Why do therapists find it difficult to treat BAME survivors of domestic violence?

Domestic violence and mental health disorders disproportionately affect people from minority groups and yet mental health professionals struggle to give BAME people the support they need.

This blog, based on the findings from my Master’s dissertation, will discuss why domestic violence is prominent amongst survivors from Black, Asian, or Minority Ethnic (BAME) backgrounds, why BAME people struggle to get the mental health support they need and how to change that.

Though we focus on BAME backgrounds in this blog, it is essential to keep in mind that other minority groups which also face barriers to treatment include those from the LGBTQ community and those with learning disabilities. 

Why are domestic violence indexes higher amongst survivors from BAME backgrounds?

Data from 2019 shows that Asian people made up 3.8% of survivors, followed by 5.6% of white survivors, 7.1% of black survivors and mixed-race survivors made up 12.9% (Office for National Statistics, 2019; table 7b). We can see that domestic violence rates in BAME groups were somewhat higher. 

However, that data is not completely representative because domestic violence survivors tend to not go to the police, especially those survivors within the BAME community. 

Why are there more BAME survivors of domestic violence?

Various factors contribute to the higher rates of domestic violence amongst BAME survivors, including:

  1. Racism and discrimination: This can create an environment of marginalization and isolation for BAME survivors, making it harder for them to seek help and support. 
  2. Cultural expectations: In some cultures, women are expected to be submissive to men.
  3. Economic factors: BAME survivors are more likely to experience poverty and financial hardship, making it more difficult to seek help.
  4. Immigration status: BAME individuals who are undocumented may be more vulnerable to violence because they fear deportation so they may become dependent on their perpetrator. 

Why aren’t there enough BAME therapists?

In 2015, the British Psychological Society (BPS) found that around 88.2% of the clinical psychology workforce in England were Caucasian. 

The underrepresentation of BAME therapists has been fuelled by institutional racism, social and economic barriers (eg. entering the field requires extensive training and can be expensive), and lack of representation which can discourage minorities from pursuing this career path. 

The small number of BAME therapists does not match up with the fact that domestic violence and mental health disorders disproportionately affect people from minority groups. Specifically, Black, Asian, and mixed women, are at a higher risk of experiencing domestic violence than White women in the UK. 

Unfortunately, individuals from BAME backgrounds are less likely to access mental health services than their white counterparts due to limited access to culturally appropriate services, discrimination, stigma and language barriers. 

Therapists don’t receive training on BAME people’s key struggles

Therapists lack the cultural competence to work effectively with BAME clients. Cultural competence refers to the ability to understand, appreciate and effectively work with individuals from diverse cultural backgrounds. 

There is an absence of training and education on cultural diversity, as well as a lack of personal exposure to diverse cultures. For example, one researcher refers to a female therapist who stated:

“These girls were told by their families to put up with the abuse…you’re expecting your daughter to sacrifice her life…it would anger me”

We can see that the therapist struggled to understand a BAME minority’s response to domestic violence which can cloud their ability to provide objective support as they were fuelled with anger towards the survivor’s family members. BAME survivors of domestic violence may struggle to leave the perpetrator for a range of reasons:

  1. Cultural and religious barriers: Some cultures may prioritise the value of preserving family relationships or may stigmatize divorce/leaving a partner. This can make it complex for survivors to leave as there is little support from their community. 
  2. Lack of financial resources: Survivors may feel that are unable to leave as they lack the financial resources to support themselves or their children. In the past, it was very normal for the wife to stay at home with the kids whilst the husband was the sole breadwinner. This is not to say that things have changed drastically over time, but this still may be the case for some families. 
  3. Lack of supportive services: Survivors may not be aware of or have access to supportive services. They may also not feel comfortable approaching services due to the fear of being misunderstood by non-BAME therapists.
  4. Fear of reprisals: Survivors may fear that if they leave, their perpetrator may harm them or their family. This can be especially true for immigrant survivors who may be afraid of losing their legal status if they leave the perpetrator. 

