The Implications of Race-Based Traumatic Stress (RBTS) Between Counselors and Clients

Racial trauma, or race-based traumatic stress (RBTS), refers to the cumulative effects of racism on an individual's health. As stated in the article Understanding Racial Trauma: Implications for Professional Counselors, published in The Professional Counselor (TPC), RBTS addresses how racially motivated incidents impede emotional and mental health for communities of color.

While research on RBTS, and mechanisms to reduce its effects, is abundant in the counseling literature, it is not considered an official mental health disorder or diagnosis in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. However, according to research, prolonged RBTS can lead to similar symptoms as those experienced with PTSD. Examples include feelings of depression, anger, recurring thoughts of the event, physical reactions (e.g., headaches, chest pains, insomnia), hypervigilance, and low self-esteem.

We recently spoke with Dr. Warren Wright, Dr. Jennifer Hatchett Stover, and Dr. Kathleen Brown-Rice, authors of the TPC article, and gathered their collective personal and professional experiences and insights with RBTS.
  
In your opinion, from when/where does RBTS stem?

People of color have been subjected to decades of atrocities that have resulted in unimaginable loss of life, land, family, and culture. The result of these cultural traumas has, and continues to, impact communities of color by generating a pathway that places the present generation at greater risk of mental and physical suffering. RBTS is a psychological and emotional stress response because of the collective experiences of racism. This emotional and psychological injury stems from incidents of racism, discrimination, oppression, and other injustices, whether real, perceived, or experienced vicariously.

Are there particular strategies you feel are best for counselors to use to assess for RBTS?

Although RBTS involves experiences of trauma, it is not recognized as a diagnosable condition within the DSM-5. Therefore, culturally competent counselors may utilize a battery of assessments for RBTS. The following are suggested, clinician-administered tools.

• UConn Racial/Ethnic Stress and Trauma Survey (UnRESTS) is a counselor-administered, semi-structured interview encompassing six sections: introduction of the interview, racial and ethnic identity development, experiences of direct overt racism, experiences of racism by loved ones, experiences of vicarious racism, and experiences of covert racism (Williams, Metzger, et al., 2018).
• The Race-Based Traumatic Stress Symptom Scale (RBTSSS) evaluates a client’s exposure to racist experiences and the symptoms that can result, including emotional and physiological concerns (Carter et al., 2013). A counselor can assist in administering this assessment, or it can be administered as a self-report measure.
• The Trauma Symptoms of Discrimination Scale (TSDS; Williams, Printz, & DeLapp, 2018) is a client-administered survey that measures discriminatory distress.
• The General Ethnic Discrimination Scale (GEDS) is a self-report assessment that measures a client’s perceived ethnic discrimination. 

Can RBTS ever be fully prevented?  

As with any causal relationship or correlation, there is a preceding event or action that elicits an effect. We feel that prevention would include eliminating the preceding event, or reducing the effects associated with the impact. That means fully eradicating incidents of racism, discrimination, and oppression, as well as any residual effects, to prevent injury. However, we are forced to consider not only the impacts of racism and discrimination in our country, but the current systems and practices that continue to perpetuate and protect racist ideologies. 

There are strategies that can be implemented to buffer the effects of racism and RBTS though, including racial socialization, externalizing racism, and micro interventions. 

Racial socialization is the intentional communication about racism that parents can engage in with their children. This serves as a developmentally appropriate way to introduce racism and racial identity to children (Anderson & Stevenson, 2019). 

Externalizing racism is the intentional act of a counselor and client to name racism as the reason for a client’s psychological distress. This can reduce the internalization and shame of racism as a personal deficit (Adames et al., 2023). 

Implementing micro interventions can create interpersonal boundaries with a client as a target and perpetrator of racism. However, it is important to note that clients should always assess for safety if they want to utilize these techniques (Litam, 2020; Sue et al., 2019).

How do you feel racial trauma compares to other types of traumas?

Racial trauma looks both similar and different from other types of traumas. Racial trauma is distinctive because it refers to the ongoing stress people of color could experience due to interpersonal encounters of racism, historical events of racialized violence, and vicarious exposure of racialized violence through social media platforms. As a result, racial trauma can be presented as hypervigilance, avoidance of unsafe environments, anxiety, depression, isolation, and flashbacks from traumatic experiences. If left untreated, there is potential to cause long-term physiological and psychological effects. The lack of awareness and consideration given to racial trauma, in comparison to other traumas, is problematic and further exacerbates traumatic experiences and trauma-related symptoms. Systemic oppression and weaponized discriminatory practices perpetuate many of the injustices held against marginalized people and are interwoven into the fabric of our society, making it difficult to avoid exposure. 

