Spring 2024
By Amal Wartalska
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This article discusses what we, as EMDR therapists, should consider in order to use EMDR effectively in processing socially inflicted trauma, specifically racial trauma. Although not a novel subject, it is under-discussed in the UK, hence the need for further dialogue and research in this area. There are two parts:
My positionality in relation to this article is of a Black, mixed-race, heterosexual, cisgender, non-religious, able-bodied woman and a first-generation immigrant in the UK, with family roots in Black African Muslim and white Eastern European Catholic cultures. My perspective on this topic is shaped by my professional experience as a therapist and supervisee working with clients from racialised and other marginalised groups. It is also influenced by my personal experiences of socially inflicted oppression and the healing work I have undergone, including through EMDR therapy.
EMDR is used worldwide to process all types of trauma, both single incident and complex, including CPTSD (complex post traumatic stress disorder) resulting from adverse childhood experiences, medical trauma, combat trauma and many other traumas.
However, the use of EMDR to process trauma inflicted by social oppressions, especially racism, but also sexism, homophobia, transphobia, islamophobia and intersectional identities (this is sometimes called cultural trauma) seems to be less well known, practised, and talked about in the UK so far.
Members of racialised and other marginalised groups carry the most complex traumas of oppression, often spanning over many generations. This has an immensely detrimental impact on the mental and physical health of those communities. There is therefore a great need for the use of EMDR to address socially inflicted trauma, since it may make a huge positive difference to marginalised and oppressed clients’ mental and physical health.
Based on my experience as both a therapist and a client, I have found that the main condition required to use EMDR successfully to process trauma caused by social oppression is the quality of the therapist’s cultural awareness and attunement. By this, I mean a therapist doing ongoing work to deepen their knowledge and awareness of social, political, historical, and cultural issues and how they may play out in their clients’ lives. Therapists need to strive to educate themselves about the realities that different marginalised groups inhabit and the oppressions, and inequalities they are subjected to by society.
This includes therapists’ responsibility to learn about their own racial and cultural identity as informed by the cultural and belief systems they originate from in order to understand how this may influence their attitudes towards other groups in society and towards clients from those groups. These findings were at the beginnings of the development of intercultural therapy in the US as early as the 1970s (Pedersen et al., 1976). In the UK, the first books on the subject were published in the 1980s and include leading authors and researchers like D’Ardenne and Mahtani (1989), Kareem &Littlewood (1992), and Lago & Thompson (1996). Intercultural therapy has produced many more contemporary researchers and writers since.
Khan, in her book ‘Working Within Diversity,’ differentiates the active quality of ‘cultural awareness and attunement’ from ‘cultural competency.’ The latter is something finite that can be acquired, while the former is an ongoing process: cultural awareness is continuously created and deepened by learning about the system and the realities all groups within it inhabit, while cultural attunement is an ongoing relational effort to understand a client and meet them where they are in their experience in cultural context (Khan, 2023). A similar debate was posed much earlier by Tervalon and Murray-Garcia about cultural competencies versus cultural humility (Tervalon & Garcia, 1998).
In this socio-geo-political-cultural system, we all inhabit different realities, shaped by the position we occupy within it in relation to oppression and privilege and determined by factors like race, ethnicity, gender, sexuality, gender identity, faith, class, age, body size, and physical and cognitive ability. As therapists, it is our responsibility to approach our clients with an open mind and enact the ability, willingness and capacity to meet them where they are in their experience, especially if the experience is that of social oppression. Otherwise, we run the risk of denying, dismissing, minimising, or in other ways, invalidating the client’s experience.
Due to clients from marginalised and oppressed groups having experienced this many times before, the therapeutic experience, instead of healing, has the potential to become re-traumatising. In this way, we may unwittingly recreate in the therapy room the oppressive dynamics of power that exist in wider society.
