by Jennine Estes, LMFT
Have you ever worked with a client who was the victim of a brutal beating because he was gay? Or has a client ever shared with you that they have been shut out of a community simply because of their skin color? Has a client resisted opening up to you out of fear that you won’t understand their religious orientation? These are real cases and situations that are all too common with underserved populations. The specialized mental health training and education required to properly help this group cannot be emphasized enough.
Definition of an underserved population
Underserved populations are groups of minorities, such as same-sex couples, ethnic minorities, the physically impaired, polyamorous relationships, and refugees. They face both daily struggles and lifelong challenges that impact them emotionally, physically, psychologically, and financially.
For example, in my group practice, we work specifically with the LGBTQ (gay, lesbian, bisexual, transgender, and queer) population and help our clients process and address the various layers of discrimination, hate attacks, family rejection, shame, and isolation that they have been through or will face.
Considerations when treating underserved populations
As mental health professionals, it is our responsibility to be educated on the specific struggles of underserved populations and consider how we can best address them. This may include approaches that are unique to any other client population you deal with.
The first area to consider when working with a minority client is to be aware that there may be layers of pain. Each client can emotional scars, but the underserved group has additional scars that are different in the sense that they have seen negative impacts on their education, career, place of residence, family, and more.
This group has not typically had space to talk about their experience, often being shut out because these experiences are not part of traditional social norms. For example, the LGBTQ community is commonly known for being “closeted,” having to disown parts of who they are and starting as early as childhood. Shame grows rapidly when disowned parts are kept in the shadows, unspoken. Furthermore, when society sends additional shaming messages, the corresponding pain increases. In relationships, the history of being open or closed about their sexual orientation impacts the security in the relationship. Couples can often draw close to one another, sharing similar experiences and understanding one another. At other times, a partner may struggle with the degrees of their openness which impacting the security in the relationship. In short, underserved populations carry pain, and it must be recognized.
Secondly, know that discrimination and the fear of discrimination is real and alive. For example, the Orlando nightclub shooting resulted in the deaths of 49 people in a gay club, and is one of the many hate attacks that keep people fearful for their safety simply because they are in a same-sex relationship. Another example of how clients are impacted is by the history of African American slavery and the current legacy of discrimination resulting from that.
My team of therapists works with LGBTQ clients and clients of color who have experienced hate attacks that range from public verbal abuse to being beaten to the point of hospitalization and fighting for their life. Even though we are in 2017 and live in San Diego, a city that values equality, it is still important to understand your client’s trauma history and to know that your client’s fear of discrimination is alive and real; they will always be scanning their environment to assess if the space is safe.
In a couple, the fear of social discrimination impacts the relationship on various levels. If one partner withholds their affection, it sends a message as if they don’t care or not proud of the relationship. The lack of communication around the discomfort can leave the other partner feeling in the dark and taking it personally. Other times, couples can come together and connect on their experiences.
Third, realize your clients’ decisions for the future are impacted by their religion, skin color, or sexual orientation. For example, a lesbian couple planning on having a child will reconsider where they should live to ensure their child will be safe and accepted in the neighborhood. Or a Hispanic couple moving to an all-white school district will worry about how to help their child fight discrimination.
What we can do to help our clients
First, there is no better way to help your clients than to talk about it. Ask the questions. Lean in to the uncomfortable topic of religion, ethnicity, or sexual preferences. Create a safe space for them to open up, because some people likely haven’t had that before. The more they talk about the rejection, physical and verbal attacks, and discrimination they’ve encountered, the more power they have. We need to help our underserved clients process their experiences so they don’t remain cloaked in shame.
Secondly, help them own all parts of themselves: their skin color, sexual orientation, religion, etc. Empowering our clients to feel proud of who they are will help combat the shame, embrace their community, and acknowledge the courage and strengths they have.
Next, address the inevitable feelings of loneliness and isolation. For example, transgender clients and their families often feel very alone, so connect them to groups where they can share stories and support one another. Encourage your clients to seek out their community either face-to-face or online. Supportive communities are out there; your clients just need the help knowing that those connections can be healing and are an important part of feeling more confident in their own skin.
Finally, even though San Diego is very open-minded compared to other cities across the country, there are still violent crimes geared toward race, sexual orientation, and other minorities. Better yet, they may experience rejection by their own family and friends. Help your client with setting boundaries. This includes developing a situational awareness and determining where it is safe to take their armor down and where they must keep it up. Encourage your clients to get educated when traveling to foreign countries knowing where it is safe versus unsafe for them to go.
In conclusion, underserved populations are impacted by the past, present and future. Their emotional and psychological scars influence how they connect with peers and loved ones, seek job opportunities, and engage in their communities. By getting trained and educated on the struggles underserved populations face, we can help them through the challenges, enhance who they are, and help them have a voice.
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