According to the most recent U.S. Census Bureau report, prepared in 2000, there were 36.4 million people, or 12.9% of the total U.S. population, who identified as Black or African American. In addition, there were 1.8 million, or 0.6% of the population, who identified as Black in combination with one or more other races.
The term African American is an evolutionary one that gives rise to much debate regarding categorization and inclusion. African American is an ethnic term that includes persons who are descended from the African continent and whose families have been in the Americas for at least one generation; in contrast, the term Black refers to race and includes diverse ethnic backgrounds, including Caribbean and African ethnicities. However, both terms are often used interchangeably as a racial term. Conflict may often arise between native-born Blacks and Black immigrants and their children, all of whose experiences within American society help inform their decision to identify with the term African American. However, concerns about competing for limited resources are often cited as the reason for a wish to be less inclusive rather than more inclusive in terms of identifying group membership.
The need to categorize and group those who were not members of the dominant group in the United States began in the mid-1600s when Africans arrived to the newly established American colonies. Initial categorizations referred to racial/ethnic characteristics, including skin color, hair texture and physical phenotypes (e.g., lips, nose, and body shape), parentage, and land of origin. It is perhaps the overlap in early categorizations which have contributed to the confusion surrounding the present-day usage of African American to denote a racial category as well as an ethnicity. Ethnic and racial group labels for people of African descent have changed over time and political contexts. Early labels used to refer to African Americans as a group included African, Negro, Black, and the derogatory term nigger.
However, with growing cultural awareness (e.g., the Harlem Renaissance), increased political power (e.g., the American civil rights movement), and grassroots activism (e.g., Black Panthers), social initiatives toward self-identification and labeling arose within African American communities. Community members began to take control of how they were referred to in arenas involving the written word, mass media communication, the arts, sciences, and the political lexicon. These self-chosen identifications were reflective of a shared cultural heritage, language, history, and legacy of slavery and included terms such as Colored, Afro-American, African American, and, of late, the lesser-used term Neo-Nubians.
Despite the extensive use of African American as a racial/ethnic label, individuals may take issue with being presumed to identify as African American. Disagreements about inclusion and identification can be linked to an individual’s generation, level of acculturation, and political affiliation. Others who do not wish to be affiliated with African Americans may deny their membership because of negative associations tied to a long history that portrays African Americans as the denigrated “other,” plagued by oppression. Still, others who have some part of their ethnic identity that interfaces with the African American experience (e.g., mixed race, biracial, or foreign-born individuals) may prefer to identify themselves as multiethnic or multiracial rather than identifying solely as African American, as this label may be too confining or restrictive.
People who identify or are identified as African Americans do not comprise a monolithic people. Factors such as gender, age, educational attainment, geographic location, socioeconomic status, religious and political affiliation, and occupational endeavor contribute to the variations of experiences among these people. Within-group differences relevant to cultural identity (e.g., racial identity attitudes and acculturation level) need to be considered and honored in the counseling relationship. Therefore, it is difficult to suggest a singular counseling approach that would address a variety of mental health concerns that affect individual members of this group.
Furthermore, the nature of African American experiences in America has significant implications for the use of counseling and mental health services by this community. In fact, for many years the counseling profession has had limited contact with African American clients. Racial boundaries in the United States have, in effect, created a national system of disparate access to societal resources. The counseling and mental health professions embedded in this culture are only now, in recent years, beginning to become more receptive to the needs and concerns of African Americans.
Thus, the impact of history has profoundly shaped the experiences of African Americans in the United States. The legacy of enslavement has embedded racism into the cultural milieu, which has had important psychological, physical, and socioeconomic consequences for African Americans and all racial and ethnic groups in the United States. African Americans, dehumanized and treated legally and otherwise as property, have worked to overcome the legacy of institutionalized racism that has been in place for more than 200 years. Many of the practices and laws that created slavery have since been overturned, and yet the legacy of racism continues.
