Therapy and race
Does the patient from a minority group benefit by seeking out a professional with a similar background? Some say picking a black, Hispanic or gay practitioner is important.
By Carolyn Feibel
FOR THE INQUIRER
Janice Warner, a 67-year-old social worker and therapist whose mother was white and father was American Indian, will never forget the teasing she heard as a child on the school playground.
"You're going to scalp me!" her classmates
would shout before running off. Or, "There's no
Indians around anymore!"
It would be years before Warner, who now lives in Plainfield, N.J., could fully explore those
experiences and how they affected her psyche. Though her first therapist, a white man, was very helpful, "when it got to race he was a little out to lunch," Warner recalled.
By the time she found a Jewish therapist who
seemed, as a result of his own experiences, to
understand the subtleties of race and identity,
Warner had children of her own - who were
feeling hurt by murals in the school library that
made Indians look like apes. Her therapist
helped her deal with the pain that her children's
troubles brought up - and how she might
approach the librarian and talk about the
problem.
Warner's mixed experience with psychotherapy
is not uncommon, particularly for minority
groups. Blacks, Latinos, Asians - and, especially now, Arab Americans - who think about entering treatment must grapple with feelings of identity and trust.
They are often concerned that therapy is a
"white" or elitist institution that will abuse them
or mislabel them as "crazy" or "paranoid."
Experts say many minorities, especially African
Americans, make special efforts to find a
therapist of the same racial background, who
they feel can better understand their experiences of racism, discrimination and minority culture. Gays and lesbians seek therapists who can relate to their situation as a sexual minority.
Warner said her own experiences years ago
taught her the importance of ethnic and cultural
issues when she sees clients for therapy.
"I tend to think very much in terms of history,
where they grew up and what was happening
racially where they grew up," she said. "With
some African American clients, they grew up
where or when schools were still segregated. . . .
How did that affect them?"
Most therapists understand the concerns of
minority patients, but they also face a
demographic reality: There are relatively few
minority psychologists and psychiatrists, so
demand outstrips supply. HMO rules and clinic
procedures can also make it difficult for patients to request a therapist with a particular
background.
"Philadelphia actually has a wide range of community mental-health clinics," said Faye Dixon, a black psychologist who works at Eastern Pennsylvania Psychiatric Institute at the Medical College of Pennsylvania
Hospital. "But when someone is specifically looking for a psychologist or psychiatrist of color, they've got to go far."
African Americans are less likely than whites to go into those professions - or, for that matter, to go to a therapist - because they tend to turn to their family or church minister when they need emotional guidance and support.
"I have heard black people say, 'Black people don't do that,' " said Barbara Williamson, 50, an African American consultant from Gulph Mills who sees a white therapist. "Some people say, 'I don't want someone telling me
what to do.' Well, that's not what therapy is all about."
Kimberly E. Walker, a black psychiatrist with offices in Bala Cynwyd, Center City and South Philadelphia, said more and more African
Americans are getting interested in therapy, in part because of the efforts of school counselors, consumer magazines such as Essence and Ebony, and television hosts such as Montel Williams, who invite therapists on their shows.
Still, Walker said, "therapy is to some extent seen as 'white.' " African Americans, she said, have not forgotten Tuskegee, the 40-year federal study in which black men in Alabama were identified as having syphilis but never told and never given treatment. If a psychiatrist prescribes drugs, "some people are concerned they might be being experimented on."
Members of other minority groups bring their own group histories to psychotherapy - if they come at all.
"Therapy is a Western concept," said Takako Suzuki, a Japanese American psychologist who practices in Radnor. "Going outside the family is an embarrassment. You're not supposed to have problems. It's a shame on the family name."
For many gays and lesbians, psychology evokes a history of being forcibly
institutionalized or drugged in an effort to "cure" their sexuality, said Maya Kollman, a lesbian therapist in Pennington, N.J.
Still, some don't want a gay therapist, because their experience is too familiar or they want the benefit of feeling heard and accepted by a straight therapist. "Others won't trust anyone straight not to be homophobic," Kollman said.
Portia Hunt, the African American director of Temple University's counseling psychology program, tries to help black clients overcome the fear that by seeing a therapist, "you're a traitor to yourself and your race." Many worry that by getting help, it means they are weak and crazy and betraying family secrets, she said.
Hispanics often face language barriers, and may have a particularly hard time finding a therapist who shares their culture: According to one estimate, there are just 29 Hispanic mental-health practitioners per 100,000
people in that community, versus 173 white practitioners for every 100,000 whites.
Compounding it all is money - an issue for the uninsured, certainly, but also for those with coverage.
"You would not get someone saying you can only go to a doctor 12 times a year if you have diabetes. But you have that with mental illness," said Monica Sweeney, medical director of Health Watch, a national nonprofit
organization that works to improve minority health care.
"We're talking about multiple levels of barriers," she said, "starting with [minorities'] built-in prejudices against mental illness and being referred to a psychiatrist. The second level is not having the appropriate people to
send them to. The third is not having primary-care doctors treat those they
can treat. . . . Then we get to health insurance as a barrier. It comes down to being a very difficult path for a person who is a minority."
If they do start treatment, many minority patients worry that a white therapist will deny their experiences.
The "classic example," according to Russell F. Floyd, an African American child psychologist who practices in Germantown, is when a
patient says he or she feels a boss is being racist, and the therapist minimizes the problem by responding that the patient is being
oversensitive.
"Black people are told we're oversensitive again and again when we may be experiencing racism," Floyd said. To hear that from a therapist - someone who is paid to listen - can damage the therapeutic relationship and cause blacks to drop out after five or six sessions, he said.
One way to avoid such misunderstandings is to educate psychology students about multicultural issues and their own identities.
"For those of us raised as middle-class white Americans, part of what we inherit is this construct of race. It's unavoidable," said Marjory Levitt, a therapist and adjunct professor at Temple who has worked as a diversity trainer for 25 years.
For therapists-in-training, she said, that may mean reexamining the idea of the "traditional" family, with the father as breadwinner and
decision-maker, or learning about the impact of the church or the criminal justice system on minority lives.
It may also involve looking at more than just skin color.
"I don't think we have to make race a bigger issue than it is," said Dixon, the psychologist at the Eastern Pennsylvania Psychiatric Institute. "People can fall into that trap." She believes socioeconomic class may be even more important than race and ethnicity when it comes to cultural understanding.
And most important of all, perhaps, the personalities involved.
"When you get into generalizations, you get into trouble," said Kollman, a couples therapist and workshop presenter who shares her life - and her New Jersey workshops - with Barbara Bingham. "The key when working with multicultural issues is to be educated, but not so educated that you put people into boxes. The individual is the most important."