Examining Secondary Trauma as a Result of Clients’ Reports of Discrimination

Traumatology, 2015

Empirical evidence has accumulated over several decades that has documented the psychological, physical, and emotional consequences of racism and racial discrimination. Still, little has been written in the legal or mental health assessment literature that is focused on describing the direct and specific effects of racism. There is little that provides guidance to psychologists and mental health professionals in understanding and assessing race-based stress reactions that may occur from exposure to racial discrimination or racism. The current article extends previous work on the Race-Based Traumatic Stress Symptom Scale (RBTSSS) by providing evidence and guidance on how the scale can be used in practice to assess and evaluate the emotional impact of race-based encounters.

The Counseling Psychologist, 2005

2009

The current study of Black patients focuses on how discrimination contributes to racial disparities in health. The authors used a longitudinal methodology to study how perceived past discrimination affects reactions to medical interactions and adherence to physician recommendations. In addition, they explored whether these reactions and/or adherence mediate the relationship between discrimination and patients' health. The participants in this study were 156 Black patients of low socioeconomic status at a primary care clinic. Patients completed questionnaires on their current health, past adherence, and perceived past discrimination. Then, they saw a physician and rated their reactions to the visit. Four and 16 weeks later they reported on their adherence to physician recommendations and overall health. Perceived discrimination was significantly and negatively associated with patient health, reactions to the Downloaded from Penner et al. / DISCRIMINATION AND HEALTH DISPARITIES 181 physician, and adherence. Path analyses indicated that adherence mediated the relationship between discrimination and patient health, but patient reactions to the interaction did not.

Cultural Diversity & Ethnic Minority Psychology, 2012

When studying discrimination, it is important to examine both perceived frequency and stress associated with these experiences, as well as the interplay between these two dimensions. Using data from Latino/a participants (N ϭ 168), we found an interaction effect of the reported frequency and reported stressfulness of discrimination on psychological distress (depression and anxiety), such that frequency predicted greater psychological distress for low-stress events, but high-stress events were associated with greater distress regardless of frequency. In addition, using the constructs of "stated" and "derived" stressfulness, we found that the frequency of experiences of discrimination that were rated as less stressful were, in fact, correlated with greater psychological distress. Discrimination events not experienced as stressful nonetheless may have negative implications for the target, especially if they occur frequently.

Journal of counseling …, 2010

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… Psychology: Research and …, 2010

This study examines adaptive responses that mental health professionals of color use to cope with racial microaggressions in their professional lives. Twenty-four mental health professionals from diverse ethnic backgrounds in the United States and Canada participated in focus groups discussing their experiences with racial microagressions and how they cope with them. Results of the analysis indicated that 8 primary coping themes illustrated strategies used by the participants. These include: identifying key issues in responding to racial microaggressions, self-care, spirituality, confrontation, support, documentation, mentoring, and collective organizing. Suggestions for mentoring professionals of color are offered.

Psychology of Violence, 2018

Objective: Veterans of color represent a unique intersection of individuals at risk of experiencing racialized discrimination during their military service and of developing negative mental health outcomes. At the same time, there has been little guidance for Department of Veterans Affairs (VA) health-care providers in how to address these clinical issues in a culturally competent manner. This article describes a group-based intervention targeting race-based stress and trauma among veterans implemented at 4 different sites. Method: The authors describe the development and application of this intervention, including information about development of the group and general aims as well as the process of implementing the group across settings. Results: The authors address broad factors to consider when implementing the group, including navigating diversity dimensions within the group and addressing provider cultural competence and identity. Finally, the authors review recommendations for future directions for implementing the group within and outside of a VA setting, seeking institutional support for the group, and developing measures to assess the efficacy of the group. Conclusions: The intervention described in this article has the potential to serve as a model for development of similar interventions both within VA health-care centers and non-VA health-care settings.

2014

I would also like to thank the faculty and staff at the UT College of Social Work who provided me with the prerequisite knowledge and skills to complete my education and embark upon my professional journey. Finally, I extend my sincerest gratitude to Dr. Stan Bowie. Thank you for working so tirelessly to prepare me to become a successful student, researcher, and professional. Thank you for your mentorship and your constant encouragement that strengthen and inspire me to continue to grow professionally. I hope to be able to repay you by supporting and motivating others as you have done for me so enthusiastically over the past two years.

