The AAMFT Blog

Chronic Stress Responses in People of the Global Majority: Exploring Somatic Therapy Interventions and Modern Clinical Approaches

 

By Octavia Neal, LMFT 
Treasurer-MFT’s Working In Trauma 

 

Chronic stress is a pervasive issue that affects diverse populations, but people of the global majority—a term used to describe those from historically marginalized racial, ethnic, and socio-economic backgrounds—often experience unique stressors that exacerbate their mental and physical health challenges. Understanding these chronic stress responses and exploring effective interventions, such as somatic therapy and modern clinical approaches, is crucial for improving the well-being of these communities. 

 

Key Definition: People of the Global Majority 

People of the Global Majority refers to those racial and ethnic groups that are numerically dominant worldwide but are often marginalized in societies where they represent a minority. This term emphasizes that, globally, people of color form the majority, challenging the notion that they are outliers or minorities. The concept seeks to shift the perspective from a deficit-based to a majority-based framework, recognizing the systemic challenges faced by these groups as a result of historical and ongoing inequities (Sims, 2020). 

 

Chronic Stress in People of the Global Majority 

Chronic stress is the continuous activation of the body's stress response system due to persistent external or internal stressors, which can lead to long-term health consequences such as cardiovascular disease, weakened immune function, and mental health disorders (American Psychological Association, 2021). 

Causes and Examples: 

• Socioeconomic Inequality: Persistent economic disparities often impact People of the Global Majority, leading to chronic stress from financial instability, job insecurity, and lack of access to quality healthcare and education (Williams & Mohammed, 2009). 

 

• Racism and Discrimination: Systemic racism and everyday microaggressions contribute to ongoing stress by creating hostile environments and undermining opportunities for advancement (Sue et al., 2012). 

 

• Historical Trauma: The collective memory of colonialism, slavery, and other forms of oppression continues to affect communities through intergenerational stress and trauma (Brave Heart, 1998). 

 

Somatic Therapy Interventions 

Somatic therapies offer a promising approach for addressing chronic stress, especially for individuals from the global majority. These therapies focus on the connection between the mind and body, emphasizing the role of physical sensations in processing and managing stress. Several somatic therapy techniques are particularly relevant for addressing chronic stress responses: 

1. Somatic Experiencing (SE): Developed by Peter Levine, SE aims to help individuals process traumatic experiences and reduce stress by focusing on bodily sensations. SE involves guiding clients to become aware of their physical responses to stress, helping them process and release stored trauma. This approach is beneficial for people of the global majority who may have experienced historical and personal traumas (Levine, 1997). It is important to note that these principles resonate deeply with historical and traditional practices used by Indigenous peoples around the world. Indigenous cultures have long understood and utilized the connection between the body and working through the physical sensations linked to past traumas. (Ex. Native American tribes such as the Lakota and Hopi that used the practice of sacred circle ceremonies to connect to physical sensations and the natural world. Often involving drumming, dancing, and storytelling (Deloria, 1995). 

 

2. Body-Oriented Psychotherapy: Techniques such as Sensorimotor Psychotherapy integrate body awareness into therapeutic practice. By focusing on physical experiences, therapists help clients access and process unresolved emotions and stress (Ogden, Minton, & Pain, 2006). For people of the global majority dealing with the cumulative effects of discrimination and trauma, these methods offer a holistic approach to healing.

 

3. Trauma-Sensitive Yoga: This practice combines traditional yoga techniques with trauma-informed principles to address both physical and emotional stress. Trauma-sensitive yoga helps individuals reconnect with their bodies in a safe and supportive environment, which is particularly beneficial for those experiencing chronic stress due to trauma or discrimination (Van der Kolk, 2014).

 

Benefits of Somatic Therapies: 

1. Holistic Approach: Somatic therapies address the physiological aspects of stress, helping individuals manage their stress responses in a more integrated way.
2. Empowerment and Agency: These therapies promote self-awareness and personal empowerment, enabling individuals to take an active role in their healing process.
3. Creation and Maintenance of Safe Therapeutic Environment: Many treatments can often trigger destabilization via re-experiencing of traumatic events through disclosure. Focusing on somatic interventions can give concrete skills to use to mitigate the physical symptoms of trauma/chronic stress response instead of feeling overwhelmed by them. 

 

Modern Clinical Approaches 

Modern clinical approaches to chronic stress in people of the global majority are evolving to address both the psychological and systemic factors contributing to stress. Some effective methods include: 

Culturally Competent Therapy: This involves understanding and respecting clients' cultural backgrounds and incorporating this knowledge into therapeutic practice. Culturally competent therapists are trained to recognize the impact of systemic inequalities and address them in therapy sessions (Sue et al., 2012). For people of the global majority, this approach can help bridge gaps in understanding and support healing in a culturally sensitive manner. This should also be a part of continuous education for any provider who is connecting with any who identifies as part of the global majority.  

