Practice Recommendations for Addressing Racism: A Content Analysis of the Counseling Psychology Literature

Matthew J. Miller, Brian TaeHyuk Keum, Christina J. Thai, Yun Lu, Nancy N. Truong, Gloria A. Huh, Xu Li, Jeffrey G. Yeung, and Lydia HaRim Ahn

University of Maryland, College Park

Although racism persists as a significant public health issue that adversely impacts the mental health of people of color (U.S. Department of Health and Human Service, 2001), there has been very little systematic guidance for mental health professionals to address racism through practice (S. Harrell, 2000). Therefore, we conducted a content analysis of the peer reviewed counseling psychology literature—the first of its kind—to provide a summary and critique of the extant practice recommendations and facilitate the development and enhancement of practice efforts aimed at addressing racism. We reviewed racism- related articles published in the Journal of Counseling Psychology, The Counseling Psychologist, and Counseling Psychology Quarterly and identified 73 relevant articles, of which 51 provided practice recommendations. Based on our review of this literature, we identified eight general categories of recommendations for addressing racism: psychoeducation, validation, self-awareness and critical con- sciousness, critical examination of privilege and racial attitudes, culturally responsive social support, developing positive identity, externalize/minimize self-blame, and outreach and advocacy. We found that most recommendations within each category were at the individual level with far fewer at the group and systemic level. A critique of recommendations is provided along with suggestions for developing and bolstering practice, research, and consultation efforts aimed at addressing racism.

Public Significance Statement For people of color in the United States, racism is ubiquitous and insidious. Unfortunately, mental health professionals lack systematic guidance in addressing racism through practice. This study—the first of its kind—summarizes and evaluates practice recommendations for addressing racism in the peer reviewed counseling psychology literature and provides mental health professionals with strategies for addressing individual, group, and systemic racism.

Keywords: racism, coping, practice recommendations, mental health

Racism, the longstanding system of dominance, power, privi- lege, inequity, and oppression based on socially constructed racial hierarchies, continues to be a social and political reality resulting in maltreatment, unjust burden, and disparities for people of color in the United States (Brondolo, Gallo, & Myers, 2009; Harrell, 2000; Jones, 1997; Lewis, Cogburn, & Williams, 2015). The system of racism was created and is sustained through “the trans- formation of race prejudice and/or ethnocentrism through the exercise of power against a racial group defined as inferior, by individuals and institutions with the intentional or unintentional support of the entire culture” (Jones, 1997, p. 280). Racism is ubiquitous and can occur at the individual, group, or institutional

and structural levels (Harrell, 2000; Jones, 1997). It can be expe- rienced directly and vicariously and can range from subtle daily microaggressions to threats of physical violence to overt acts of hate and violence (Brondolo et al., 2009; Harrell, 2000; Liang, Li, & Kim, 2004; McNeilly et al., 1996; Utsey & Ponterotto, 1996). As a social construction, the manifestation of racism evolves in concert with changes in societal racial attitudes (McConahay, 1986). It is therefore important to note that although the trend in the racism literature in recent years has shifted from a focus on explicit and overt forms to subtle, aversive, colorblind, and micro- aggression forms (cf. Dovidio & Gaertner, 1998; Neville, Lilly, Duran, Lee, & Browne, 2000; Sue et al., 2007; Yoo, Steger, & Lee, 2010), we argue that the current sociopolitical climate in the United States reflects more explicit, overt, blatant, and hostile manifestations of racism. For example, the number of hate groups operating in the United States recently increased from 892 in 2015 to 917 (Potok, 2017) and 58.5% of the hate crimes recently reported by the Federal Bureau of Investigation Uniform Crime Reporting Program (2017) were race-based.

Whether subtle or blatant, individual or systemic, direct or vicarious, the mental health consequences of racism for people of color are overwhelmingly negative. Meta-analytic evidence based

This article was published Online First August 9, 2018. Matthew J. Miller, Brian TaeHyuk Keum, Christina J. Thai, Yun Lu,

Nancy N. Truong, Gloria A. Huh, Xu Li, Jeffrey G. Yeung, and Lydia HaRim Ahn, Department of Counseling, Higher Education, and Special Education, University of Maryland, College Park.

Correspondence concerning this article should be addressed to Matthew J. Miller, Department of Counseling, Higher Education, and Special Edu- cation, University of Maryland, 3214 Benjamin Building, College Park, MD 20742. E-mail: [email protected]

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Journal of Counseling Psychology © 2018 American Psychological Association 2018, Vol. 65, No. 6, 669 – 680 0022-0167/18/$12.00 http://dx.doi.org/10.1037/cou0000306

