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CHIDEYA: Depression, paranoia, schizophrenia, are seen as scary words and even more frightening realities. Does our fear of even talking about mental illness keep us and those around us from getting help? African—Americans in the U.S. facing mental health issues, aren't very likely to get therapy or medical support. We continue our month long series on mental health with a look at the ways black communities are getting over the stigma of therapy. Joining our conversation, Janice Sanchez, she's a psychology professor at Old Dominion University and the author of, "The First Session With African—Americans: A Step-by-Step Guide". And Laverne Williams a community outreach educator for the Mental Health Association in New Jersey and a deaconess at Union Baptist Church in Montclair, New Jersey. Welcome to both of you.

Dr. JANICE SANCHEZ (Psychology professor, Old Dominion University): Thank you.

Ms. LAVERNE WILLIAMS (Outreach educator, Mental Health Association): Thank you.

CHIDEYA: So let me start with you Janice. A lot of black folks aren't very likely to get medical help for mental illness or therapeutic help. Can you tell me what are the roots of the distrust?

Dr. SANCHEZ: Sure. There's a great deal of stigma attached with seeking mental health services for African—Americans. It takes a long time before they are willing to acknowledge that they have a problem. And typically once they acknowledge the problem, they do not want to go for formal help.

They will sometimes talk to their minister, and they will get advice, and one of the things that's helped me in my practice is when we have ministers who actually encourage clients to seek out psychological services. I think people really feel that there's something wrong with them, and there's really this attitude of we don't want to air dirty laundry to the wider public. There's a sense of shame about talking about psychological problems.

FARAI CHIDEYA, host:

Laverne, some people say that they just hold on through church, through prayer, through other spiritual practices. How important has that been, and is there any downside to people's reliance on, you know, religion? That's a very touchy question in some ways, isn't it?

Ms. LAVERNE WILLIAMS (Community Outreach Educator, Mental Health Association in New Jersey): Absolutely. A lot of times, unless you admit that you have a problem, you cannot get any healing, and so going to your pastor and/or the clergyperson, if they have not had psychological training, they could be doing you a disservice, and so that's why the PEWS program is helping pastors and lay-clergy identify persons in their congregations who may be at risk or have a psychological problem, to be able to refer them to the proper services in the community.

CHIDEYA: You mentioned the group that you founded, Promoting Emotional Wellness and Spirituality, PEWS, but what do you actually do?

Ms. WILLIAMS: It's in three parts, actually. The first step is to acknowledge that a faith community would like to have a presentation, and we start with a video and a PowerPoint presentation. And the video is entitled "Anything but Crazy: African-American Spirituality and Emotional Wellness," and we sort of meet people where they are. We start with grassroots myths that are out there and try to see what people have been brought up to believe.

After that, the second time we come back into that faith community, we bring professionals with us because we want professionals to feel comfortable with what is happening in some of our faith communities, but also for the faith communities to see that perhaps a psychiatrist or psychologist is not the big, bad, boogeyman.

And then the third step is…

CHIDEYA: Please go ahead.

Ms. WILLIAMS: And then the third step, we tailor information based on what the congregation wants. For example, some churches have more elderly in it, so maybe we talk about elderly and depression. Some congregation may have more single parenting. So it depends on what that congregation wants.

CHIDEYA: You came to this work because of, you know, an experience in your own family. Can you tell us a little bit about that?

Ms. WILLIAMS: Absolutely. I'm the last of eight children, so I'm from a very large family, and the girls were very close. And my sister - second sister, who passed away - well she was having, she had a terminal illness, and she just was in denial through the whole process.

And because I wasn't able to talk to her about it, I started to internalize it so much that I started having panic attacks and depression. You know, I would be driving down the parkway, and unfortunately, my hands would shake, and I would break out in a cold sweat, and I knew that was not normal, but I couldn't stop myself.

Because I worked for the Mental Health Association, I knew that I should seek some help, but I didn't really know who to go to because there's not a lot of African-Americans in this field, and for me actually, I went to a phone book.

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Ms. WILLIAMS: And I ended up looking at a psychologist's name, her last name was the same as mine, Williams, so I called her up. She told me she was Caucasian, and did I have a problem with that, but at that point, I just wanted to feel better. So I went to see her, and it worked out very well for me, but I know a lot of time the issue in the black community is that people want to go to someone who looks like them and who they feel will understand their culture.

