Therapy for Racial Justice Activists
A Guide for Therapists
“When you’re an activist, you’re never working hard enough.”
(Maslach & Leiter, 2010, p. 43)
This guide is intended to support activists and organizers in having the most useful therapy experience possible. As such, it is a decentralized document. Activists are invited to update, improve, and tailor the guide to better serve them, their community, or their part of the movement. The author, a psychologist who created the guide as part of a dissertation, runs the email address therapyforactivists@gmail.com, and can be contacted for both the editable version of this guide, and consultation on this topic.
If you are struggling to feel helped in therapy, or just wish your therapist were better equipped to relate to your activism, look through this guide and see what resonates with you. Bring it into therapy and use it to begin the discussion. You and/or your therapist can email therapyforactivists@gmail.com for a free consult on therapy for activists. If you would like to edit the guide to better serve you or your community, you can email to request an editable copy. Unless otherwise requested, the author will remain a Viewer on that document in order to learn from the changes you make and improve the quality of consultations.
If your activist client brings this document to you, listen to what resonates with them and how you can better meet their needs. Some aspects of this guide may feel accurate and relevant to them, and other parts not. You may be seeing the original guide, or a version edited to be more relevant to a particular community or part of the movement. This is intended to be a tool for exploration, discussion, and improved attunement in psychotherapy. You and/or your client can email therapyforactivists@gmail.com for a free consultation on therapy for activists. If you have feedback or wisdom to share on best supporting activists in psychotherapy, consider sharing these at the above email address to contribute to ongoing learning and increased quality of consultations with the author.
Please direct all inquiries, feedback, requests for consultation, or requests for an editable document to: therapyforactivists@gmail.com
Racial justice activists constitute a client group with specific mental health needs. To varying degrees, activists are subject to stresses and risks that can result in activist burnout and activist trauma, among other mental health difficulties. When in need, activists who seek mental health services may have difficulty accessing attuned care. In particular, multidimensional alliance issues can render the therapist and therapeutic process untrustworthy or unhelpful to activist clients. While existing resources for activist mental health provide a foundation of useful information, no resource exists to specifically support clinicians in providing effective mental healthcare to this client population.
This document is designed for clinicians operating from a variety of modalities. Clients may seek out different types of therapy to meet their particular needs. Regardless of presenting concern and therapy type, this guide will support you in understanding their cultural context and their relationship to mental healthcare as a whole. Because this guide focuses specifically on the relationship between therapist and racial justice activist client, it is relevant across orientations and approaches.
Likewise, this guide is intended to support therapists working in a variety of settings. Perhaps you are a clinician in private practice who intentionally began work with an activist. Maybe you were randomly assigned your client in a large clinic setting. In either case or others, this guide will support your development of an effective therapeutic alliance with your client.
This guide is broken into five sections.
The United States is a racially stratified society. Since before the founding of the nation, the oppression of People of Color has taken many forms. From slavery and the theft of Indigenous lands, to Jim Crow segregation, to discriminatory housing policies, to mass incarceration and police brutality, institutionalized racism has persisted through American history to the present, baked into all aspects of our society.
Endeavors for racial justice are frequently carried out in groups or collectives with deeply held values of equity. Participation in the struggle against institutionalized racism, or racial justice activism, comes with both costs and benefits to wellbeing.
Activists work to shift status-quo injustice by unearthing and expressing what society ignores within the lived experiences of marginalized people. They use themselves as instruments of change by taking action to make manifest the hypocrisy, cognitive dissonance, indifference, and cruelty in our institutions. Often from a sense of calling or obligation, they live the “struggle for consciousness in a largely unconscious world” (Kovan & Dirkx, 2003). As such, their bodies, relationships, communities, and movements hold and express the tensions and conflicts of society. This places activists at the painful nexus between the incredible suffering of some, and the privilege of disengagement by others.