Given the myriad within-group differences among African Americans, shared experiences related to the legacy of slavery and racism contextualize health and mental health, educational, and socioeconomic disparities evidenced among African Americans. Despite the tremendous strides African Americans have made in the United States, they remain overrepresented in lower socioeconomic strata. Psychosocial stressors arising from ongoing interactions with racism in the United States have led some African Americans to seek treatment. Yet, members of this group are disproportionately located among homeless and incarcerated populations, making it difficult to offer consistent, effective interventions.
Furthermore, with regard to mental health disparities, African Americans face numerous obstacles. These obstacles include overdiagnosis of schizophrenia, compared with affective disorders; less availability of, and access to, services; and overall poor quality of treatment received for mental health disorders. In comparison, disparities in the treatment of physical health issues for African Americans also remain problematic. African Americans are more likely to suffer from heart disease, stroke, obesity, breast cancer, and prostate cancer than are Whites.
To this end, gross inequities impact every aspect of this group’s existence in the United States, including economics, housing, and employment. Although it is clear that exposure to trauma (e.g., neighborhood violence, genocide, racial microaggressions) influences mental health, particularly with reference to race-related stress, African Americans have also demonstrated tremendous resilience in the face of such difficulty. Resilience refers to a person’s ability to recover from hardship. Counselors who encounter African American clients can use a strength-based approach that focuses on positive attributes African Americans possess rather than retraumatizing or over-pathologizing this population. Strengths African Americans possess that need to be considered by counselors include the family unit, their ability to recognize the importance of education, and their use of religious/spiritual coping strategies as a way of improving their life circumstances.
Cultural Values Relevant to African Americans
There are several cultural values that African Americans embrace which help to sustain their communities. These values include familialism and connection to spirituality and religion, values that originated with Africentric cultural values. In addition, when encountering difficulty, African Americans have been described as being more likely to face the problem to find resolution and to rely upon spirituality to aid in relief from problematic situations. It is recommended that counselors and mental health professionals consider the diversity in the endorsement of these cultural values when working clinically with African American individuals and families.
The family is an important social, cultural, and psychological structure within the African American community that is subject to being classified as dysfunctional by members of the dominant culture making peripheral observations. African American family units represent diverse structures, including multigenerational, single-parent, and two-parent blended or intact. The makeup of African American families can be extensive, including several generations living together and the informal adoption of fictive kin (i.e., non-blood related members of the family). The institution of slavery had required that African Americans transform the very meaning and structure of the family because slave families were fractured by slave masters who bought and sold slaves like chattel. For slave families, the Eurocentric nuclear family model did not exist; rather, broadened definitions of family, inclusive of multiple generations and fictive kin, were adaptive forms of social support. Furthermore, fictive kin and the nature of extended family networks facilitated the African American family’s ability to share limited resources (e.g., child care responsibilities, housing, and economic resources).
Regardless of the structural makeup of the African American family, the unit is faced with concerns as members of the family engage and interact with components of the dominant culture. For example, the African American family as a unit is concerned with issues related to (a) sustaining economic survival; (b) achieving financial prosperity; (c) perpetuating itself despite obstacles such as child abuse, poverty, unwed mothers, and the proliferation of AIDS; (d) meeting the challenges of day-to-day survival; (e) overcoming the undereducation of its children; and (f) protecting its community from violence associated with the illegal drug trade, police shootings, or victimization in the form of random acts of violence.
Families that have a stable economic foundation, possess racial pride, provide a consistent environment for its children, use extended family networks to create a support system, are connected with a larger community, and have the skill to obtain what they need are thought to have protective factors against the development of mental illness. On the other hand, factors such as child abuse, neglect, and substance abuse are detrimental to the family unit and can influence the prevalence of mental illness within a family unit, especially when compounded by deficiencies in the aforementioned protective factors. Biological and psychological factors also influence the onset of mental illness.
Experiences within African American families vary vastly; however, commonalities of heritage, culture, and contexts inform counselors about unique considerations within African American families. For example, it is possible for the existence of various levels of acculturation and racial identities (i.e., refers to the spectrum of how one thinks about oneself as a racial being) within the context of a single African American family unit. Family members’ differing racial identity statuses may contribute to discord and tension across multiple domains, such as education, employment, and relationships. Similarly, generational and regional cultural differences can influence family members’ role expectations, such that intergenerational conflict and social class differences may arise. Counselors’ ability to recognize the nuances that these variations create within the family and the tensions that may arise when differences exist is crucial.
