Locals Advocate For Culturally Competent Care Providers

By Genoa Barrow | OBSERVER Senior Staff Writer

As awareness of Black men’s mental health needs has increased, so do calls for culturally competent care. The National Institutes of Health says cultural competence helps patients feel comfortable with their provider and leads to their seeking continued care. 

For many, culturally competent means therapists who look like them, but therein lays the challenge. Preferring a same-race provider doesn’t guarantee you’ll get one. According to 2022 data from the American Psychological Association’s Center for Workforce Studies, only 4% of U.S. psychologists identify as Black and of those, only 8% were Black men.

Of the hundreds of local mental health providers listed on the Psychology Today directory, only a small percentage are African American and fewer still are men. Many aren’t accepting new clients because they’re at capacity.

Dr. Troy Williams compared finding Black male therapists to help facilitate mental health sessions he co-hosts in barbershop settings to “finding a needle in a haystack.” 

Dr. Williams kept asking around for someone to participate with the Cut to the Chase support group and was eventually given the name of Bryant Howard, owner of Heart of the Matter Counseling. Dr. Williams also became a client for individual therapy through Heart of the Matter. While the counseling center is owned by a Black man, Dr. Williams was assigned to one of his other therapists, a white woman. The Black therapists there at the time all had full client loads.

“I’ve never had a white therapist before, even though I’ve been in therapy for well over two years,” Dr. Williams said.

“The first day that I met her, excuse my language, I was like, ‘Honestly, I’m not f–king with a white therapist. There’s so much racial trauma happening to me, every single day. I don’t want to have to explain my Blackness and my life to a white woman.’“

“She said, ‘My boss is a Black man, therefore, as a therapist, I have to check in and tell him what’s happening with my patients and he’s able to assist, add information and kind of coach me in a way that’s more culturally responsive than any other white boss that I would have had.”

Today, Dr. Williams calls her “one of the best therapists” he’s ever had. She’s helped him process personal and professional topics. He started individual therapy sessions at Heart of the Matter in November 2021, a month before his best friend was murdered.

“When I began to have conversations with her about that, she shared with me that she also experienced the death of her best friend. It was kismet. How could this woman who I kind of resisted being my therapist, end up having so much insight and information to share with me on getting through these challenging times. It is more important to find someone who can do that than necessarily having them be of the same race,” Dr. Williams said. 

Dr. Ruth Shim, a professor of clinical psychiatry in UC Davis’ Department of Psychiatry and Behavioral Sciences, says she’s optimistic about the future mental health workforce.

“I’m training more and more students of color from disadvantaged backgrounds and training more and more Black psychiatrists,” said Dr. Shim, author of “Social (In)Justice and Mental Health.”

“For years, we didn’t have any Black male psychiatrists in our residency training program. We’re slowly starting to increase the number of Black male psychiatrists in our training program. We’re aggressively moving in a direction where the entire workforce, the psychiatry workforce, is going to look dramatically different than it did.”

The changes are being made to address the concerns they’ve heard from people of color, Dr. Shim says. “It’s their negative experiences with the healthcare system. When I read and evaluate applications for people on why they chose psychiatry and why they’re going into mental health, most of the time it’s because they had a close family member, somebody that they cared about, who had a tragic outcome related to mental health – particularly issues related to addiction and substance use, and undiagnosed or untreated conditions, Dr. Shim added.  “And so they want to fix the system, they want to go into psychiatry to make sure that nothing like that happens to other people.”

“I always say the health care system itself is not a good system, but the mental health care system is even worse than that. Most people, especially people of color, cannot access mental health care in this country and that’s a big contributor to the problem. The fact that we have more and more people going into psychiatry that want to fix those issues is really exciting to me,” Dr. Shim said. “When I was in residency, people weren’t going into psychiatry; they weren’t choosing psychiatry to fix these problems. They were choosing psychiatry because they wanted to have one-on-one patient interactions and work with high paying rich people who were the group that we call the ‘worried well.’ That’s shifted dramatically and that’s really exciting to me.”

