Using cognitive therapy for PTSD when racism was part of the traumatic event(s): Case illustrations and practical considerations for therapists and supervisors

Cognitive therapy for post-traumatic stress disorder (PTSD) is recommended in a range of national and international guidelines. This clinical guidance paper specifically focuses on cognitive therapy for PTSD (CT-PTSD) where racism has been part of the index trauma event(s). It aims to support CBT therapists to maintain fidelity to the CT-PTSD model but also ensure that racism is integrated into the formulation and interventions in ways that are sensitive and validating. It explores barriers to this occurring ranging from societal factors (e.g. ongoing racism, discouragement from discussing racism), to therapist factors (e.g. lack of understanding of racism, lack of own understanding of racialised identity, anxiety, lack of knowledge, skills and confidence) and patient factors (e.g. shame, fear of therapist response). The paper aims to provide guidance on how these can be addressed alongside case illustrations and practical considerations for therapists and supervisors. Key learning aims (1) To understand how Ehlers and Clark's (2000) cognitive model and related treatment of PTSD can be applied when racism is part of the traumatic event. (2) To provide guidance, tips and examples on how to identify key personal meanings around the trauma index event involving racism. (3) The article will encourage therapists to reflect on their own identity and experiences (or lack of) around racism, considering how this might hinder or facilitate the appropriate inclusion of racist experience within CT-PTSD. (4) To provide suggestions on how to ensure that supervision of CT-PTSD supports the consideration and addressing of relevant experiences of racism and supports therapists where patient experiences may overlap with their own experience of racism.