Socioeconomic class has a tremendous impact on the African American family and its functioning. Within the same family, broad variations that exist within social classes can contribute to tensions related to education, status, and access. Despite these differences, African Americans are more likely than Whites to remain connected to their family unit regardless of these variations in socioeconomic status. For example, unlike their White middle-class peers, middle-class African Americans are often the first generation to reach this class status and thus are looked upon to provide economic, educational, and emotional support to family members who have not joined the ranks of the middle class. Dynamics created by shifts in social class may be stressful and overwhelming. Thus, the resources that may have been sufficient to sustain the individual when stretched to support an extensive family network may cause middle-class African Americans to experience a sense of economic paucity.
Role of the Black Church
African Americans have a long and rich tradition of involvement with the Black church. The Black church has been a sanctuary, gathering place, and social change agent in the African American community. The term Black church in this context serves as a collective description that includes a variety of Christian denominations (e.g., Baptist, African Methodist, Episcopalian, Catholic, Jehovah’s Witness, Church of God) to which African Americans belong. African Americans also practice a variety of other religions, such as Islam, Buddhism, and African religions such as Kemet or Ifa. Given its historic role in this community, African Americans continue to depend heavily on the Black church for support. Members of the clergy are often consulted to provide advice to members of their congregation.
At times, counselors and clergy members may need the benefit of mutual collaboration to facilitate the counseling process. Collaboration is beneficial in circumstances where members of the clergy are not equipped to address various mental health concerns or the complexities associated with psychological distress and mental illness. Counselors can receive additional insights about the individual or family that only the clergy member may be able to access. However, African Americans who identify themselves as very religious may be unwilling to attend counseling for fear that it may demonstrate a lack of faith on their behalf.
In some instances, African American adults who actively attended church as children may attend church less frequently or not at all; nevertheless, they may still identify as spiritual or religious and may depend on prayer. Prayer serves as a coping mechanism for many African Americans, particularly women. Prayer plays a vital role in the lives of African Americans, affording them the opportunity to express concerns, request intervention with various life circumstances, and seek comfort and connection to a higher power.
A key component to working with a diverse group of people such as African Americans is developing multicultural counseling competence. Multicultural counseling competence refers to developing the ability to understand one’s own cultural perspectives and developmental process in relation to diverse cultural perspectives and life experiences. Several aspects of multicultural competence involve being able to discuss issues of race, class, and culture without discomfort, whether the discussion is initiated by the therapist or client. With respect to African American clients, counselors can fortify their knowledge base through talking to informed colleagues, working collaboratively with members of the African American community (e.g., clergy, community leaders), reading about the cultural experiences of African Americans, and attending professional conferences to learn about issues African American face and how to effectively address these issues in clinical practice.
A primary vehicle that may be used to ascertain extensive knowledge of clients’ experiences is the structured clinical interview. Through the structured clinical interview, the clinician may gather information about clients’ development, family experiences, and personality in order to formulate a profile and build a holistic understanding of clients’ experiences and concerns. However, some clients may experience this interview as intrusive and overly reliant on verbal expression. For example, African American clients who may not have received a formal education or do not express themselves well verbally may be at a disadvantage not only in this interview but also in traditional “talk” therapy settings. African Americans who do not trust the counseling process may be unwilling to respond openly to inquiries and may withhold pertinent information. Clinical misinterpretations of Black ways of speaking and use of language can lead to missed opportunities for understanding the nuances of African American clients.
