By Yara Mekawi, M.A., and Joya Hampton, PhD
Note: This article is featured in our Clinical Science newsletter: Fall 2019
A California-native, Dr. Natalie Watson-Singleton’s journey in academia started at the University of Dallas for her undergraduate degree in psychology, then to the University of Illinois at Urbana-Champaign for her doctorate in clinical-community psychology, and then back south to Atlanta, where she is currently an assistant professor at Spelman College. Dr. Watson-Singleton’s expertise centers on Black women’s mental health, a passion she has been pursuing ever since she learned about and was “hooked” on the concept of intersectionality in college. You can find her work in outlets such as Cultural Diversity and Ethnic Minority Psychology, the Journal of Counseling Psychology, and the Journal of Black Psychology. Right now, she is focused on implementing a study funded by the National Institute on Minority Health and Health Disparities entitled, “Culturally Responsive Stress Reduction: A Mobile Mindfulness Application to Support Health Promotion for African Americans.” When she isn’t busy piloting culturally-responsive mobile health apps for African Americans, mentoring students, or teaching, she enjoys practicing restorative yoga, getting soothing massages, and eating good food with good friends. We are so excited to have had the opportunity to sit down with Dr. Watson-Singleton and talk to her about her research and approach to diversity across scientific, clinical and pedagogical contexts.
1. What is your definition of intersectionality (or diversity)?
Intersectionality recognizes that intersecting identities (e.g., race, gender), along with intersecting forms of oppression (e.g., racism, sexism), contribute to different experiences and health trajectories for individuals. Also, consistent with the initial theorizing of intersectionality by Black feminist theorists, such as the Combahee River Collective, it’s important to me to highlight how intersectionality’s original aim was to examine multiple marginalized identities specifically rather than multiple identities generally. Although this application of intersectionality has been debated, I think it is imperative to focus on multiple marginalized identities because I have seen research employ the “buzzword” of intersectionality while conducting research with the most privileged members of marginalized groups (e.g., white women) when this approach is what Black feminists were trying to problematize and challenge.
2. From your perspective, how is intersectionality (or diversity) relevant to the field of clinical science?
First, clinical science aims to expand scientific knowledge in the field of clinical psychology in order to reduce the pervasive and persistent burden of mental illness. Yet, in our discipline, there is limited scientific knowledge and research on the experiences of marginalized groups who are affected by intersecting “–isms” (e.g., racism, sexism), like African American women, poor women, and sexual minority people of color. Therefore, intersectionality becomes a clarion call to remind us of the gaps and blind spots in our scientific knowledge base; blind spots that can cause us to overlook and to not address the disproportionate rates of mental illness and barriers to treatment for diverse groups. Second, clinical science values delivering empirically-based services, and when this value is combined with intersectionality’s key questions of, “Who is included?” and “Who is not included?”, we are encouraged to examine for whom our services were designed to serve and for whom are services treat best. For example, research indicates that African American women experience more health benefits when they are treated with culturally-tailored interventions. Yet, despite this information, African American women are not routinely offered culturally-responsive behavioral health care. Also, African Americans are less likely to receive evidence-based medication therapy or psychotherapy. Therefore, when the field does not prioritize making treatment decisions or using treatments that are scientifically grounded, underrepresented communities suffer the most. Third, intersectionality provides a useful heuristic for understanding how individuals’ identities and lived experiences are negotiated via direct contact with sociocultural factors, like institutional practices, politics and practices, and societal values. This focus ensures that we, as clinical scientists, encompass multi-level variables within our understanding and treatment of mental health for marginalized populations.
3. From your research, what are some major themes or lessons learned about African American women’s mental health and help-seeking behavior?
#Blackwomenscholarshipmatters - As an African American woman doing research on African American women, I sometimes felt I had to go above and beyond to justify the importance of my work. There have also been times when there seemed to be an implicit devaluing of topics related to women of color, especially if this work was being conducted by women of color. Despite not always feeling welcomed within the academy, whenever I would discuss my research about strength and its impact on African American women’s health, I would watch as my friends’ and family members’ eyes would widen with excitement. They were moved to know that someone cared enough to do research on a topic that was relevant and meaningful to them. These experiences validate and affirm the importance of my work, and they further motivate me to conduct psychological research that reflects the importance of context and culture.
Culture matters – like, it really matters. Given my research and clinical interests, I spend a lot of time talking to African Americans about how to create and develop culturally-responsive behavioral health interventions. I truly enjoy this work, and one of the things that has continued to surface is the importance of culture. Culture – the socially shared values, norms and beliefs reflected in our everyday practices, institutions and artifacts – imbue our perceptions, behaviors, and attitudes regarding mental health. For most of the people I talked to, it was important to see their cultural values and practices reflected in behavioral health interventions and provided by people who understood their cultural background. Therefore, for many of the African American clients and research participants I have spoken to, there is a desire to engage in interventions developed “for us by us.” I have learned that if we – clinicians and researchers alike – truly and meaningfully attend to culture in its complexity, we can create interventions that promote comfort, validation, and a sense of belonging among diverse communities, including African American women.
