Degree Date

2024

Degree

Doctor of Philosophy (PhD)

Department

Social Work and Social Research

Abstract

Systems of Community Mental Health (CMH) care often operate as apparatuses of oppression and social control over marginalized groups. Rooted in colonialism and racial capitalism, these systems have a history of causing harm in particular to Black, Indigenous and People of Color (BIPOC) (Metzl, 2009; Wade, 1993; Szasz, 2009). Pressured to comply within neoliberal practice environments, clinicians are limited in their ability to resist enacting oppression, and experience dissonance—a state of tension arising from psychologically inconsistent cognitions (Harmon-Jones & Mills, 2019)—as they find themselves caught between anti-oppressive practice ideals, and what is required of them by their agencies. In this qualitative study, I conducted individual semi-structured interviews with 13 current and former CMH clinicians, who were asked to reflect on their experiences of and responses to dissonance around power and oppression in these practice settings. I used content analysis to examine how white clinicians experience and respond to dissonance related to power and oppression in critical moments of the clinical encounter, exploring the ways that dissonance motivates acquiescence vs. resistance in these moments. My analysis revealed the ways that clinicians experienced powerless dissonance in areas where they don’t have choice, and discretionary dissonance in areas where they do. Building on Dominelli’s (1999) work, I found that in some moments, clinicians succumb to powerlessness, leading to acquiescent accommodation of oppressive agendas. In other moments, clinicians harnessed discretionary power, for strategic accommodation to find maximal space for their clients, or explicit resistance to push back against harmful practices. The role of clinicians’ emotional experiences and elf-concept as it relates to their racial and professional identities in the drive to reduce dissonance are explored through a critical conceptual framework centered on critical whiteness theory (Applebaum, 2010; Frankenberg, 1993; Hook, 2011; Sullivan, 2014). I conclude that dissonance can be generative if clinicians are able to sit with it in moments where it cannot be reduced. These findings suggest the importance of clinicians participating in practice communities that center anti-oppressive aims and provide tools that help them lean into the discomfort of dissonance in their practice.

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