POTENTIAL COSTS OF ACTIVISM | POTENTIAL BENEFITS OF ACTIVISM |
Bodily harm or death | Sense of agency, authenticity, conscience |
Psychological harm or trauma | Source and sense of community |
Acute and/or chronic physical/mental health distress | Joy and pride in successes |
Poverty; reduced access to basic needs | Can protect against internalization |
Alienation, stigma, stereotyping | Regard of like-minded others |
Arrest, conviction, imprisonment, legal consequences | Investment/engagement in community, society, and world |
Hopelessness and despair | Enrichment from ongoing learning |
Guilt regarding care of self | Provides purpose and meaning |
Loss of relationships + social normalcy | Skill building |
Activists, and those engaged in racial justice work in particular, constitute a unique group that faces specific mental health challenges and presents with specific clinical needs.
The reparation of past and present inequities that systemically oppress, harm, and disadvantage non-white individuals and communities.
Refers to a broad range of activities engaged in for the purpose of promoting and bringing about sociopolitical change. These activities can range in scale and visibility, from boycotts and protests to individual lifestyle changes or interpersonal choices.
Struggle against institutionalized racism. Refers to activities engaged in for the purpose of challenging white supremacy and systems of racial injustice. Examples include Black Lives Matter, groups working to protect Deferred Action for Childhood Arrivals (DACA) recipients and immigrant populations, and groups associated with the preservation of the sacred lands of Native tribes. There are many different models of activism, different activities within activism, and different roles one can play within activism.
Collectively held and enforced beliefs, explicitly or implicitly, that: considerations of self-interest amount to self-indulgence and lack of commitment to activism; all time ought to be spent working to relieve the suffering of others; and that self-care is an irresponsible act of privilege. Also: culture of martyrdom, guilt culture.
Collective promotion of the explicit public calling out of comments or behavior deemed problematic, oppressive, harmful, or unsafe within the community.
The dissemination of personal information for the express purpose of inciting ongoing harassment, surveillance, and intimidation.
Refers to a white person who shows up to help those with less privilege, but does so with narcissistic motivations, explicitly or implicitly centering their own ego needs over the needs of marginalized people.
A set of customs shared by a community whose members may be targeted, designed to minimize risk.
Activist burnout is not an official DSM diagnosis, but rather a useful frame to understand the constellation of symptoms, circumstances, and distress related to one’s activism. Individuals experiencing activist burnout are likely to meet criteria for one or more disorders, for which they may choose to receive treatment. Likewise, activists may present with distress and symptoms that predate their activism, in which case activist burnout may be more relevant as context for current stressors that may exacerbate pre-existing difficulties.
When these experiences and symptoms overwhelm the activist’s felt ability to cope, trigger prior traumatic experiences, or lead to/exacerbate traumatic symptoms such as emotion dysregulation, dissociation, and flashbacks, this can be thought of as Activist Trauma.
Causes of Activist Burnout | ||
Internal to Activist | External to Activist | In-Movement |
Strong sense of morality | Threat/experience of violence | Racism, “white savior” dynamics |
High emotional investment | Harassment and surveillance | Sexism, heterosexism, transphobia, ableism, classism, interpersonal abuse |
Intense commitment | Threat to employment | Culture of selflessness |
Sustained awareness of injustice and oppression | Daily confrontation with oppression | In-fighting and ego clashes |
Reduced likelihood to deny or avoid difficult realities | Poverty and/or marginalization | Perfectionism/call-out culture |
Pre-existing distress | Social and emotional isolation | Lack of role clarity |
At the outset of therapy with a racial justice activist, it is critical to evaluate safety. In addition to the safety considerations that therapists routinely evaluate such as suicidality, racial justice activists may present with specific safety concerns that ought to be collaboratively assessed. Clinicians should endeavor to learn more about the psychological impacts, both in the research as well as in the life of the individual client, of the following:
It is paramount that therapists working with activist clients are aware of these realities, feel comfortable incorporating activist-specific risks into assessment and safety planning, and practice informed consent in all aspects of treatment.
All treatment should be based on the principle of informed consent: permission given by the receiver of treatment, with a clear understanding of the process and associated risks. However, this is even more crucial when working with marginalized individuals, such as activists and especially activists of color and those who hold other marginalized identities, as they face greater and more serious risks in interfacing with institutions and systems, such as mental healthcare.
