Recently in a meeting about how to make an organization I am involved in more "diverse," myself and others struggled with the meaning of the word as well as how to engage people who might otherwise not feel welcome, due to race, ethnicity, and sexual orientation, to name a few of the most common diverse categories. Although all of us felt that this was a productive discussion, I walked away feeling more confused than I did at the start of the meeting. In part, this was because I felt that there was so much we had left out.

Although many of us have notions regarding what diversity means and there are clearly some groups that have historically been (and still are) oppressed and marginalized, I found myself thinking about "hidden" diversity categories. These include people with conservative political views (who are very lonely in liberal San Francisco), those with certain religious beliefs, and even people who have grown up in lower socioeconomic backgrounds. I am part of this latter group of people: yet, I don't see myself as a minority, and have experienced relatively little oppression, at least not outside of the ways in which many women continue to struggle (though I am still hoping for equal pay, for what it is worth).

And let's face it; women have a lot more power in the field of psychology these days, yet most of us are white, as are our patients.

The practice of psychotherapy has historically been provided by white clinicians. Patients who attend psychotherapy tend to be white as well, with racial and ethnic minorities bearing a number of unmet mental health needs. A Surgeon General Report indicates that, "Most minority groups are less likely than whites to use services, and they receive poorer quality mental health care, despite having similar community rates of mental disorders." Further, minorities who live in wealthy neighborhoods are more likely to receive "crisis" healthcare (meaning in emergency rooms) with the implication that they do not receive on-going support, like their white and well-off neighbors.

So what are well-intentioned clinicians to do?

My experience is that most people in the field really do try to do the right thing by addressing the cultural struggles of diverse patients in the ways that we have all been taught. Yet, we also know bias is often unconscious. And as we know from the great playwrights Robert Lopez and Jeff Marx, "Everyone's is a little bit racist."

On the other hand, I have felt that some of the literature that has informed much of my training has neglected the actual trauma that occurs to persons who are victims of racism and oppression in our country. As psychologists, we are taught that we should address these issues directly, with the assumption that voicing reality will be soothing to our patients. I have not always found this to be true. Like talking with someone who has experienced traumatic abuse in childhood, addressing issues of oppression can be similarly destabilizing, perhaps even more so when addressed by a clinician who is viewed to be ensconced in white, heterosexual culture. I mentioned recently to someone I have been seeing for years that something she discussed might be understandable in the context of racial inequality; it might be hard to trust white people, whom she has good reason to be suspicious of. Even in the context of our close therapeutic relationship, she had trouble hearing what I said. As she has identified with the majority culture, such a comment was troubling to her, as she wants to believe that things are equal, even if they are not.

Although diversity means trying as hard as we can to know our biases and the need to address societal oppression in our work, we also need to know our patients, friends and colleagues. I hope that we can move toward a time when "diversity" means that we can not fully comprehend anyone's story, until they feel safe enough to tell us. Oppression is often traumatic. When we respect this, we can help people know their experience in a timely way that fits for them. 

About the Author

Tamara Greenberg

Tamara McClintock Greenberg, Psy.D., M.S., is an associate clinical professor of psychiatry at the University of California, San Francisco.

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