CHIDEYA: Janice, your book really deals head-on with this. It's called "The First Session With African-Americans," and it sounds like it's targeting people who will be therapists for black Americans, whether or not those therapists are actually black. Is that what you're doing?

Ms. SANCHEZ: Well basically, this book is really designed to help capture the experience. It's for therapists, and it's for clients, it's for educators, but the important message is really just what you guest said is that we really believe that African-Americans can receive help from a variety of therapists of different ethnic backgrounds.

But we really point out why it might be important for them to be very adamant about asking if there's an African-American therapist that is available. We think that the reason why African-Americans come for help vary.

I live in the Hampton Rose area. We have a lot of military individuals, and they do have insurance coverage, but there are many communities where people don't have insurance, and typically we find that African-Americans try to struggle with their problems, they don't want to ask for help. But many people get to the point where they have to ask for help. It may be a case their child is having educational problems and may be retained. It may be relationship problems. It may be the loss of a job. It may be violence. It may be drug abuse.

But you know, African-Americans have problems the same way that other populations do, but because of various economic factors, because of the alienation we receive from our communities, may African-Americans feel very alone, and it's very difficult for them to ask for help

So what we try to do is to make sure they know that there are African-American therapists or they can ask for an African-American therapist to find out if the therapist can help them with their presenting problems.

CHIDEYA: So you think that it's really better, easier, more seamless of a transition to work if you're a black person with a black therapist.

Ms. SANCHEZ: I would say that it really depends upon the individual. I think for many people, it's going to be very important to have a client who looks like you. There are some individuals that I've worked with who did not to have an African-American therapist because they had been brainwashed to believe that if someone's African-American, they don't have the same credentials, they're not as intelligent, they're not going to be able to provide the same quality of services.

So we have some individuals who only want to see black therapists. There are some individuals who don't want to see a black therapists, and there are a lot of people who are ambivalent. And I just take the perspective in "The First Session" to lay out to the individual - I ask them to tell me what's happening, what their concern is.

We chart out a possible plan for intervention, and then I leave it to the client to decide if I'm the right therapist that they would like to work with, of if they are not comfortable, I'm happy to make a referral.

CHIDEYA: All right. I want both of you ladies to stay with us. We're going to go to a break. We're talking about the African-American community and mental illness with Janice Sanchez, a psychology professor at Old Dominion University and the author of "The First Session With African-Americans: A Step-By-Step Guide"; and with Laverne Williams, a community outreach educator for the Mental Health Association in New Jersey.

Next on NEWS & NOTES, we continue this series on mental health, and I head over to a Los Angeles museum to visit artist Kara Walker. Her trademark silhouettes have drawn controversy and earned her big-time fame. I talk with Kara about taking the fine-art world by storm and coping with the critics.

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CHIDEYA: I'm Farai Chideya, and this is NEWS & NOTES. We're continuing our conversation about African-Americans and therapy. It's part of our month-long series on mental health, and with me is Janice Sanchez, she's a psychology professor at Old Dominion University; and Laverne Williams, a community outreach educator for the Mental Health Association in New Jersey.

So welcome back, and you know, Janice, let me just dig a little deeper into this whole issue of black person, black therapist, white therapist. It sounds like as with everything, it's complicated. Everything having to do with race is complicated.

Ms. SANCHEZ: Yes.

CHIDEYA: How do you walk into a room and make an evaluation as a client of whether or not someone understands you, not just in a general sense but also culturally?

Ms. SANCHEZ: I think that if I'm a client coming to therapy, the most important thing is that the therapist understands who I really am, and I think that clients have different opinions about their racial identification.

For some individuals when they come for therapy, their race is very much tied to the particular problem. As Mrs. Williams said, sometimes your race may not be. You may be struggling with depression, or you may be struggling with anxiety, or you may have a work situation in which your race doesn't really have an impact on the therapy.

So the first thing that I think the client has to be clear on is they need to understand their sense of identity and whether or not it requires having a therapist of their background.

I think if you're coming for a child, if you're coming for a partner, if you're coming for a situation that you don't think is really tied to your ethnic identity, then I think it's fine to have a different therapist.

You might be coming because there's an emergency. When there's an emergency, when there's some sort of a crisis situation, you really don't care about the race. You just want to get help.

But I think if you're talking about getting in touch with who you are, if you're talking about an issue in terms of relationships, I think that your race may be very salient. And I think that individuals who are dealing with relationship issues, for instance, they really might want to have a therapist who understands their cultural background, who understands what it's been like to be African-American, and even when I use that term, I'm talking about so many different people.

