by Raushanah Hud-Aleem, DO, and Jacqueline Countryman, MD

From the Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio

Psychiatry (Edgemont) 2008;5(11):37–44

Series Editor: Paulette M. Gillig, MD, PhD
Professor of Psychiatry, Department of Psychiatry,
Boonshoft School of Medicine, Wright State University, Dayton, Ohio.

Editor’s Note: All cases presented in the series “Psychotherapy Rounds” are composites constructed to illustrate teaching and learning points and are not meant to represent actual persons in treatment.


Identity development is an important area with which therapists who work with children should be familiar. The number of biracial children in the United States is increasing, and although this may not be the reason that a child presents for therapy, it is an area that often should be explored. This article will review the similarities and differences between Black and White racial identity development in the United States and address special challenges for the biracial child. Recommendations for treatment in therapy are reviewed.


The 2000 census showed that there are more than 4.5 million married and unmarried couples in the United States of whom the two members were from differing racial or ethnic groups. In the last census, 6.8 million people or 2.4 percent of the US population endorsed two racial categories. Of these 6.8 million people, 42 percent of them were under the age of 18.[1] The number of multiracial children in the US is rapidly increasing in comparison to previous census data.

Identity development and specifically biracial identity development is an important area. Even if biracial issues are not the main focus of the therapy, the biracial child may benefit from exploring this area and having some intervention, if needed.


Identity development is a lifelong process, beginning in early childhood and continuing into adulthood. The goal of this process is to answer “Who am I?” On the surface this sounds simple, but for many people it is a difficult question to answer.

An individual’s identity is complex and consists of several different aspects or domains. As reviewed in a textbook by Tatum,[2] Erikson stressed the impact of cultural, historical, and social context on identity development. According to Erickson, “identity formation employs a process of simultaneous reflection and observation, a process taking place on all levels of mental functioning in which the individual contemplates how others (society) perceive him and how he perceives himself.” According to Tatum,[2] one’s identity is “shaped by individual characteristics, family dynamics, historical factors, and social and political context.” Examples include race, temperament, gender, age, intact or divorced family, community environment, exposure, socioeconomic class, sexual preference, religious beliefs, and present social and political climate.

Much of what we think about ourselves is strongly linked to how we believe others see us and the feelings associated with those beliefs. If we receive or perceive negative or nebulous messages through our relationships with those with whom we are supposed to connect, positive identity development is difficult to achieve.[3]

Identity is a lifelong dynamic process that may fluctuate depending on circumstances. Identity formation begins at birth, becomes more prominent during adolescence, but continues to develop throughout adulthood. Identity is important because it influences our perception, behavior, and how we relate to others throughout our lifespan.


Race is a category manufactured or socially constructed to distinguish a group of people based on physical characteristics. Although the history of the concept of race is beyond the scope of this article, it is important to note a few historical points to put things into context. According to the American Anthropological Association, in spite of scientific evidence to the contrary, people have been conditioned to view human races as natural and separate divisions. In fact, however, the “physical variations in the human species have no meaning except the social ones that humans put on them.”[4]

The concept of race became especially prominent in the US in the 18th century to describe the different populations in colonial America. Race was used to justify prejudicial attitudes and the mistreatment of enslaved people. Inferior and negative traits were attributed to the enslaved and superior traits were attributed to the Europeans to support the subordination of one racial grouping in relation to another. This attitude became entrenched in American society.[4]

Unfortunately, these perceptions of race did not die with the emancipation of slavery nor with the civil rights era. It has been argued that many of these perceptions are still present today but are subtle and inconspicuous, intentional and unintentional.[4] Because of the emphasis our society places on race, understanding racial identity development is important and should not be ignored when working with any patient in psychotherapy.


