Is the Client’s Racism the Therapist’s Business?

Racist statements can provide a window into a patient’s neurosis.

Posted Jul 13, 2020

Patients often say racist, sexist, or homophobic things, and therapists wonder if they are supposed to ignore these or correct them. The answer is neither, but it takes some understanding of what psychotherapy is to get there. I’ll focus on racism in this post.

Psychotherapy changes people for the better by resolving internal conflicts, by airing them in a neutral, accepting environment, or by welcoming the marginalized aspects of the real self into the totality of the person’s experience. Therapy is not advice, guidance, or friendship, all of which are important for people but must be obtained elsewhere. We are trained all our lives to keep certain aspects of ourselves hidden, often even from ourselves. Psychotherapy depends on a special kind of welcoming curiosity that induces people to take off their social masks. Any hint of professionalism or, especially, friendship, tends to evoke all the social norms that keep the hidden self hidden.

There is good reason to believe that racism is psychopathological, in the technical sense. I posted here about Horney’s humanist view of pathology, the short version of which is an investment in an idealized or perfectible self instead of an investment in the real self. Fran Liebowitz said that racism is essentially a fantasy of superiority. Racism typically serves a false, idealized self by claiming a superior stance.

I posted here about psychopathology as a reliance on old maps, intuitive theories about how the world works that don’t stand up to evidence and scientific thinking. In How to Be an Antiracist, Ibram Kendi links racism to any belief that there are intrinsic, important differences between the races. (His argument is that observed differences between races must relate systemically to policies since there are no significant intrinsic differences.) Beliefs in racial differences are like the untutored theories that Andrew Shtulman (in Scienceblind) says interfere with scientific thinking.

There is good reason to think of racism as pathological, but that doesn’t mean it should be ignored or corrected in therapy. By the same token, most people would agree that non-suicidal self-injury, such as cutting, is pathological, but good therapists don’t rebuke cutters, nor do they teach them what is wrong with it, nor do they ignore it. These responses just show that the therapist doesn’t know how to do therapy. Rebuking, like any punishment, as I posted here, just makes the patient hide their racism from the therapist. Teaching could work if, as Shtulman demonstrates, it were not a lesson laid down on top of the patient’s particular intuitions but instead used the patient’s ideas as a starting point, which requires a relationship in which the patient will share those ideas. Ignoring racist statements treats therapy as if it were dentistry. A dentist, charged with filling a cavity, say, may ignore a racist statement in the interest of fulfilling their obligation to treat the patient. They might mildly rebuke the patient first and then ignore the racism. But whatever gives rise to cavities is unlikely to be the same thing that gives rise to racism, and treating racism is not likely to align with dental health.

How a good therapist responds to racism depends on the function of the racist statement in the moment. For example, it might be a meaningful metaphor about polishing the patient’s idealized self. “These people are impulsive—that’s why they’re poor.” The therapist might empathize with the patient’s fears about how their own impulsivity will be received by the therapist and others, or with the patient’s wanting credit for stifling themselves. The therapist might reflect on whether the fee is too low (a metaphor for poverty) and what the patient thinks the therapist is getting out of the therapy in the way of impulse gratification that makes it worth it for the therapist to work for such a low fee. The technique here depends on the therapy relationship. Some therapies can sustain the therapist speculating about the meaning of the statement. Most therapies would benefit from the therapist calling attention to the statement and suggesting that it has some meaning that the two parties could explore together. As with any meaningful statement that a patient refuses to explore collaboratively, the patient’s refusal here would be further grist for the therapy mill.

A racist statement in therapy might be a vessel of strong emotion or a sign that the person is claiming a position of superiority to humanity. The therapist is authorized to slow down the process whenever unintegrated emotion or a neurotic claim is expressed. Again, the technique depends on the relationship and can include anything from, “That sounds meaningful” to “When you imagine getting close to someone, you panic, and you express your panic about how suitable you are for human closeness by distancing yourself from a group of people that you characterize as unfit for human closeness.”

A racist statement can be a projective identification, by which I mean that its communicative import may be found in the emotions it arouses in the therapist. For example, a young black man was treating an old white man in a version of CBT that had the therapist writing things on a whiteboard in the therapy room. When the patient dropped the N-word casually into a story, it made the therapist feel disqualified, angry, and hopeless. This led to an understanding that the limber, lithe therapist jumping out of his seat to write on the board made the patient feel disqualified, angry, and hopeless. The first order of business was to fix their relationship by exploring whether these feelings were caused by the therapist showing off his agile body (they weren’t) or whether they were related to the patient’s feelings about getting old (they were). This led naturally to an exploration of how racism was used by this patient to restore a sense of masculine efficacy.

Racist statements are often justifications for racist conduct, not altogether unlike a patient who justifies cheating by disparaging their spouse or adoring the paramour, or one who justifies overeating by disparaging or adoring their body. For example, a patient who by any reasonable assessment had it pretty easy growing up would insist on viewing his life as a heroic, successful quest, overcoming enormous obstacles. One example was his making a ton of money in real estate even after getting turned down by Ivy League schools and having to attend another (highly-ranked) private college in New England, paid for by his parents. He saw his overcoming of the college rejections the way most of us would see overcoming a physical disability. He constantly took advantage of his Puerto Rican tenants and disparaged their inability to read the leases in English, which led eventually to all the other disparaging ideas he had about them, ideas that justified his exploitation of them (by providing housing he knew was barely habitable). (Note that I am not talking about whether Americans “should” learn English, a political question. I am talking about the function of this belief in his psychology.)

It wasn’t until he agreed to explore his status as a lessee of my office for an hour a week (and the considerable efforts I undertook to keep the place private, which was the main feature of its habitability) that we began to see how his racism served his pocketbook. (Kendi and others would say this was the original function of racism.) We realized together that he could never make peace with himself (i.e., not drink himself to sleep every night) as long as he was exploiting others.

The real self is not racist. The acorn (one of Horney’s metaphors for the real self) is concerned with becoming an oak tree, not with whether the white oak is superior to the red oak. Yes, I understand that babies notice skin color and react to it as they react to any strange stimulus, but it takes a racist community to turn that into a fantasy of superiority. White parents can’t turn black bystanders into teachable moments for their kids, as they might with a new animal or new food, but neither do they have to communicate that the child’s suspicions are merited. Because the real self is not racist, any therapy organized around welcoming and integrating the real self will reduce racism.

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