Kathryn’s Story: Developing My Roots as an American of African Heritage

“Black people don’t need to tan!” my White friend said as we sat at the pool shortly after I emigrated from Jamaica. This was the start of my journey toward discovering my Blackness. No matter how I tried to ignore it—moving along with my idea that everyone is the same and race didn’t matter—it kept resurfacing. Junior high and high school were a painful time of reckoning for me. I was mainly teased and ostracized for my accent, but certainly my skin color became a factor. The move to Miami when I was thirteen tested my sense of myself and my place in the world. I truly lost my voice because I was afraid to speak and be ridiculed. I regained some confidence in my undergraduate years at the University of Miami when I joined the Jamaican organization and took on some leadership roles. When I began to work with Carolyn Tucker, an African American woman who was the most successful grant writer and prolific researcher in my counseling psychology doctoral program at the University of Florida, I began to experience a shift in my conception of how African Americans and minorities live in America. My experience on her research project helped me learn how racism, microaggressions, and economic oppression reduce Black children’s ability to experience growth like their more privileged counterparts. I realized at that time that there was definitely an uneven playing field.

It was a painful time for me to admit that I was living in a racist country. By taking up this fight, it meant that I was acknowledging that I might not be able to succeed because of the color of my skin. I decided to become a champion for racial and social equity, educational achievement, and antioppression forces. That started my journey toward being a cultural competency trainer as part of my role as a health psychologist and behavioral science faculty member in a family medicine residency. It was here that I crossed paths with Karen for the first time.

Ironically, although she is White and Jewish, learning about anti-Semitism and sexism from her viewpoint allowed me to more fully understand and work through my experience of being Black in America. She was in fact the first person to discuss with me that she “acknowledged her White privilege,” and she did it shortly after we met. Frankly, I was taken aback and not quite ready to have that conversation. It would eventually become apparent to me that she was bringing attention to the “power over” aspect of our relationship in order to avoid abuse of power or shaming, salient tenets of RCT.

Karen’s Story: Acknowledging My White Privilege in Community, Profession, and Relationships

My grandfather settled in Daytona Beach, Florida, in 1910, one of the first Jewish settlers in this community. Fifty-five years later, I was taunted in my elementary school cafeteria by classmates demanding to see the horns hidden in my thick, curly, brown hair. Threats that I was destined to burn in hell for eternity terrified me. My parents owned a roofing business; indeed, everyone in my family worked in the family business. We learned early in life of the responsibility that came with White privilege and to manage anti-Semitism. The history of close alliances between the Jewish community and African American community was evident in my home. I won’t attempt to sugarcoat it, though: in the roofing business, the men toiling in the Florida sun were primarily African American. We worked inside, in the air conditioning.

My junior high school was integrated in 1969, when I was in seventh grade. In civics class, my best friend was Martin, an African American young man who sat in front of me. Surprisingly, we talked about racism. Our school was beachside. Only a few years earlier, Blacks were not allowed on the beachside without a permit. We shared our memories on the segregated buses, bathrooms, and water fountains as our school was struggling with civil rights. We found a way to bridge our very different perspectives during this tumultuous time.

When I returned to live in this community and practice as a psychologist in 1990, my office was down the street from the site of my former junior high school. The school had been demolished; the site was now a parking lot. The destruction of the building seemed a powerful metaphor. The places we sought to change may be gone, but the invisible boundaries of segregation have taken decades to erase.

When we began our work together in clinical supervision, Kathryn’s experience as a Black woman in a predominantly White and male traditional medical workplace brought my White privilege front and center. The traditional supervisory position of authority and power could not be the status quo. It was painful to recognize the microaggressions happening both in her workplace and by my actions. Our relationship became central to every discussion. It was important to name our racial and cultural differences and to examine how my perspective was naive regarding her reality, especially within the dominant health-care system. Adopting the language of RCT, the focus became how we could embody the change we seek while working together with honesty and candor.

Relational Cultural Theory

Our theoretical foundation lies in RCT. Jean Baker Miller’s text Toward a New Psychology of Women (1986) posits the fundamental notion that humans are relational beings who develop in a cultural context, seeking growth in interpersonal connection. Acknowledgment of racial or cultural dissimilarities is critical to meaningful relationships. Humans beings are hardwired for connection, not isolation, in the face of forces that convey, “You are not enough or don’t belong.” Chronic disconnections are viewed as the primary source of suffering, exacerbated by abuses of power from the culture. Strategies of disconnection become lifesaving and mind-saving survival tactics, as humans both long for and are terrified of connection. The quality of healing connections is evidenced by an increased sense of worth, clarity, zest, and desire for more (Miller & Stiver, 1997).