American Journal of Public Health, 2009

Objectives: Examine whether three measures of perceived racial discrimination in health care detect similar rates of discrimination and show similar associations with patients' healthcare experiences. Design: Cross-sectional observational study involving telephone surveys and medical record reviews. Setting: Veterans Affairs Pittsburgh Healthcare System Participants: 50 White and 50 African American veterans with diabetes Main Outcome Measures: Three types of measures of perceived racial discrimination in health care were compared: single-item and multi-item measures assessing personal experiences of discrimination in healthcare settings, and a measure assessing general racism in the healthcare system. Associations of each measure with patient-reported problems with their medical care and receipt of recommended preventive screenings were also explored. Results: More African American than White veterans reported perceived discrimination on all measures (personal discrimination, singleitem: 42% vs 6%, P,.001; personal discrimination, multi-item: 42% vs 18%, P5.01; general racism: 74% vs 40%, P5.001). In the total sample, discrimination was more likely to be reported on the general racism measure than on the single-item (OR536.53, 95% CI57.95-167.89) or multi-item measures (OR520.28, 95% CI55.12-80.34) of personal discrimination. The multi-item measure of personal discrimination (OR53.96, 95% CI51.29-12.18) and general racism measure (OR53.61, 95% CI51.34-9.71) were significantly associated with patient-reported problems with their care. Receipt of recommended screenings was not associated with any of the discrimination measures. Conclusions: Different measures of perceived racial discrimination in healthcare settings yield different rates of discrimination and show variable associations with patients' perceptions of care.

Journal of Systemic Therapies, 2018

As therapists of color, it is important for us to acknowledge a particular and compelling larger systems issue: how racism contributes to poor mental health and relationship quality for African Americans in comparison to their White counterparts. This creates challenges for therapists and supervisors as well as our clients. The issue of much-needed self-care and support for therapists of color, and the corresponding requirements for White allies in the struggle, are the subject of our case examples. As systemic family therapists, we gracefully capture the essence of our work in various settings, including among others in academia, private practice, non-profit agencies, government organizations, and medical facilities. We work with larger systems beyond the family as well . As therapists of color, it is important for us to acknowledge a particular and compelling larger systems issue: how racism contributes to poor mental health and poor relationship quality for African Americans in comparison to their White counterparts. This creates challenges for therapists and supervisors as well as for our clients. The issue of much needed self-care and support for therapists of color, and the corresponding requirements for White allies in the struggle, are the subject of our case examples. Porshia, Franchesca, and Danielle are doctoral students in a family therapy program, and also practice as master's-level family therapists. Their experiences reflect that practice. Christine is in faculty and director of the same doctoral program, and a mentor and supervisor to many struggling with these complex issues.

2022

Background: The adverse mental health consequences of discrimination among Black adults, such as anxiety symptoms, are well documented. Prior research establishes anxiety as a risk factor for suboptimal health outcomes among Black adults. Most discrimination and mental health studies, however, have focused on the effects of personal experiences of discrimination. Moreover, of the studies that examine the mental health effects of vicarious exposure to discrimination, few investigate this relationship from a stress and coping perspective beyond the life stages of childhood and adolescence. Thus, the purpose of this study was to assess the effects of vicarious and personal experiences of discrimination on the subjective well-being of Black adults, while observing the potentially moderating effects of utilizing mental health care. Methods: A subsample of Black adults (N = 627) between the ages of 22-69 years old were drawn from the Nashville Stress and Health Study and analyzed to assess within-group variation. Multivariate linear regression was employed to examine the association between vicarious experiences of major discrimination and selfreported anxiety symptoms. Additionally, we evaluated the moderating effects of lifetime utilization of mental health services on the relationship between discrimination and symptoms of anxiety. Results: Findings revealed that vicarious experiences of major discrimination and personal experiences of everyday discrimination were both associated with higher levels of anxiety symptoms among the participants. Additionally, lifetime utilization of mental health care moderated the effects of vicarious and personal experiences of discrimination. Conclusions: The secondhand consequences of discrimination must be considered while assessing the racismrelated stress experience. Results from this investigation suggest that mental health treatment should be included in programs targeted to reduce the negative effects of discrimination among Black adults. Additionally, culturally-specific strategies should be considered for addressing racism-related adversity.

