When Race Becomes a Factor in Therapy
By Carrie Feibel
Janice Warner, a 67-year-old biracial social worker, will
never forget the teasing she heard as a child on the
playgrounds of her school in Albany, N.Y. White
classmates taunted Warner, who is both white and Native
American, claiming, "There's no Indians around anymore."
Sometimes they would scream, "You're going to scalp
me!" and run off. But it was years before Warner could fully
explore these memories in therapy.
Though her first therapist, a white man, was very helpful,
"when it got to race he was a little out to lunch," Warner
recalled. "Oh well," she said to herself. "There are enough
other things that are bothering me."
"I just tucked it aside," she said, until 1973 when she found
a Jewish therapist who seemed to understand some of
the subtleties of race and identity. By that time, Warner
had children of her own who were being teased on the
playground and who felt hurt by some murals of Native
Americans in the school library. "They looked like apes,"
Warner said of the Native Americans in the murals. "They
didn't look like people." Warner's therapist helped her
think about how to approach the librarian and talk about
the problem.
Warner's experience is not unique. Minorities who think
about entering therapy must grapple with feelings of
identity and trust when the therapist is white. They are
often concerned that therapy is a "white" or elitist
institution that looks down on religion and community
bonds. Many minorities, especially blacks, make special
efforts to find a therapist of the same racial background
whom they feel can better understand their experiences of
racism, discrimination and minority culture.
Minority therapists in the New York region understand the
concerns of minority patients, but they also face a
demographic reality: there are still too few minority
psychologists and psychiatrists, so demand outstrips
supply. Many therapists choose to focus on educating
other therapists about how racial identity can affect
therapy, or conduct research on how racism can affect
self-esteem, stress and achievement. But while some
minority therapists push for the creation of an affirmative
"black psychology" or more culturally inclusive
psychological theories, others say too much emphasis on
race can actually hamper progress in therapy. Over the
last few decades, therapists have begun discussing how
race, that great American taboo, can affect their work. But
they are far from agreeing on what the solutions should be.
Joan Adams, a black psychoanalyst, said it doesn't help
that Sigmund Freud lingers in popular culture as the
symbolic figurehead of therapy. "He's a white bearded
male," said Adams, a clinical director at the Postgraduate
Center for Mental Health in Manhattan. "It's just symbolic
that psychotherapy is white."
But African-Americans are less concerned with Freud's
race than the race of their therapists, Adams said. At
many community health clinics, she said, clients are
simply assigned the next available therapist. "Their
concerns are: 'Am I going to have someone who's white
who simply won't appreciate what it's like to be the subject
of racism?' " Adams said. " 'Can I trust my most personal
feelings with someone who is a stranger?' "
Sandra Goodridge, a black Urban League fundraiser who
was raised partly in Barbados, felt those doubts in "three
aborted attempts" at treatment with different white
therapists. Goodridge, 32, is also studying part-time for a
master's degree in psychology, but she describes her own
experiences in therapy as alienating. "I was always
constantly very suspicious and guarded," she said. "It was
extremely hard for me to trust my therapist - to trust most
white people."
Establishing trust is critical for the relationship between
therapist and patient. Therapy requires that the patient
remain emotionally open and articulate about his or her
most vulnerable and private thoughts and feelings.
"Shared identity helps," Goodridge said. "That's one
reason why it's more important to have more black
therapists in general."
Goodridge's goal is to become a practicing therapist, but
she sometimes thinks about dropping out of her program
at the New School University. The only other black student
in her class of 12 recently transferred to the psychology
department at Howard University, and Goodridge is the
sole remaining black student.
Many African-Americans distrust therapy because they
see it as "individualistic," something that will pull them
away from solidarity with the black community. According
to Dr. Thomas O. Edwards, the eastern regional
representative for the Association of Black Psychologists,
"with the African-American population, talking to a
psychologist is simply taboo within the community."
"A lot of black people think if you have a problem, you
don't need to go to a stranger and tell them your
business," said Cherie Black, 25, a journalism student at
Columbia University. Black comes from a mixed
marriage; her mother is white and her father black. "You
go to church and pray or you keep it within your family,"
Black said. There is a fear that by talking to white
therapists, blacks betray family secrets or display
weakness to white society. When Black told her black
boyfriend she was seeing a therapist, his initial reaction,
she said, was "whoa!" and "why?"
The church has been the traditional source of emotional
comfort for many African-Americans, and they wonder if
therapy is antagonistic to religious belief. Black patients
can feel caught between two emotional support systems.