Prior to the 1970s, identity development models for women in general and people of color were neither applicable nor objective. For example, the models theorized that there were inherent deficiencies of the African American personality. Theories were created on assumptions rather than empirical research and from the perception of individuals of the dominant culture with very limited exposure to African Americans. Consequently, this led to misinterpretation and misdiagnosis.[3]

Dubois was influential in developing and promoting a more realistic and objective re-examination in the African American experience and development in America. His contribution influenced Erikson and expanded Erikson’s perception of the African American identity and the variables that influence it.[3]

People of Color Racial Identity Model (PCRIM). There are several racial identity development (RID) theories. Cross developed one of the most popular RID theories, the Nigrescence Model of African American Identity. Initially published in 1971, the work was revised in 1991. It is now most often referred to as the People of Color Racial Identity Model (PCRIM). The original model was that race was assumed to be a part of an African American’s personal identity (PI), thus affecting the individual’s mental health functioning. African Americans who accepted values of white society were thought to be more likely to experience self hatred and low self esteem, and those who accepted African American values and identity were assumed to have a healthy mental functioning and high self esteem.

In contrast, the revised theory hypothesized that self concept is made of two components: PI and reference group orientation (RGO)/group identity, which may differ from personal identity and have varied degrees of importance.

PI refers to general personality features, such as traits, and is reflected in measures of general personality, psychopathology, and self esteem. RGO/group identity refers to the social group memberships that a person has. An individual may have more than one social group membership that may include race, gender, sexual orientation, and religion. According to Cross, PI and RGO differ because RGO is based on one’s preference, whereas PI is based on the individual’s perception of the individual’s own uniqueness.

PI plays a minor role in African American identity according to the revised PCRIM theory, but RGO may play a significant role depending on, according to Cross, the importance, or salience, of race in the life of an individual, as well as the valence given to race.[5] Race, a social identity, may not be important (low salience) to some, may be very important (high salience) to others, may be associated with negative, positive, or neutral valence. Therefore, one cannot assume that an African American child or adult who has a RGO toward the white race suffers from low self esteem or poor mental health nor can one assume an African American with a RGO toward the African American race has high self esteem or good mental health.

The Revised PCRIM model is composed of the following four stages that have major themes: pre-encounter, encounter, immersion/emersion, and internalization.

The pre-encounter stage is characterized by the belief that African Americans identify primarily with European American/mainstream culture and reject their own culture. According to Helms, the primary theme of this stage is idealization of the dominant traditional White world view and, consequently, denigration of a Black world view.[6]

The second stage, the encounter stage, takes place when an event or several events occur that threaten the individual’s original world view leading to a critical evaluation of identity, group membership, and American society. In this stage, individuals realize that racism is real and this propels them into the immersion/emersion stage.

The third stage, the immersion/emersion stage, is when individuals immerse themselves in African American culture in an attempt to replace the pre-encounter identity. This is a two-phase process. In the immersion phase, individuals may primarily associate with African American culture, disdain European American culture, and try to dress, talk, and act like what they perceive is “black.”[6] They may also judge other African Americans based on these standards, thus categorizing whether or not others are “black enough.” Although the degree of overt manifestations of Blackness is high, the degree of internalized security about one’s blackness is minimal.[6] In the emersion phase, an individual may become cognizant of his or her stereotypic views of African Americans and develop a non-stereotypic perspective. This may spark reevaluation of one’s identity, leading to signs of the fourth stage, internalization.

During the internalization phase, individuals have begun to view the world in a more objective way. They are more confident and secure about their group membership. They are able to appreciate not only African American culture but other cultures as well. They still acknowledge African American/Black as their primary reference group, but they are able to develop relationships with European Americans, reject racism, and no longer judge people based on race but rather on the content of their character.

Initially, it was proposed that Black racial identity development occurred in a sequential linear fashion, with the assumption that a person’s racial identity was complete after a single cycle of the stages. However, that belief failed to explain changes that may occur in late adulthood. Research and observation now have demonstrated that identity formation occurs throughout life and therefore the development of racial identity extends beyond the early-adolescent years as well.

White Racial Identity Development (WRID) Model. Most racial identity research has focused on African-American racial identity development, and there has been little research that examined white racial identity development (WRID). WRID models were developed after the development of minority racial identity models. It is believed that all people, regardless of race, go through a process of developing racial consciousness. The process may differ in content because of different socialization experiences associated with a particular race in the US.