What do you feel are the best strategies in broaching RBTS with White supervisees?

Education on broaching is imperative, as well as creating a safe and inclusive environment to openly discuss RBTS without inducing fear, blame, or shame. It is important for supervisors who are persons of color to assess their own feelings, behaviors, and biases before beginning the broaching process with their supervisees. Additionally, culturally relevant discussions and reflection should be imbedded into the supervisory relationship, allowing for supervisees to practice ongoing reflexive strategies, such as journaling, to become familiar with how cultural implications affect not only their clients, but their own lives. Furthermore, in addition to providing literature and training on RBTS and other cultural competencies, supervisors can provide opportunities for supervisees to learn through active and affective experiences to increase efficacy (Bandura, 1997). 

Jones and colleagues (2019) authored a comprehensive article of cultural broaching in supervision that suggested supervisors look at adjusting their style based upon the supervisee, the cultural factors of the supervisee, and the situation being discussed. For supervisees that identify as White, cultural broaching may uncover biases or microaggressions in which they previously, or currently, engaged. Supervisors who are persons of color could best broach the topic of RBTS with their White supervisees by assessing their understanding of racism, RBTS, privilege, and oppression. Supervision is a great space to discuss and explore these topics so that counselors-in-training and supervisees feel prepared and competent to recognize and address RBTS with their clients. 

For children/teens impacted by RBTS, should a counselor’s strategies be the same as for adults? Should we start educating children when they’re young, or does introducing it too early pose a risk?

A counselor’s strategies and approaches to address RBTS should not be the same for children and adults. Like all counseling interventions and services, counselors should consider the development of their clients to ensure their interventions and approaches render positive outcomes.

As a former school educator and school counselor, Dr. Stover does not believe there is a risk in appropriately educating children and teens on RBTS. Dr. Wright believes that education on trauma, and its effects, of any kind is developmentally appropriate and should be addressed with the presenting needs and concerns. In his experiences working with children and teens, many have experienced racism and discrimination from other children, most often in the form of bullying, and trauma-responsive approaches should be implemented. These approaches should be collaborative and restorative, involving all relevant stakeholders, when appropriate, to mitigate conflict, reduce harm, and protect individuals from re-traumatization.

Dr. Warren B. Wright is a National Certified Counselor and Licensed Professional Counselor (TX). He completed his doctoral requirements at Sam Houston State University in the Department of Counselor Education. He obtained his Master of Education in Counselor Education with an emphasis in Clinical Mental Health Counseling from Georgia Southern University. Dr. Wright is the proud owner of Transformational Counseling, Coaching, and Consulting, LLC, where he provides individual and couples counseling services. Moreover, Dr. Wright is a 2021 Doctoral Mental Health Counseling Fellow for the NBCC Minority Fellowship Program. His primary scholarly interest includes working with clients impacted by racial trauma, Black counselor identity development, and entrepreneurship in counseling. As a counselor, author, and speaker, Dr. Wright creates space for healing and transformation.

Dr. Jennifer Hatchett Stover is a National Certified Counselor, Licensed Professional Counselor, Certified School Counselor, Certified Clinical Trauma Professional, and a registered yoga teacher. She received her education from Texas Woman’s University, Prairie View A&M University, and Sam Houston State University. Dr. Stover has served in public education for over 17 years and has experience supporting the mental health and crisis needs of students and families. She is the owner of Counseling in Color, PLLC, where she specializes as a clinician working with trauma, cultivating wellness and creative intelligence across the life span. Her nonprofit, Untriggered, focuses on bridging the mental health gap in underserved and never-served communities. Dr. Stover is also a published author, the first being a children's book focusing on positive and inclusive practices for children in the educational setting, and a contributing author to several publications focused on trauma counseling research. Above all, she is dedicated to her calling, sharing knowledge and tools that empower healing, wellness, and success for others.

Dr. Kathleen Brown-Rice is a Professor of Counselor Education in the College of Education at Sam Houston State University. She is a National Certified Counselor, Approved Clinical Supervisor, Licensed Professional Counselor-Supervisor (TX), Licensed Professional Counselor (NC), and Licensed Clinical Mental Health Counselor (SD). She has worked as a professional counselor in various clinical settings and currently operates a private practice assisting clients with mental health, trauma, and substance abuse issues. Dr. Brown-Rice’s scholarly research activity focuses on counselor supervision and training, with an emphasis in ethical considerations, the implications of historical/generational trauma, and the impact of substance abuse on individuals, families, and the community. She also incorporates the use of biomarkers in her research to understand emotional regulation, risky behaviors, and resiliency.

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