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on 23 independent studies of Asian American (Lee & Ahn, 2011), 51 independent studies of Latina/o (Lee & Ahn, 2012), 27 inde- pendent studies of Black (Lee & Ahn, 2013), and 66 studies of Black (Pieterse, Todd, Neville, & Carter, 2012) populations all found significant relationships between racism and psychological distress. Scores of independent studies have also documented the associations between racism and depression and anxiety (Bron- dolo, Rieppi, Kelly, & Gerin, 2003; Pascoe & Smart Richman, 2009; Paradies, 2006; Priest et al., 2013; Williams, Neighbors, & Jackson, 2008), life satisfaction (e.g., Utsey, Payne, Jackson, & Jones, 2002; Valentine, Silver, & Twigg, 1999), self-esteem (e.g., Barry & Grilo, 2003; Harris-Britt, Valrie, Kurtz-Costes, & Row- ley, 2007), eating behavior (Durso, Latner, & Hayashi, 2012), substance use (Gibbons, Gerrard, Cleveland, Wills, & Brody, 2004), and quality of life (Utsey et al., 2002).

The deleterious effects of racism have garnered significant pub- lic health attention and the Surgeon General’s Office has urged scholars to develop strategies and interventions to buffer the harm- ful influences of racism (U.S. Department of Health and Human Service, 2001). However, although there is a vast literature high- lighting the negative impact of racism on psychological and phys- ical health, there is much less certainty on how the application or practice of psychology can be leveraged to address the prevalence and impact of racism. Given the ubiquity and severity of racism in the United States, there is a clear and pressing need for counseling psychologists (and mental health professionals in general) to be well equipped to address racism through practice. However, whereas summaries of racism literature to date are meta-analytic reviews of research findings (e.g., Pieterse et al., 2012), conceptual (e.g., Harrell, 2000), and/or measurement focused (Paradies, 2006), a summary and evaluation of practice recommendations for addressing racism has not been published. We felt that there were numerous responsive and effective practice recommendations for addressing racism in the peer reviewed counseling psychology literature and that providing a critical summary of these recom- mendations would be a valuable resource for counseling psychol- ogists interested in addressing racism through practice. For exam- ple, counseling psychologists could use such a resource to develop and/or bolster prevention and intervention programs aimed at helping individuals cope with racism. Therefore, we conducted a content analysis of the practice recommendations specific to ad- dressing racism in the peer-reviewed counseling psychology liter- ature.

Addressing Racism: A Social Justice Imperative for Counseling Psychology

Counseling psychology’s applied nature, history, and core val- ues in educational, developmental, preventative, multicultural, and social justice foundations make it uniquely positioned to effec- tively and appropriately address critical societal issues such as racism through practice (Goodman et al., 2004; Helms, 2015; Vera & Speight, 2003). From its inception, counseling psychology has emphasized justice and the eradication of social inequity (e.g., working with veterans in the 1940s; Fouad et al., 2004; Hartung & Blustein, 2002). In recent decades, counseling psychology as a field has further deepened its commitment to “scholarship and professional action designed to change societal values, structures, policies and practices” (Goodman et al., 2004, p. 795) to system-

atically challenge the status quo and promote well-being and achieve equity at individual, community, and systemic levels (Vera & Speight, 2003).

In her 2009 Presidential Address at the annual business meeting of the Society of Counseling Psychology, Janet Helms called on counseling psychologists to take action against racism (Helms, 2015). Over the past several years counseling psychologists have heeded this call and have produced a number of important, inno- vative, and informative articles that have elucidated our under- standing of racism and the field of counseling psychology has emerged as a leader in the study of race and racism (Delgado- Romero, Galván, Maschino, & Rowland, 2005). For example, studies in the counseling psychology literature suggest that it is beneficial to help clients use adaptive coping strategies such as problem solving (Villegas-Gold & Yoo, 2014), social support (Cheng & Mallinckrodt, 2015; Lee & Ahn, 2011), and family support (Wei, Yeh, Chao, Carrera, & Su, 2013) to cope with racism. Studies have also demonstrated the costs of coping strat- egies such as self-criticism, social withdrawal, wishful thinking, and suppressive coping (Wei, Ku, Russell, Mallinckrodt, & Liao, 2008; Villegas-Gold & Yoo, 2014) when dealing with racism. This literature also suggests that when discrimination was low, cogni- tive restructuring and problem solving buffered the effects of racism on psychological well-being (Yoo & Lee, 2005). Counsel- ing psychology research has also demonstrated the importance of attending to the intersections of race and other social identities (e.g., gendered racial microaggressions; Lewis & Neville, 2015; Wong, Tsai, Liu, Zhu, & Wei, 2014), and gendered differences in the function coping strategies (Alvarez & Juang, 2010). For ex- ample, Alvarez and Juang (2010) found that active racism coping functioned differently for Filipino American women than it did for Filipino American men.

Purpose

Although there are numerous practice recommendations for addressing racism in the peer-reviewed counseling psychology literature, the lack of a summary of this literature represents a practical barrier for counseling psychologists (and other mental health professionals) intent on developing and implementing prac- tice efforts to take action against racism. According to Harrell (2000), “mental health practitioners have had little systematic guidance in exploring the multiple ways that racism may influence their clients’ well-being” (Harrell, 2000, p. 42). Based on our own attempts to develop a racism coping intervention, we similarly assert that even though excellent practice recommendations for addressing racism have been articulated in the counseling psychol- ogy literature for some time now, practitioners seem to have little systematic guidance in developing and implementing a nuanced, comprehensive, and theoretically and empirically derived strate- gies for addressing racism through practice.