According to Sue,[9] a white identity theorist, the WRID theories are based on the following theoretical assumptions: “Racism is integral to US life and permeates all aspects of our institutions and culture. Whites are socialized into society and therefore inherit the biases, stereotypes, and racist attitudes, beliefs, and behaviors of the larger society. How whites perceive themselves and process their reactions as racial beings follows an identifiable sequence that can occur in progressive (linear) or non-progressive (nonlinear) fashion. White racial identity status will affect an individual’s interracial interactions and relationships. The desirable outcome of the white racial identity development process is that individuals accept their status as white persons in a racist society and define their identity in a nonracist manner.”

Helms’ White Racial Identity Model. The White Racial Identity Model[7] by Helms is the most commonly cited and researched model for acquiring white racial identity. It involves the interplay between perceptions and evaluations of both European Americans and African Americans. The model consists of six stages through which White Americans may progress and become racially conscious: contact, disintegration, reintegration, pseudo-independence, immersion/emersion, and autonomy. It can be further conceptualized as a two-phase process. In Phase 1, racism is abandoned. In Phase 2, there is a redefining positive white identity. Helms suggests that positive resolutions result in progression from one stage to the next and “are associated with better cross-racial interactions and a greater degree of personal adjustment.” An appreciation of White racial identity formation is important when working with the biracial child and his or her parents, especially if the child is partly of African-American ancestry but being raised by white parents or where one of the parents is white.

Phase 1: Abandoning racism. Phase 1 consists of three stages. Stage 1 is the contact stage. In the contact stage, individuals do not identify with a race and there is “an assumption that ethnicity is relevant only for ethnic minorities.” Tokar and Swanson describe this stage as “characterized by a naiveté about Blacks and racial differences… are unaware of their Whiteness and maintain a complacent, naively curious attitude toward Blackness.”[7] Individuals in this stage are unaware of the privileges associated with their race and develop their attitudes of people of color based on media, family, peers, and heresay. If this stage dominates, individuals will avoid discussions about race and deny the reality of racisim.

Stage 2 is the disintegration stage, where the previously held view crumbles as the person realizes that racism is prevalent and that we live in a society that discriminates against people based on race. Anxiety, guilt, and depressed mood often accompany this stage because there is internal conflict between this knowledge, internal moral standards about past and present injustices against African-Americans (and other people of color), and whether or not to conform to the European-American racial norm. If an individual conforms, he or she will benefit from racism and if the individual does not conform, he or she may be ostracized by other Whites for breaking the norms of cross-racial interaction. Helms says the individual will try to resolve the negative feelings associated with this stage by selecting one of three solutions: 1) She or he may attempt to overidentify with African Americans (that is he or she may attempt to put on the behaviors and customs that are believed to be characteristic of the African American culture like one puts on a new coat); 2) she or he may become paternalistic toward particular African Americans as a means of protecting them from further potential abuse; and 3) he or she may “choose to retreat back into the predictability of the white culture.” The retreat is fueled by a need to reduce the discomfort; subsequently some may deny the existence of racism and subconsciously avoid people of color. The chosen option depends on other personality characteristics. According to Helms, the first two solutions will lead to rejection by African Americans and/or European Americans. Eventually the White person who attempts to become African American realizes that it is impossible, while the protector realizes his or her protection is unappreciated. At this point, the White individual begins to feel helpless and look for ways to resolve those feelings, thus entering reintergration stage, or shields the self from contradictory information therefore avoiding the reintergration stage and adopting “white values and beliefs that emphasize racial differences and encourage separation.”[8]

The third and final stage of Phase 1 is the reintegration stage, which is “characterized by hostility and anger toward Black culture and strong positive bias toward White culture.”[7] Helms felt this stage was characterized by the tendency to stereotype African Americans and minimize similarities and to negativly label characteristics of African Americans that are percieved to be different. Conditions associated with African Americans are assumed to be due to a lack of effort. Some choose to distance themselves from possible cross-racial interactions; therefore they remain in this stage unless a significant event or societal pressure forces them to interact with African Americans.