Counselors who work with African Americans need to be prepared to work with clients traumatized by racism-related stress, which has implications for the psychological functioning of African Americans. Racism-related stress is stress generated from ongoing encounters and experiences with discrimination and prejudice. It manifests itself daily in the lives of African Americans (e.g., employment, housing, commerce, and criminal justice system) and can appear as depression, lower self-esteem, sub-par school performance, and an overall sense of dissatisfaction with one’s state of well-being. Racism-related stress has been linked to increased rates of high blood pressure, stroke, diabetes, and cancer among African Americans. A holistic approach, which addresses the mind, body, and spirit to alleviate negative energy located in the psyche, may be an effective alternative to traditional medicine for treating these manifestations of stress in African Americans. Exercises that use progressive relaxation and meditation may help reduce racism-related stress.
Therapists who work with African Americans also may want to consider the influence of Africentric cultural values on clients’ psychological functioning and willingness to engage in the therapeutic process. Africentric cultural values are an outgrowth of African traditionalism and the historical experiences of African Americans. These beliefs and values refer to individuals’ ways of viewing the world which acknowledges the importance of one’s relatedness or connectedness to others by engaging in collaborative efforts, spirituality, and presentation of one’s true self to the world. Despite taking these factors into account in the counseling process, counselors may find that African American clients who embrace Africentric cultural values may be more difficult to engage in traditional counseling and therapy; clients may have stigmas about seeking therapy or have a wish to withhold their true thoughts and feelings from the therapist.
As has been previously suggested, the counseling relationship is one built on trust, an alliance, created between therapist and client. At times, this relationship can be challenged or damaged by racial micro-aggressions that occur at conscious or unconscious levels during the therapeutic process. Racial microaggressions are slights that occur in the counseling relationship, when the therapist expresses a racist belief or thought. Examples of racial microaggressions that can manifest in therapy include making stereotypical assumptions about members of ethnic and racial groups, suggesting that racial-cultural differences do not exist, denying that racism occurs, and dismissing the client’s concerns about issues of race. In addition, racial microaggressions are likely to give rise to further cultural mistrust in the therapeutic alliance.
Cultural mistrust occurs in therapy when African American clients become concerned that the therapist is racist or biased and that the therapist’s biases will prevent both members of the counseling dyad from participating genuinely in the counseling process. On the other hand, the phenomenon of cultural paranoia is described as a healthy, adaptive response to historical racial discrimination and oppression that African Americans have experienced. Both cultural mistrust and cultural paranoia have been linked to increased rates of premature termination of the counseling process among African American clients. At times, clinicians unfamiliar with the intensity of racial dynamics may diagnose patients who appear to have paranoid ideations with paranoid schizophrenia without considering the potential influence of racial dynamics within the counseling setting or the degree to which race-related vigilance has been adaptive for the client. Because paranoid schizophrenia is overrepresented, and arguably overdiagnosed, among African Americans above other mental disorders, counselors are advised to foster an awareness of cultural paranoia.
Assisting African Americans with issues of cultural mistrust and paranoia requires a willingness to acknowledge the realities of racism in the lives of African Americans. Possessing flexibility and ability to embrace diverse worldviews can help to establish a strong therapeutic alliance with clients. Using a cognitive-behavioral approach to work with clients to help them to identify irrational thoughts and beliefs can help them to gain insight into racial dynamics as they occur and challenge fixed beliefs that all White people aim to harm African Americans. Using a cognitive-behavioral approach, counselors can assist clients with gaining control of their reactions to incidents where perceived instances of racism have occurred and can offer problem-solving techniques and strategies to address the events.
One common practice in African American family life is keeping family problems within the family. Secrets are those parts of family historical knowledge and life that distinguish family from nonfamily. Cultural values that endorse keeping family problems “within the family” may contribute to African American individuals’ reluctance to enter counseling or self-disclose with their therapists. Examples of secrets that families may not want to discuss in therapy are informal adoptions, a relative with mental illness, or a family history of substance abuse. Furthermore, for many African American individuals and families, secrets related to sexual or substance abuse, marital difficulties, identity issues, or mental illness are unlikely to receive psychological attention until such concerns have escalated. Mandated individual or family therapy may engender feelings of humiliation, embarrassment, anger, and resentment, all of which need to be explored with counselors. In addition, families may view counselors as intruders into the family’s business. Having an understanding of how clients become engaged in the therapeutic process can help inform counselors’ strategies for overcoming personal, social, and institutional barriers toward treatment and developing a helpful working alliance. Given the tremendous influence of the family on the development of the individual member, consideration should be given to expanding the therapeutic alliance to include members of the family for assessment purposes and treatment if needed.
