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Racial Trauma and the Therapy of Tomorrow

Racial Trauma and the Therapy of Tomorrow

A Conversation with Dr. Monnica Williams

Emilie Azevedo & Giles Holland

Feb 2021

Emilie: Out of all your research interests, which is the most important to you?

Monnica: Right now, particularly with everything going on in the world, my biggest interest is in racism.

Emilie: What are you doing as a researcher to tackle the issue of racism?

Monnica: One of several directions I’m working along is how do we help people who are suffering mental health consequences of racism? I’m doing work around racial trauma or PTSD symptoms that are caused by racialization and race-based stressors. Ultimately one of the things I'd like to do is develop treatments for people who are suffering as a result of racial trauma. A lot of my work thus far has been creating psychological metrics to measure racial trauma, which is an important step. For example, I have a scale called the Trauma Symptoms of Discrimination Scale, which is in use right now. I’m also working on a metric that's specific to racial trauma called the Race Trauma Scale, and we're doing research now to validate that. I also developed a clinical interview for mental health professionals to elicit information about racism from their clients, and that's available now—and we're adding to it by creating scales that go with it and by making it available in other languages.

Emilie: What outcomes have you seen so far?

Monnica: First, good metrics are needed for research to help us understand more about racism and trauma. What does traumatization look like? What forms of discrimination are most harmful? Second, we can use metrics to identify people who may be in need of clinical services due to their experiences of racism. One of the things we know is a big problem is that a lot of clinicians don't have enough training dealing with issues of race and racism. Good metrics give them the tools they need and generally contribute to bringing them up to speed so they can help people with these problems.

Emilie: Let’s talk about what these metrics seek to measure. How might the experience of being black impact one’s mental health?

Monnica: Really every negative way that you could think of that a person's mental health could be affected—racism can make it worse. For example, if a student is experiencing racism at school and people don't want to talk to them, or sit next to them, or invite them to things, the person can start to feel isolated and alone and think there's something wrong with them. And so racism can cause people to have low self-esteem. Or if they've been mistreated—let’s say they've been attacked or assaulted—that might cause them to have social anxiety around people and could even result in trauma symptoms. So there are a lot of different ways that racism can result in mental health problems.

That said, I think the most common thing that I see is that people get depressed as a result of experiences of racism because they feel there’s nothing they can do about it, it keeps happening to them, and they feel powerless to make it stop. So they feel more and more helpless.

Emilie: I noticed another research focus of yours is psychedelic therapy. Can you tell us more about that?

Monnica: It's actually very related to my work around racism because one of the ways that I would like to see psychedelic medicine used is to help people who are suffering from racial trauma.

We have conventional treatments for PTSD. So the standard way of thinking right now is that to help people with racial trauma, we want to use a culturally adapted version of some existing PTSD treatment. But the most effective existing PTSD treatments are exposure therapies [where the client is re-exposed to the traumatic stressor in a controlled way over time with the aim of reducing the trauma response]. These treatments are very difficult for both the clients and the therapists—nobody wants to do them. Psychedelics are a promising option because they seem to be very effective but are more humane.

Emilie: How so? What’s the difference between the two?

Monnica: With traditional exposure therapy, the person will revisit the trauma during their sessions and the therapist will encourage the person to remember their trauma and talk about it in detail. For prolonged exposure, the person comes to therapy and spends half an hour just telling their trauma story as well as they can. Most of the session is devoted to telling and retelling their story. They record that and re-listen to it. They come back the next day and tell their story again, but in more detail because there will be more things that they remember throughout the process. And they do that ten more times. It’s very challenging, especially at the beginning because they don't want to think about their trauma. As a therapist I’ll gladly do it because I know it works. But if there's a better way, let's do that.

What we're looking at is psychedelic-assisted therapy, which is less directive. So the person would take the psychedelic substance [e.g. psilocybin] with the therapist present. What happens is parts of the brain that don’t normally talk to each other can communicate in a way that allows the person to gain a different perspective on their trauma and how it relates to their life, one that they might not have been able to find otherwise. The mind kind of knows what it needs to do to heal itself in most circumstances, and the psychedelic allows that to happen. The therapist is mostly there as support—they aren't dictating the session.

Psychedelic therapy is not a medicine you take every day like Prozac. You would only take it when you’re getting the therapy. Current protocols are to only use the substance two to four times. And that’s its strength: It’s more curative, whereas with the drugs that people take today for mental health problems, they’re not cures—people take them for years and they just tamp down the symptoms. What I really like about psychedelic therapy is that we see people's symptoms resolve long-term.

Emilie: What are the most challenging and rewarding parts of your job?

Monnica: The most challenging is also the most rewarding, and that is training therapists, particularly white therapists who work a lot with people of colour. People tend to have ways that they were raised and that they approach interracial interactions. These ways tend to be very much ingrained in them. The process of unlearning all the unhelpful stuff and relearning new approaches to working with race, ethnicity, and culture—it’s hard work but it’s very rewarding.

Emilie: Is there anything you’d like to add?

Monnica: Another piece of work that I do that I think is very important is linked to the climate of racism that we live in. A lot of people are beaten and incarcerated for no reason, just because they were the wrong colour. They often spend a lot of time in jail for things they didn't actually do, or they end up in jail because they had a trauma-based reaction to something that was happening. So, I do work in legal settings for people who have been harmed by law enforcement. That’s work that I'm really proud of because not a lot of people are doing it. I hope more people will start to do it—there's a big need for it.

Unfortunately, most people who are incarcerated have some sort of mental health problem. Some are very serious. But people with mental health problems don’t belong in jail. It’s not a good place to get your mental health care—the mental health care provided in jails and prisons is substandard. I don’t think it makes sense to incarcerate someone because they have a substance use problem or they’ve committed a non-violent crime. If such people can pay fines or be under house arrest, that’s a better option. I think the only reason we need jails is for people who are violent and dangerous—but that’s a small portion of the people who are in jail now. The public is paying for the rest to be there, and they're not getting better. They’re actually getting worse. So how does this make sense at any level?

We have so many people in prison. We have to say: what's wrong with our system, that this is the product of it?