Phase 2: Redefining white identity. Phase 2 of the WRID model also consists of three stages: pseudo-independence, immersion/emersion, and autonomy.

The pseudo-independent stage is where the White individual begins to question whether African Americans are truly inferior. The individual begins to “operate more from an intellectual understanding of racism rather than from a sense of personal responsibility based on their own racism.”[9] The individual begins to acknowledge the role European Americans have in past and current racism. The individual no longer consciously holds on the belief that European Americans are superior, but subconsciously still applies the belief as demonstrated in the individual’s behavior. Cross-racial interaction may occur but is limited to African Americans who appear to be similar to European Americans (i.e., African American professionals).

In the immersion/emersion stage, the White individual looks to redefine racial identity to feel more comfortable and confident about himself or herself. This stage examines racism, what it means to be White, and how one may have contributed to racism. During this stage, individuals will research information about their group’s history and culture and may also get involved in activist groups.

Finally, there is autonomy. During this stage, the individual’s personal journey has helped identify and internalize a positive and secure White racial identity. The White individual is comfortable recognizing and acknowledging the differences between European Americans and African Americans. Differences are not seen as deficits and similarities are not seen as enhancers.[8] The White individual tends to assume nonracist attitudes, develop a diverse cultural identity, and is more open and able to relate to other races. As a result, White individuals may avoid getting involved in activities that perpetuates racism; they may also get involved with activities that confront racism and other forms of oppression.


There has been controversy about the applicability of monoracial identity development models for biracial or multiracial individuals.[19] In the 1980s, it was assumed that biracial individuals should adopt the same race of the parent of color. This assumption was based on historical mandate of the “one drop rule,” which stated that any individual with African ancestry would be considered a member of the Black race.

Therefore, if a biracial individual resisted being categorized as Black, the individual was pathologized.[19] Eventually, multiracial individuals began to challenge this assumption, which led to research, new concepts of biracial identity development, and inclusion of a biracial option on the census.

Poston’s Biracial Identity Development Model.
Poston proposed one of the first biracial identity development models and suggests that biracial individuals will experience conflict and periods of maladjustment during the development process. See Table 1 for comparison with other identity models. Poston’s Biracial Identity Development Model consists of the following stages: personal identity, choice of group categorization; enmeshment/denial, appreciation, and integration.

Personal identity occurs during childhood when the child is not aware of his or her mixed heritage. Choice of group categorization occurs as a result of numerous influences (e.g., parents, peers, community, society). It is during this stage that the individual feels pressured to choose one racial or ethnic group identity over another.

Enmeshment/denial occurs because the individual feels guilty and disloyal for choosing one group over another, subsequently denying the differences between the racial groups and identify with both racial groups.

Some individuals who largely identify with one group may explore the other group and grow to appreciate it during the fourth stage.

In the fifth stage of this model, integration, the individual may still identify with one group but appreciate “the integration of their multiple racial identities.”[10]

Continuum of Biracial Identity Model. Another common biracial identity development model is referred to as COBI (Continuum of Biracial Identity). This model, proposed by Rockquemore and Laszloffy, attempts to reflect the diverse ways multiracial individuals see themselves racially, without placing judgment on the individuals if they do not see themselves the way existing models suggest they should. This model does not attempt to “fit” mixed-race people into a singular correct identity, and instead recognizes that multiple and equally valid racial identifications exist among the growing multiracial population.”