Professionals often lack empathy for the victim 

There is no single answer to why BAME survivors of domestic violence may not leave their perpetrators, but having awareness of the possible reasons is vital as a therapist. 

Therapists who are not aware of those complexities have been found to lack empathy towards survivors. Therapists will struggle to empathise with the victim based on a lack of understanding of how BAME victims’ cultural beliefs drive an unwillingness and fear to leave their perpetrators. 

For example, therapists can become frustrated by gender norms in some BAME communities. This has resulted in a defeatist attitude and a belief that BAME survivors are unlikely to break long-standing customs. If a therapist has a negative and defeatist attitude, this can harm the therapeutic relationship and lead to uncomfortable feelings when working with minorities.

I believe, however, that we should not entirely blame therapists. Cultural competency should be mandatory within psychology, but that is not the case. 

Let’s call them survivors instead of victims

Another component of cultural competency is language. The language used to refer to an individual who has endured domestic violence can be an important tool. I would suggest you refer to “survivor” rather than “victim”. By doing so, we acknowledge the individual strength and resilience in overcoming a traumatic experience. We are also moving away from “blaming the victim” for the abuse and rather empowering the survivors to take control of their life and move forward.

There has been little cultural training because psychology as a discipline has a history of reflecting the dominant cultural perspectives of the society in which it was developed. This led to a focus on Western perspectives, with less attention given to cultural diversity. 

Once again, there is a lack of diversity in the field which can lead to the inability to relate to the experiences of people from different backgrounds, a lack of awareness among psychologists about the importance of cultural competence, and limited research available on culturally specific interventions. There is still much work to be done to ensure cultural competence is a core component of education and practice, and that is part of the work I do. 

While not all therapists may feel fully equipped and confident to provide therapy to BAME groups, many are taking steps independently to improve their cultural competence. This is positive! Therapists are being proactive with attending training and workshops on cultural competence, seeking supervision from BAME therapists, and engaging in self-reflection. 

Why is it important to have more BAME therapists?

It is important to have a diverse and representative workforce in the field of psychology for a number of reasons:

  1. People from minority backgrounds may feel more empowered and willing to access mental health services. Having a workforce that is representative of the population can help to address the existing disparities and ensure everyone has equal access to quality care. We are addressing social justice issues! 
  2. Therapists who are culturally competent and aware of the experiences of diverse populations are more effective in their work. They can tailor their treatment to their client’s unique challenges. 
  3. Therapy is a personal and sensitive process, and having a therapist who shares a similar cultural background or life experiences can help to build trust and rapport. Some clients may feel more comfortable and willing to share their experiences. 

You do not have to have the same colour skin to be an effective therapist, but understanding the inequalities that affect the lives of minority groups is essential.

What to do if you or someone you know are currently experiencing domestic violence

If you or someone you know are currently experiencing domestic violence and are living with your perpetrator, here are some tips for increasing your safety and that of your children. 

  • In the UK, you can contact the police if you are in danger by dialling 999, you can also call 101 in a non-emergency situation to report an incident or gain advice from a local domestic abuse team.
  • You can tell someone, is there a friend, neighbour or family member you trust? Let them know you are at risk from your partner and perhaps arrange a secret code like sending a blank text or emoji that lets them know you need help. You could also think about telling a trusted professional like a therapist or a GP. 
  • Find specialist support, there are multiple charities in each area, for example, in London, a few include Refuge and Solace, and in Birmingham, Solihull Women’s Aid. You can find support here without making an appointment. Most charities have helplines which you can contact – remember you are not alone! 
  • The National Domestic Abuse Helpline is 0808 2000 247, they are open 24 hours a day. 
  • This is a helpful resource for understanding what violence is, actions that can be taken and how to keep safe https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/97924/english-3-steps.pdf 

Msc Saiyuri Naidu is a Senior Assistant Psychologist at the RESET Health Group and an MSc Clinical Psychology Graduate with a special interest in trauma and how this can affect an individual’s mind and body. 

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Why do therapists find it difficult to treat BAME survivors of domestic violence?