"There's a fear the therapist is going to put down religion,"
Adams said, and dismiss spiritual beliefs as illogical.
Another concern is that "the church is going to cry therapy
is a no-no, or sinful or bad." Some fundamentalist black
Christians, Adams said, suspect therapy can lead to
moral relativism or encourage too much discussion of
sexual feelings. But fundamentalist whites and
working-class whites also share those fears, Adams
added.
Most therapists today disagree with Freud's contention
that religion is merely a psychological construct. Adams
said more and more therapists recognize that therapy and
spiritual practice are not only compatible, but mutually
beneficial.
Because she is a practicing Christian, Sandra Goodridge
has often felt like a cultural outsider in her graduate
psychology classes because of the prevalence of "the
whole notion that religion is dead, that it's a crutch, the
opiate of the masses," she said. When Goodridge worked
in a mental health clinic, she often secretly prayed for her
patients' recovery. But she never told her supervisor about
it. Many psychologists think believers are "children who
can't face the truth," Goodridge said.
Trust and comfort can also be affected when the therapist
is black and the patient is white. Joan Adams has seen a
range of reactions from white patients when they walk in
the door and discover that she's black. "Sometimes it's a
subtle expression, a double-take," Adams said.
Occasionally a white person will flatly refuse to work with
her, offering a flimsy excuse to find someone else. "It's
usually someone who hasn't had a lot of peer experience
with black people who they see as competent or in an
authority position," Adams said. Sometimes white
patients fear that a black therapist will think their problems
are petty when compared to the history of black
oppression and struggle. They censor themselves,
because they don't want to seem like they're "just
complaining," Adams said.
Dr. Hugh Butts is a black psychiatrist and psychoanalyst in
Manhattan who has been writing about interracial therapy
since the 1960's. "It was the tumultuous Sixties," he
recalled. "The death of King, the rioting and all that. Very
often patients were not told I was a 'Negro,' " Dr. Butts
said about the times another therapist or family doctor
provided a referral. Some white patients would walk in
and become "almost psychotic" when they saw him, Dr.
Butts said. One white woman, whose sister was suicidal,
momentarily lost the ability to speak when Dr. Butts
arrived at the hospital to talk with the family. She left to call
the referring doctor, who calmed her down by reassuring
her that Dr. Butts "won't rape you." Dr. Butts smiles at the
absurdity of this memory, but says it illustrates a very
important psychological principle: for many whites, racial
stereotypes about blacks incorporate sexual fears, guilt
and desires.
Dr. Butts believes that when doctors or HMOs refer a
patient to him for therapy, the patient should be told that he
is black and male. Likewise, the patient's preference for a
therapist of a particular ethnicity or gender should be
honored. "It should not even be questioned," Dr. Butts
said.
But other therapists disagree. Arthur Gray, a
Jamaican-born black psychologist in Manhattan, once
treated a "racist white male," as he described him, who
didn't realize Dr. Gray was black for seven years. "I didn't
bring it up and he didn't notice," Dr. Gray said, gesturing
to his close-cropped hair, "my being lighter-skinned and
with sort of straighter hair." Dr. Gray's supervisors told him
to tell the patient he was black, but Dr. Gray said, "You're
out of your mind!" Dr. Gray believed that if he drew
attention to his race, it would destroy the positive
attachment the patient felt for him.
Gradually, the patient worked through his anger, his
paranoia, his troubles with alcohol and a history of abuse.
One day, the patient said to Dr. Gray, "You know, I never
realized you were black." Once the patient initiated that
discussion, he and Dr. Gray began to speak more freely
about race and to work through some of his racist
thoughts and feelings.
Like Dr. Gray's supervisors, Joan Adams believes that in
an interracial treatment, the therapist has a responsibility
to bring up race in the first session, if the patient fails to
mention it. "I will ask, 'How do you feel about working with
a black woman therapist?' " Adams said. It is incumbent
on the therapist to bring it up, Adams said. Otherwise,
race becomes like a pink elephant in the consulting room.
For Adams, explicitly addressing race and ethnicity
signals to the patient that therapy represents a safe place
where the everyday conventions of tact and evasiveness
don't - and shouldn't - apply. "If you ignore racial
differences, what are you saying about being open?"
Adams said. "Because race is an issue in this society. So
to not talk about it is to deny a huge piece of who this
person is!"
Until more minorities are recruited into the mental health
field, white therapists must educate themselves about how
different cultural backgrounds can affect mental health,
many psychologists say. Adams, for her part, teaches
identity workshops for students of all races at the
Postgraduate Center for Mental Health. She also writes
about the therapeutic treatment of black women. The
Association for Black Psychologists is creating an African
Psychology Institute that will provide a certificate for
psychologists qualified to work with African-Americans,
Dr. Edwards said.
