Am I Overreacting?” What Therapy Should Feel Like for Racialized Clients

If you are a racialized person (Black, Indigenous, or a person of color), you have probably had experiences of feeling erased, misunderstood, dismissed, or like you had to explain your reality to be taken seriously. Therapy isn’t immune to this. Many people come into therapy already questioning themselves: 

“Do I bring up race? Or will that make things awkward?” 

“Am I overreacting, or is this a normal response to oppression?” 

“Do I have to code switch with my therapist as well? Will they get it” 

These questions do not come out of nowhere. As healthcare workers, our training tends to emphasize anti-oppressive frameworks, cultural competence, and humility. But in practice, this is often surface level. “Practiced” but not integrated.  

As an African Nova Scotian therapist, I have yet to work with a racialized client who has not brought up the impacts of racism, and minority stress as part of their mental health experience. Whether that’s navigating being the “only one” in professional settings, chronic hypervigilance, the emotional fatigue of code switching, adjusting to broader Canadian culture as a newcomer, or feeling overlooked for opportunities—race and culture shape our everyday realities.  

Some clients have had therapists who have avoided conversations about race entirely, reframed actual experiences as cognitive distortions, or over-focused on “coping skills”. And while coping skills can certainly support well-being, they are inadequate on their own in the face of structural oppression. If this has been your experience, it makes sense that trusting new clinicians has not come easily (and no, you are not “resistant”). While finding a clinician with lived experience of racialization is usually helpful, it is inaccessible for many people. The question then becomes, what should you expect regardless of who you are sitting across from? As a racialized person, a good therapist will: 

• Create space for you to talk about the impacts of race without it being dismissed or framed as distorted thinking 

• Hold your internal experience along with the external realities shaping it 

• Skillfully adapt therapeutic modalities to suit your reality (i.e. how to “set boundaries” with family members varies greatly by culture) 

• Validate your experience, while gently pushing you to move forward  

• Create safety for you to speak as you usually would without changing your cultural vernacular  

• Understand that distress is expressed differently in different cultures (i.e. in many Black communities, openly expressing sadness or vulnerability often isn’t encouraged or validated. It may instead show up as irritability, guardedness or over-functioning, which therapists may misinterpret.  

• Understand when NOT to challenge a thought or reaction 

• Show willingness to learn and adapt, without requiring constant education and emotional labor from you 

• Allow you to show anger or other “negative” emotions without labeling them as hostility or aggression  

• Welcome your FULL identity. Not just race, but culture, family dynamics, language, and religion/spirituality  

  
  

These elements are not accidental; they are intentionally created through how evidence-based therapies are adapted and show up in the room. 

Cognitive Behavioral Therapy (CBT) 

CBT focuses on identifying and shifting unhelpful thinking to support behavioral change and increased self-esteem. However, if not adapted skillfully, this can sometimes feel out of touch or invalidating (for anyone!). A culturally informed CBT practitioner will: 

• Differentiate between distorted thinking and realistic concern. Many racialized clients have had their experiences questioned in ways that have increased self-doubt and mistrust in healthcare workers. 

• Gently explore vigilance. Is it pathological “anxiety” or learned awareness in the context of psychologically unsafe environments? 

• Encourage psychological flexibility. A good therapist will not try to convince you that everything is safe and fair…It is not. They will help you to acknowledge reality, problem-solve when appropriate, and respond in ways that support your well-being. 

  
  

Dialectical Behavior Therapy (DBT) 

DBT is the gold standard for emotional dysregulation. It helps clients to build skills in regulating intense emotions, tolerating distress, and managing interpersonal relationships effectively. However, how these skills are applied matters. A culturally informed DBT practitioner will: 

• Use skills to support positive coping and not to suppress valid emotional responses. Sometimes, anger makes a lot of sense and is not a “problem” to be solved. Intense emotions are often valid sources of knowledge to be held and explored compassionately. Skills are tools, not rules. 

• Recognize how the long-term impacts of racial stress can function as a form of traumatic invalidation. This often causes people to engage in self-invalidation (i.e. “maybe I am being too dramatic”, “maybe I overreacted”).  

• Use mindfulness to connect with culturally relevant spiritual or religious practices (when appropriate). Mindfulness is not merely a clinical exercise to force acceptance. 

Schema Therapy 

Schema Therapy helps clients to understand long term emotional, cognitive, and behavioral patterns shaped by early experiences and reinforced by environments. For racialized clients, these patterns are often reinforced not only by immediate environments, but by broader society. A culturally informed schema therapist will: 

 Understand that racialized clients may disproportionately identify with schemas (deep rooted sets of beliefs and patterns) like defectiveness, isolation, or mistrust. These often present in childhood and are chronically reinforced by experiences of racism, erasure and marginalization. 

 Expand the framework of “healthy adult mode”. “Healthy” responses are shaped by culture, religion, and history and are always congruent with flexibility, dignity, and self-respect. 

Trauma Work (Prolonged Exposure and Beyond) 

Trauma-focused therapies such as Prolonged Exposure, EMDR, and Cognitive Processing Therapy are highly effective for PTSD. However, manualized treatments often treat trauma as occurring in a vacuum, outside of a broader context. A culturally informed trauma therapist will: 

• Understand that experiences of racism, chronic exclusion, and marginalization are forms of cumulative complex trauma in and of themselves. This can seriously impact wellbeing, safety, and one’s sense of identity. 

• Distinguish between over-active trauma-based fear structures and realistic pattern recognition and risk. 

• Explore how experiences of racial trauma contribute to chronic hypervigilance, irritability, and avoidance. They explore how these coping strategies have developed for a reason and without dismissing real world context.  

Therapy should not require you to question your reality or fit into a rigid model to heal. Difficulty with trusting and connecting with healthcare workers makes sense and is not always “resistance”. You should not have to defend, over-explain or self-erase to receive care. A good therapist will understand you within your context and help you move forward on your own terms. This is not a bonus; it is the standard.  

Tia DeGiobbi (MSc, OT) has advanced training in DBT, CBT, ERP (Exposure with Response Prevention), and PE (Prolonged Exposure). She also draws on schema-informed concepts to help clients identify and shift deeply held patterns that impact their lives. She is deeply passionate about working with racialized clients and integrates her own lived experience to ground evidence-based care in real world context.