Culturally Speaking

Challenging assumptions about culture, race, and mental health.

How Therapists Drive Away Minority Clients

Many therapists unknowingly perpetuate racism against their own clients.

 

Racial discrimination is pervasive, and minorities regularly experience it in blatant ways (e.g., old fashioned racism) and subtle ways (e.g., microaggressions). In the US, African Americans experience the most discrimination, followed by Hispanic Americans and Asian Americans (Chao et al., 2012), although discrimination against other groups, such as women and sexual minorities is common as well.

The therapeutic relationship is unfortunately not immune to this problem, despite the best intentions of therapists who think they would never act in a racist manner. One example of this can be seen in the experience of race-based trauma, as many White therapists are dismissive of the impact of racism on their minority clients. Having never been subjected to the minority experience, it may not have occurred to them that racism could be traumatic.These are typically therapists who ascribe to a colorblind approach as their method of choice for working with people who are culturally different. However, colorblind ideology is actually a form of racism (Terwilliger et al., 2013), as it provides an excuse for therapists to remain ignorant of the cultures and customs of their non-White fellow human beings.

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Racist remarks by therapists

Even among therapists who have received multicultural training, racism often inserts itself unwittingly into the counseling process. Here are a few examples of actual statements made by therapists to African American clients. I explain why a person of color might find each of these remarks offensive.

“I don’t see you as Black. I just see you as a regular person.”  I’ve commented previously on this type of remark (see my article on circular stereotypes).  It tells the client that the therapist finds the client odd or irregular in some way, due to their Blackness. It is as if something is wrong with being a person of color and the therapist is going above and beyond the call of duty to politely ignore inconvenient differences.

“I’m not sure we need to focus on race or culture to understand your depression.” This illustrates the therapist’s own discomfort with the idea that racism and mental health are linked (Chae et al., 2011; Chao et al., 2012). Furthermore, how can the therapist possibly know if racism is cause the of the client’s mental health problem when s/he won’t even take the time to listen and learn? The client quickly discovers this therapist will not take him/her seriously.

“If Black people just worked harder, they could be successful like other people.” This shows that the therapist has uncritically accepted the pathological stereotype that African Americans are just plain lazy. By extension, the client is also lazy and would be successful and happy with a bit of good hard work. It also ignores social forces, such as institutionalized racism and other barriers that make it harder for minorities to be successful.

“Don’t be too sensitive about the racial stuff. I didn’t mean anything bad/offensive.” Gottcha. The therapist made a racist remark and this client was brave enough to call it out. Does the client get an apology from the therapist or even a discussion of the occurrence? No, in a typical blame-the-victim fashion, the client is accused of being hypersensitive.  After all, the therapist meant well. Right.

Do no harm

I took these remarks by therapists directly from a journal article (Constantine, 2007), but I have heard such statements made by therapists many times. Constantine (2007) describes these as racial microaggressions, and they were in fact found to be the largest predictor of dissatisfaction with counseling by African American clients. Clients subjected to such comments were understandably less satisfied with the counseling experience. They believed that such therapists were less competent and, unsurprisingly, the therapeutic alliance suffered.

Insensitive remarks can be particularly harmful to vulnerable clients, who may already feel stigmatized and exposed by even attempting therapy. Minority clients may find it difficult to respond to racist comments in counseling situations due to self-doubt and power dynamics. These problems contribute to feelings of distance from the therapist, unwillingness to disclose sensitive information, and early termination from treatment. Thus clients may be unable to overcome the condition for which they sought help due to undesirable therapist factors, creating a barrier to treatment.  The degree of harm therapists may cause in this way is unknown and likely underestimated.

Why do therapists make these mistakes? One of the main reasons is stereotypes. No one is immune from the effects of the myriad of pathological stereotypes that cast disadvantaged groups in a negative light. These are false or incorrect ideas attributed to members of a group, based on illogical reasoning and social status. Stereotypes represent unfair generalizations that do not change in the face of accurate information. When we uncritically accept these social messages, racism follows, even from people who mean well.

Can conscientious therapists perpetuate racism?

This article covered some of the more blatant types of microaggressions against clients, and these are likely to committed by therapists without proper multicultural education. There are also a number of mistakes made by more egalitarian therapists who genuinely want to avoid offending clients and may work hard to prevent being racist.  Errors made by such therapists may be in the area of patronization, idealizing the client’s culture, and excusing dysfunctional behavior as culturally normative. We discuss these types of microaggressions in my next article.

Dr. Williams offers a monthly webinar for therapists on understanding and connecting with African American clients. Visit TZK Seminars to learn more and/or register (6 CEUs).

References

Chae, D. H., Lincoln, K. D., & Jackson, J. S. (2011). Discrimination, attribution, and racial group identification: Implications for psychological distress among Black Americans in the National Survey of American Life (2001-2003). American Journal of Orthopsychiatry, 81(4), 498-506.

Chou, T., Asnaani, A., & Hofmann, S. G. (2012). Perception of racial discrimination and psychopathology across three U.S. ethnic minority groups. Cultural Diversity and Ethnic Minority Psychology, 18(1), 74-81. 

Constantine, M.G. (2007). Racial Microaggressions Against African American Clients in Cross-Racial Counseling Relationships. Journal of Counseling Psychology, 54(1), 1-16.

Sue, D. W., et al. (2007). Racial microaggressions in everyday life: Implications for clinical practice. American Psychologist, 62(4), 271-286.

Terwilliger, J. M., Bach, N., Bryan, C., & Williams, M. T. (2013). Multicultural versus Colorblind Ideology: Implications for Mental Health and Counseling. In Psychology of Counseling, A. Di Fabio, ed., Nova Science Publishers. ISBN-13: 978-1-62618-410-7.

Have you experienced a microagression from a therapist? Have you made such a blunder as a therapist? I’d love to hear about your experience. Make a comment below. Please be sensitive and respectful.

 

Monnica Williams, Ph.D., is an Assistant Professor in the Department of Psychological & Brain Sciences at the University of Louisville.

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