The therapist should be clear about what they offer, how they work, and their perceived level of competency working with what the activist client is presenting for treatment. Additionally, both client and therapist should understand confidentiality, including its limitations. This includes the awareness that clinical records could be subpoenaed in the event that the client experiences legal trouble. For clients who face risks, it is imperative that the therapist and client discuss possible scenarios in advance such that both parties are clear on the frame. Therapists should be aware that activist clients may choose not to disclose details or plans of illegal actions. In order to ally with your client while mitigating potential security risks, you may choose to encourage them to instead share feelings or impacts.
Operating on a shared understanding of the purpose of the treatment, the therapist should make a practice of asking permission prior to introducing new elements or inquiring into new content. Because the therapist holds more power in the relationship, the therapist must continuously check in with the client in order to build a collaborative dynamic.
For some activists, your professional need to document is a direct threat to their safety and the safety of their fellow activists. This is true for other clinical populations as well: for example, undocumented clients, whom we put at risk if we note that they are undocumented in our clinical records. Nevertheless, our profession necessitates note-taking. Your activist client may request that you document as little and as vaguely as possible to protect their safety.
If for any reason during or after the course of treatment you feel the need to consult legal counsel related to your clinical work with an activist client who has expressed legal or surveillance concerns related to their activism, it is imperative that you:
*Each state’s rules of ethics for attorneys vary slightly. When in doubt, make sure to speak with counsel in advance for clarification on their documentation or mandated reporting obligations during a professional consultation.
As with any therapeutic alliance, your relationship with your racial justice activist client is a dynamic interplay of factors, circumstances, and interpretations contributed by both parties. This section intends to support your adoption of a useful stance by positing areas of content and process that may arise.
Your client is serving the necessary function of seeing and attempting to change what does not work in our culture: the fallacies, harms, and entrenched power dynamics. This function both requires and engenders skepticism and/or disbelief in the notion that things work as they are supposed to. This skepticism may also apply to the mental health system. The field has historically played the role of enforcer of harmful social normativity. Clients may reasonably worry that their therapist may pressure them to conform, or in the case of activists, to reduce or cease activism. This pressure can be demonstrated outside of the therapist’s awareness, through the implicit bias we all carry.
Tension | |
Need/desire to develop trust in therapy in order to access treatment. | Need/desire to remain vigilant to risks and harms in order to stay safe. |
It is important that you are willing to hear and discuss critique of the enterprise of therapy without becoming defensive or pathologizing (i.e., communicating that their feelings are exclusively a result of their person/their life experience and not a reasonable reaction to external realities). Your ability to explore the meaning of any vigilance, and support the legitimacy of their skepticism and/or fear is vital to the development of trust and rapport. Likewise, it is critical that therapists be willing to open to, and reflect upon, their impact on clients, intended or otherwise.
Your client is confronting dangerous inequities in our social systems. They may operate in a context that distinguishes people who understand and acknowledge systemic oppression from people who do not. They may partake in conversations about identity with above average frequency and/or above average skill. They may also be working to increase others’ awareness of their impact on marginalized communities. This may result in being perceived as communicating on these topics with above average hostility, sensitivity, or criticism.
The topic of your personal and professional identity may become relevant as they seek to determine whether you are a safe person. This could manifest as interest in:
Tension | |
Need/desire to develop trust in therapist in hope of feeling understood and helped. | Need/desire to remain vigilant to degree of therapist’s complicity in oppressive systems. |
Reflective work may support your understanding of your own experiences, beliefs, and levels of comfort regarding these topics and conversations, including your relationship to disclosure and boundaries. The more you understand your own location relative to this aspect of the therapy, the more likely your client will be to experience you as authentic. Exploration of any fragility you may experience associated with these topics – in particular, white fragility – is critical to your ability to relate to client vigilance with openness and care.
Your client may hold values that complicate access to care and self-care. In particular, because they spend time understanding and working to ameliorate conditions under which human needs are not met, your client may experience a version of survivor’s guilt in which they experience guilt or shame when they use time and resources to meet their own needs. They may experience self-care as a betrayal of their values, an abandonment of marginalized people, or an irresponsible act of privilege that contributes to the oppression of others. These beliefs are a primary contributor to burnout, as they fuel unsustainable practices.
