A new therapy model, built in Louisville, helps kids heal from racial trauma

Steven Kniffley Jr. is a clinical psychologist. He’s also a Black man, and he repeatedly recognizes how much that matters to clients who share this identity.

“When I go out into the waiting room to see one of my Black male clients for the first time, and this look of relief and surprise that they have on their face, that a Black guy who’s a doctor is coming out to support them,” he said. “There’s like an increase in hope, a feeling of empowerment, and an instant level of trust.”

Decades of research show the cumulative impacts of racism cause emotional and psychological distress for people of color. Kniffley wants to help people of all ages learn to heal from racial trauma.

That’s why he developed a new model of therapy – one made by, and for, people of color. The work began in Louisville several years ago, when he led Spalding University’s Collective Care Center .

Now, Louisville Metro Government is putting federal money behind Kniffley’s model to make it more accessible to local residents.

What is racial trauma, and why create a new therapy for it?

Racial trauma is similar to Post Traumatic Stress Disorder. However, PTSD often emerges after experiencing or witnessing a dangerous but isolated incident.

“Racial trauma, on the other hand, stems from these subtle experiences of racial discrimination that cause distress for folks,” Kniffley said.

Because it’s distinct from PTSD, psychologists like Kniffley believe treating racial trauma requires different therapeutic tools.

His approach, the Kniffley Racial Trauma Therapy Model , is influenced by African-centered psychology and liberation psychology , which value cultural knowledge and collective healing.

“So we're not using tools that were designed for, by and researched on white individuals,” Kniffley said.

Instead, the focus is on utilizing tools that are more consistent with the cultures of various people of color.

Growing up in Louisville, 18-year-old Mariana Salazar and her older siblings experienced a lot of racism.

“Back whenever we were younger, I feel like as a Hispanic kid, we weren't really liked. It was a lot of hatred towards us,” she said. “So we would experience a lot of hate, where people would come vandalize our apartment.”

Salazar’s family emigrated from Mexico before she was born.

“I'm proud to say that I'm never going to be ashamed of where I came from, nor how I was raised,” she said.

As a kid, Salazar didn’t defend herself when people said racist things because she thought she’d make it worse.

Today, she speaks up.

“Although I don't want to give into the situation, someone has to know when they're wrong,” she said.

Learning to be proud of your identity and to advocate for yourself are core pillars of Kniffley’s therapy model.

How does the Kniffley model work?

The model has three main goals.

1. To help clients develop an affirming racial identity, which means they feel positive about being a person of color.
2. To provide a welcoming space to talk about traumatic experiences with racism.
3. To empower them to deal with discrimination.

Kids six and up can do the Kniffley model, which takes a few months to complete. A caregiver joins the weekly sessions with younger kids.
“Because they're the ones that can reinforce the things that we're sharing with our young folks within the therapeutic process,” Kniffley explained.

Before they talk about trauma, the therapist helps the client build a foundational belief in their value as a person of color. They learn to celebrate their identity.

“When you walk out of here, when you see all these negative images that paint you as this dumb, deviant, dangerous individual, you can refute those by saying, ‘Well, actually, this is what I think about myself,’” Kniffley said.

Next, it’s time to process one racially traumatic event they went through. It could be subtle or explicit.

The client forms a narrative about what happened and how they survived it. They explore the experience through art, like writing a song.

For generations, Kniffley said people of color have coped with trauma by compartmentalizing. They put painful thoughts and feelings in boxes and shut them tight.

The therapist asks the client to open just one.

“It gives us an opportunity to teach them how to do their own processing of racial trauma. That way in their own spaces, they can start to unpack those boxes they've been holding on to,” he said.

Young clients create an empowering fable – like a tale about a kid in quicksand who grabs a vine and pulls themself out.

The model also teaches skills to cope with microaggressions. Those are often subtle comments or behaviors that insult people of color. Kids learn to advocate for themselves and talk to a safe adult.

With a new therapy like this, studying its effectiveness is an important but long process. Kniffley said therapists regularly assess clients to check for improvement.

And now, Louisville Metro Government is helping expand local access to Kniffley’s model.

Evaluating the model and expanding access

On a hot July day at Parkhill Community Center, a group of kids dropped slips of paper in decorated jars. Artist Ashlee Phillips told two Black teens they can write down their goals, or fears.