Even showing just a lack of awareness of the systemic nature of experiences of social oppression may leave the client feeling abandoned and disillusioned and jeopardise the therapeutic relationship. It is not possible to assist clients with healing their cultural trauma without creating cultural safety in therapy. Therefore, assuming an active anti-oppressive position and way of practice is necessary for facilitating processing and healing from traumas resulting from socially inflicted oppression.
An important point to mention here is that, as therapists, we must take responsibility for our own learning about the systemic dynamics of power and oppression existing in our society rather than relying purely or mainly on learning from our clients. We do learn from clients; however, clients cannot be used as the sole source of our learning. We need to ensure that we find and make use of other sources of information and knowledge, which, in this global information era, is more accessible than ever. This learning is a continuous process requiring ongoing commitment and humility. Not understanding everything and getting things wrong occasionally is inevitable and alright, provided it is followed by acknowledgment and apology, but showing up and doing the work is paramount.
We need to be able and willing to acknowledge in the therapy room the positionality of both therapist and client in the social system in relation to oppression and privilege.
Khan offers a ‘working within diversity’ model for anti-oppressive practice, which can be applied to therapy, supervision and training and is different from ‘working with difference and diversity’ (Khan, 2023).
In a traditional model of working ‘with difference and diversity,’ the therapist, usually predominantly white, middle-class, is considered an unacknowledged and neutral norm while the client, with their differences and diversity, is different from the therapist (supervisor, trainer). Therefore, in this model, the client is left in an isolated space and pathologised.
As opposed to this, the ‘working within diversity’ model places both therapist and client under the same scrutiny and requires acknowledging the outside social, political, historical and cultural context and the positions they occupy within it.
Khan writes: “It is imperative that we understand systemic, structural, social, political, cultural, historical, societal, community and familial contexts when working as counsellors, because they are right there in the room with us. They are right there in the truth (identity, narrative and lived experiences) of our clients. They are right there in our truth (our own identity, narrative and lived experiences)… We can’t hold the truth of our clients without acknowledging and understanding the existence and impact of social, structural and systemic inequalities in the world” (Khan, 2023, p.13).
Similarly, Levis writes in her chapter ‘Placing Culture at the Heart of EMDR Therapy’ that “therapy may be yet another arena in which social hierarchy is reinforced. The average EMDR therapist in the Western World is white, educated, able-bodied, and upwardly mobile. This places clients from many minority groups in a challenging situation, where verbal adherence to neutrality begins to render the therapist’s racial, social, class, gender and other privileges invisible, thereby reinforcing white, middle-class cultural narratives and social norms. Even Therapists of Color have found it to be true, as their assimilation to Western cultural norms and the Western practice of psychotherapy places them in a privileged position, thus reproducing social inequalities. In spite of these challenges, the therapist’s own awareness her position, culture, and values will allow them to be more effective in building a strong therapeutic alliance with a client from a minority group” (Levis, 2017, p.100).
Another crucial condition for offering culturally safe therapy is the therapist’s awareness of their own feelings or countertransference in relation to the client’s material related to their experience of social oppression. It is especially important because unacknowledged and misunderstood countertransference tends to create a block to empathy. A classic example is a client of colour sharing with their white therapist their experience of racial trauma and the therapist being overwhelmed by feelings of shame, guilt, fear of retaliation or even anger. This type of countertransference in relation to racism and any other similar oppressive social dynamics, e.g., sexism, homophobia, transphobia, classism, and fatphobia, needs to be acknowledged and processed by therapists in their own therapy and supervision and during ongoing work aiming to deepen their cultural self-awareness.
Being attuned to and willing to explore the client’s transference is equally important and necessary to facilitate building cultural safety and the client’s trust in the therapist.
The social, racial, cultural and political dynamics of power are there in the therapy room and in cases where there is a difference between the positions of therapist and client, if unacknowledged and without the genuine will to step into the vulnerability of discussing those aspects of the relationship, they inhibit and sabotage the work. The result may be clients not bringing those forbidden experiences to therapy and the chance of healing the trauma being missed.