Therefore, our purpose for the present study was to provide practitioners with comprehensive and integrative summary of the peer reviewed counseling psychology practice recommenda- tions—the first of its kind—to facilitate and guide the development of practice efforts aimed at addressing racism at individual, group, and systemic levels. We felt it was timely and important to content analyze the racism practice recommendations in the counseling psychology literature given the current sociopolitical climate in the

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670 MILLER ET AL.

United States, which has seen reemergence of explicit racial hate and violence (Potok, 2017). Given this climate, we believe that it is essential that counseling psychologists continue heed Helms’ call to action and leverage their strong multicultural counseling training and commitment to social justice advocacy to combat racism at individual, group, and systemic levels.

In the present study, our goals were to (a) summarize and critique the recommended practice strategies for addressing racism in the peer reviewed counseling psychology literature, (b) assess the degree to which these recommendations addressed systemic aspects of racism, (c) examine the trends of racism practice rec- ommendations over time, and (d) articulate next steps for devel- oping and advancing practice recommendations aimed at address- ing racism. We focused on counseling psychology because (a) it is and has been at the forefront of psychology fields in terms of its focus on race and racism (Delgado-Romero et al., 2005), and (b) whereas basic areas in psychology, such as social psychology, that study race and racism are focused on elucidating basic psycholog- ical processes associated with this phenomenon, as an applied specialty, counseling psychology is interested in addressing and solving racism in the real world by developing and implementing culturally responsive practices (Helms, 2015). We focused specif- ically on the peer-reviewed counseling psychology literature given the quality (e.g., conceptual and methodological rigor, innovation, expert feedback to ensure that inaccurate claims and inappropriate interpretations are not published; Kelly, Sadeghieh, & Adeli, 2014), associated with the peer review process. Ultimately, we believed that it was important to review the state of the peer- reviewed counseling psychology literature to evaluate the rigor with which the field is attending to its applied mission, obtain a clearer sense of the strengths and weaknesses of the field’s practice recommendations for addressing racism, and advance practice efforts aimed at taking action against racism.

Method

Procedure

Location of articles. For the current study, we focused on the Journal of Counseling Psychology (JCP), The Counseling Psy- chologist (TCP), and Counseling Psychology Quarterly (CPQ) as they are the primary field-specific peer-reviewed publication out- lets in counseling psychology. Our search examined all published articles in these journals from their inception to 2015. For each of the journals, we used the PsycINFO database and conducted a title keyword search with the following racism related search terms: “racism,” “ethnic discrimination,” “racial discrimination,” “racism related stress,” “racial microaggressions,” “racial aggression,” “prejudice,” “oppression,” “colorblind,” “racial attitudes,” “racial bias,” “stereotypes,” “racial invalidation,” “racial conflict,” and “racial hate.” In total, 92 articles were identified. Based on a review of article abstracts and discussion sections, 19 were not coded as they were not specific to racism (e.g., focused on dis- crimination due to gender or sexual orientation, racial identity).

Coding of articles. We (a longstanding research group com- prised of four self-identified Asian and Asian American female, three self-identified Asian and Asian American male doctoral students, and one self-identified Asian American male faculty member in an APA accredited counseling psychology doctoral

program all with expertise in the study of racism and who believe that there is a need for additional literature on practice efforts aimed to address racism) developed a codebook that covered bibliographic information (e.g., authors, publication source), meth- odological information (e.g., conceptual or empirical, sample char- acteristics), topics— or correlates—studied in conjunction with racism (e.g., body image), level of practice recommendation (e.g., individual, group, institutional/systemic), target of practice recom- mendation (e.g., who was responsible for addressing racism), and categories (or types) of practice recommendations. This initial codebook was used to conduct group coding training using three of the identified articles. Feedback from the group coding training was used to revise the codebook (e.g., addition of examples and guidelines for coding decisions) until the final version of the codebook was developed. Given our focus on practice recommen- dations, only discussion sections were coded in empirical studies. Conceptual papers were reviewed in their entirety to identify practice recommendations.

Content analysis allows researchers to quantify narrative text through coding (Hsieh & Shannon, 2005). To minimize errors due to coding, each article was coded independently by two people and coding disagreements were discussed until consensus on a final coding decisions were reached (cf. Hill, 2012). Any discrepancies were brought to large group meetings for further discussion. Once all articles were coded by the pairs, they were then discussed in large group meetings to finalize (through consensus) the coding decisions. Content analysis also requires that coded units (in this case practice recommendations) be placed into meaningful cate- gories (Fraenkel, & Wallen, 2003). We used modified consensual qualitative research (CQR-M; Spangler, Liu, & Hill, 2012), to identify the broad categories of practice recommendations for addressing racism. Unlike traditional CQR, CQR-M is a simpler approach to data analysis (e.g., it does not require an external auditor) and was our content analysis method of choice for iden- tifying categories given that our data (i.e., practice recommenda- tions) were not complex or lengthy and our goal was to place these recommendations directly into categories (Spangler et al., 2012).

