Black Psychotherapy: Observations of Black Psychiatrists and Psychologists

Clare Xanthos, PhD
4 min readMar 13, 2023

20 Years After “Unequal Treatment” Report, Still No Meaningful Changes

Image by Yori Designs from Pixabay

In 2003, the Institute of Medicine (now the National Academy of Medicine) released a ground-breaking report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The report demonstrated the staggering inequities in both health and mental health services, regardless of insurance coverage. Regrettably, 20 years on, it doesn’t appear that there have been any meaningful changes.

This article takes a brief look at the observations of Black mental health professionals with specific reference to psychotherapy among Black individuals. In 2004 and 2005, I conducted 10 interviews with Black psychiatrists and psychologists (nine participants were US-based and one was UK-based). Their reflections about the state of Black therapy services are (sadly) still very relevant today.

The Diagnosis of Black Individuals

The overall consensus among interviewees was that in Western societies, the diagnosis of Black mental health concerns is based on the White experience and does not recognize the racialized stressors affecting Black clients, resulting in frequent diagnostic errors. As one psychologist pointed out, the diagnosis of Black patients is based on “the conceptual and experiential framework of European and European American cultural reality.” Another respondent stated that when the mental health symptoms of Black patients are interpreted using a Eurocentric framework, “culturally acceptable experiences may be interpreted as paranoia.”

Anti-Racist Therapy

In general, the interviewees noted that much of mainstream therapy is irrelevant when it comes to helping Black clients since it ignores the societal context of Black mental health. In the words of one psychologist:

“I have not found any one traditional therapy relevant for Black clients. I have taken bits and pieces from Euro-American therapies and added a considerable amount of cultural knowledge and understanding to enable proper engagement with my Black…



Clare Xanthos, PhD

WRITER. AUTHOR. SCHOLAR. Interests: Racial Equity, Racial Health Equity, Racial Justice. Co-Editor: Social Determinants of Health among African-American Men