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Uncovering the effects of race and generational trauma on the maternal experience

Nikki Lively, M.A., LCSW
• April 11, 2022

When I think about psychotherapy’s role in Black maternal health, one woman in particular comes to mind. She was a new mom and came into the therapy room, seeking help for severe postpartum anxiety. She hadn’t been sleeping and was hyper-vigilant to her baby, reactive to any signs that the baby was not okay. I wondered about her family history. What generational history was this new mom carrying with her into her experience of taking care of her infant?

Family systems therapists have long used a tool called a genogram to track emotional patterns in families. We can’t physically see this emotional inheritance, but it works on us like gravity. Genograms enable us to take into account life circumstances of the generations before us, helping this new mother understand, for example, how her postpartum anxiety may be rooted in an untimely death in an earlier generation.

The woman’s maternal grandmother lost her firstborn child — likely to sudden infant death syndrome, the family now knows, though at that time there was no satisfactory explanation. The loss led her grandmother to fear the same thing happening with her second born (this womans mother). It also kicked off an inheritance of anxiety, now showing up in the present day new mom watching over her baby with unnamed and unprocessed grief whispering over her shoulder: Something bad can happen at any moment.”

During our therapy sessions, the woman shared that people at the time treated her grandmother with suspicion; her grandmother never felt like her questions or concerns about her baby were answered or that her doctors listened to her.

That’s one woman’s tragic, traumatic story, but consider the broader racial context of this unexplained infant death. Black women in the U.S. historically have felt uncared for, in terms of their own lives and the lives of their children — and statistics support that, even through the present day. The legacy of trauma, grief and underlying hypervigilance my client experienced makes sense. Facing this context lets the healing begin. And as the late James Baldwin said: Not everything that is faced can be changed. But nothing can be changed until it is faced.”

Psychotherapy is all about facing — the past, present, future; our values, feelings, and our most important relationships, among other aspects of life. When framed this way, psychotherapy has so much to offer everyone, including Black postpartum women, who deserve a space to cry, laugh, be nurtured, and come into their own as mothers.

Psychotherapy and racial discrimination

Facing racism is incredibly painful in modern conversations, present-day situations and when you recognize the toll the United States legacy has taken. That legacy continues to play out markedly in Black maternal health. Discrimination, fear, violence and death severely limited millions of people’s lives and potential in the U.S. since the country’s founding and through today. This legacy leaves all of us with an astounding amount of grief and pain to face.  

Psychotherapy itself played a part in the legacy of racial discrimination. As a result, many people of color don’t consider the service a viable option, as you never know what kind of treatment you will receive from a therapist in our healthcare system. Recently, the American Association of Psychology issued an apology for its role in promoting, perpetuating, and failing to challenge racism, racial discrimination, and human hierarchy in the U.S.” That acknowledgment is one way the therapy field is finally facing its history of making therapy yet another place where black women may not find safety. Yet, as Baldwin said, with recognition comes the potential for change.

With the will and motivation to reckon with this in our field, coupled with a trauma-sensitive lens, psychotherapy models are set up to help us understand and make sense of inter-generational patterns. Family systems theory, for example, understands that more than our own direct experiences impact every person. We’re all a combination of our lived history, as well as our emotional inheritance from people we have never met and whose life circumstances we never directly experienced. At its core, psychotherapy loves the past. We therapists love to make sense of how we all develop our coping strategies and beliefs; we compassionately approach current problems from the vantage point that all behavior makes sense in context.

Contextualizing the present

Psychotherapy with a systems- and trauma-informed lens can offer postpartum Black women a place to understand, make sense of, and heal the damage done to ones sense of self by these legacies. People tend to blame themselves for their experiences or struggles because we live in a culture that readily ignores, minimizes or denies the past and its lasting impact. 

Psychotherapy also offers a systemic vs. linear view of the present experience where we can support clients to have compassion for themselves and the elements of intergenerational inheritance beyond their control. We can then identify the places where there is emotional reactivity, and facilitate healing and soothing of those areas so mothers can now parent their own children in a responsive way. They can ground their parenting in their values, with the potential to change the emotional inheritance for themselves and future generations. 

If you are considering psychotherapy, make sure your therapist is equipped to face the topic of race and its impact on your transition to parenthood. Ask your potential therapist these questions to decide if they’re culturally attuned to issues of race:

  • Does race or racial identity come up often with your clients in therapy?
  • How do you discuss racism with clients?
  • How does your own race play into therapy?
  • What do you do to work on your own professional and personal understanding of racial identity?

If you’re a therapist wondering how you would answer these questions from a potential client, please join us at our next Transitions to Parenthood seminar: Perinatal Mental Health for Black Women: Understanding the Transition to Parenthood in Cultural Context” in September 2022. Find more information here.

Always, but especially in celebration of Black Maternal Mental Health Awareness Week, we hope these ideas help you better understand how to find culturally attuned psychotherapy as one of many possible tools for healing.

Nikki Lively, M.A., LCSW

Clinical Director, Transitions to Parenthood Program
Ms. Lively is a certified Emotionally Focused couples Therapist ​and Supervisor (EFT), ​Certified in Perinatal Mental Health (PMH-C) through Postpartum Support International and ​trained in Eye-Movement Desensitization and Reprocessing (EMDR). Her main area of expertise is supporting women, men, infants, couples and families in the transition to parenthood ​and specializes in women's reproductive health.