A ‘Heart’ For The Work

Bryant Howard owns and operates Heart of the Matter Counseling in the Pocket area. A native of a small town, Derby, Connecticut, Howard, 36, originally envisioned a career designing video games, but shifted focus to school guidance counseling and later marriage and family therapy. 

“I love where I’m at now,” he says.

Howard holds a bachelor’s degree in psychology from Sacramento State and a master’s in counseling psychology from the University of San Francisco. He didn’t see many other Black men during his pursuit of higher education.

“You’re used to looking around and not seeing anyone that looks like you,” he said. “It doesn’t faze you because you’re so desensitized to it. You’re the only Black person in the room a lot of times, so it’s a normal feeling. When there is another Black person in the room, you notice.”

Males in the field are rare in general, Howard says.

“Mental health and therapy used to be a male-dominated field. I don’t know when the shift happened, but it isn’t anymore.”

Howard created his own lane — and his own business.  “I was going through my master’s program and all the teachers will tell you in this area of expertise, you are not going to make a whole lot of money, they’ll tell you that from the get-go. And I always thought, that doesn’t make any sense. I look at therapists on TV all the time and those people look like they’re rolling a little bit.

“I soon figured out that the reason these professors are saying that you’re not going to make a whole lot of money in mental health is because most people don’t open up their own private practices. They’ll go and get jobs in the community and do community based-mental health. Therapists who work for non-profits don’t generally make a lot.”

 “That was never who I wanted to be. I wanted to be successful. I wanted to make good money and all that stuff,” Howard said.

Howard worked in community-based mental health for about five years, earning hours toward his license before starting his private practice.

“There’s more risk because I own a business and the risk falls on me,” Howard said. “Everything falls on me, but I wouldn’t have it any other way.”

Howard’s Heart of the Matter Counseling has a diverse team of therapists, but its owner knows that many seeking culturally competent care seek him out because he is a Black man. 

“I have been called a unicorn,” Howard said. “I’m a unicorn in terms of me being a Black man who’s doing therapy. I’m a licensed marriage and family therapist and you just don’t see that often. Because of that, yes, there’s a whole lot of African Americans reaching out to me wanting to schedule sessions with me.”

Other clients want him as their therapist because they grew up in urban or diverse neighborhoods and feel more comfortable with someone of similar background. 

“Therapy is about the fit,” Howard says. “When you have a conversation with someone and you’re gonna tell them all your stuff, you have to have a good vibe with them. If you come to me and you’re just like, ‘This ain’t gonna work,’ that’s OK. When you step into this room and sit on that couch, you have to be comfortable being able to talk to me.   Initially, you may not be comfortable, but who is yet in their first session, but maybe their first couple of sessions are going to be nervous and thinking, ‘Okay, I’m going to tell this person all of my business and I have to trust this person, so it’s natural for a person to be (hesitant), but you kind of have to get past that and allow therapy to happen.”

Culturally-competent therapy helps build stronger, authentic and trusting relationships between clients and therapists, says Heart of the Matter clinician Thelma Zazueta.

”The way I approach culturally competent therapy in my daily work is to remind myself who I am, where I come from, and why I identify as a BIPOC therapist,” Zazueta said. “Although I also implement what I have learned from cultural competency training, what I focus more on is learning the story of my clients and understanding where they come from.”

Attitudes toward therapy are changing for the good, Howard says.

“COVID was a big, big thing for all of us,” he said. “Our eyes opened to that example of mental health is something that we need to deal with. It is a thing. What COVID did is it forced us to be home, it forced us to have to deal with the things that we locked up and put away.

“COVID made us focus on that. A lot of people just said, ‘You know what, I need help with this’ regardless of what stigma there is. It really forced a lot of people to go and seek out the help that they absolutely needed,” Howard said. “Whether it was issues in their lives, especially the issues in relationships, traumas and things like that, COVID forced us to be in our houses and forced us to be in situations where we were thinking about stuff and recognizing the pain that we’re in and we said, ‘This hurts. Forget what anybody thinks, this hurts and I need to go get it figured out.’  It’s been amazing to see men come in for therapy and say, you know, I just need to, I need to work through this. Seeing that stigma being lifted has been an amazing thing.”