In psychology supervision, the internalized messages often are critical and subordinating. Moving away from “thou shalt not” shaming to “how we learn together” collaboration embodies a relational model. Thus our relationship evolved from “mentorship” to collaboration within the first three to four years as we worked together in community social justice activities and presentations at national medical education meetings. The shift from “I” and “you” to “we” required us to work toward something mutually empowering.

People feel shut out of relational possibilities when their “differences” thwart the opportunity to be seen and heard, to know “beloved community.” “Beloved community is formed not by the eradication of difference but by its affirmation, by each of us claiming the identities and cultural legacies that shape who we are and how we live in the world” (hooks, 1995, p. 265). The goal is to shield vulnerability, to maintain a safe space so that connections can happen, and to create relational possibilities. When there is authentic communication, the magic happens: we are both seen and heard. The “relational anchors that enable healing and healthy development are empathy, authenticity, and mutuality” (Walker, 2017). We relied on RCT to cocreate a multifaceted alliance over nearly twenty-five years.

The Story of Two Friends, Colleagues, and Allies

We recognized early that our cultural differences bound us together. As xenophiles, we share a curiosity about and attraction to foreign cultures, customs, and people. It seemed inevitable that we would collaborate in social justice action regarding race, gender, and sexual orientation. Kathryn was up against the wave of White male dominance in the medical world. Karen morphed into a “white ally” (Sue, 2017), not only to support Kathryn but also to support our clients, our causes, and our community. We shared a passion to listen and be heard on what matters to us: social justice, health-care disparities, and a “power over” world that continues to crush efforts to empower marginalized “others.”

We began antiracism work together in the mid-1990s. We were the two psychologists in Mission United (MU), a group of young professionals that was 50 percent African American and 50 percent White. The group initially formed to address local racial tensions following the Rodney King riots. Our seminal task was to monitor and patrol the activities of Black College Reunion, a weekend during spring break celebrating historically Black colleges and universities. We went to the community events and neighborhoods in pairs, one Black and one White MU member, wearing shirts identifying our organization. The Black College Reunion events ignited a firestorm of local controversy. MU sought to mitigate outcomes with our presence and communication with both visitors and residents. The White residents were suspicious of the convergence of thousands of Black youths along their beachside neighborhoods. The Black visitors and residents, in turn, were outraged at this overt prejudice. The MU pairs served as local ambassadors seeking to promote coexistence. Thankfully, these weekends did not escalate racial conflicts, although arrests skyrocketed compared with the remainder of the spring break week.

MU members recognized the enormity of our goal: assuaging the reactivity across the community sparked by Black College Reunion. RCT reminds us that growth occurs as a yearning for connection in the face of repeated and chronic disconnections. Our efforts in MU emphasized our need for empathic attunement (Walker, 2004) to our group, to the disenfranchised community, and to the dominant cultures’ efforts to silence and eradicate these events.

MU continued to address racial concerns in the community for several years. The topic “Why can’t we talk about race?” was the subject of numerous MU meetings and community workshops. Group members had backgrounds in business, law, finance, law enforcement, education, health care, hospitality, housing, entertainment, and sports. Kathryn and Karen united to encourage others to bring their professional and personal expertise to the group so we could dismantle misconceptions and create cooperative opportunities. We were frequently tasked with communication skills training when discussions went sideways, and sometimes we were simply asked to intercede.

Despite good intentions, we recognized the group’s discomfort with addressing the issues of racial hostility and implicit bias. Membership in the group did not mean we could openly admit our racial bias and stereotypes. As psychologists schooled in RCT, we realized that our unique positions in the group enabled us to steer the conversation in ways that fostered connection rather than division. The group’s members needed skills and guidance to work side by side, Black and White, to dispel racial tensions.

As psychologists, we were granted permission to steer discussion of uncomfortable topics toward understanding and compassion. We provided diversity education and additional trainings to promote friendships and professional alliances that likely would not have evolved without this group. This method of developing relationships was not “power over” but “power with,” and it explicitly addressed racial disparities among young professional leaders.

We have persevered through anguished conversations, exchanging memories about racial slurs, being ostracized, and “having difficult hair.” Our misunderstandings and hurt feelings moved us from disconnection to connection as we shared suffering.

Confronting Race and Culture in Medical Education

Education becomes most rich and alive when it confronts the reality of moral conflict in the world.