Trauma-Informed Care: Trauma-informed care is a framework that recognizes the prevalence of trauma in individuals’ lives and seeks to create a safe and supportive therapeutic environment. This approach emphasizes safety, trustworthiness, and empowerment, making it particularly effective for individuals dealing with chronic stress from trauma or discrimination (Substance Abuse and Mental Health Services Administration, 2014). Active practice and observation of this framework often has difficulty being implemented in large systems or inundated systems of care.  

 

Mindfulness-Based Stress Reduction (MBSR): Developed by Jon Kabat-Zinn, MBSR is a structured program that teaches mindfulness meditation techniques to manage stress. MBSR has been shown to reduce stress, improve mood, and enhance overall well-being, making it a valuable tool for those experiencing chronic stress (Kabat-Zinn, 1990). 

 

Combining Somatic Therapies with Modern Approaches 

Combining somatic therapies with modern clinical approaches, such as somatic experiencing techniques with trauma-informed care, can address both the physiological and emotional aspects of stress. Similarly, incorporating mindfulness practices into culturally competent therapy sessions can enhance clients’ stress management skills while respecting their cultural contexts. 

There has been success in using these integrative, collective approaches. A community mental health clinic serving a diverse urban population implemented a combined approach using somatic therapies and trauma-informed care. Clients participated in somatic experiencing sessions to address their stress responses and engaged in culturally competent therapy to explore and resolve underlying issues related to systemic discrimination. The clinic also offered mindfulness workshops as part of their stress management programs. This integrated approach resulted in significant improvements in clients' mental health and well-being, demonstrating the effectiveness of combining these methods (Rothschild, 2000). 

Chronic stress for people of the global majority is a multifaceted issue that requires a nuanced approach to treatment. By integrating somatic therapies with modern clinical practices, mental health professionals can offer effective interventions that address both the physiological and emotional components of stress. Somatic therapies, such as somatic experiencing and trauma-sensitive yoga, provide valuable tools for helping individuals manage their stress responses. When combined with modern clinical approaches like culturally competent therapy and mindfulness practices, these therapies offer a holistic framework for improving mental health outcomes for people of the global majority. As we continue to develop and refine these methods, a focus on both individual and systemic factors will be essential for creating supportive and effective mental health care for all communities. 

 

 

 

References 

-American Psychological Association. (2021). Stress: The Different Types of Stress. Retrieved from APA 

-Brave Heart, M. Y. H. (1998). The Return to the Sacred Path: Healing the Historical Trauma of the Lakota. Journal of Human Behavior in the Social Environment, 1(1), 1-21. 

- Deloria, V. (1995). Red Earth, White Lies: Native Americans and the Myth of Scientific Fact. Scribner. 

-Kabat-Zinn, J. (1990). Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. Dell. 

- Levine, P. A. (1997). Waking the Tiger: Healing Trauma: The Innate Capacity to Transform Overwhelming Experiences. North Atlantic Books. 

- Marmot, M. (2004). Status Syndrome: How Your Social Standing Directly Affects Your Health and Life Expectancy. Bloomsbury Publishing. 

- Ogden, P., Minton, K., & Pain, C. (2006). Sensorimotor Psychotherapy: Interventions for Trauma and Attachment.  Norton & Company. 

- Rothschild, B. (2000). The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. Norton & Company. 

- Sims, D. (2020). The Global Majority: A Radical Reimagining of Diversity. Journal of Critical Race Theory, 3(2), 12-24. 

- Substance Abuse and Mental Health Services Administration. (2014). Trauma-Informed Care in Behavioral Health Services. SAMHSA. 

- Sue, S., Cheng, J. K. Y., Saad, L., & Rivera, D. P. (2012). Racial Microaggressions and the Stress Process: Theory, Research, and Clinical Implications. American Psychologist. 67(7), 532–544. 

- Van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. Viking. 

- Williams, D. R., & Mohammed, S. A. (2009). Discrimination and Health Inequities. Journal of Behavioral Medicine, 32(1), 20–47. 

-Williams, D. R., & Mohammed, S. A. (2009). Discrimination and Health Inequities. Journal of Behavioral Medicine, 32(1), 20-47. 

Co-Creating Improved Clinical Outcomes for Marriage and Family Therapists

This content is provided by zynnyme, an affinity partner of AAMFT. This information is not necessarily the view of AAMFT and should not be interpreted as official policy. 

Creating a Successful Private Practice

What makes for a successful private practice as a Marriage and Family Therapist? Success in business is more than the cash in a bank account. This is about impacting lives. Our work has a ripple effect. As marriage and family therapists we know that by the shifts and transformation of the person on the couch or in the therapy room, that transformation becomes multiplied through the lives that the client touches. One change can upend an entire system whether that be familial relationships or beyond. That shift also transcends generations. You see it when people get sober, embrace their identities, heal traumas, and stop abuse cycles.

As marriage and family therapists we are most successful when we facilitate those transformative outcomes for our clients. But we don’t do this on our own efforts alone. Improving clinical outcomes is a co-creative process for both the clinician and the client.