Compared with other ethnic/racial groups, African Americans are the least likely to use counseling services. Thus, when African Americans do arrive to counseling, the situation is usually extreme and may be reflective of African Americans’ cultural perspective of immediacy, dealing in the here and now. Issues of social stigma, lack of financial resources to pay for treatment, concerns about stigmas of weakness or abnormality, as well as lack of information about the counseling process are contributing factors to African Americans’ underutilization of counseling to relieve psychological distress.
Frequently, African Americans who experience psychological distress do not receive adequate relief from their symptoms because they are not connected with appropriate or culturally responsive mental health professionals (e.g., psychologists, psychiatrists). African Americans are more likely to receive mental health services from hospital emergency rooms. This approach is often ineffective because although the immediate crisis is averted, follow-up is often needed to fully address or resolve systemic problems. Furthermore, overreliance on emergency room treatment can result in misdiagnosis or the over-diagnosis of serious mental disorders in this population. Outpatient services remain underutilized by this group for similar reasons.
Although African Americans may appear to be struggling and beleaguered by social injustice and racism, as a group they remain resilient. Their resilience is evidenced by the steady growth of the African American middle class, economic gains, and social progress. Although varied, their experiences share common links; thus, it is important for counselors to examine the cultural context of the issues African Americans bring to the consultation rooms. Greater efforts must be made to inform, educate, and encourage African Americans to use the therapeutic process to unburden themselves of the stress and trauma often associated with the overlays of social locations in the United States.
The counseling profession has made strides to improve the quality of treatment received by African American clients; however, a concerted effort must be made to help this population focus on their strengths rather than on the negative aspects of prejudice and racism. A strength-based approach can serve as a powerful tool in helping engage African Americans in the therapeutic process. Focusing on strengths can help them continue to adapt and thrive, relying on their families, religious affiliations, and communities for support, uplift, and advancement.
- Boyd-Franklin, N. (2003). Black families in therapy: Understanding the African American experience (2nd ed.). New York: Guilford Press.
- Constantine, M. G. (2007). Racial microaggressions against African American clients in cross-racial counseling relationships. Journal of Counseling Psychology, 54, 1-16.
- Constantine, M. G., Alleyne, V. L., Wallace, B. C., & Franklin-Jackson, D. C. (2006). Africentric values: Their relation to positive mental health in African American adolescent girls. Journal of Black Psychology, 32, 141-154.
- Daniels, L. A. (Ed.). (2001). The state of Black America 2001. New York: National Urban League.
- Grier, W., & Cobbs, P. (1968). Black rage. New York: Basic Books.
- Jones, R. (1996). Handbook of tests and measurements for Black populations (2 vols.). Hampton, VA: Cobb & Henry.
- Lewis-Coles, M. E. L., & Constantine, M. G. (2006). Racism-related stress, Africultural coping, and religious problem-solving among African Americans. Cultural Diversity & Ethnic Minority Psychology, 12, 433-443.
- Neighbors, H. W., & Jackson, J. S. (Eds.). (1996). Mental health in Black America. Thousand Oaks, CA: Sage.
- Snowden, L. R. (2001). Barriers to effective mental health services: African Americans. Mental Health Services Research, 3, 181-187.
- U.S. Department of Health and Human Services. (2001). Mental health: Culture, race and ethnicity. A supplement to mental health: A report of the surgeon general. Rockville, MD: Author.
- Utsey, S. O., & Ponterotto, J. G. (1996). Development and validation of the Index of Race-Related Stress. Journal of Counseling Psychology, 43, 490-501.
- Whaley, A. L. (2001). Cultural mistrust: An important psychological construct for diagnosis and treatment of African Americans. Professional Psychology: Research and Practice, 32, 555-562.