Tension | |
Need for self-care and access to various services in order to attend to distress and move towards sustainability. | Discomfort, disagreement, and/or guilt regarding use of privilege to engage in self-care, access services, or move towards sustainability. |
It is important to hold a curious and compassionate stance towards this ambivalence should it arise. Aligning yourself with one side or the other risks alienating your client, who may feel that you do not understand the complexity or respect their values. Your client may appreciate your ability to validate that this tension is endemic to the work of activism, as they navigate the stark contrast between the privilege of some and the oppression of others.
The following are ideas for interventions to address common mental health needs of racial justice activists: the need to feel understood on their own terms, to explore their relationship to their activism and its effect on them, and to consider their own needs in the context of their values.
Racial justice activists may present to treatment with any and all concerns, including ones less uniquely influenced by activism. The intervention ideas below are flexible in order that they may either stand alone, or be interwoven into more focused treatment.
Questions of Curiosity are questions about which you feel genuine interest. You may believe you already have the answer, or you may be aware that you have more to learn. While important for information gathering, questions also impact both the asker and the asked, even before the question is answered. Indeed, even cultivating your curiosity and crafting questions accordingly will impact your stance towards your client, even if you never ask the question.
The following are examples of questions you might ask a racial justice activist client. You might decide to do so during intake, if you are aware of their activism at the outset of treatment. Or, you may do so upon learning of their activism, or throughout the process of exploring together the meaning of their activism.
Because your own curiosity is vital to the relationship, some blank space has been left at the bottom of the list for you to craft questions of your own.
What model(s) of activism are you participating in (or, upon what theory of change is your activism operating)? What resonances and/or tensions do you experience between your values and the values of this model?
What are the goals of your activism, short- and long-term? How are these goals similar or different to the goals of the group(s) with which you work? What would be different if the changes you seek to make took place? How do you measure success?
What role(s) are you playing in the activism you are participating in? How do these roles interact with your preferences and abilities?
What are the primary activities you participate in as an activist? What activities have you found most meaningful? Most frustrating/difficult?
How does your activism, and the values that underlie your activism, shape your lifestyle and the choices you make day to day?
How does your activism impact your relationships, both with other activists and with non-activists?
How do you understand the stakes of your organizing? What is your relationship to being imperfect, experiencing limitations, or making mistakes in this work?
Actions, rallies, protests, and other public movement events are times when your client may be particularly vulnerable to physical and psychological trauma. Likewise, internal movement events may present unique stressors for activist clients. Preparation can have a protective effect, mitigating short- and long-term impacts.
Although your client may or may not discuss with you the details of upcoming public movement events, you can still participate in helping them prepare.
Your client may have a practice of preparation, collectively with other activists and/or individually. If this is the case, consider asking:
If your client does not already have a practice of preparation for actions, and they wish for your engagement in this way, consider developing one together. Increased awareness of risks and resources may bolster resilience to the stressors of the event, build skills for future coping, and enhance understanding and trust between you and your client. Consider facilitating reflection on the following topics. If your client feels unable to share details in discussion, they can still think through or write down elements that may serve them without verbalizing them out loud.
Feelings are not facts. While feelings of failure can occur when social movements are not meeting their goals, these feelings can also arise for a variety of other reasons. Feelings of failure do not themselves indicate failure. For clients with whom a cognitive-behavioral approach could prove useful, the following are three categories of maladaptive beliefs common among activists, and how to challenge them.
Because systemic change can be slow to achieve, and the obstacles formidable, it is natural to feel hopeless. Signs of progress are not always readily available. The individuals and institutions being targeted for influence are not often willing to reveal the ways in which they are being impacted by activism and dissent, sometimes going to great lengths to discredit the movement. Furthermore, due to feelings of urgency, it can be difficult for activists to set achievable en-route goals with demonstrable results. While these feelings are a natural result of complex and uncertain circumstances, they cannot be taken as true data. Learning to tolerate uncertainty, ambiguity, and long-term struggle can help to reduce hopelessness. Furthermore, while certain goals may not be achieved, the campaign may be nevertheless contributing to a larger vision by building power, spreading awareness, developing leadership within the movement, or creating coalitions.
