I keep wondering if I could be an effective therapist for her, were my role to provide that kind of long-term therapy. It’s a question I vaguely remember from graduate school about cultural competence and how we work with clients who have cultural differences that we may or may not understand. This woman and I live in the same town; we are both mothers; we are around the same age. And yet, her lived experience is radically different than my own. In short, I can help her but I wonder if the help would lack something essential.

As usual, I end with few answers and more questions. The good news is, I’ll get to see her the next time she visits her primary doctor, so at least I’ll know how she’s doing. I hope she finds the right therapist. And I hope (corny though it may sound) that things keep getting better so her fears become unfounded ones.