Author: Rakhi

– Jennifer Nash

‘You know more about loss in your bones than any thesis could capture’, I wrote to my sister at the end of my PhD. In the last years of my research, the losses in my orbit were not ordinary, slow and quiet. Grief was hot. It is therefore no coincidence that loss became my research lens. Arguably, however, loss – in all its iterations – was always my backdrop: as a psychotherapist, I find some truth in the idea that therapy is ultimately an education in loss.

During the PhD years – some five of them – my education in many (loss-adjacent) worlds spiced up. I read hungrily, for example, about Black feminism, decolonisation, whiteness and misogynoir. I got to thinking and feeling about women on the margins of the margins:  various categories of racially minoritised women.

In the UK’s National Health Service (NHS), racially minoritised women comprise 21% of the workforce yet only 10% of senior leaders (NHS Digital 2024, Unpublished). Though this problem of underrepresentation is far from unique to healthcare, or indeed the UK, the scale of the problem is: the NHS is the world’s sixth largest employer. This was my research setting.

I interviewed fifteen diverse racially minoritised women leaders extensively to sense their career progression journeying within the NHS. Gendered racism, the mutually constitutive experience of racism and sexism, appeared common. Through the lens of ‘loss’, I waded through stories of heartbreak, body-break, break-outs and break-throughs. I too was nearly broken at times. And here I am, sharing some snippets.

One of my own break-throughs came from being ushered toward Jennifer Nash’s ridiculously stunning book, ‘How We Write Now’ (thanks to another stunner, my supervisor, Foluke Taylor). Nash, Black feminist and academic, writes of ‘the always-already-thereness of loss at various scales as constitutive of Black women’s lives’ (Nash 2024, p.4). Nash, like other influential Black feminists, treats the term ‘Black’ as a political and expansive category rather than a purely biological one. In an earlier paper Nash (2019, p.103) defines loss

capaciously to capture absence, erasure, what is missed and missing, what is taken or stolen, what is unknown and unknowable. … loss […] signal[s] experiences of invisibility and dispossession, to capture institutional arrangements that render Black women unseen and disappeared, to describe persistent feelings of loneliness and alienation that are structurally produced, and to name Black feminist theory’s persistent attention to ghosts, to the palpable presence of the past in the present.

I found (research) home in pausing on these facets, or constellations, of loss since this framing recast my understanding of participants’ words. They gave me a vernacular to recognise and name certain experiences – experiences that were rarely (if ever) named as ‘loss’ by research participants or therapy clients. For instance, several participants described rarely experiencing social support at work. Absence, I thought: the first facet of loss described by Nash. I note that the size, shape and impacts of such social absences may be hard to grasp, speaking to unknown and unknowable losses. The consequences for the women (research participants) I spoke to were, however, undeniable: the absence of social networks meant limited access to power – including leadership opportunities.

Experiences of not being acknowledged or remembered, being unseen and unheard, were also reported. I was reminded of Nash’s loss lexicon as including invisibility and erasure. Participants’ distance to (male, white, able-bodied, cis and heterosexual) norms appeared related to such invisibility. A lack of social power followed: leadership positions were elusive for those tending to go unseen. Such invisibilisation is worryingly pervasive across fields: there is also limited research on the career experiences of various categories of racially minoritised women.

The field of psychotherapy is no exception in risking erasure of  minoritised groups. It has long been shaped by white, western and often male perspectives; many of its institutions still reflect that legacy. One way that practitioners can and do work against that in the (research or therapy) room is by widening what they attend to. Legal scholar and activist Mari Matsuda’s influential method of ‘asking the other question’ helps to see the non-obvious and avoid erasure. In her words, when she sees something that looks racist, she asks, “Where is the patriarchy in this?”. When she sees something sexist, she asks, “Where is the heterosexism in this?”. The premise here is that no form of erasure stands alone – similar to Matsuda’s (1991, p. 1189) thinking that ‘no form of subordination ever stands alone’.