The COBI model suggests (Figure 1) that biracial individuals can locate an identity any place along a “blended continuum.” Singular racial identity is located on the poles of the continuum; for example, if the individual’s parents were African American and European American then one pole would represent African American and the other pole European American. An equal blended identity of the two (not in biological terms) is located in the middle of the continuum. Individuals can locate themselves anywhere along the continuum, and because the belief is racial identity dynamic, it can be subject to change. Biracial individuals may self identify with only one of their birth parents for many reasons and although some anthologize a singular identity option, it is important to recognize that it is “possible for a singular identity to be valid and rational choice and can result in a well-adjusted individual with high self esteem.”[11]


Being biracial does not automatically lead to emotional or relational problems. When biracial children are raised in homes that are nurturing with emotionally involved parents they can be expected to acquire stability and cohesiveness of the self and the attributes that are associated with healthy self structure. Children who are biracial do have additional issues to contend with because they are biracial. They may deal with glares, strange looks, and comments about their family structure. Negative societal reactions to one’s race are problems that can deeply affect the wellbeing of biracial patients. The biracial child and family will meet with disfavor quite regularly.

Experiencing negative social reactions.
Though most interracial families enter into treatment for reasons other than race, most have experienced social disapproval at some time. They are likely to possess some memories of unkind stares, questioning by others, family disapproval, feelings of uncertainty and discomfort, or outright racism.[12] Studies have also shown that biracial children are at risk to develop racial identification issues, lowered self esteem, violence, substance abuse, and feeling marginal in two cultures.[13] A sample dialog follows between a parent of a biracial child and a psychiatrist follows.

Parent: Sometimes I feel others are judging us. For example, last week Ryan and I were at the grocery store and someone asked me if Ryan was my son. I took it as judgmental.
Psychiatrist: Have you talked to Ryan about this?
Parent: I don’t want him to have to deal with that. I guess I figured if we don’t talk about it and ignore any comments it won’t affect us.
Psychiatrist: Ryan, what do you think about what your mom has stated?
Child: There have been times that I’ve felt different, and sometimes, if someone is looking at us, I wonder what they are thinking. You know, someone at school said to me that my mom couldn’t be my real mom.

Addressing lowered self esteem and/or violence in therapy. A psycho-educational approach is helpful when working with biracial children. Some basic but important suggestions to raise psychologically healthy children are listed in Table 2. A sample dialog between a biracial child and a psychiatrist follows.

Child: Sometimes, I don’t like myself. I look different from everyone else in my family and I always do the wrong thing.
Psychiatrist: Why is being different a bad thing?
Child: I don’t know. I guess it shouldn’t be but it’s harder to fit in and then I try too hard and mess things up.
Psychiatrist: I think we need to talk about this more. Looking different is ok, and we need to start with why you don’t accept yourself for who you are.

Environmental factors that can facilitate a healthy identity. The psychiatrist should help the family to see how identity formation occurs and what environmental factors can facilitate a healthy identity can promote change. These factors include 1) encouraging children to acknowledge and discuss their racial heritage with their parents and other significant individuals; 2) parents acknowledging that their children’s racial/ethnic heritage is different from their own and recognizing that as a positive; 3) giving their children opportunities to develop relationships with peers from many different backgrounds by allowing them to attend integrated schools and by living in integrated neighborhoods; 4) allowing their child to meet role models through participation in social activities held by support groups; and 5) forming as a family an identity as an interracial unit.[14]

Parents of biracial children should acknowledge the differences and help form a sense of pride in their childrens’ “doubly rich” heritage.[15] Opportunities for children to take part in cultural activities of both parents should be attempted. This can give a sense of normalcy and comfort in their dual heritage. Parents can take an active role in facilitating their children’s healthy identity development by exposing them to persons, books, dolls, pictures, and toys that are representative of all races and cultures. One challenge that biracial children face is in finding an acceptable name. Often in today’s society, biracial individuals are forced to pick a classification that may deny half of their heritage. Having a child choose sides can be a difficult decision for any child who is emotionally attached to both parents, even if one of the parents is physically absent. It is recommended that when working with families, a preferred racial “label” is chosen that the family can negotiate. By having others in the child’s life (e.g., teachers and relatives) use this label, it can be actualized. Studies have shown that biracial children who grow up with a true biracial identity are happier than biracial children who grew up with a single-race identity.[17]