Results

Characteristics of the Articles

Of the 73 identified articles, 19% (n � 14) were conceptual/ theoretical and 81% of the articles were empirical (n � 59). In terms of the life stage of the study samples represented in the 59 empirical studies, approximately 47% (n � 28) were college aged, 32% (n � 19) were adults in the community, 7% (n � 4) repre- sented multiple populations (e.g., college students and children), 3% (n � 2) were children/adolescents, and the remaining 6 articles were nonhuman subjects studies (e.g., meta-analysis). The break- down of the racial groups represented in the 59 empirical study samples were as follows: 24% (n � 14) African Americans, 34% (n � 20) Asian Americans, 22% (n � 13), European Americans, 10% (n � 6) Latino/a Americans, 12% (n � 7) multiple racial groups, and 0.1% (n � 1) Middle East Americans. One noteworthy finding was the disparity in frequency of racism papers published across the counseling psychology journals. Specifically, JCP (n � 45; 62%) and TCP (n � 27; 37%) published the majority of the identified racism papers whereas CPQ only published one (1%).

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671RECOMMENDATIONS FOR ADDRESSING RACISM

Another interesting finding was that 100% of JCP papers were empirical whereas 46% of TCP were conceptual. The 73 articles were reviewed for correlates (variables) studied in conjunction with racism (see Table 1). The correlates most commonly studied in conjunction with racism were mental health (n � 28), subjective well-being (n � 12), ethnic and racial identity (n � 10), White reactions to racism (n � 10), and stress (n � 10).

Categories of Practice Recommendations

We examined the discussion sections of articles published in the JCP, TCP, and CPQ to identify theoretically and empirically categories of practice recommendations for addressing racism. Based on our review of the articles we developed a list of practice recommendations. Using this list, we identified eight categories of practice recommendations for addressing racism (see Table 2). Following typical CQR-M procedures, the frequency of categories was classified as “general” (i.e., identified in all cases), “typical” (i.e., identified in at least half of the cases), or “variant” (i.e., identified in at least two or three, but fewer than half, of the cases). Psychoeducation, validation, and self-awareness emerged as gen- eral categories whereas externalize/minimize blame, developing positive identity, and culturally responsive social support were variant.

The first general practice recommendation category was psy- choeducation and outlined ways in which counselors can (a) teach clients strategies for coping with racism and antiracism advocacy, (b) increase client knowledge about racism and the sociopolitical context and history in the United States, and (c) help clients to understand racism from a trauma framework. Validation, another general category, highlighted ways in which mental health profes- sionals can normalize and facilitate the clients’ exploration of racism experiences and frame coping with racism as a form of resiliency. Counselor self-awareness and critical consciousness, the last general category, was primarily focused on the necessity for mental health professionals to develop self-awareness and critical consciousness regarding (a) the history and pervasive na- ture of racism in the United States, (b) the complex and intersec- tional ways in which it manifests in individual and systemic ways,

(c) the psychological impact of racism and the importance of addressing one’s own racial attitudes, and (d) the awareness of the ways in which counselors can actively perpetuate racism.

Culturally responsive social support, a variant category, high- lighted the importance of developing substantive connections in one’s own family and racial and ethnic community, ethnic churches and religion, as well as developing connections with members from other racial groups including White allies. Another variant category was developing a positive identity, which offered a number of ways in which mental health professionals can help clients cope with racism by helping facilitate their racial pride, self-esteem, and recognition of their own strengths. Specific strat- egies in this category highlighted the importance of exploring one’s own cultural worldview and heritage and framing multiracial experiences as strengths and opportunities. Externalize/minimize self-blame, another variant category, outlined ways in which men- tal health professionals can help clients externalize causes of racism while simultaneously minimize their perception that they are somehow personally responsible for the experience. Specific strategies in this category highlighted the importance of helping clients avoid self-criticism and self-blame by considering the myr- iad possible external factors that could explain racism experiences. Another specific strategy in this category outlined the very impor- tant goal of minimizing the internalization of racist ideology.

Critical examination of privilege and racial attitudes, a variant category, was generally focused on the training of White mental health professionals and highlighted the fundamental importance of processing emotional reactions to racism and privilege (e.g., White guilt and White empathy), and challenging colorblind racial attitudes. Although this category was similar in ways (e.g., both require a degree of critical consciousness) to self-awareness and critical consciousness, we felt compelled to keep them separate given that critical examination of privilege and racial attitudes had a specific and unique focus on White privilege (McIntosh, 1988).

