African American Men's Perception of Psychotherapy at a Mental Illness & Chemical Dependency (MICD) Program: What Factors do they Consider Therapeutic/Helpful

There are limited empirical data that study the factors that enhance or prevent African American men from using psychotherapy. The purpose of this study was to explore the perception that African American men have of psychotherapy and factors that they consider helpful. Using a qualitative design, eight African American men volunteer to participate in the study to explore their perception of psychotherapy. These eight African American men came from a day treatment facility in the Twin Cities area and had a positive perception of psychotherapy as a tool to help them manage their drug and alcohol and mental health problems. The participants in this study contributed lack of knowledge, stigma of being labeled crazy, fear of being misunderstood, misdiagnose and medicated, fear of being considered weak, selfpride and defensiveness as some of the factors that discourage African American men from using psychotherapy. AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 3 Acknowledgement I am very grateful to all of you who encouraged me and helped me along my journey in writing this paper. A special thanks to all my committee members, Dr. Choi, chair, Dr. Hill and Dr. Holloway, for all of your patient, suggestions and working with me. Thanks to the African American Family Services and all the participants that made this research possible. Thanks to the St. Kate writing center, especially Dr. Obah and her staff, for helping me with editing my paper. Thanks to my kids, Miracle and Samuel, my nephew Hartzell and his family, for putting up with me during this long journey. I also want to thank Rev. Tabla for his help. AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 4 Table of Content Introduction.6 Literature Review . 9 Barriers to Seeking Psychotherapy.9 Cultural Barriers.9 Accessibility.10 Stigma . 11 Lack of Knowledge . 12 Therapist & the Therapeutic issues . 13 Cultural Mistrust.14 Racial Microaggressions in Contemporary Society.16 The Impact of Race in CrossCultural Psychotherapy Relationships.17 Conceptual Framework . 20 Methods.24 Research Design.24 Sample.25 Protection of Human Subjects.26 Data Collection Instrument and Process.28 Data Analysis.28 Findings.28 Discussion.34 Implication for Clinical Practice and Policy.37 AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 5 Limitations and Future Research.38 Conclusion.39 References . 40 Appendices.43 Appendix A. Participants consent form.43 Appendix B. Interview Questions.46 AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 6 Introduction African American men experience the same mental health issues as everyone else, but they are at a higher risk of experiencing mental health issues than the rest of the population due to racism and social and economic disparities they encounter daily (Thorn & Sarata, 1998). Many researchers and therapists wonder why African American men do not use psychotherapy as a means to solve their mental health issues. According to Sanders Thompson, Bazile, and Akbar (2004), African American men do not use psychotherapy as often as Caucasian men do, and if they do, they will attend fewer sessions and terminate services earlier than the Caucasian men. Sanders Thompson and his colleagues (2004) further went on to say that, African American men overuse inpatient services because it reduces the stigma that is associated with seeking mental health services in outpatient settings. Several factors have been identified as barriers to African American men seeking psychotherapy. Some of these barriers are culture, accessibility, stigma, finance, and lack of knowledge of psychotherapy, race and mistrust of psychotherapists (Thompson et al., 2004). These barriers are briefly discussed later in the literature review. These barriers, as well as the African Americans’ perception of Caucasian psychotherapists in cross-cultural therapeutic settings, could affect the degree to which African Americans seek and remain in psychotherapy (Constantine, 2007; Thompson et al., 2004). This study was stimulated by the researcher’s curiosity as to why the African American men at the African American Family Services (AAFS) were receiving psychotherapy when the literature indicates that African American men shy away AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 7 from using psychotherapy in dealing with their mental health issues. Many of these men were involved in cross-cultural therapy. Some of them were involved in therapy(group or individual) with both Caucasian and African American therapists and therefore would give a good evaluation of their interaction with their therapists. This further increased the researcher’s interest in knowing if any of these men have experienced racial microaggressions from their therapists (Constantine, Smith, Redington, & Owens, 2007). Racial microaggressions as described by Sue et al., (2008) are brief everyday behavior, verbal or non-verbal exchanges that send denigrating messages to people of color because they belong to a particular racial minority group. Racial microaggressions are unconsciously carried out against minority groups in the form of subtle snubs or dismissive looks, gestures, and tones (Sue et al., 2008). These exchanges are so automatic in daily conversations and interactions that they are often overlooked as being innocent and harmless. Sue et al., (2008) identified three categories of racial microaggressions, which include microassaults, microinsults and microinvalidations. These categories are discussed in the literature review. However, Muran (2007) gave a scenario that best describes microinvalidations in psychotherapy. He talked about the African American men who like all men, have been socialized to avoid expressing their feelings of weakness and vulnerability. When the African American man is in therapy and the therapist fails to acknowledge the racial issues he faces and equates his situation to all men, and misinterpret the racial issues he faces, the African American man tend to feel invisible and unknown. AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 8 The next concept is cultural competence. Sue (1998), defined cultural competence as: “the belief that people should not only appreciate and recognize other cultural groups but also be able to effectively work with them. One is culturally competent when one possesses the cultural knowledge and skills of a particular culture to deliver effective interventions to members of that cultural” (p. 440). According to Sue and his colleagues (2008), to be culturally competent, the therapist needs to understand his/her own worldviews and those of the clients. The therapist must guard against stereotyping behaviors and misapplication of scientific knowledge in his/her interaction with the clients. Cultural competence is also getting cultural information and then applying that knowledge. This cultural awareness allows the therapist to see the entire picture and improve the quality of his/her therapeutic relationship with the client (Sue et al., 2008). To adapt to different cultural beliefs and practices requires a therapist to be flexible and have respect for others viewpoints (Sue, 1998). Cultural competence means to listen to the client and to find out and learn about the client's beliefs of health and illness. To provide culturally appropriate care, the therapists need to know and understand how the client’s culture has influenced their health behaviors (Sue, 1998). The general purpose of this study was to explore the perception of psychotherapy held by African American men in a mental illness and chemical dependency (MICD) program and to identify those factors in psychotherapy that are beneficial to them. The research questions for this study are: (1) what is the African AFRICAN AMERICAN MEN’S PERCEPTION OF PSYCHOTHERAPY 9 American men’s perception of the psychotherapy they are receiving in the MICD program and (2) What factors do these men value as therapeutic or helpful? However, for the purpose of this research, the researcher used the theory of racial microaggression and the concept of cultural competence to uncover barriers that the African American men face, their perception of the psychotherapy they are receiving at the African American Family Services (AAFS) agency and the factors they considered therapeutic or helpful. The significance of th