But Arthur Gray dismisses efforts to create a "black
psychology." He prefers to think of racism in psychological
terms, as one possible manifestation of hostility and
paranoia. "It's not my responsibility to go and educate
minorities, or whites," Dr. Gray said. "When people reach
a certain point, they will seek psychological help. There's
not a black psychology. There's not a white psychology.
There's only psychology." Dr. Gray, who does not belong
to the 2,000-strong Association of Black Psychologists,
says his views make him a bit of a "renegade" to other
black psychologists.
Even if a minority patient feels comfortable with a white
therapist, cultural differences can confuse their
communication and lead to psychological misdiagnoses.
A white therapist might tell a black mother she's being too
overprotective of her teenage son, Dr. Butts said. "Without
recognizing that adolescent African-American boys are at
risk of being murdered in the streets every day is
absurdity," Dr. Butts said. The tendency to be
overprotective is a social adaptation for blacks, not a
mental pathology, according to Dr. Butts, and not seeing
the difference can alienate a black mother from her
therapist. White doctors often label blacks as "paranoid,"
when they're just being "healthily suspicious" in a society
that often discriminates, Dr. Butts said.
Another complication, Dr. Butts said, arises when black
patients feel they have to educate their white therapists
about black food and family gatherings and customs. The
patients often feel frustrated and long for a black therapist
who doesn't need constant explanations. For example, Dr.
Butts said, a white therapist might think a black patient
was insecure or overly dependent because he faithfully
visits his mother once a week.
Hispanic and Asian-American patients may also have to
grapple with a cultural gap when the therapist is white.
Carmen Cabello, 50, a Puerto Rican educational
administrator, has had both black and white therapists.
But she felt the similarities between Latino and black
culture - the leadership role of women in the family, the
rules on how to discipline children - gave her a "closer
connection" to the African-American therapist.
"I have less of that breaking down to do in order to inform
the therapist, if it's someone that's African-American,"
Cabello said, "because we share a lot of experiences in
this country."
When she worked with a white therapist, Cabello had a
good experience, but said it was more work. "I had to take
responsibility and not expect that person to 'know' as an
authority figure. It put more of the burden on me." For a
minority patient in crisis, or a patient who expects the
therapist to be the all-knowing savior, Cabello would
recommend a therapist of the same race.
"I don't think it's a bad thing to have a therapist of a
different race,"
Cabello said. "It could be good for both people if you both
go in as learners."
Dr. Alan Roland is a white psychologist who specializes in
treating Asian-American patients. He spent a year doing
research in India and has written two books on the
psychology of South Asians and Japanese. Like Dr. Butts,
he cringes when he hears stories of white therapists
misinterpreting cultural difference as psychological
abnormality. Dr. Roland said one white woman therapist
published an article describing an Indian man as "too
passive" because he let his family arrange his marriage.
As Dr. Roland knows, most Indians, even immigrants to
the United States, have arranged marriages.
Another common South Asian custom is for children to
sleep in the same bed as their parents, even late into
childhood, Dr. Roland said. Therapists need to be careful
not to interpret this custom as abnormal or possessive on
the part of the parent. In addition, family reputation is
extremely important, which may make some Indians and
Pakistanis wary of seeking therapy for fear the stigma will
jeopardize their own or even their siblings' marriage
prospects, Dr. Roland said.
For South Asians, especially, the Western psychological
ideal of individual autonomy and self-actualization may not
even apply, Dr. Roland said. "Here we value authenticity in
relationships," he said. "That would be a negative value
for them because they want to observe the hierarchical
nature of a relationship." Relations between parent and
child, husband and wife, even older and younger siblings
are governed by exacting rules. So South Asians may
harbor a deep or passionate feeling for another person,
but may not necessarily want or need to express it.
Because of these cultural differences, uninformed
therapists risk labeling South Asians as passive,
uncommunicative, or overly dependent on parents and
authority figures.
Cherie Black continues to see a white therapist, but when
she graduates and leaves New York, she will specifically
seek out a black female therapist. "I know I'm going to
have issues dealing with prejudice and race - that's going
to be coming from white people mostly," Black said. "I
would like to be able to share that with a black woman and
get her advice and reactions because I think at some
point she will have dealt with that as well."
But if Black can't find a black woman therapist, she will
find someone else. "The therapy and what I want to get out
of it is ultimately more important to me than the color of the
skin," Black said.