Outreach and advocacy, another variant strategy, represented a number of innovative ways in which mental health professionals could proactively affect systemic and institutional change such as advising an institution’s human resources policy, develop media events and/or programming (e.g., music, food, and/or film festi- vals, service learning opportunities) to teach about racism at col- lege campuses and create experiential activities and opportunities for interactions with racially diverse students and participating in dialogues about race. This category also included mental health service and training recommendations including the need for train- ing mental health professionals in antiracism activism and assist them to view racism as a mental health concern and including racism in standard interview/assessment protocol with clients.

Level of Practice Recommendations

To assess the degree to which the counseling psychology liter- ature provided guidance on how to address racism at the structural/ systemic level, we examined the level (individual, group/commu- nity, and structural/systemic) of practice recommendations in each study. Of the 73 papers analyzed, 51 provided practice (e.g., counseling, intervention, assessment, training, outreach) recom- mendations. Forty-nine (96%) of the 51 papers provided practice recommendations at the individual level (e.g., client or counselor). Eighteen (35%) of 51 papers provided practice recommendations

Table 1 Topics Studied in Conjunction With Racism

Correlate categories Number of

articles

Mental health outcomes 28 Subjective well-being 12 Ethnic and racial identity 10 White experience of racism 10 Stress 10 Coping 9 Racism in research 7 Intersection of race and gender 6 Racism in clinical settings 5 Racial climate 5 Protective factors 4 Worldview/ideologies 3 Risk factors 3 Psychical health risk factors 3 School adjustment 1 Body image 1

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672 MILLER ET AL.

at the local peer network, local organization/community level. Only six (12%) of the 51papers provided recommendations for addressing racism at the structural and institutional level (e.g., policies).

Intended Audience of Practice Recommendations

Next, we examined the intended audience (i.e., who is respon- sible for implementing the recommendation) of practice recom-

Table 2 Categories of Practice Recommendation Themes and Examples of Specific Strategies

Themes Frequency Strategies

Psychoeducation General • Educate culturally-focused coping strategies • Educate racism as a trauma and treatment for clients with posttraumatic symptoms due to racism • Initiate discussions on racism • Educate antiracism efforts/strategies • Educate the historical context of racism • Educate on the value of interracial connection • Educate professionals to view racism as a mental health concern

Validation General • Explore and validate racism experiences and racism-related stress • Normalize racism experiences • Empower clients’ strengths • Validate existing resilience and coping strategies in dealing with racism

Self-awareness/critical consciousness

General • Awareness on psychological impact (e.g., anxiety) of racism • Nuanced/complex/sophisticated understanding of racism experiences • Consideration of intersectionality • Awareness on counselors unknowingly perpetrating racism • Awareness on the daily and lifelong nature of racism • Recognition of cognitive attributions of the racist incidents, and examination of behavioral responses

following the unfair treatment • Awareness on available psychological help to deal with racism (e.g., counseling) • Incorporation of racism and oppression in case conceptualizations

Critical examination of privilege and racial attitudes

Variant • Training opportunities for White trainees to process their emotional reactions and awareness on racism and White privilege

• Examine White guilt and empathy • Challenge color-blind racial attitudes or racial prejudice • Examine unintentional perpetuation of racism/racial microaggression • Examine of White self-segregation

Culturally responsive social support

Variant • Develop of belongingness and connection to ethnic community • Family support • Association with individuals or allies from other races who hold favorable views of person’s race • Discuss support-seeking coping vs active-coping • Help identify and develop White allies • Encourage clients to access local resources such as schools, churches, community leaders, and cultural

groups • Identify religion as a potential support

Developing positive identity

Variant • Raise clients’ self-esteem by exploring strengths and positive self-attitudes • Validate strengths and opportunities associated with multiple identities • Develop racial pride • Encourage clients to confide in peers who can relate and reinforce strengths • Explore the importance of cultural worldviews and ethnic origins

Externalize/minimize self-blame

Variant • Externalize discrimination and minimize self-blame • Help clients avoid self-blame and potentially lessen their anxiety symptoms by externalizing the

impact of racial stressors • Encourage engagement in problem-solving (e.g., making a plan of action, role playing, or developing

pros and cons lists) and avoid wishful thinking, social withdrawal, and self-criticism related to racism • Explore possible external factors that could explain discrimination-related events • Help minimize internalization of negative race-based messages

Outreach and advocacy Variant • Conduct outreach programs about openness to diversity among students • Advise human resources policy and policy creation at an institutional level • Engage in consultation with other professionals for advocacy work • Host media events to teach about racism across campus • Incorporate teaching materials related to racism • Initiate intercultural programs/workshops to bridge dialogues among race • Create service learning opportunities • Promote positive interracial interactions in campus spaces • Include racism and racism-related stressor assessments as standard protocol • Engage in antiracism activism

Note. General � results apply to all cases; Typical � results apply to at least half of the cases; Variant � results apply to at least two or three, but fewer than half, of the cases).

