Speaker 1: Last week, I walked out of a training from my colleagues feeling a sense of exhaustion and frustration. And this is not the first time I have felt this way. When I leave these trainings, I typically feel like they have doubled down on stereotypes rather than provided me with ways to address my biases and practice anti-racism. Racial competency and diversity trainings are so prevalent these days. And they should be, as we venture to a space of acknowledging, addressing, and understanding the impact that power, prejudice, and privilege has on this world and all those that reside in it. However, the truth is, typically when I attend these trainings, I find them to be a waste of my time. And that is heartbreaking to me because we are worse off due to these poor trainings that do not provide us with ways to improve the human experience. I take personal offense to these lackluster trainings because in the many roles that I hold, I see the impact that subpar cultural understanding, limited cultural humility, and outdated cultural knowledge has on the world. I see the impact as a professor when my students come to me and share that once again they have been invalidated and the victims of racism by my colleagues in academia. I see the impact as a scientist when I look at statistic after statistic regarding the number of Black patients and patients of the global majority that feel seen when they visit their doctors. These patients are significantly more likely to be misdiagnosed because the biases that their doctors hold impact their ability to do an appropriate assessment and do their job. I see the impact as a licensed clinical psychologist when I work with patient after patient after patient regarding ways to deal with the impact of oppression that they experience in the workplace, in their neighborhoods, and sometimes in their own families. And I see the impact as a Black woman in America who often has to convince others that I am not a threat simply because of the color of my skin or the fact that my hair defies gravity. I see the impact every day. You know, so many people attempt to teach about cultural competence and the role of cultural competence without understanding the history behind the term. Did you know that when professor and psychologist Dr. Darrell Wing Sue coined the phrase cultural competence, he stated that it is not possible to be fully versed on a group of people in your lifetime. It's true. He actually stated that it is more important to have experiential learning, to engage with people that don't look like you from different walks of life as human beings than it is to focus on the academic trainings, the cognitive understanding that so many of these diversity trainings seek to embody. But that's not really how we're taught cultural competence, is it? Every year we are mandated to go to at least one mandatory training. Most of the time it is in February. We all know why it is typically in February. And then we see a speaker. We watch a webinar. We check off a box. We get the certificate. And too often the education ends there. No afterthought, no follow-up, no experiential learning. And that was never how it was meant to be. When we treat cultural competence like an achievable goal, like a finish line to be crossed, we completely miss the mark. And we do injustice to all those that will be significantly impacted by our ignorance, by our insensitivity, and by our inconsideration. I unfortunately have witnessed many incidents of poor cultural competence. But one that always sticks with me was during a panel, a planning session between licensed clinical psychologists. The purpose of the session was to identify ways to teach distress tolerance to a group of black youths. We typically do this by stimulating some form of stress that is deemed reasonable and then allowing the children to practice their coping skills in a safe environment. This is typically done by showing a scary movie clip. But this year a psychologist proposed that they change the scene to a scene from the movie Crash, which depicted police brutality. The offenders were European American police officers and the victims were a black couple. I want you to think of how abominable a decision it was for licensed mental health professionals whose job it is to contribute to the mental healing of youths, to decide that showing a scene that depicted police brutality would create what is deemed as a reasonable amount of distress in black youths. I often wonder what contributes to these poor decision making, especially among licensed mental health professionals. I believe it happens because the way we seek to understand and learn more about individuals from diverse backgrounds and cultures is limited to Zoom meetings and workshops and webinars. I want to share some data with you so I can fully help you understand and humanize the experience of what poor cultural confidence contributes to. Black boys and girls are respectively three and six times more likely to be suspended from school than their European American peers for displaying the same behaviors. In 2003, the Institute of Medicine published a 700 page document entitled Unequal Treatment. This revealed that black patients have a higher mortality rate when it comes to heart disease, cancer, and HIV and AIDS than any other U.S. racial or ethnic group. This disparity is not due to differences in access to care. In fact, at equivalent levels of access to care, black and Hispanic patients are significantly less likely to receive gold standard treatments that are known to treat medical disorders including heart attacks. There's even disparity in the effectiveness level of medical apparati. Pulse oximeters are used every single day in hospitals to measure the level of oxygen in the blood. They are used with disorders such as pneumonia, lung cancer, and asthma. However, a study in 2022 revealed that they are less effective in individuals with dark skin pigmentation like black patients. The inability to appropriately measure the level of oxygen in the blood can contribute to a number of medical difficulties and possibly death. A study of over 4,700 participants revealed that black patients are more likely to be subjected to dominant communication styles from their doctors, less likely to be provided with all the treatment options, and less likely to be engaged in participatory decision making for their own medical care. And if we go back to the development of the field of medicine, we will come across J. Marion Sims, a man who is lionized as the father of modern gynecology and who perfected his technique by operating on enslaved African women without anesthesia and certainly without their consent. I often see these things happen in therapeutic care as well. I want to put you in the driver's seat so you can understand how this can manifest in the therapeutic process. A patient comes to your office, a black woman comes in, and she is seeking mental health care. After you do an assessment, you identify the fact that she is having difficulty identifying her strengths and abilities. She often feels like a fraud in her environment. And she is having such difficulty meeting her goals. So you collaborate together to identify a plan. You decide to start with assertiveness training. It is an effective treatment when it comes to anxiety and stress. But it doesn't work. During the next appointment, she shares that she is having difficulty identifying any positives in her life. When she thinks about goals, when she thinks about what she can achieve, she can't identify one. So you propose the use of a gratitude journal. But it doesn't work. During the next session, you do more