—Zinn (2002)

Family medicine is undoubtedly one of the noblest professions. No other profession concerns itself with the well-being of the entire human being—mind, body, and spirit. Most family medicine residency training programs hire mental health faculty to address the psychosocial aspects of medicine, and residents are trained in the biopsychosocial model of health care (Sternlieb, 2014). The social, racial, and spiritual complexity of our nation, which is only increasing, requires that these emerging physicians understand their patients’ backgrounds (American Psychological Association Working Group on Stress and Health Disparities, 2017; Edgoose et al., 2017; Ring, Nyquist, & Mitchell, 2008). The behavioral science coordinator position was Kathryn’s first job out of graduate school, and it involved steep learning curves about the culture and atmosphere of graduate medical education. Despite being seen as an outsider as a petite woman of color who couldn’t possibly understand the issues of teaching medical residents, she forged on as the driving force in the initiative to recruit more minorities to the program. Being able to talk openly and depend on her alliance with Karen was of major benefit in this cause. There were numerous challenging but ultimately rewarding experiences when dealing with racial identification and its intersection with medical education.

In 1997, we had the opportunity to make exponential progress toward our goals. The residency program received two consecutive three-year federal grants, nearly $1,000,000 in funding, to promote cultural competence as well as technological advances in health-care education. The curriculum was dedicated to teaching medical residents techniques to improve care of ethnically diverse and medically underserved populations, with Karen playing major roles in developing lectures and providing consultation in topics regarding diversity and women’s health.

When we began to develop the lectures and seminars, the cultural competency curriculum in medical education was in its infancy. We focused mostly on trying to teach about the health beliefs of the major cultural groups in the United States. As the White ally and an outsider to the program, Karen would often raise the more provocative challenges to status quo health care. We quickly learned that Kathryn’s role as a Black female spearheading these conversations was a crucial part of the process. Though we did not specifically intend it to be the catalyst of a movement, it became clear from some of the residents’ reactions that this presence was unsettling, disturbing, and in fact a target to rebel against. This prompted difficult discussions. It also laid the foundations for further attention to how diversity in providers, as well as patients, could present barriers to communication and ultimately result in inequitable health care if not addressed (Bahls, 2011; Edgoose et al., 2017; Rodgers, Wending, Saba, Mahoney, & Brown Speights, 2017; Smedley, Stith, & Nelson, 2003).

Evolution of the Curriculum: Teaching about Culture, Racism, and Socially Responsible Medicine

Reni Eddo-Lodge (2017) wrote, “White privilege is an absence of the consequences of racism. An absence of structural discrimination, an absence of your race being viewed as a problem first and foremost” (p. 60).

So what could we do about the negative feedback, the attempts to marginalize us and this work, and the personal hurt felt as we started this journey? We raised some provocative questions about racism and its effects on health care and professional relationships. When participating in discussions about moving minority candidates on a rank list as part of resident recruitment meetings (at the behest of her White male program director, interestingly enough), Kathryn was often confronted by some of the White males. Once, one of the White females came and offered supportive statements—this kindness encouraged Kathryn to “press on.” In those days, it didn’t take much to feel like a fool in front of this tough audience of medical trainees.

That’s where Karen’s support and can-do spirit were instrumental. Her empathy, energy, and respect were zestful. We found that instead of backing off, we needed to take the conversations deeper and further. When asking the residents questions about what they learned in their families and communities regarding those who are different, we were often met with chagrined looks, defensiveness, and more silence than we had hoped for. Karen was able to use her experience as a White person to make it OK for the group to talk about our nation’s complex history with racism. The residents didn’t necessarily expect to be talking about racism during a lecture like this. They were used to being given formulas, algorithms, and decision trees to make their choices about patient care. This was a much deeper and more emotional process than they usually experienced in a lecture. Our partnership became a model for them of how differences can be bridged and how lessons can be learned by having challenging conversations in a supportive and nurturing atmosphere. Our rapport and obvious camaraderie fostered the belief that awareness and transformation were possible.

Over the years, medical education about culture and diversity has grown from simply trying to make sure our students understand different cultures to in fact teaching them about the complexity of living in a multicultural, democratic society. Camara Jones (2000) describes the tripartite approach to racisms at three levels: institutionalized—propagated and accepted by institutions; personally mediated—differential actions toward others; and internalized—instilled in persons of color by racist attitudes around them. All of these feed implicit bias, which exists in all of us. Those of us in medical education should help our learners unearth destructive racist attitudes and promote healing approaches in equitable, relationally based care. These are challenging tasks, and we have learned that White allies like Karen are instrumental in advancing these causes.

Professional Development as a Black Female Educator

There is somewhat of a paradox in the fact that as a Black female educator, you may be highly sought after to fill a position to satisfy your organization’s desire for diversification. However, once you get there, they often don’t know what to do with you. Black females remain underrepresented in this field, and it is important to be well versed in the medical facts of health-care education, as well as the social issues that affect and are affected by the topic of health care for minorities. Having forged a firm alliance around principles of RCT, Karen and I have used methods of mutual empowerment and goals of authentic actualization to strengthen our work and our friendship. Our partnership has been instrumental over the years, and many elements of this have been captured in a recent issue of Counseling Psychology entitled “White Allies: Current Perspectives.” These articles detailed the joys and challenges of being White and doing this kind of work, voicing strong encouragement to take on an antiracist identity that “walks the talk” (Sue, 2017).