Medical Care, 2011

Background-The impact of patients' perceptions of discrimination in health care on patientprovider interactions is unknown. Objective-Examine association of past perceived discrimination with subsequent patientprovider communication. Research Design-Observational cross-sectional study. Subjects-African American (AA; N=100) and white (N=253) patients treated for osteoarthritis by orthopedic surgeons (N=63) in two Veterans Affairs facilities. Measures-Patients were surveyed about past experiences with racism and classism in healthcare settings before a clinic visit. Visits were audio-recorded and coded for instrumental and affective communication content (biomedical exchange, psychosocial exchange, rapport-building, patient engagement/activation) and nonverbal affective tone. After the encounter, patients rated visit informativeness, provider warmth/respectfulness, and ease of communicating with the provider. Regression models stratified by patient race assessed the associations of racism and classism with communication outcomes. Results-Perceived racism and classism were reported by more AA patients than by white patients (racism: 70% vs. 26%; classism: 73% vs. 53%). High levels of perceived racism among AA patients was associated with less positive nonverbal affect among patients (Beta=−0.41, 95% CI=−0.73, −0.09) and providers (Beta=−0.34, 95% CI=−0.66, −0.01) and with low patient ratings of provider warmth/respectfulness (OR=0.19, 95% CI=0.05,0.72) and ease of communication (OR =0.22, 95% CI=0.07,0.67). Any perceived racism among white patients was associated with less psychosocial communication (Beta=−4.18, 95% CI=−7.68, −0.68), and with low patient ratings of visit informativeness (OR=0.40, 95% CI=0.23,0.71) and ease of communication (OR=0.43, 95% CI=0.20,0.89). Perceived classism yielded similar results.

Psychological Trauma: Theory, Research, Practice, and Policy, 2013

The paper describes the development of the Race-Based Traumatic Stress Symptom Scale (RBTSSS), a measure designed to assess the psychological and emotional stress reactions to racism and racial discrimination. Scale items were derived from existing measures of race-related stress and models of trauma, and were tested on a 330 racially heterogeneous (e.g., Blacks, White, Asian, and Hispanic) adult sample. Exploratory Factor Analyses with oblique rotations revealed a 52-item measure consisting of seven scales; Depression, Anger, Physical Reactions, Avoidance, Intrusion, Hypervigilance/Arousal, and Low Self-Esteem. The findings are consistent with symptom clusters associated with the conceptual model of race-based traumatic stress. The RBTSSS adds a tool to counseling assessment by providing mental health professionals a way to assess the emotional reactions of racism and racial discrimination. Implications for counseling and future research are discussed.

The Counseling Psychologist, 2001

A treatment model for the psychological sequelae of discrimination is illustrated via three treatment cases in which experiences of racism, gender and/or ethnic/religious hostility were a primary focus of intervention. The client's level of psychological functioning, acuity of hate victimization, coping and identity re-formation strategies are addressed in this phase-oriented model of counseling. The five treatment phases are: (a) event containment and safety, (b) assessment of client-event characteristics, (c) addressing diversity in the counseling alliance, (d) acute symptom reduction, and (e) identity recovery and reformation. Counseling tasks with clients of hate victimization include the amelioration of acute post-event symptoms, re-framing of aversive outgroup attitudes, alleviating disturbance of ingroup identity, and the eradication of avoidant intergroup behaviors. It is proposed that the effective treatment of victims of chronic harassment and acute hate incidents requires the integration of behavioral, cognitive, and multicultural counseling modalities.

Journal of Traumatic Stress, 2021

In the United States, Black residents exposed to a traumatic event are at an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing more severe symptoms compared to their non-Hispanic White counterparts. Although previous work has suggested a link between racial discrimination and PTSD symptoms, no studies have assessed this association in a sample of traumatic injury survivors. The current study investigated whether (a) past racial discrimination was associated with acute posttraumatic stress symptoms (PTSS) and (b) discrimination prospectively contributed to the prediction of future PTSD symptoms. African American and/or Black patients (N = 113) were recruited from an emergency department in southeastern Wisconsin. Patients in the acute postinjury phase (i.e., 2 weeks posttrauma) completed self-report measures, with PTSD symptoms assessed using the Clinician-Administered PTSD Scale at 6-month follow-up. Bivariate associations indicated past racial discrimination was significantly related to acute PTSS. A multiple regression analysis revealed that pretrauma exposure to racial discrimination significantly predicted PTSD symptoms at follow-up, even after controlling for age, gender, previous psychiatric diagnosis, social support, and lifetime trauma history. Our results suggest that experiences of racial discrimination add significant additional risk for PTSD symptom development following traumatic injury, R 2 = .16, F(6, 106) = 3.25, p = .006. Broadly, these findings add to the body of empirical evidence and personal testimonies of Black individuals in White-centric societies asserting that racial discrimination affects mental health and overall well-being and further highlight the recent call for racism to be classified as a public health crisis.