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673RECOMMENDATIONS FOR ADDRESSING RACISM

mendations. Not surprisingly, the majority (n � 47; 87%) of papers provided practice recommendations that outlined actions that mental health professionals could take to address racism. Approximately 16% of papers (n � 10) provided recommenda- tions specific to counseling training programs and approximately 13% of papers provided recommendations for school and univer- sity educators/instructors. Approximately 4% (n � 2) of papers provided recommendations for university administrators and only one paper provided recommendations for families.

Trends of Practice Recommendations Over Time

We also examined the trend of level and targets of racism coping recommendations in the counseling psychology literature over time. The publication frequency across the years is displayed in Figure 1. For level (individual, group/community, or structural/ systemic focus) of recommendation, we noticed that the clear majority of recommendations over time have been at the individual level and have been targeted at mental health professionals (par- ticularly on awareness-building and client validations of racism experiences by mental health professionals). Individual level rec- ommendations for clients first appeared in the literature in 2008. The first group/community level recommendation to appear was in 2006 and focused on the fostering a more conducive environment for racial equality in schools. Recommendations for family did not appear until 2015. Systemic recommendations first appeared in 2007 and was focused on counseling psychology training program issues. Overall, the current trend appears to be a focus on individ- ual level of racism, followed by a focus on group/community level racism, and lastly, systemic racism. For example, Figure 1 shows

that in 2015, the number of individual level recommendations doubled group level recommendations, whereas group level rec- ommendations doubled systemic level recommendations. It is, however, worth noting that there appears to be an upward trend over time in the overall frequency of individual, group, and sys- temic practice recommendations published in the pee-reviewed counseling psychology literature.

Discussion

For people of color in the United States, racism is ubiquitous and insidious. Racism is therefore a salient social justice and public health issue that requires intervention. For some time now, the field of counseling psychology has emerged as a leader in the study of race and its peer-reviewed literature provides a number of practice recommendations for addressing racism. One of our study goals was to summarize and critique this literature in order to facilitate further practice efforts aimed at addressing racism. Our study identified eight categories of recommended practice strate- gies for addressing racism in the counseling psychology literature (see Table 2). These recommendations include specific strategies for addressing racism through traditional work with clients includ- ing psychoeducation (e.g., teaching culturally responsive coping strategies), validation (e.g., normalize and validate racism experi- ences), self-awareness and critical consciousness (e.g., understand- ing the intersection of racism/racism and other historically marginalized identities), culturally responsive social support (en- courage development of and connection to ethnic community and allies), developing positive identity (e.g., explore strengths and opportunities associated with multiracial experiences), externalize/

Figure 1. Trends of level of racism practice recommendations over time.

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minimize self-blame (e.g., minimize internalization of negative race-based messages), and critical examination of privilege and racial attitudes (e.g., provide opportunities for White trainees to process emotional reactions to racism and racial privilege).

Another study goal was to evaluate the degree to which systemic racism was addressed in the counseling psychology practice rec- ommendation literature. Although the conceptual and empirical racism literature has for some time now highlighted the fact that racism is systemic, the majority of practice recommendations failed to address racism at this level. This finding likely reflected the fact that the research on which the practice recommendations were developed focused solely on racism at the individual level and therefore it was not possible to make inferences about systems level practice recommendations. Given that the field of psychology has been individual-focused, it is perhaps not surprising that this individual level focus continues to dominate the practice recom- mendations in counseling psychology literature. We resonate with recent calls in the counseling psychology literature (cf. Helms, 2015; Shin, Ezeofor, Smith, & Welch, 2016; Vera & Speight, 2003) for the transformation and evolution of our field to address racism in a more effective and ecologically valid manner.

We believe that providing detailed and ecologically valid guid- ance to address systemic racism beyond traditional approaches (e.g., individual or group counseling) is fundamentally important and a social justice imperative for counseling psychologists. Our findings suggest a more recent effort to address institutional and structural racism by providing recommendations targeted for school and university administrators, which represents an impor- tant and needed trend in the literature. Although consulting with and for policymakers and administrators is one way in which to take action against systemic racism, as noted by Pieterse, Evans, Collins, Risner-Butner, and Mason (2009) another innovative ap- proach might be for counseling psychology training programs to incorporate formal advocacy training in their curriculum to better prepare counseling psychologists to impact racism at the structural and systemic level. Ultimately, we feel that it is important to reiterate what others have stated in the past—that preparing coun- seling psychologists to address systemic racism likely requires a fundamental shift in the traditional counseling psychology training model (cf. Vera & Speight, 2003). For example, advocacy efforts aimed at addressing systemic racism likely require a knowledge base and skillset that may not yet be formally integrated in the majority of doctoral training programs (it is important to note that the revised multicultural guidelines published by APA, which includes a systems level focus, may help to increase training focus on systemic racism—and other oppressive systems—in APA ac- credited training programs; American Psychological Association [APA], 2017).