Defining Positive Clinical Outcomes

For the purposes of this article, it’s important to establish the definition of a positive clinical outcome in therapeutic practice. Good outcomes are about your client’s experience. There needs to be an observed and felt transformational value of therapy by the client and that the client is able to verbalize or express the positive changes in their life. Yes, you could go with a score on the SRS or ORS but ultimately what matters most is the client's experience and reflection.

Clinical Outcomes Research

Clinical outcomes require the feedback from our clients. Miller & Duncan* found that "providing therapists with real-time feedback improved outcomes nearly 65%. No downside exists to determining your baseline effectiveness. One either is proven effective or becomes more effective in the process."

Scott Miller who has been studying what puts some therapists consistently getting the top 25% of outcomes across all kinds of different settings and with different types of clients found the following: “Super shrinks, our research shows, are exquisitely attuned to the vicissitudes of client engagement. In what amounts to a quantum difference between themselves and average therapists, they’re much more likely to ask for and receive negative feedback about the quality of the work and their contribution to the alliance."

"We have now confirmed this finding in numerous independent samples of practitioners working in diverse settings with a wide range of presenting problems. The best clinicians, those falling in the top 25 percent of treatment outcomes, consistently achieve lower scores on standardized alliance measures at the outset of therapy—perhaps because they’re more persistent or are more believable when assuring clients that they want honest answers—enabling them to address potential problems in the working relationship. Median therapists, by contrast, commonly receive negative feedback later in treatment, at a time when clients have already disengaged and are at heightened risk for dropping out.”

Based on decades of research about what makes some therapists great and get consistently better outcomes Scott Millers teaches the following

“(1) determining your baseline of effectiveness, (2) engaging in deliberate practice, and (3) getting feedback—depends on and is informed by the others, working in tandem to create a “cycle of excellence.”

Not to oversimplify, but just by being intentional and asking your clients how they are doing in therapy and making it truly SAFE for them to respond honestly, your outcomes overall will improve even if initially that feedback is negative.

Clinical Outcomes Conversations

 

You can find a script to use in our training that covers this in detail on The Outcome Driven Practice, where we list questions to ask your clients. Our clients report that these are often some of the most transformational conversations they have with their clients, deepening the therapeutic relationship and also improving future outcomes.

You would use a session for inquiry and shared dialogue. Asking questions such as

• Share what you remember about how life was immediately before you started therapy.
• What was the last straw when you decided to reach out to find a therapist?
• Do you remember what it felt like to call a therapist?
• Do you remember what in particular you were expecting and hoping for when you found me and came into your first session?
• What do you recall feeling during and immediately after that first session?
• Who do you have for support right now?
• What are your biggest world-related concerns right now?
• Is there something you wish we could change about your therapy?
• Has there been a time when you’ve tried to tell me something and I missed it or you didn’t feel fully heard?

It is important that in your initial consult and in your first session you stress that you will be checking in on outcomes on a regular basis, after each session but in depth quarterly or every 6 months depending on your treatment pacing. Set the tone from the beginning of the relationship that you are open to feedback, positive, negative, and neutral and that you will be asking for it, even persistently because outcomes matter to you and are important for the client.

Negative Feedback

Sometimes the feedback is negative. Negative feedback is a good sign! It is a sign that there is enough trust to share. Often, there also won't be as much negative as you think it will and we find most therapists have a more negative view of their work than their clients do. These conversations can help you see yourself more clearly, including the positives and where you can really improve vs where you think you need to improve.

The ability to have this conversation and receive any kind of feedback is a tool to help the client pattern how to have conversations where feedback may be negative, giving them a safe space to practice navigating the emotions and tension that might arise.

Creating a Feedback Loop

While the responses are documented as part of the clinical note, you want to take the feedback and make adjustments accordingly. You can use the feedback to improve clinical intervention - there may be a different methodology, a referral to another provider for adjunctive services, or a change in frequency or length of session, for example. You can also use the feedback to get clarity on how you best do your work and with whom. You may discover that you prefer working with a niche, providing a different approach or level of service. You will learn not only about the client but about yourself as well so that you can speak more clearly to future clients in your informed consent and marketing. This is how the feedback creates a loop of excellence. Outcomes inform improvements that improve future outcomes.

As you take the feedback and implement changes it will impact your joy, making you more burnout resistant as you now KNOW you are doing good work and have language for that when you question yourself.  You will increase your commitment to refer people out that aren’t progressing and that drain your energy and it allows you to focus your energy, time, and investments into what really works for you and your clients.

Co-Creation with Clients

We cannot build our practices without our clients. By integrating clinical outcomes conversations, we co-create a better practice and improved transformation for our clients. To learn more about having these conversations, access the free training here.

*Miller, S.D., Duncan, B.L., Brown, J., Sorrell, R., & Chalk, M.B. (2006). Using Formal Client Feedback to Improve Retention and Outcome: Making Ongoing, Real-time Assessment Feasible.

Miller, Scott & Hubble, M. & Duncan, Barry. (2008). Supershrinks: What's the secret of their success?. Psychotherapy in Australia. 14. 14-22.