Critical Race Theory at Walnut
Updated: Feb 28
When engaging in psychotherapeutic practice and the study of psychotherapeutic theory, it is essential to note the very specific contexts from which these theories arose. The recognition of this context is a way of questioning and deconstructing the theories in the service of thinking with inclusivity and intention. Psychotherapeutic theory, which has most traditionally been born of psychodynamic theory, is a set of principles that have been created and conceptualized by nearly all white, heterosexually identified, cis-gendered men. These are men who were beginning to consider the possibility that a cure for mental illness and suffering was to provide the time and space for someone to talk. Simply put, psychotherapy is based on the notion that there is a talking cure for internal strife.
While we still adhere to that principle in practice, the ways that we talk and what gets talked about and who talks to who has been shifting over time. The psychotherapeutic relationship has become a site at which trauma is more closely studied and understood. The relationship has also evolved beyond reductive notion that the therapist is a blank slate that sits with an unraveling client in the service of ultimately putting them back together. While the idea of psychotherapy has been challenged and continues to evolve, a true integration of critical race theory has not been adequately addressed or put into practice.
At Walnut we have given considerable thought to what a synthesis between Critical Race Theory and Psychodynamic Psychotherapeutic theories would look like. We are particularly interested in what it would mean to operationalize an integration of these theories into daily clinical practice. The list below is our attempt at clearly articulating what it looks like to take critical race theory, socioeconomic status and racial identity seriously as a facet of practice and mental health that must be continuously and vigorously thought about.
Critical race theory is the acknowledgement that racism is sustained by social structures; legal systems and the prison industrial complex; economic policy; our education system; and our health care system. It is then exacted and maintained through social relationships, macro and micro aggressions, and personal relationships.
Racism is the byproduct of white supremacy.
White supremacy has historically (and is continually) enacted through the mental health system and associated unexamined, under-criticized clinical theories.
There is a dearth of research and theory written about the intersection of critical race theory and psychodynamic theories.
To properly practice critical race theory, the social context in which we are practicing must be acknowledged: the city of Philadelphia, in the Center City Business District.
In Philadelphia, racial and socioeconomic inequality are inextricably connected to each other. Philadelphia is the second poorest large city in the United States: At 25.7 percent, the poverty rate is the highest among the nation’s 10 largest cities. About 400,000 residents—including roughly 37 percent of the city’s children under the age of 18—live below the federal poverty line.The poverty line in Philadelphia is $19,337 in annual income for an adult living with two children. Nearly half of all poor residents are in deep poverty, defined as 50 percent below the federal poverty line. This translates to less than half $10,000/year for an adult with two children: the equivalent of one month’s rent for our practice. While the rest of the country’s poverty rate has largely stabilized, it has increased in Philadelphia. A large reason for this increase is the 10-year tax abatement offered by the city for new construction. The city has asked for new businesses to enter the city without allowing the money made by these new businesses to help stabilize the poverty that exists in the city. We are practicing in one of the zip codes that benefits most from this tax abatement, in the direct vicinity of businesses that are being financially rewarded for starving the poorer parts of our city.
Philadelphia is a city that is largely impacted by gentrification, more precisely understood as colonization. We need to use the word colonization to recognize the long-standing tradition on which this country was founded: first genocide and then colonization, both fueled through the enslavement of Black people.
We are not in a "post-slavery" era. Instead, our current system obscures the system of slavery with capitalist practices. These include: minimum wage jobs, the assignment of uniforms for work (to make segregation and caste systems both obvious and recognizable), higher wages associated with skills that can only be acquired in highly white and economically privileged institutions, the enslavement of Black people in the prison industrial complex, and performing surprise by our current political climate as if our current circumstances are new. Perhaps our awareness is new, but our social conditions are not.
If we practice in a way that keeps us in a state of disavowal and disassociation from these realities, we are not dismantling racism and white supremacy.
There is no such thing as reverse racism.
To be white in America is to be racist. White people are simply on different places along a continuum of recognizing versus disavowing this reality.
Racism can also take the form of participating in institutions and learning environments that to do not recognize race as an as underlying issue in all social dynamics in America.
Racism, as a mental illness, can be seen in the form of cultural appropriation of the other, fear of the other, an unchecked sense of and/or a performance of privilege and entitlement.
The theories through which we understand the human psyche, at Walnut, are largely psychodynamic and thus their origins are often attributed to white, Jewish, European men. These men were largely functioning in a mentality informed by the events surrounding WWII and the extermination of the Jewish people. These theories all have colonizing and tyrannical tendencies. We need to acknowledge the social context of these thinkers; whose racism continues to inform our practice.
The DSM has traditionally been used as a tool to legislate the pathologization of minority populations, largely populations of color and queer communities. This includes over-diagnosing Black men with schizophrenia, leading to over-institutionalizing this population.
It is not a sign of poor mental health for a person of color to distrust social institutions.
A staff that is led by a white person is one that will always struggle for full racial equality.
Without improving hiring (of employees) and recruiting (of clients), we are engaging in the maintenance of a white supremacist space.
The term POC (people of color) is both important and useful, while also serving to negate the idiosyncrasies and the differences that exist in non-white populations. When using this term, we must be clear that we are not trying to erase nuance, but instead trying to honor that any non-white person suffers at the hands of a white supremacist system.
Racism is something that must be unlearned and unpracticed and considered on a daily, constant basis.
White clinicians are responsible for doing the daily work of examining their own racist practices and beliefs without relying on people of color to monitor, mandate or demand this work.
We need to consider the psychological toll of living intersectionally (holding two or more marginalized identities) before introducing any concepts around the diagnosis and pathology provided to us by the DSM.
While interfacing with the healthcare industrial complex, we must also acknowledge the way that these companies sustain and maintain white supremacist practices, which both grow and thwart the development of our own work.
When diagnosing any client of color, we must consider the racial history and context of certain diagnoses.
When functioning as a practice, we must seek to understand how whiteness dominates and informs our decision-making processes, both consciously and unconsciously.