In supervision, the omission of the topic of race and other socially inflicted oppressions may manifest itself as supervisees censoring themselves in what they bring into the supervision process and leaving out the work related to their clients’ experiences of oppression. During my 13 years of practice, I have frequently witnessed new client cases being presented in supervision without mentioning the client’s racial background. In this way, the whole crucial aspect of their life experience and their positionality in the socio-political-cultural system is omitted or censored out, making understanding who they are and their experience very difficult, if not impossible.
This attitude of treating race as a taboo subject and not acknowledging it is a form of cultural dissociation in western culture. Its subconscious purpose is to avoid confrontation with our own feelings about the trauma of racial violence in the past and present.
Isha McKenzie-Mavinga refers to it as ‘cultural schizophrenia,’ which she describes as “unconscious or conscious splitting-off of communication about black issues” (black issues meaning here the issues related to culture, race and racism), and she points to it happening on a personal, professional and institutional level, including psychotherapy and counselling training (McKenzie-Mavinga, 2009, p.117). McKenzie-Mavinga created the concept of the ‘Black Empathic Approach,’ which she describes as “pay(ing) particular attention to the cultural influence of racism” (McKenzie-Mavinga, 2009, p.57).
Resma Menakem, the author of ‘My Grandmother’s Hands,’ emphasises that we are all impacted by the legacy of the atrocities of historical racism and its current manifestations, and we carry this trauma in our bodies. He created the term ‘somatic abolitionism’ for the work we all have the responsibility of doing by engaging with the process of race on a community and long-term level so that we can together “develop a living, embodied antiracist culture and practices” (Menakem, n.d.).
Eugene Ellis, in his book ‘The Race Conversation,’ also points to the embodied nature of the trauma of racism (Ellis, 2021). He discusses it in the context of trauma theory and the emotional and physical reactions, which attempt to talk about race triggers. Ellis’s book is a guide towards becoming aware of those triggers and bodily responses, understanding them in the context of the common history we share and trauma theory, and being able to have and continue the conversation about race rather than allowing them to shut it down.
Clients, supervisees and trainees may, and often do not feel safe broaching the subject of race or their experiences of other social oppressions, and sometimes they may not be fully aware of their existence or impact on them due to internalised oppression. That is why it is imperative that therapists, supervisors and trainers, operating from their positions of power, strive to create a culturally safe space where experiences of social oppression can be brought up and broach the subject where the readiness and the potential for healing exist.
Day-Vines et al. (2007) write about the importance of recognising the racial identity of the client and the therapist’s capacity to broach the topic of race in their article, ‘Broaching the Subject of Race, Ethnicity and Culture During the Counselling Process.’
Even in cases where a therapist and client have taken the step towards processing cultural trauma, constant attention needs to be paid to those cultural aspects of their relationship, to the transference and countertransference stemming from the difference. For clients from marginalised and oppressed groups, voicing their experiences of socially inflicted trauma means taking a big risk and is an act of great courage. They need and deserve cultural and relational safety and to be met halfway by the therapist. The relational process across the difference may be difficult and challenging, and clients should be able to feel safe enough and held, to bring to light their feelings of mistrust, fear and vulnerability to be explored.
This is especially important with EMDR therapy, where the nature of the approach is based on spontaneous associations. The information processing in EMDR takes clients straight into the realness of their experience and the truth of their feelings, and it doesn’t leave space for censorship, aimed at keeping the therapist feeling comfortable. Neither should the therapist’s feelings of comfort be a priority here. If the client doesn’t feel safe enough to be held in this process, the process will either not start or come to a halt, or even worse, the relationship with the therapist may break down. At its worst, it can lead to clients internalising the distress they were trying to work through even deeper as shame and the self-belief ‘there is something wrong with me,’ could discourage them from ever attempting to surface it again.
Developing an intercultural and anti-oppressive approach constitutes a fundamental basis for using EMDR safely and effectively to process socially inflicted trauma.