Whilst finding resonance in Matsuda’s neat formulation, yet more elusive – and at times more troubling – erasures haunted participants’ stories. Post-colonial writers (titans really, like Gayatri Spivak) helped me to name these. Epistemic erasures arose from racially minoritised women leaders tending not to be seen as ‘knowers’. Ontological erasures, instead, related to being perceived – consciously or not – as inherently inferior. An example of the latter could be policy makers not even imagining this group as policy subjects. Some participants reported that institutional policy makers did not, for example, conceive of the needs of racially minoritised women staff when deciding who might facilitate training to support career progression, much less separate staff groups by ‘race’ or gender for developmental discussions. Experiences of ontological erasure were especially familiar to Black women of all heritages and/or those born outside of the UK. I call such subtle, profound erasures ‘screaming silences’, adopting academic Laura Serrant-Green’s term. I am better equipped to hear such silences with therapy clients, taking care not to impose my awakening upon their narrative. They may really just want to talk about their mother.

Both kinds of profound erasure (epistemic and ontological) I consider inseparable from Britain’s slavery-trading, imperial and colonial histories and their lingering impacts. For instance, postcolonial legacies rendered some first-generation migrant participants deeply respected by senior figures, and still not recognised as leaders. Put another way, to be depended upon and simultaneously not fully trusted mirrors colonial patterns of racist discrimination. As Nash (2024, p.3) writes, these losses are lived where ‘intimate, political, or social scales intersect’. This, for me, is manifest in the therapy room: I am as interested in the systems of power at play as in tip-toeing around in a client’s very personal world. Furthermore, given that future possibilities for leadership also appeared erased for some participants, these losses are also lived where past, present and future scales intersect.

Novelist Toni Morrison called the serious function of racism to be distraction from the real work of living. I suggest in this context that gendered racism is a serious distraction from the real work of navigating one’s career. Though some participants had climbed to senior levels, occasionally with wonderful support, almost all reported not having achieved their potential. Some reported something akin to surviving their careers; losses of health abound. This is not to suggest victimhood, or to overlook all the living and leading (professionally and personally) done regardless. Neither do I mean to suggest that the lens of loss is everything. Though it has expanded my professional thinking and being recently, like all theories, I aim to hold it lightly lest it obscure other dimensions.

Research on workplace inequalities often ends with a list of recommendations. I couldn’t bear to follow suit given that decades of (important) recommendations have not led to the reduction of workplace inequalities. I did, however, find some resonance in a recent report by ‘brap’, a fairness and human rights charity, on racism in the NHS. The report urged for more empathy and less defensiveness from the organisation and its members: shifts in the affective domain. Similarly, my research suggests that the ‘conjoined twin’ of recommendations to address workplace inequalities is the gruelling affective work of gendered racism and other forms of discrimination. That is, ‘feeling the feels’ of the myriad losses encountered. Drawing on scholar and activist Sara Ahmed’s work, it is perhaps only through this affective labour that the ‘not yet’ of leadership—and of more liveable working worlds—can begin to emerge.

References

Ahmed, S. (2002) ‘This other and other others’, Economy and Society, 31(4), pp. 558–572. Available at: https://doi.org/10.1080/03085140022000020689.

Bhabha, H. (1982). The other question. [Online]. Available from: https://www.librarysearch.manchester.ac.uk/discovery/fulldisplay/cdi_scopus_primary_2_s2_0_77958400524/44MAN_INST:MU_NUI

Matsuda, M.J. (1991) ‘Beside My Sister, Facing the Enemy: Legal Theory out of Coalition’, Stanford Law Review, 43(6), p. 1183. Available at: https://doi.org/10.2307/1229035.

Morrison, T. (1975). A Humanist View. Portland State University.