Having each parent create a cultural narrative should be part of the therapy. Each parent can construct a cultural genogram that focuses on identity, coping strategies, child-rearing practices, strengths, and adversities faced by each ancestor. Discussion of the genograms can help each family member understand the unique cultural stories that make up their family. The values and expectations of each parent’s story should be explored in a nonjudgmental, supportive way. Limitations of this include when there is a parent absent, such as when biracial children are raised by a single parent or foster parents.[12]

Having the parents of a biracial child discuss the pressures that they have faced from society, such as societal opposition, stereotypical and biased assumptions, and being accepted by society at large, is recommended. The coping strategies that the parents have used should be discussed, and this can give parents more confidence in raising their children to have strong racial identities.[16]

A stronger, positive racial identity may serve as a protective factor, particularly for reducing the frequency of substance use and violence.[13] Earlier preventive interventions targeting youth’s multiracial background as well as the issues related to race/ethnicity may be more likely to benefit multiracial youths than later interventions.[13]

Therapists themselves need to understand their own attitudes about people who are different from themselves as well as their attitudes toward interracial relationships.[12] Such awareness is needed to maintain a nonjudgmental perspective with the counseling. Avoiding biased language is extremely important in forming and maintaining relationships with families. Therapists, if unfamiliar, should learn about the different cultural backgrounds of their patients.

Addressing biracial identity development issues: a case example.
Ryan was a 12-year-old biracial boy who presented to therapy for an initial complaint of depressive symptoms thought to be occurring because of social problems with peers. Ryan lived with his biological mother and stepfather, who were Caucasian, and would visit with his biological father, who was African American, on holidays and during the summer. During the initial evaluation, Ryan identified himself as African American because “that’s what I look like.” Though biracial identity was not the initial focus of the therapy, it became more clear as the therapy progressed that Ryan’s presenting problems partially stemmed from identity issues.

Psychiatrist: Ryan, you have said that you see yourself as African American.
Child: Well, that’s what I look like. I look like my dad.
Psychiatrist: I know you visit your dad sometimes around the holidays and during the summer. Do you see family members on his side during those visits?
Child: I haven’t been visiting much lately, but when I do visit I see my grandmother and my dad mostly.
Psychiatrist: Living at your mom and stepdad’s house, do you have contact with anyone who is African American?”
Child: Not really. There are a couple of kids in my school who are African-American but they are in different grades.
Psychiatrist: What do you know about your African American heritage?
Child: Not much. When I’m with my dad we don’t really talk about that stuff. Mom doesn’t talk about it either. I know I look different than the family I live with, but we don’t talk about it.

Ryan identified himself as African American due to his appearance, but had little contact with anyone who was African American. His visits with his father out of state were brief and inconsistent. He did not have much contact with family members on his father’s side of the family except for a grandmother, though she was also far away. His family lived in a predominately Caucasian neighborhood, and he attended a school that was greater than 90-percent White.

Looking at biracial identity formation, Ryan would be at Poston’s stage of “Choice of Group Categorization” when he started in therapy (Table 1). Ryan talked about feeling pressure to call himself African American because that is what others had called him and what he had seen on television and in the movies. He could not remember ever talking to his mother about his race. During the therapy, his mother voiced that she had been uncomfortable talking about this with Ryan.

The psychiatrist started with parent psycho-education on identity formation, specifically biracial identity, and explored with Ryan why he looked at himself as African American. It was explored with the family ways that Ryan could learn about his African American heritage along with his European American heritage. Though his father’s side of the family could not attend therapy sessions, Ryan was able to discuss with his father and grandmother via telephone the history of that side of the family. Ryan’s mother and stepfather encouraged this and attended cultural events that were related to African American history.

Over a period of two years, Ryan gradually showed an appreciation of both heritages and started calling himself biracial (appreciation of multiple identity and exploration of heritages). His self esteem improved along with his peer relationships and school performance.

Because the number of biracial children in the United States is increasing, psychiatrists need to be aware of possible issues that may be affecting a biracial child’s mental health and also be aware of how identity formation may differ in this population. A preventative approach is recommended for most cases. Teaching parents how to facilitate healthy identity formation in their children is an important therapeutic intervention for any biracial child even if this is not the main focus of the therapy.

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