by Jeneé Darden for KQED’s California Report. You can read the original story here or listen to the original broadcast here.

Choosing the right mental health therapist means finding connection and trust. For some African American seniors living in the San Francisco Bay Area, for instance, finding that therapist takes extra work. Finding someone they trust and who understands the challenges older people face is important, but African American seniors say another major factor is that the provider understands race and culture.

Paula Marie Parker, 64, is a retired newspaper journalist. She stays active in the Oakland community as a health advocate for people of color and as a storyteller. Parker’s family has a history of mental health challenges, and she is particular about what she seeks in a therapist.

“I’m looking for somebody who is a really good listener,” Parker says. “I’m looking for somebody who is empathetic.”

Parker, who identifies as African American with some Native American ancestry, says a therapist with an understanding of her race and culture is another requirement.

“I am really focused on finding someone who’s a fit for me as a woman of color,” Parker says.

Few Black Psychologists

Finding a black therapist can be tough, even in a city as diverse as Oakland. According to the American Psychological Association, a little over five percent of working psychologists in the country are black.

African Americans, including those who are seniors, go to therapy in lower numbers compared to white people. Lack of financial resources to pay for treatment is one reason. But there’s also concern the provider won’t understand, nor empathize with their racial and cultural experiences. Black seniors face problems in their personal lives, but social issues affect them, too.

“White therapists may be really great, “ Parker says. “But when you talk about the [mental] impact of worrying about black men in your family being pulled over by the police, beaten or killed — they just can’t feel it the way that somebody of an African American background can.”

Parker bonded with her former black therapist, who was closer to middle age.

“We would hug at the end of the session,” she recalls. “Even though she wasn’t my age, she was a woman of enough age that she understood a lot of things.”

Parker is currently with a white therapist, whom she likes. They discussed early on Parker’s need for a therapist to understand her race and culture.

“Day one I was worried that I would scare her off,” Parker says. “But I just laid my cards out on the table. I still think that’s just the best way because she will understand why I seem skittish. I’m sizing her up.”

Senior black clients come in the door dealing with the high cost of living, homelessness, raising their grandchildren, health issues and more, according to Dr. Patricia Maul-Jones. She is an African American psychotherapist who practices in the Pill Hill neighborhood, home to many Oakland hospitals and medical clinics.  She came to this practice when there were no black  therapists. She says older black clients had a hard time opening up with her white colleague. But Maul-Jones made a connection.

“They say, ‘You know exactly where I’m coming from,’ ” Maul-Jones says. “Yeah I know, because that’s my uncle, that’s me.”

Medical Racism’s Ripple Effect

Maul-Jones says African American seniors have some distrust of the mental health field and remember historical incidents of medical racism like the Tuskegee experiment. Racial inequality in health services still exists. A 2011 report from Alameda County Behavioral Health Care Services, which serves Oakland, said African Americans are disproportionately misdiagnosed and labeled with mental health issues that are much more serious than their actual problems.

Maul-Jones says it’s important for providers to know and understand the history of black clients. Generations of trauma continue to affect their mental health, such as poverty, abuse and daily encounters with racism.

“Even if you were not personally traumatized, your mother probably was, your grandmother probably was, your neighbor, so you are surrounded by trauma in some form,” Maul-Jones says.

Chances are there was little to no mental health support to help them recover from the trauma years ago. But some effort is being made in the field today, such as cultural trainings and classes for aspiring therapists.

Still, there are those who can’t or choose not to see a therapist. They may turn instead to community structures for mental health support.

Black Men Speak

Joe Anderson is one example. He’s chairman of Black Men Speak. The  group in East Oakland spreads the word about mental health to the community. Many of the men who participate are over 50 and live with mental health challenges common in elderly populations.

“I’m 69 years old, and I cannot work full time,” Anderson says. “I do not have the income to rent a home or even an apartment right now. I’m basically homeless, living in a room.”

Anderson has been a Black Men Speak member for nearly 10 years.

“Black Men Speak became my lifesaver, my support group,” he says. “I have people with similar backgrounds, who share the same hopes, who have been through some of the traumatic situations. But they found a way to create something. That’s how Black Men Speak was created.”

Anderson is around people there who share his culture. Years ago, he had a white therapist who he says didn’t listen to him during their sessions. The therapist made an angry phone call to Anderson when he stopped using his services. It brought back memories from Anderson’s early days in Texas.

“It made me feel like I was down South again,” Anderson recalls. “Like the boss man was telling me what I should do and then reprimands me because I didn’t.“

He stopped seeing therapists after that incident.

“It goes back to basically respect,” adds James Glenn, 63, a member of Black Men Speak, also a retired assistant mental health clinician. “One of the worst sins that anyone can do working with a black person is not listen to them. And I mean really empathetically listen to them. Listening not only with the words, but with the body language.”

Many African American seniors in California, like Joe Anderson, are from the South and still practice Southern manners. They expect a higher level of respect when speaking with them, such as the provider asking if they prefer to be called mister or miss.

Dr. Jones explains: “You go to therapy, walk in and a young white woman says, ‘OK John, I’ll see you.’” She says a black senior may think, ‘This white woman called me John?’ It’s uncomfortable. Now as a senior, I’m wondering if you’re disrespectful because I’m black and you’re white.”

R-E-S-P-E-C-T

This question of disrespect may resurrect memories from a time when black people had to address white people by their last names, but white people addressed black people by their first names.

Yet, with so few black providers available, Paula Marie Parker urges seniors to remain open.

“There are really good people out there, in all colors,” she says. “It might be somebody who is in a whole other packaging and yet is an old soul who can really hear you and help you.”

Parker says the lack of black therapists won’t stop her from working on healing.