Nash, J.C. (2024). How We Write Now: Living with Black Feminist Theory. US: Duke University Press. [Online]. Available from: https://gendersexualityfeminist.duke.edu/books/how-we-write-now-living-black-feminist-theory

NHS Digital. (2024). NHS Hospital and Community Health Services (HCHS) staff by staff group, grade, gender and ethnicity, in NHS Trusts and other core organisations in England, as at the last day of the month, March 2023 to September 2024, headcount. [Unpublished]

Richardson, K. (2023). Exclusion and Erasure: Two Types of Ontological Oppression. Ergo an Open Access Journal of Philosophy, 9(0). [Online].

Serrant-Green, L. (2011). The sound of ‘silence’: a framework for researching sensitive issues or marginalised perspectives in health. Journal of Research in Nursing, 16(4), pp.347–360. [online].

Spivak, G.C. (1988). Can the Subaltern Speak? In Colonial Discourse and Post-Colonial Theory. London, UK: Routledge.

Taylor, F. and Downes, R. (2021). Re-imagining the space and context for a therapeutic curriculum. In Black Identities + White Therapies: Race, Respect + Diversity. UK: PCCS Books. [online]. Available from: https://www.pccs-books.co.uk/products/black-identites-and-white-therapies.

Warmington, J., Kline, R. and Somra, G. (2024). Too Hot to Handle? [online]. Available from: https://www.brap.org.uk/post/toohottohandle

“Four seasons fill the measure of the year;
There are four seasons in the mind of [wo]man”
– John Keats

Women are four times as likely to suffer from Seasonal Affective Disorder (SAD). Yes, four. This phenomenon is evidenced in a 2013 study by Norman E. Rosenthal – a world expert in SAD. Continue reading “Seasonal depression: How to feel less crap about less light”

Love is love – familial, romantic, fleeting or friendship. And love can be a bugger. Continue reading “When Friendship Falters”

‘I’m white in the mornings and brown in the evenings’. This is what a four year-old of dual heritage told me recently. I wanted both to laugh and cry. And what this exemplifies is that the topic of race is as confusing – and conflicting – as it gets. Moreover, such feelings are far from limited to littles. Continue reading “Interrupt discrimination without lifting a finger: listen more, talk less”

Eight reasons why therapists find it tricky to make suggestions

‘I suggest that you.. ’ is something I rarely say to clients. If you are deciding how much (it’s a continuum) you want to be led by your therapist – how directive an approach you want – the following may help. For the purposes of this piece, I’m defining directivity as the ‘I suggest’ kind of comment.

Here are 8 reasons why I don’t tend to direct clients – and some exceptions. Continue reading “To direct or not to direct”

This is not a ‘ten ways to be more mindful during lockdown’ article. I considered writing something similar given that these have their place; and at the same time I’m cautious of endorsing a ‘quick fix’ mentality.

So, this is me starting to unpick the relationship between self-disclosure and peace, instead. I choose this topic because this is ultimately what many clients are grappling with: the fear of being – and showing – themselves. Of disclosure. The great Dane-ish philosopher Soren Kierkengaard said that an individual’s deepest despair lies in choosing to be another than themselves.

For self-disclosure: fear – and courage

I don’t much feel the need to protect myself these days. This means that it isn’t usually fear that stops me from self-disclosing – both personally and professionally. If anything, I’ve always felt more acutely the alternative; the risk not to disclose. No doubt this is linked to having been burnt by not sharing what was important to me in the past; the inaction clawed at me. I struggled to find clarity – and courage. Now, I fear more the risk of keeping myself out of relationship, of not communicating. In clients’ relationships with others, I also often witness the damaging consequences of not sharing the big and the small.

Against self-disclosure: when keeping shtum is king

As in my article below, I’m not evangelical about self-disclosure and ‘the talking cure’. Keeping shtum I’ve occasionally found would have been vitally protective. For example, when I’ve disclosed something personal and difficult, and have not been ‘received’ in that communication. Self-disclosure of course does not guarantee connection and empowerment. We need the receiver to sufficiently understand and accept us for this to be the case.