Cultural awareness and attunement cannot be overstated when working with clients who have experienced socially inflicted trauma. Therapists must continuously educate themselves about the realities faced by marginalised groups and the systemic inequalities they encounter. This includes understanding one’s own racial, cultural, and social identity and how it may influence attitudes towards clients from different backgrounds (Pedersen et al., 1976; D’Ardenne & Mahtani, 1989; Kareem &Littlewood, 1992; Lago & Thompson, 1996; Khan, 2023).
Therapists must pay attention to transference and countertransference when working with clients who have experienced socially inflicted trauma, especially racial trauma. Unacknowledged feelings can create a block to empathy and hinder the therapeutic process. These emotions must be acknowledged and processed in their own therapy, supervision and through similar means.
Therapists need to be aware of the pull towards splitting the issues of race and racism off and make a conscious effort to become aware of their trauma response to ‘the race conversation’ (McKenzie-Mavinga, 2009; Menakem, 2017; Ellis, 2021).
It is essential to recognise and acknowledge the positionality of both therapist and client within the social system (Levis, 2017; Khan, 2023).
It is imperative that therapists, operating from their position of power, create cultural safety for clients and broach the subject of race and other oppressions, where the readiness and the potential for healing exist (Day-Vines et al., 2007).
All the above applies equally to training and supervision.
The aim of my article was to discuss what we as EMDR therapists should consider in order to use EMDR effectively in processing racial and other socially inflicted traumas.
In this part of the article, I focused on what we need to learn from the achievements of intercultural therapy to be able to offer anti-oppressive, culturally safe and culturally attuned therapy.
The list of considerations I included regarding the need for all EMDR therapists to develop towards offering culturally safe and effective anti-oppressive therapy is not exhaustive and could be expanded; however, I find it crucial for this purpose. It is an attempt at contributing to the dialogue on the subject and voicing the need for more honest conversation, topic-related research and general engagement with it.
EMDR is a powerful approach that addresses trauma on all levels – cognitive, emotional and physical – and as such, is perfect for processing complex trauma resulting from social oppression. However, to be able to apply it in this way, we need to develop an intercultural and anti-oppressive basic approach first, to build our EMDR practice on. Specific standard protocol adaptations, which I will talk about in Part 2 of this article, are invaluable; however, they can only be applied and work if we open our minds and hearts to the realities and lived experiences of clients from marginalised and oppressed groups first. The first step is acknowledging the problem itself, the importance of working towards addressing it, and taking on the challenge of striving to be effectively relational across difference.
D’Ardenne, P. & Mahtani, A (1989). Transcultural counselling in action. Sage.
Day-Vines, N. L., Wood, S.M., Grothaus, T., Craigen, L., Holman, A., Dotson-Blake, K. & Douglass, M.J. (2007). Broaching the subject of race, ethnicity and culture, during the counseling process. Journal of Counseling & Development, 85(l), 401-409.
Ellis, E. (2021). The race conversation. Confer Books.
Kareem, J. & Littlewood, R. (1992). Intercultural therapy: Themes, interpretations and practices. Blackwell Scientific.
Khan, M. (2023). Working within diversity. Jessica Kingsley Publishers.
Lago, C. & Thompson, J. (1996). Race, culture and counselling. Open University Press.
Levis, V. (2017). Placing culture at the heart of EMDR therapy. In M. Nickerson (Ed.), Cultural competence and healing culturally based trauma with EMDR therapy, (pp. 97-111). LLC, Springer Publishing Company.
McKenzie-Mavinga, I. (2009). Black issues in the therapeutic process. Palgrave Macmillan.
Menakem, R. (2017). My grandmother’s hands. Central Recovery Press.
Menakem, R. (n.d.). Notice the rage; notice the silence. Retrieved from https://onbeing.org/programs/resmaa-menakem-notice-the-rage-notice-the-silence/
Pendersen, P.B., Draguns, J.G. & Lonner, W.J.(Eds). (1976). Counselling across cultures. East-West Center.
Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health care for the Poor and Underserved, 9(2), 117-125.