Another study goal was to examine the trends of racism practice recommendations over time. Our first noteworthy finding was the over time there has been a clear and consistent pattern of focusing on practice recommendations at the individual level that are tar- geted at mental health professionals (e.g., helping clients explore feelings associated with racism). However, another trend we ob- served was that overall there has been an upward trend over time in the articulation of (individual, group, or systemic) practice recommendations aimed at addressing racism. Given the afore- mentioned increase in hate groups, (race-based) hate crimes, and the more explicit racial hostility in the current sociopolitical cli-

mate (Potok, 2017), it is perhaps not surprising to see an increase in practice recommendations that are aimed at helping clients cope with racism.

Our final study goal to was articulate next steps for developing and enhancing practice recommendations aimed at addressing rac- ism. First, we believe it important is to build on existing recom- mendations by expanding their nuance and detail. This is based on our analysis, which revealed that the nature of racism practice recommendations within and across papers varied greatly. We found that the most helpful recommendations were those that provided detailed and tangible steps or procedures that can be employed to address racism. For example, Iwamoto and Liu (2010) outlined specific counseling approaches when working with Asian American men who might be dealing with negative external and internal messages about their gendered racial identity. They recommended that clinicians should use direct probes such as “What does it mean to be Asian American?” or “What are some positive or negative messages you receive about your racial group?” to promote a dialogue about the client’s identity and race-related stress. Utsey, Giesbrecht, Hook, and Stanard (2008) recognized the need for counselors to broaden the scope of their work beyond the therapy room to a multidisciplinary team when working with African American clients dealing with racism. They noted the importance of encouraging and supporting clients to access and seek support from their community and cultural re- sources such as churches and African American community lead- ers. Notably, Utsey and colleagues (2008) asserted the importance of focusing on clients’ spirituality and religiosity as resilience factors and to foster greater racial pride and self-esteem through psychoeducational strategies that introduce clients to historical contributions of African Americans to science, medicine, politics, culture, and art. In working with White students’ awareness on racism, Spanierman and colleagues (2008) emphasized that community/school-based interventions are necessary to implement systematic experiential and didactic programming that can help these students address potential fear, tension, continued avoidance, and relational difficulties pertaining to racism. Furthermore, they noted that follow up outreach efforts are necessary to support developing White allies in addressing their guilt and pain so that they do not revert back to White supremacist attitudes.

Although there were a number of well-developed and clearly articulated strategies for addressing racism, in many instances we did not feel as we would be able to develop and/or implement a given practice strategy based on the information provided. In fact, many practice recommendations were described in one or two sentences. We realize that many practitioners will find these types of recommendations helpful in identifying meaningful starting points for practice. However, we also realize that there are likely many practitioners who would greatly benefit from a more detailed description of practice strategies. For example, many recommen- dations were presented as static and universal recommendations; however, we assert that much more nuance and detail of practice recommendations is needed to help practitioners have a clearer sense of for whom and under what circumstances a given strategy may be effective and/or appropriate. Although dynamic and content-specific practice recommendations for other areas of prac- tice exist in the broader literature (e.g., see Hill, 2014 for a dynamic model of general counseling), we feel that there is a

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dearth of dynamic and context-specific racism practice recommen- dations.

Perhaps intersectionality approaches to understanding racism, which are beginning to emerge in the counseling psychology literature (e.g., Lewis & Grzanka, 2016; Lewis & Neville, 2015), could serve as a model of one way in which to provide more nuanced and dynamic practice recommendations. Intersectional approaches to racism assume that racism experiences do not exist in a vacuum and that they change as a function of one’s member- ship in additional marginalized and oppressed identity groups (e.g., sex, gender, sexual orientation, class, etc.). We were encouraged to see that intersectionality is beginning to emerge (e.g., gendered racism and the racist perception of gender roles; Lewis & Grzanka, 2016; Lewis & Neville, 2015) in the counseling psychology prac- tice recommendations for addressing racism and believe that re- sponsive and effective strategies for addressing racism require attention to intersectionality. Given that intersectional racism re- search is a recent phenomenon, it is not surprising that intersec- tional practice recommendations for addressing racism are a rarity in the literature. We expect that has this literature grows and evolves so too will the intersectional practice recommendations for addressing racism.

One noteworthy nonfinding was that our review of the literature revealed that except for strategies for helping counseling trainees examine their racial privilege and attitudes, the counseling psy- chology practice recommendations are virtually silent on address- ing racism by focusing on perpetrators of individual and group level racism. Although, other basic specialty areas in psychology (e.g., social psychology) have provided valuable insights on psy- chological processes underlying the development and espousal of racist ideologies and racism behavior (e.g., aversive racism; Dovi- dio & Gaertner, 1998), we feel that it would be advantageous to develop practice recommendations for addressing intervening with perpetrators of racism and developing prevention work to reduce the development of racist beliefs. It is important to note that this type of important antiracism prevention and intervention work is beginning to emerge in the counseling psychology literature (Pi- eterse, Utsey, & Miller, 2016). In addition, Spanierman and col- leagues’ (2008) framework on the psychological costs of racism for Whites, which has been used to study White college and graduate students, could serve as another conceptual framework from which to develop antiracism workshops and experiential activities for the general public and other noncounselor trainee populations (Spanierman & Heppner, 2004; Spanierman, Poteat, Beer, & Armstrong, 2006).

