The Elephant In the Room

Race, Culture, and the Therapy Relationship

The Reality of Race In Everyday Life

Let's stop pretending we are all the same.

Welcome! This blog is about the differences that separate us, how they shape the therapy relationship, and how to establish meaningful connections across social, cultural, and experiential divides.

Some of you are already rolling your eyes.  So let me reassure you, there will be no drum circles or choruses of “Kumbaya” here.  Not that I have anything against the celebration of diversity.  The problem though, is that for many people, celebrating diversity means pretending that our differences are superficial, that people are people.  Your hair is coarse and curly, mine is straight.  You do taichi and I do Soulcycle. You celebrate Diwali, I celebrate Christmas.  You drink your café con leche I drink my coffee with milk. So what if your skin is brown, and mine is pinky peach.  It’s all good. 

And yet, even in these celebratory spaces, there is an elephant in room.  The reality is, that these differences do matter in U.S. society in deeply disturbing ways.   In fact, research shows that one’s race, ethnicity, gender, social class, immigrant status, and sexual orientation, among other dimensions of identity shape our life prospects from birth until death, including: 

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  • the chance that your children will be born premature or die as infants
  • your test scores on standardized tests
  • the likelihood that you will be poor
  • the safety and cleanliness of your neighborhood
  • your ability to get a loan or a mortgage
  • your chances of getting a job or gaining admission into college
  • your risk for being a victim of violence
  • your risk for heart attack or stroke, diabetes, cancer, and suicide
  • your risk for developing a mental illness or substance abuse disorder
  • your access to quality health and mental health care
  • the likelihood that you will be stopped and searched by the police
  • your risk of going to jail and the length of your prison sentences
  • your life expectancy

In short, these aspects of the self matter more than many of us want to acknowledge, because doing so means admitting that life isn’t actually an equal playing field, that the American dream is more easily fulfilled for some than for others.  So we just smile, seek common ground, and do our best to ignore those differences right before us.  While these polite strategies help us get along, they do little to help us truly understand each other and develop the kinds of relationships that are meaningful, and in the therapeutic context, transformative.

Through my teaching, research, and clinical practice, I have tried to understand the structural, cultural, individual, and interpersonal factors that impact the mental health and treatment experiences of people of color.  I have learned from my students’ struggles to overcome their own racial and class socialization in order to grapple with this beast-that-shall-not-be-named. In my current research, I am exploring what racial and ethnic minority patients think about their White therapists, how racial differences are negotiated in real-life therapy relationships, and how culture embeds the treatment process itself.  As a clinician, I try to help my patients see the structural and cultural realities that are often invisible, but exert a powerful effect on their psychological and interpersonal functioning, and our own relationship as therapist and patient. 

Beyond these professional roles and identities, I am also just a Chinese American wife and mother of two Jewish-Buddhist biracial children, who thinks an awful lot about race, culture, and difference, because well, she just wants her children to be safe, happy, and secure in the world.

This blog is about our collective efforts to understand, to learn from, and to be changed by each other’s experiences so that we can form more authentic relationships, build stronger communities, and create a more socially just world for us all.  I welcome you into the conversation.

 

For further exploration:

Alexander, M. (2010). The New Jim Crow: Mass incarceration in the age of colorblindness. The New Press.

Alexander, G.R., Kogan, M., Bader, D., Carlo, W., Allen, M., & Mor, J. (2003). U.S. birth weight/gestational age-specific neonatal mortality: 1995-1997 rates for whites, Hispanics, and Blacks. Pediatrics, 111(1), e61-6.

Braveman, P.A., Cubbins, C., Egerter, S., Williams, D.R., & Pamuk, E. (2010). Socioeconomic disparities in health in the United States: What the patterns tell us. American Journal of Public Health, 100 (Suppl. 1), S186-96.

DeAngelis, T. (2002). “New data on lesbian, gay and bisexual mental health: New findings overturn previous beliefs. American Psychological Association Monitor on Psychology. 33(2), 46. http://www.apa.org/monitor/feb02/newdata.aspx

Rooks, N. W. (2012) “Why it’s time to get rid of standardized tests. Time.com.  http://ideas.time.com/2012/10/11/why-its-time-to-get-rid-of-standardized-tests/

Smedley, B. (2012). The lived experience of race and its health consequences. American Journal of Public Health, 102, 933-935.

U.S. Department of Health and Human Services (2001). Mental Health: Culture, race, and ethnicity—A supplement to Mental Health: A Report of the Surgeon General. Rockville, M.D.: USDHHS, Public Health Service, Office of the Surgeon General.

The 7-part documentary film, “Unnatural Causes: Is Inequality making us sick?” and companion website: www.unnaturalcauses.org

Doris F. Chang is a clinical psychologist and Associate Professor of Psychology at the New School for Social Research.

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