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Thriving instead of surviving, Pittsburgh therapist talks Black mental health

Katie Blackley
90.5 WESA News

Race-based trauma describes the mental and emotional injury caused by racially motivated violence and discrimination. For many Black Americans, the past year and a half was particularly traumatizing. 

For WESA’s series on the pandemic’s impact on mental health, Sarah Boden speaks with Neal Holmes, a therapist who specializes in treating Black Pennsylvanians. Much of Holmes's work intersects with race and identity, which he says has prompted many of his clients to reconsider their career paths.

This conversation has been edited for length and clarity.

Sarah Boden: I have been told by many mental health providers that they’re seeing a significant uptick in people seeking services. I know you’ve experienced this in your own practice. What kinds of topics are your clients wanting to explore in therapy?

Neal Holmes: Most of the conversations that I'm having right now are centered around race-based trauma. I feel like a lot of my clients are at a point in their lives where they're like, 'You know what? I'm so tired of just surviving with these feelings, surviving with these emotions, these negative thoughts about myself and my identity. And I really want to explore with someone to a deeper level of how I can advocate for myself and see more activism in my life.'

Boden: So you mentioned identity. You're a Black man. Many of your clients are Black men. Do you think there are some benefits of receiving therapy from somebody who you have a similar identity with?

Holmes: For me, it greatly impacts the work that I do with my clients. And it definitely comes into the sacred space of us when we have conversations within our session. I also just like to point out that sometimes clients may say, 'You know, I would like to see a clinician of a different race, or a different ethnicity, because I want to be challenged in a different way or look at my thoughts from a different perspective.' And I'm honored to hold space, and even give referrals for those clients if needed.

Boden: I think what you brought up is interesting, how with therapy you need this kind of perfect balance between feeling comfortable so you can be vulnerable, but also feeling challenged so you can grow. And that must be such a hard balance to hit.

Holmes: It is a hard balance to hit. And for me, what comes to mind when you ask that question is lessening the power dynamics in a session. I think traditionally when we talk about a more Eurocentric or Western view of therapy, it's one in which, you have a client, you have a therapist, and the therapist provides insight and knowledge. But in this work that I do specifically with people of color, and personally, it's just my mantra with most of my clients, is to really lessen that power dynamic. I think in order for me as a clinician to be challenged, I really have to take an introspective look at my own biases and preconceived notions, and see how they align with where I am in the world and where my clients are.

Boden: Racism and white supremacy have always harmed Black Americans. But in the past couple of years, there has been more discussion in the media about issues like police brutality, which stems from white supremacy. Is this prompting more conversations with your clients?

Holmes: It is. It's also prompting conversations that my clients are having with other people who identify as white and having those conversations with them about race and about privilege. I'm really honored to hold space for and to help them with the level of advocacy. I think it is important that we don't internalize these feelings that we have, particularly in a working environment, about a hierarchical, systemic macro, or microaggression that someone is experiencing. And for some of my clients, it may have even resulted in them deciding, 'This is not the place for me to work because they don't respect or honor parts of my identity.'

Boden: When someone is speaking up for themselves, honoring who they are, or asserting their true self, that is a risk. Is it hard for you as a therapist to watch your clients do this important thing that they have to do to be the fullest version of themselves while knowing that there might be unfair outcomes and consequences? Is that scary for you?

Holmes: It is very scary for me. I've had a couple of clients that just decided to leave their job and we safety planned around that financially. And I had many nights where I would think about my clients and wondered, 'What are they going to do?' But at the end of the day, I have to know within myself that they are strong and they are resilient. And they had those characteristics long before they encountered me.

This story was produced as part of "Pittsburgh's Missing Bridges," a collaborative reporting project by the Pittsburgh Media Partnership.

Sarah Boden covers health and science for 90.5 WESA. Before coming to Pittsburgh in November 2017, she was a reporter for Iowa Public Radio. As a contributor to the NPR-Kaiser Health News Member Station Reporting Project on Health Care in the States, Sarah's print and audio reporting frequently appears on NPR and KFF Health News.