The culture of failure is a reasonable result of highly stressed movements. Under great strain, depressive narratives take hold. It may be useful to present a counterpoint to these narratives. Social change has taken place throughout history. Activists of movements past likely had days, months, even years of uncertainty and discouragement. While activists may experience guilt, this is likely not their only source of commitment. Grounding in one’s values and identity, and in realistic expectations, can lessen the grip of these hopeless voices. Additionally, what elements exist inside the activist network itself to create and maintain motivation? For example, movement cultures often utilize songs and chants to rally and sustain collective energy and hope.
Activism can be such an intense endeavor that one’s identity can become part and parcel with the cause. Indeed, activism is often driven by deep values, and felt not as a choice, but a calling. It is reasonable then that attachment to the movement may render change threatening. It may help to consider that change is a constant part of life. Even changes that we worked for and wanted to bring about can come with loss. It can help to explore places of victory, success, joy, and fun in the work (Pinderhughes, 2018), in addition to making space for grief. This may also help ground activists in their values and conscience, which could lessen fear of invalidation and corruption.
A combination of high stakes and deep commitment make it difficult for activists to strike a balance between their needs and their work. Indeed they may believe that to do so would be a betrayal of the cause. For those clients interested in exploring the idea of their own needs, towards a vision of increased sustainability and wellbeing, the following are possible strategies for exploring the topic.
What needs do you have? What is your relationship to your needs (food, water, shelter, connection, sleep, play, etc.)? Which do you feel allowed to meet/have met? Which not? Which needs are getting met, which aren’t? By whom, how, when? What is the impact of having needs met/not met?
What are your beliefs about human needs? What or who influence(d)(s) your beliefs about human needs? What care do you believe all people need and/or deserve? How do these beliefs and values apply/not apply to you and your needs?
To what extent do you need to be cared for, by yourself and/or by others, in order engage in activism sustainably?
If you were mentoring another activist, what would you want for them/suggest to them regarding their needs/care/self-care/sustainability?
The following categories are useful content areas to explore in research or training to enhance your competency with the racial justice activist population.
Relevant Competencies | Relevance to Racial Justice Activism |
Trauma | Many activists experience trauma resulting from activism, and/or prior traumas complicate activist burnout. |
Political violence | Some but not all activism involves confrontation with political violence, by the state or by non-governmental opponents. |
Power & Privilege | Provides a framework for understanding systemic oppression and reflecting on one’s own position and experience. |
Movement literature | Online articles, blogs, and zines constitute current movement writing, where the most current activist thought is articulated. |
Social change theory | Illuminates the mechanisms by which activist movements seek to bring about change. |
These questions are intended to guide and support your reflective work. They may also reveal places where you (and your clients) would benefit from your seeking further education or consultation.
To what extent do you:
How might the presence or absence of explicit relationship to racial justice impact your work with a racial justice activist?
Consider racial justice activists you have personally known and observed, or reflect on your abstract ideas regarding activists. What are your:
How might these preconceived notions impact your work with a racial justice activist?
How might dynamics related to identity, privilege, oppression, or power impact your work with a racial justice activist client?
How might your experience of burnout, your own endeavors to cope, and/or your messaging to yourself and others about burnout impact your work with a client experiencing a parallel form of burnout?
Consider:
How might your relationship to disclosure impact your work with a racial justice activist client?
Reflect on:
How might your relationship to making mistakes impact your work with a racial justice activist client?
Reflect on your personal and professional networks and/or the options available to you, and list below individuals or groups with whom you could consult to enhance the quality and safety of your work with racial justice activist clients.
*Please keep in mind that individuals with marginalized identities are disproportionately asked to educate others about the oppressions they themselves experience, without compensation. Consider how you can honor this unjust distribution of labor and, when possible, offer compensation for the support you request or seek support from knowledgeable allies*
Please direct all inquiries, feedback, or requests for consultation or an editable document to therapyforactivists@gmail.com
To cite, please use: Therapy for Activists (2020). Therapy for racial justice activists: A guide for therapists. https://sites.google.com/view/therapyforactivists/