We are each well within our rights not to disclose – or answer – anything we don’t want to. I’m reminded of the writer Rebecca Solnit’s statement, ‘not all questions have to be answered’. For me, as long as it isn’t fear that’s stopping me from speaking or doing, I’m good.

Power, power, power

Decisions not to self-disclose, if not made with awareness, tend to have a power implication. That is, the more ‘mysterious’ I am, the more likely I am to have power over others. Power over others is the last thing I want. In my personal life, if I’m needing to hold back – not disclose – then this probably speaks of some insecurity in me. It may be fruitful to check your motivation if your tendency is to be private, not just for you but so that you are not inadvertently exerting power over another.

Context, content and trust

Self-disclosure, like other aspects of human relating, is far from a binary issue but mediated by context, content and trust. In my professional context, clients tend to feel like they know me well, even if I rarely disclose about my personal world. I believe this is because I’m pretty open with clients about how I am impacted by them. I would even say that, other than romantically or sexually, there are no parts of my world that are categorically off limits to clients. And at the same time it has thus far never occurred to me to share things like my romantic status or how I feel about my mum because I have not found it relevant to another’s therapy.

Self-disclosure is nuanced: I am not discussing here sharing ‘stats’ like whether I have a partner or siblings, but how I am impacted by another. It is possible to create intimacy – like the kind I have with clients – without in some ways sharing many ‘facts’ at all.

What kind of content might I share with clients? I may feel easy sharing my political persuasion but less so talking about how I feel about my beloveds – the latter is more personal to me. The nature of the content impacts my choices around disclosure, naturally.

Although I have thus far described self-disclosure as the process of imparting information, in my experience it is rarely just this. It is more often a back and forth conversation between people, involving clarification, interest, digestion and so forth. For the process of self-disclosure to ‘work’ I need to have sufficient trust in a confidante that they would be willing and able to engage in such a conversation. The role and person of the receiver – and my relationship with them – is therefore also key to whether self-disclosure ‘works’. Given this, as a confidante I strive to be non-judgemental; to be trustworthy. Lofty but true: I strive to be worthy of the honour.

Disclose on your terms (mainly)

Some have found me positively guarded. Others have found me overwhelmingly open. I don’t know if it makes a difference that the latter experience has been with British friends. I have felt pulls in both directions: both to be more open and to be more contained.

Contorting myself too much to suit others rarely leaves me feeling at peace. I understand of course that I must mediate myself socially to some degree. And, a theme across the board in my own therapy and witnessing clients tends to be a movement away from pleasing others. Generally speaking, we are all doing too much of this. Being aware of the pull to please helps me not to disclose habitually.

In the absence of disclosure: are your fantasies helping you?

When we don’t have information – such as when it is not disclosed – we can automatically fill those gaps with assumption or fantasy. This is a common phenomenon.

When clients dare to trust me with their fantasies about me it tends to help their therapy. Note, I don’t need to put fantasies right by correcting with disclosure; I do need to explore how a client’s fantasy affects their therapy. For example, an assumption about me having or not having children may impact how an individual relates to me, and how they reflect on the topic in our conversations.

Outside of therapy, it may be trickier to check out fantasies we hold about others. Still, consider it if you don’t already do this, especially where there is sufficient trust between you and the other. If that’s a struggle, being aware of assumptions and fantasies we hold is in itself in the direction of health.

Self-awareness

It’s worth noting where you are on a spectrum of disclosure (closed/private at one end and open/public on the other). Consider what you are not disclosing – with loved ones, a therapist, or even yourself – and why. The eminent therapist Carl Rogers’ observation after decades of research might be of interest if fear is a factor in your privacy: ‘what is most personal is most universal’. People often say to me, ‘what’s the point in sharing? Others can’t change [XYZ]’. This may be true, but we may be changed – for the better – instead.