As a minority, it is easy to become the target of anger and resentment, to experience feelings of shame when doing this work. White allies can help bridge the gap between the learning experience and changes in actual practice. We must help our learners unearth the deeper factors that feed implicit bias (Cooper et al. 2012). This blocks providers from accessing skills for equitable health care. Kathryn’s dedication to these practices undoubtedly contributed to her rise to leadership in behavioral medicine education; she was appointed to direct a national training fellowship for early career faculty. Karen has also received a national award for community activism and advocacy. Clearly, our collaborative work with diverse groups has created advantages in being able to reach greater numbers.

Future Directions and Collaborations

Bell hooks (1988) wrote, “Even in the face of powerful structures of domination, it remains possible for each of us, especially those of us who are members of oppressed and/or exploited groups as well as those radical visionaries who may have race, class and sex privilege, to define and determine alternative standards, to decide on the nature and extent of compromise” (p. 81).

Multicultural relationships and social inequity seem to be more pronounced and glaring today than ever before. The question remains: What factors have emerged that are crucial to propel effective Black leadership? If we are empowering difference in the face of inequity, what are the gray areas of power, race, gender, and class that remain the roadblocks to change? The advances, triumphs, and travails of our partnership have all led to a deeper mutual understanding. The exciting discovery of relational possibilities fuels our work, and we continue to strive to embrace the challenges that accompany growth.

We encourage others to move toward and work through conflicts that arise due to difference, and we feel that effectively doing so will allow Black leaders to emerge more powerful and skillful. In their work Toolkit for Teaching about Racism in the Context of Persistent Health and Healthcare Disparities, Edgoose and colleagues (2017, pp. 4–5) offer guidelines for conducting provocative discussions on race, racism, disparities, and privilege:

Before the Discussion:

• Take some time to self-reflect.
  • –  What are comments, situations, and feelings that trigger you? How will you handle it if they come up during the session that you are leading?
  • –  Consider the impact of your own identity. What might White facilitators need to be sensitive of? What might facilitators of color need to be sensitive of?

During the Discussion:

General Do’s and Don’ts of Facilitating

• Do practice empathy
• Do be prepared that everyone will not agree with your points
• Do explore emotions in addition to content
• Don’t make anyone a spokesperson
• Don’t rescue or reassure White people
• Don’t turn to people of color (POC) as experts

Ways that Privilege Presents Itself and Common Defense Mechanisms

• Invalidating/reframing experiences of POC
• People of privilege distancing themselves from their group (e.g., a White person talking about the way other White people behave in an attempt to separate themselves as exceptional)
• Focusing on ways in which one has been oppressed other than race (e.g., bringing up class or a White woman focusing on her identity as a woman rather than her White privilege)

We have presented at national conferences, published articles, and provided trainings on health care with diverse, minority, and underserved populations. We also cofounded a local not-for-profit in 2001 dedicated to raising awareness about eating disorders and body image concerns across the life span that affect all ethnicities and populations of all socioeconomic statuses. Our partnership has been the common thread that has elevated us to better understand the dynamics of the populations we serve. It has not always been easy for us as women from such varied backgrounds, but we have learned from our own differences how to bridge the gaps of race, culture, ethnicity, and spiritual beliefs.

Ultimately, our friendship has deepened as our lives unfolded, losing loved ones, enduring health crises, getting married, having children, experiencing rites of passages, and evolving into seasoned psychologists in our respective specialties. We are constantly reminded that Kathryn’s Black identity and Karen’s White identity are central to our deep connection. Meeting at the points of connection across difference reinforces the idea that “getting along is not enough,” as Maureen Walker (2017) reminds us. We must do more to confront White racial privilege and Black oppression. Complacency is not an option.

A Final Note: Our Lessons for Black Leaders

1. Start where you are, do what you can, and speak your truth, even if it is spoken quietly at first.
2. Find small causes, assess local needs, and gather support, even if it is a small but loyal following. Find your allies and start some conversations about your experience.
3. Question the status quo. Ask why or why not. Why shouldn’t I get involved with this cause?
4. Allow yourself your down days, where you question yourself and your efforts. Be sad, feel deflated, but keep going even if you have to slow down a bit.
5. Find bigger causes, speak your truth even louder, and gather your tribe.
6. Find more allies, those who are different from you, who want to learn about your experience. Continue those conversations, even bigger and louder as you go along.
7. Teach about your experience and reach out to those who are just starting. Encourage them through the process.

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