One other emerging and promising practice recommendation for addressing racism was the strategy of helping individuals mini- mize self-blame and reduce the internalization of negative racist messages while simultaneously helping them to explore external causes of racist events. Internalized racism is arguably one of the most psychologically damaging aspects of racism and can erode one’s sense of self and worth (Speight, 2007). We, therefore, believe it to be of the utmost importance to develop further intervention and prevention practice recommendations aimed at minimizing the internalization racist beliefs. We realize that be- cause the empirical literature on internalized racism is scant, it is difficult to provide evidence-based practice recommendations. However, we believe that the recent publication of Choi, Israel, and Maeda’s (2017) Internalized Racism in Asian Americans

Scale and Campón and Carter’s (2015) Appropriated Racial Op- pression Scale, will usher in a new era of research and practice recommendations for addressing internalized racism.

We also believe the online racism is an additional area for developing practice recommendations for taking action against racism. Recent research has found that explicit and hostile racism is frequently encountered online these encounters have a negative impact on mental health (Tynes, Rose, & Williams, 2010). Al- though the very nature of online racism is fundamentally different from offline racism (cf. Keum & Miller, 2017), research has only started to attend to these issues and very few strategies for ad- dressing online racism have been articulated. We believe that even though online social platforms are frequent sources of online racism experiences, these platforms also represent an opportunity for developing and delivering online racism coping outreach con- tent (e.g., videos that describe racism coping strategies in a clear and ecologically valid manner).

Although our primary focus on the study was on practice rec- ommendations, our findings might be helpful for counseling psy- chologists who seek to address racism through other efforts such as research and consultation. For example, our review of the coun- seling psychology literature found that there is a dearth of studies that test directly interventions aimed at helping individual cope with racism. We believe that an important future area for research would be to develop and test culturally responsive and ecologically valid (APA, 2017) intervention and prevention programs aimed at helping individuals cope with individual, group, and systemic racism. Although it would be beneficial to develop interventions within the individual or group counseling context, we also believe it is essential to develop large scale intervention and prevention models such as a university or institution wide program aimed at educating (for prevention) individuals about racism (for preven- tion) or coping strategies to deal with racism (for intervention). Counseling psychologists could use the general categories outlines in Table 2 as a starting point for the development of such inter- vention and prevention efforts.

In addition to research efforts, counseling psychologists are also equipped to address racism as consultants to executive committees and administrators who shape institutional and government policy. For example, when developing policy regarding screening, hiring, and promotion decisions, counseling psychologists, with research and practice expertise, are well positioned provide executive com- mittees and administrators with an evidence based understanding how racism can be perpetuated at the systemic level (e.g., using culturally inappropriate assessment approaches, understanding the impact of test bias, etc.) and/or using data to demonstrate current inequities in representation, pay, or promotion. We also believe becoming formal members of these committees and boards repre- sents a nontraditional but ecologically valid way in which coun- seling psychologists can directly address racism at the systemic level. For example, counseling psychologists with established rep- utations in the community might be able to secure a position on a local school board and help shape policies that affect literally thousands of K–12 students.

Finally, we believe there is one noteworthy finding regarding trends that emerged across publication outlets. We found that only one racism article was published in CPQ, which represents a significant deviation from the other two field-specific journals. We understand that there are numerous factors that determine publi-

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cation submission and acceptance rates. Although we do not know why only one paper on racism has been published in this journal, one tentative explanation might be that unlike the other field- specific journals CPQ is an international journal. It is possible that authors of racism (usually in the context of the United States) articles might feel that a journal with a strong focus on interna- tional issues associated with counseling psychology and training might not represent a good publication fit.

Study Limitations

Study findings should be considered in light of a number of important study limitations. First, our review only included pub- lished papers in journal explicitly identified with counseling psy- chology. Therefore, the present findings are biased to the extent to which unique practice recommendation strategies are unpublished or published in noncounseling psychology journals and/or coun- seling psychologists have published their racism work in noncoun- seling psychology journals. We realize that this is an important limitation and that other fields are doing important work in ad- dressing racism. However, many of the fields are not applied in nature and have only more recently begun to attend to racism; ultimately, we felt that including noncounseling psychology liter- ature was beyond the scope of the present study. In addition, the code book and coding decisions reflect the authors’ understand- ings, biases, and interpretations of the published literature. It is possible that had another group of researchers examined the same literature that a unique set of findings would emerge. Finally, although we conducted a literature search based on a comprehen- sive list of 15 racism-related terms, it is possible that a search comprised of different terms would have produced a different pool of appropriate articles.

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Received November 20, 2017 Revision received April 9, 2018

Accepted April 30, 2018 �

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