“So the jar serves as, like, a backup for your brain, so you don’t have to store everything in here, right? So you can operate more in things that you enjoy, and being excited, and being positive, right?” she explained.

This is Mind, Body & Soul , a summer art program for kids. It’s part of Louisville Metro’s Trauma Resilient Communities project, which aids youth and families affected by violence.

The city-run project is funded by several million dollars in federal grant money. In recent years, it connected over 100 therapists to training on Kniffley’s racial trauma therapy model.

University of Louisville professors Shantel Crosby and Jennifer Middleton are co-leaders for evaluations of the Trauma Resilient Communities project. That included assessing the Kniffley training therapists went through, which factors into how effective Kniffley’s overall racial trauma therapy model is.

Crosby, Middleton, Kniffley and other professionals co-authored research that surveyed 54 therapists who were trained in Kniffley’s model.

Data showed a statistically significant increase in how prepared white therapists felt to address racial trauma after the training.

“It helps white clinicians to better sort of navigate these conversations because they’re not having to kind of come up with it on their own,” Crosby said. “It’s very structured.”

Therapists of color also felt better able to help clients with racial trauma, although the increase wasn’t statistically significant. The research team also did focus groups with 15 therapists who did the training.

Crosby said they talked about how their professional education didn’t prioritize BIPOC individuals – meaning Black, Indigenous and people of color.

“Even BIPOC clinicians coming into it with some lived experience still don’t have the clinical terminology, interventions, (and) the knowledge of assessment tools to really wrap their hands around what to do with racial trauma,” she said.

Louisville therapist Alex Hammond said the Kniffley training helped her personally, as a Black woman. And it gave her evidence-based tools to help clients recognize how racism affects them — and see that they can heal.

“Most people … for me, aren't coming in and saying, ‘Hey, I need help with racial trauma,’” she said. “I don't think most people know that term or know that there's even treatment for it.”

Narrative therapy, like the fable kids create in Kniffley’s model, is a favorite approach of Hammond’s. She has a client who wrote an anime-style origin story.

“The characters and what they represented for that client was just so healing,” she said.

Several local therapists said they don’t always do the Kniffley model’s months-long process. They do use specific exercises from it in the course of ongoing therapy. And sometimes, clients don’t want to pursue racial trauma therapy. At least not right now.

Lucille Gardner leads Spalding University’s Collective Care Center, where Kniffley worked while developing the model.

For younger kids, scheduling can be a barrier. Kniffley’s model is designed for a caregiver to join the therapeutic process, and Gardner said this collective approach is beneficial. But some parents can’t do weekly sessions, due to work and other responsibilities.

And for clients of all ages, other issues may feel more urgent than racial trauma – like family problems or grieving someone’s death.

“Racism is always present and underlying and likely to come up at every single session and in multiple different ways,” Gardner said. “But it's not always the center because people have had to deal with this their whole lives. Even if that person is just 12.”

Kniffley believes any person of color can benefit from his racial trauma therapy model. But few therapists are prepared to provide it. He estimates about 1,200 therapists worldwide are trained in it so far, including around 150 in Kentucky.

Kniffley is developing a group therapy option so therapists can help multiple clients at once. Louisville Metro’s Trauma Resilient Communities project is partnering with him on that effort, and supporting the work with federal grant money.

Kniffley is also fine-tuning the individual therapy version, learning from the feedback of clients and therapists. For example, he wants to make it more useful to Latinx clients by adding more culturally specific details.

“Different cultures require different tools, based on the experience of historical trauma … or the experience of immigration,” he said.

Developing and adapting the racial trauma therapy model has been a group effort since the beginning, through partnerships with students at colleges like Spalding University – and now with Louisville Metro Government.

Today, Kniffley lives in Cincinnati, where he works as a senior associate dean at the University of Cincinnati’s College of Medicine. But Louisville will always be his home. Building a new therapy for racial trauma here is meaningful to him.

“Seeing folks that were trying their best to understand and create spaces of healing, and then to be able to create a model that could be something that could stand in the gap was something I'm incredibly grateful for,” he said.

This reporting was supported by a grant from the Solutions Journalism Network.