Culture matters, but it’s not the only thing that matters. Because of my research and clinical interests, I not only talk to African Americans about how to develop culturally-responsive behavioral health interventions, but also I provide consultation on how to tailor interventions to meet the needs of diverse groups. One of the challenges of this work has been to emphasize the importance of culture and culturally-relevant factors while also protecting against the tendency to overly rely on cultural stereotypes. Therefore, I am continuing to learn about the importance of helping people to understand the salience of cultural values while also attending to meaningful within group differences.
4. How do you utilize research about African American women in a clinical context, in terms of assessment and case conceptualization?
In my research, I am repeatedly reminded of the clinical relevance and impact of the Strong Black Womanhood Schema – a multidimensional dispositional style that reflects women’s distinct intersectional race-gendered experiences – in African American women’s lives. Many women adhere to this schema’s expectations, like suppressing emotions, taking on multiple roles and responsibilities, forgoing emotional support from others, and prioritizing others’ needs over their own. I am especially attuned to how this unique socialization for African American women gives way to prescribed attributes and behaviors that foster inner strength and self-efficacy as well as may influence emotion regulation difficulties. For example, this schema’s expectation to suppress emotions to avoid appearing ‘weak’ can lead to chronic emotional inhibition, nonacceptance of emotions, and limited emotional awareness. These emotion regulation processes may lead to unhelpful coping strategies and harmful health outcomes in the context of individual stressors, like trauma and gendered race-related discrimination. Therefore, as a multiculturally-oriented clinical scientist, I approach assessment and case conceptualization by attending to prominent, empirically-validated theories of psychopathology (e.g., models of emotional regulation) as well as individual-level (e.g., trauma history) and sociocultural-level factors (e.g., gender socialization) that influence presenting concerns and barriers to effective action.In my research, I am repeatedly reminded of the clinical relevance and impact of the Strong Black Womanhood Schema – a multidimensional dispositional style that reflects women’s distinct intersectional race-gendered experiences – in African American women’s lives. Many women adhere to this schema’s expectations, like suppressing emotions, taking on multiple roles and responsibilities, forgoing emotional support from others, and prioritizing others’ needs over their own. I am especially attuned to how this unique socialization for African American women gives way to prescribed attributes and behaviors that foster inner strength and self-efficacy as well as may influence emotion regulation difficulties. For example, this schema’s expectation to suppress emotions to avoid appearing ‘weak’ can lead to chronic emotional inhibition, nonacceptance of emotions, and limited emotional awareness. These emotion regulation processes may lead to unhelpful coping strategies and harmful health outcomes in the context of individual stressors, like trauma and gendered race-related discrimination. Therefore, as a multiculturally-oriented clinical scientist, I approach assessment and case conceptualization by attending to prominent, empirically-validated theories of psychopathology (e.g., models of emotional regulation) as well as individual-level (e.g., trauma history) and sociocultural-level factors (e.g., gender socialization) that influence presenting concerns and barriers to effective action.
5. What unique barriers or stressors might graduate students of color face in clinical science doctoral programs? What strategies do you think faculty members and administrators can employ reduce these barriers?
Barrier 1) As an African American woman doing research on African American women, I often felt like I had to go above and beyond to justify and/or explain the importance of my work. Growing up I witnessed how my mother, grandmother, and aunts displayed a quiet strength as they cared for others. They persevered in the midst of hardships, forever “keeping it together” for the sake of family and work life. Experientially, I knew that African American women were utilizing life management strategies that were a response to marginalization and that were negatively impacting their health. Yet, I was not satisfied with what the (lack of) research had to say about this phenomenon. When I decided to study this phenomenon, I received support from some. Also, I regularly received questions like, “Is this phenomenon generalizable to all women?” “What are the implications of solely focusing on African Americans/African American women?” These kinds of questions about my research made it difficult to disentangle which questions/concerns were indicative of the desire to enhance my research’s scientific merit versus indicative of an implicit devaluing of topics related to communities of color. Meaning, when students conduct research with European American samples do they routinely receive similar questions about the (lack of) generalizability of their findings? Therefore, I think some graduate students of color may feel that the kinds of questions they’re interested in are devalued and discouraged.
Barrier 3) In my experiences, academia has been designed to highlight all the ways we are not enough – the ways we have not published enough, the ways we have not written enough, the ways we have not done enough service nor secured enough grants, etc. This is difficult for anyone, and I think this is especially challenging for graduate students of color who may already feel as if they do not belong or as if they are navigating a space not designed with them in mind.
6. You graduated from a combined clinical and community program. How did your community psychology education influence how you think about clinical research and practice?
I received invaluable training in my clinical/community program, and it has shaped my clinical research and practice in a number of ways. Because of this training, I am committed to adequately attending to the effects of institutional and social inequities that enable and/or perpetuate marginalization, and in turn, shape the health trajectories of marginalized group members. Therefore, my clinical understanding of any presenting problem, whether as a clinician or researcher, takes into account systems of equality and inequality. Relatedly, although my research agenda considers the necessity of access to and availability of culturally-responsive behavioral health interventions for diverse groups, I understand the inherent limitations of treating behavioral health concerns at the individual level. Therefore, I am an advocate for social justice initiatives that aim to create policies and institutional practices geared towards enhancing the lives of diverse communities.