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Lessons
From Practice with Black Middle-Class Families
Monica Pierrepointe, LCSW, BCD, Private Practice
Human beings across culture, class, gender and time share certain universals: We’re born small, develop along pre-determined lines, and grow up to love, work, play and procreate.
Black middle-class families present for treatment with problems that arise
from much the same interface of developmental and societal forces that
contribute to problems in all socioeconomic groups. However, class and
ethnicity, along with individual and familial styles of coping with developmental
and societal challenges, can result in a dysfunctional dynamic. Also,
forces like immigration, economic discrimination, and a new middle-class
status can be contributory.
Families often lack the financial support of extended family members that
established middle-class families might have to lessen the financial burden
of providing their children with middle-class experiences. Often, both
parents need to work to maintain a basic middle-class lifestyle –
sometimes at multiple jobs – leaving children with less than adequate
supervision or attention to schooling, etc. Sometimes, these families
help to support relatives here or “back home” or help to raise
children of other less successful family members.
The African Diaspora Continues to Resonate
Forces rooted in the early European encounter with Africa affect all people
of color in America. Recent voluntary African immigrants, upon arrival,
experience the same social conditions that shape the lives of people of
color here. Other blacks, both native born and descendents, and Caribbean-Americans
and their descendants, are products of the African Diaspora: the dispersal
of peoples of African descent throughout the New World and their subsequent
enslavement – i.e., the theft of their labor, and the psychological
and physical subjugation that made that possible. Psychological and economic
consequences continue to resonate in black families today. It is critical
that the treating therapists understand each individual’s subjective
relationship to that history and its impact on his/her life. A social
work perspective is especially helpful in understanding the dynamics of
families such as these.
Learning to Live with Privilege
Some middle-class blacks react with conflict about their achievements.
This may be evidenced in their feelings of guilt, extreme sense of responsibility
to family members and their sense of not deserving the benefits of their
achievements. Also, fear about the tenuousness of their middle-class status
may add to the financial burdens carried by many that have managed to
achieve their education without benefit of family
support. The following case example illustrates some of the dilemmas.
Marva, age 30, completed a graduate degree, under considerable financial strain, in order to secure a rewarding and prestigious position in the corporate world. In treatment she presented with anxiety about her performance and doubts about how her supervisors and co-workers viewed her performance. A child of a middle-class family, M had a fairly comfortable upbringing, attending private school for part of her education, and enjoying a range of cultural and social opportunities. But, she felt considerable guilt about the struggles her parents and grandparents had endured to make her comfortable life possible. She also imagined that some more creative or artistic- but financially less rewarding- career might be more satisfying. This seemed in part a consequence of some identity diffusion resulting from her limited socialization with black peers because of her attendance at a largely white private school. Her parents, like many middle-class black parents, opted to provide her with the best educational opportunities available, instead of social opportunities with black peers. Treatment helped to lessen the pressure of an overly harsh super-ego and further the consolidation of her identity. It also enabled her to begin to search for appropriate ways to contribute to her community while enjoying the benefits made possible by her hard work.
Black Patients Seek a Therapist of Color
Given the health profession’s history of mistreating and over diagnosing
black patients, black patients often seek a therapist of color, hoping
to, thus, bypass some of the concerns that arise elsewhere in the cross-cultural
interface of blacks and whites in our society. White patients working
with a black therapist present with similar concerns, but these tend to
unfold in different ways. Always, the critical and universal need is for
the therapist to be sensitive to her/his own reactions to the patient’s
presentations. She/he must be vigilant for the ways in which her/his own
regressive and disorganizing feelings and impulses, with regard to the
highly charged issue of difference, can readily threaten the intimacy
and trust of the therapeutic encounter.
Finding My Way to Private Social Work Practice
My own path to private social work practice was serendipitous. The Social
Work Recruiting Center at my college steered me to a summer job, which
after graduation became a position in foster care. With the guidance of
professors andsupervisors, I found my way to a career in mental health
– a specialty previously unknown to me, though consonant with my
interests. Employment and further training at the Jewish Board of Family
and Children’s Services enabled me to gain experience with varied
populations, reinforcing the knowledge that problems in living develop
across class and ethnic lines. My own treatment provided the arena within
which to integrate these experiences with my own life situation.
Opportunities for students like myself, from ordinary middle-class families
of color with no real knowledge of mental health, to be identified and
introduced to open-ended mental health treatment, seem rarer nowadays.
This may be an unfortunate result of the current mental health climate
– managed care, cuts in the mental health budget, and a de-emphasis
on professional provision of services in preference for volunteer and
non-professional providers. The erosion of confidentiality that has accompanied
managed care is an additional challenge in providing patients with a climate
of trust. The work itself, however, remains endlessly rewarding.