Duration: 16 minutes, 41 seconds

CHRIS AIKEN: Racial bias is real, and it has measurable effects on healthcare outcomes. Today, we talk with Beverly Stoute about how unconscious racial biases play out in the therapy room.

Welcome to the Carlat Psychiatry Podcast, keeping psychiatry honest since 2003. I’m Chris Aiken, the editor in chief of the Carlat Report. And

KELLIE NEWSOME: I’m Kellie Newsome, a psychiatric NP and a dedicated reader of every issue.

CHRIS AIKEN: Psychoanalysis was built on the things we can’t talk about. The stuff that gets suppressed, repressed, or otherwise goes unconscious. In Freud’s time, that was sex… and aggression. But what ideas do we shy away from in the US today? Religion, politics, money, privilege, power, and race.

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KELLIE NEWSOME: That was Kirkland Vaughans from the documentary Black Psychoanalysists Speak

CHRIS AIKEN: The idea is that you can’t keep the unconscious locked down forever. Sooner or later, it leaks out, and today we’re going to speak with psychiatrist and psychoanalyst Beverly Stoute about racial enactments in psychotherapy.

First, some terminology. An enactment is when two people – the therapist and the patient – play out their unconscious biases or motivations – without being aware of what they are doing. For example, suppose you are treating a patient with chronic depression who has an unconscious desire to be rescued. Meanwhile, you have an unconscious desire to be a hero, a bit of a savior complex that you’ve never fully grasped but that is part of the reason you became a doctor. Here’s how that might play out in an enactment. Every time you start a new medication, the patient feels rescued and gets better, only to collapse again into depression. They cycle keeps repeating itself, much to the delight of both parties, but not toward any lasting recovery. 

Other enactments may not delight either party, as when we harbor unconscious biases about people with substance use disorders, and react in a not so therapeutic way when they appointments or misuse our prescriptions.

Now, let’s hear from Beverly Stoute on how unconscious racial bias can get enacted in psychotherapy.

KELLIE NEWSOME: Throughout this interview we’ve inserted clips from the documentary Black Psychoanalysts Speak, which you can watch in full at black psychoanalysts speak.org or on YouTube.

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KELLIE NEWSOME: Let’s pause for a preview of the CME quiz for this episode – earn your CME through the link in the show notes.

1. According to Dr. Stoute, what is the most common form of racial enactment in the treatment setting?

A. Indifference to the early experience of race

B. Pretending that race does not matter

C. Microaggressions

D. Interpreting racial differences as hostile

KELLIE NEWSOME: Beverly Stoute is a child, adolescent and adult psychiatrist and psychoanalyst and a Supervising Analyst at the Emory University and the New York Psychoanalytic Institutes. She is the co-editor with Michael Slevin of the 2023 book, The Trauma of Racism: Lessons from the Therapeutic Encounter. Last year, Dr. Stoute served as co-chair of the Holmes Commission on Racial Equality in American Psychoanalysis, and we’ll talk with her about the findings of that report in our upcoming episodes.

Check out our July issue online where we talk with David Mintz about how to enhance medication response in a brief med-therapy visit. Get $30 off your first year’s subscription with the promo code PODCAST. Your support helps us stay free from industry bias.

The Carlat CME Institute is accredited by the ACCME to provide continuing medical education for physicians. Carlat CME Institute maintains responsibility for this program and its content. Carlat CME Institute designates this enduring material educational activity for a maximum of one quarter (.25) AMA PRA Category 1 Credits^TM. Physicians or psychologists should claim credit commensurate only with the extent of their participation in the activity.