The harmful impact of racism and sexism on individuals’ mental health has been well documented by researchers from various fields in recent decades. But two new studies—both led by Boston College School of Social Work Assistant Professor Maggi Price—indicate that racism and sexism also hamper the effectiveness of interventions aimed at improving mental health, especially in young people.

Price and her collaborators found that Black youth living in areas with a significant degree of cultural racism were less likely to benefit from psychotherapy compared to those living in relatively less racist places; similarly, according to the other study involving Price, girls fare worse in psychotherapy if they live in an environment marked by cultural sexism.

Most any psychotherapeutic intervention can be affected by external factors beyond the purview of the therapist: A person being treated for PTSD, for example, may be triggered by an unforeseen event or random encounter. But, Price said, a set of pervasive biased attitudes, behaviors, and practices in the community can pose a considerable obstacle to a therapy patient’s progress. Mental health professionals therefore may need to adapt their therapeutic approaches on an individual basis to address the impact of these biases, while also working within the community to foment more holistic changes, she said.

“Research on the negative mental health effects of racism and sexism is well established, and recent studies have shown that women and Black people living in places with high levels of cultural stigma–—that is, dominant beliefs about a group’s inferiority in a community–—have worse mental health. We also know that psychotherapy is not always helpful, but might that be in part due to cultural stigma? That is an important question for the mental health field to explore. We were the first, to our knowledge, to study whether cultural stigma undermines the efficacy of mental health treatments.”

The two studies involved taking randomized controlled data from hundreds of youth psychotherapy studies and from publicly available data on sexist or racist norms, then using meta-analysis to see how spatial factors, such as prejudicial norms and economic inequality, related to the efficacy of the interventions.

As Price explained, with the source material used for the research—such as the General Social Survey, a longtime, frequently-cited fount of information on social characteristics and attitudes in American society—it is possible to reasonably gauge the extent of sexist or racist attitudes in a given locale. These may be reflected in, for example, the availability of maternity leave policies and protections for reproductive rights; or responses to survey questions related to support for public programs or government policies that aid Black people.

Racism or sexism are not constituted simply by explicit, individual incidents, noted Price: the uttering of a racial slur, for example, or sexual harassment by an acquaintance or coworker. The implicit, more ubiquitous manifestations, and how rooted these are in the community where the client lives, must also be considered.
“Perhaps in a given place, there is a particularly pervasive attitude that women should stay at home and not be in the workplace. We know that sexist gender roles extend to young people’s environments, too, such as school— might girls in that community be even less likely to be encouraged to pursue STEM careers? Or might Black girls be even more likely to be penalized for assertiveness?

“Maybe in another community there is an especially strong racist belief that Black youth are likely to cause trouble. We know that Black youth are more likely to be unfairly and harshly disciplined for the exact same behaviors as white youth. And studies show that these stigmatizing messages are internalized and affect mental health. In other words, if one is repeatedly given the message that they are incompetent or a trouble-maker because of their gender or race, they may come to believe that. Those internalized beliefs can hurt self-esteem and heighten depression.

“Our study may suggest that if a young person with such experiences goes to therapy, some of the potentially positive effects of therapy might be hampered, either during or after treatment, by the cultural messages they receive about their inferiority.”

Because identity and stigma are central to the wellbeing of their clients—and perhaps determine how well they respond to psychotherapy—these should be integrated into the interventions that practitioners devise, said Price, who adds that further research is needed to better understand the complex interplay between stigma, mental health, and treatment.

“It’s also vital that practitioners incorporate advocacy into their practice by recognizing and making efforts to reduce sexism and racism in their client’s environments. For example, by advocating for policy changes in their clients’ schools to eliminate racist disciplinary practices or reduce teacher bias.  
“And, of course, enhanced training in culturally responsive care, including how to address racism, sexism, and other stigma in therapy, is essential, and will help clinicians better serve their clients.”

Sean Smith | University Communications | January 2022