I don't want to reply to that thread about CBT & the harm it can cause bc I don't want to dismiss or speak over the people who have been harmed by it. Bc these are very real experiences. The mental health field, like every other system in the U.S. /1

is steeped in racism & white supremacy. As a white person & clinician-in-training, I can't speak to the extent of this & the voices of POC & POC therapists are more important voices to listen to. /2

What I will say is that CBT utilized to dismiss rational fears, esp. around experiences with racism, sexism, homophobia, transphobia, etc. is not necessarily inherent to CBT. Rather, it's CBT being used as a tool of oppression rather than a tool to actually help the client /3

I don't think it's possible to effectively & ethically provide treatment without significant training & continuing education in cultural competence. I also think there are a LOT of people who provide therapy who don't have the training they should in this area /4

I've personally been helped a lot by CBT. But my therapist combines his CBT approach with a feminist one, among other theoretical orientations. An ethical therapist is a therapist who takes into account a client's cultural background, understands systems of oppression, /5

& works with the client to help them find ways to empower themselves. Dismissing a client's fears, sadness, etc. is unethical. Period. Even more so in the context of oppression, power & privilege. /6

There is a lot of work to be done on decolonizing therapy. The reality is that there are far too many therapists who end up engaging in harmful, unethical practice bc of a lack of cultural competence. Whether willful or not, it's deeply harmful /7

& acts as a function of oppressive systems. While it is in the code of ethics of social workers, therapists, & psychologists to maintain and increase cultural competence, that doesn't mean it's something everyone does. /8

Unfortunately, a lot of people walk away from therapy deeply harmed & believing that therapy & the specific theoretical orientation of their therapist is inherently harmful. /9

I don't think it's CBT that's the problem. I think it's clinicians who don't take cultural competence seriously. I think it's clinicians who don't understand systems of oppression. Who don't understand power & privilege. Who don't check their biases. /10

So much of the work of being a therapist or training to be one requires being vigilant about our own biases, & working to address them. Self-reflection & being willing to work on our own problems, our own biases, our own prejudices, is vital to the work of therapy /11

If we aren't willing or aren't able to do this, we cannot be ethical in our practice. & we should seriously reconsider whether or not to move forward on this career path. /12

We can do deep, irreparable harm to clients when we don't do these things, when we don't think about cultural competence, or how systems of oppression, power & privilege, affect our clients, or how they affect us. We can actually retraumatize our clients when we do this. /13

& as we can see, this can turn people off of therapy entirely & make them weary of mental health workers, for good reason. /14

To be an ethical clinician is to be a culturally competent one. To use CBT or any other approach ethically, systems of oppression, power & privilege, must be taken into account. Otherwise, we can deeply harm our clients. /15

It is the responsibility of therapists, mental health professionals, and other healthcare workers to understand our own biases & prejudices, to work to address them, & to understand how it impacts us & our clients. /16

It is also our responsibility to understand the dynamics of racism, sexism, homophobia, transphobia, ableism, classism, xenophobia, etc. in order to provide ethical care. /17

To be a healthcare professional, we must be willing & able to look at these things. Otherwise, people get hurt, & sometimes, that hurt can cause damage that we may not be able to repair. #culturalcompetence #therapy #medtwitter #therapist /18