Some identify as black, some as African-American, so I think it really depends upon what you think about yourself and how you want to communicate that to the therapist in terms of how much focus you want to spend on your ethnic identity.

CHIDEYA: Laverne, you made a decision to go to someone who wasn't black, but what this all calls us is what does it really mean for someone to understand you? In some ways, a therapeutic relationship is really about does this person understand me? Or if you are a client or, you know, if you're trying to advise someone else to get help, it's like are you being heard? And how did you make a decision about whether or not you were being heard?

Ms. WILLIAMS: The panic attacks was coming so fast and furious, I didn't care who it was. You could've been purple, just give me the help that I needed. And I'm just so excited to hear what Sanchez is really doing, assessing persons in the African-American community, because again, it's just about awareness.

When I think about 15 years ago, when HIV/AIDS was - everyone was afraid of that issue, with education and with training, people are now able to hug someone who has AIDS and go visit them in hospitals without any problems.

And that's the same thing about mental illness. Until we start getting the word out, which the Mental Health Association does, and letting the people feel comfortable about, I like to say that mental illness is not a casserole disease. If someone had a heart attack or they had diabetes or if they have cancer, people will flock over to their houses with casseroles and oh, what can I do to help you?

When you say mental illness, people just back up, and it's all about education. And the last thing I do before I leave here, from this side of the world, I'm going to make sure awareness is raised, and particularly in the African-American community. The only shame is not getting help

CHIDEYA: When you think about the people you've helped, Laverne, helped connect with professionals, with support, what are you most proud of?

Ms. WILLIAMS: I am most proud that people can come up to me and really talk about the issues that they have, and for example, when I do a presentation at a faith community, I can almost spot somebody in the room who I know is maybe battling with something, whether it's for themselves or a loved one. And they may not say too much during the presentation, but they will come up afterwards and give me their phone number or ask for more information.

And if they have to do it on the side and where they think others aren't watching or hearing, that's fine because they're asking for it, and so now, I can't tell you how many persons in my faith communities have come up with me and shared problems and directing them that they be able to talk about it without the shame and stigma involved. I just think that's wonderful.

CHIDEYA: Janice, should you go into therapy, if you choose to go into therapy, with a game plan, like okay, I'm fighting with my husband. I want the fights to end. I want to decide if, you know, I should do this, this and this.

I mean, is it about really practical things? Because there's this whole idea of Freudian analysis, as you lie back on the coach and talk about your childhood until you expire. You know, what are we really talking about?

Ms. SANCHEZ: I think most therapists today are very solution-focused therapists. It's very helpful for an individual to come into therapy and to say this is the problem, this is where we're at, I'm not comfortable, I want to make some changes, and I'm here for you to help with that process. So I think that if you have a good conceptualization as to what your concern is, I think it's going to help the therapy to go even faster.

I think that psychoanalysis is still available and that there may be individuals who have the time to really delve deeper into one aspect of their personality. But I think most African-Americans that I see are really very focused on having a very specific problem when they come in, and many of them really think it's like going to a doctor's office - that they'll come in and in that first session I'll lay out for them how the problem can be resolved.

So I think that my job is to, you know, to speak on the radio, to speak live, but to let people know that there are places where they can go to get help with their problems. But I tell them that usually, they're going to need to come for more than one session.

We know that 40 percent of all individuals who come for therapy never return for another session. In African-Americans, that's even higher. So one of the things I try to communicate is that we're here, we're able to help, we just need you to come in and talk, and I try to take away the stigma that there's not a stigma associated with coming for mental health. It's like going to the doctor.

It's like going to get any other kind of help. You would not stop if you were having some sort of a physical crisis, and we try to explain to people if you're having emotional or psychological problems, it's very normal for you to come and see us.

CHIDEYA: All right, well Janice, Laverne, thank you so much.

Ms. SANCHEZ: Thank you.

Ms. WILLIAMS: Thank you.

CHIDEYA: Janice Sanchez is the author of "The First Session With African-Americans: A Step-By-Step Guide," and she's a professor of psychology at Old Dominion University. She joined me from member-station WHRO in Norfolk, Virginia. And Laverne Williams is a community outreach educator for the Mental Health Association in New Jersey and a deaconess at Union Baptist Church in Montclair, New Jersey. She joined me from member-station WBGO in Newark, New Jersey.

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