digging. And she shares that she has never experienced this form of feeling like an imposter before. Typically, she thrives in all her environments. And that is when you decide to empower her. You share that she simply needs to be authentic in her space, and people will welcome her obvious intellect and her vivacious personality. And that is where you lost her. She ghosts you, and she does not come back for another session. Now as the clinician in the room, you do what anyone does when they are ghosted personally or professionally. You ask yourself why. What happened? You walk yourself through the steps. You utilize patient-centered care because your training taught you that so often black patients aren't even engaged in treatment options. They're just given to them. You empowered her and used a strength-based perspective because you learned in your training so often black patients are treated from a framework of deficits, which is also harmful. You did everything that you were taught to do, but what you missed is what wasn't included in the training. And what so often is not included in the trainings because they seem to make others uncomfortable. And that is the fact that when your skin is weaponized, everything is a privilege. Identity is a privilege because everything can be perceived as a threat, from the tone of your voice to the way that you wear your hair. Did you know that black women were one and a half times more likely to know someone who was sent home for their hairstyle or to be sent home for their hairstyle? And this isn't limited to the workplace. Hair discrimination has been found in youths as young as five years old. The creating a respectful and open world for natural hair is a piece of legislation that was created by four phenomenal women who felt that black individuals should not be held back and discriminated against in the workplace and in school because of the way that they wore their hair. However, not even 50% of states and the United States have enacted this piece of legislation. In fact, although it passed the House in March 2022, it was blocked in the Senate in December in 2022. I want you to think about that for a second. How many times when you think of privileges do you think about authenticity? When you take a step to ruminate on that, I want you to ask yourself, has legislation ever had to be passed so that you were not retaliated against for the way that you wore your hair, the way that it came out of your head? What's more authentic than that? That stress, that anxiety that your patient felt could likely have been a result of stereotype threat. This is a form of stress and anxiety that presents itself when you have a fear of conforming to a stereotype that is attributed to your group. There are many egregious stereotypes when it comes to black people, but a very common one deals with the lack of intellect. If I am working and stereotype threat presents itself, and it often does, I will create so much mental energy combating that stereotype. I'm not stupid. I'm smart. I can do this. Let me check, triple check, and double check that I won't even divert the right amount of energy to perform the task that is well within my ability to do, which will contribute to significantly more mistakes. Everyone has stress when it comes to performing tasks, but stereotype threat gets in the way of you doing things that you can even have the ability to do overall. When you think about the integration of all the symptoms and what contributes to racism-related stress and difficulties within the environment, I want you to think about a tree. That stress, that hesitance, that fear, that imposter syndrome that your patient was experiencing, that was a branch. But the things that are contributing to the maintenance of those branches thriving and whistling in the wind every day is racism. Those are the roots. If we ever want to improve the human experience of individuals overall through all of these trainings, they must address the roots. When you walk out of a training with the same way of thinking, the same information that you walked into the training with, the problem is the training. We need to vary the forms of information that we herald. So many times we focus on peer-reviewed journals, and those are a good start, but publication bias also exists. It is easier for a research study that focuses on European-Americans to be published than one that focuses solely on black people or people of the global majority. Not in comparison, one that focuses solely on these individuals and the intricacies of the experience in the diaspora. We also need to look at the way we do these trainings. Are we looking at intersecting identities, age, ability level, sexual orientation? It seems like a lot to include in one training, and it is, and the goal is not to include it in one training. The whole purpose of this is to be an experience in understanding that it is a journey when it comes to cultural competence. We need to focus on engagement. A three-hour talk with 15 minutes of Q&A is not enough time. You need to look at books and break them down. You need to listen to podcasts and break it down. We need to really vary the information that we share, the narratives that are experienced, and the way that people choose to share them, and have a conversation. Do you have difficulties having the conversation? Are you uncomfortable? Let's start there. Where is the discomfort coming from? Are you afraid of being wrong? That's okay. I would trust someone who admits to being wrong way before I trust someone who says that they're right all the time. Are you feeling oppressed in the environment that the training is happening? Let's start there. What form of oppression are you experiencing? Is it internalized? Is it institutional? Is it cultural? We have different treatment plans, but they can all be accomplished. We need to come back with tangible goals and metrics for achieving those goals. It's not enough to say that we want the environment to be less oppressive. We need to say that we are going to look at our policies and come back in two months, in three months. Yes, your policy may state that it is against discrimination when it comes to skin color, but what about hair? What about hairstyles or hair lengths or protective styles that are attributed to certain individuals of racial or ethnic origins? How diverse is your company? Is your organization really? When you go up different levels of the hierarchy, do you notice that individuals start to look the same? That's not diversity. It's just important to look at these things from day to day. It didn't take one day to build that bias. It's not going to take one day or one training to break it down. There is no such thing as being colorblind. When you say you don't see my color, you don't see me. And it also places emphasis on the wrong thing. Color is not the issue. Race is not the issue. Racism is. When we focus on what is really important, we can work towards improving the human experience overall. And the many roles that I hold, scientist, psychologist, person, professor, I'm here to tell you, therapy is not going to fix it all. My office should not be the only safe space that someone holds. I should not have to manage the fear of individuals who took a Hippocratic oath to protect me, or those who decided to serve and protect others. The world should feel like a safe space. And if we are going to address that, we have to look at the roots. We have to be okay with being wrong, and we have to improve the human experience overall by understanding that cultural competence is not a finish line. We're going to work on this our whole lives. Thank you.