Fellow White Therapists — We Need to Talk about Our Microaggressions Toward Clients Immediately
The ethical responsibility to prevent prejudice from poisoning your work with Black clients is on us, the psychotherapy practitioners.
With colleagues and leaders in the field, I co-authored this article on how to avoid microaggression with psychotherapy clients. It’s a brief read to expand your culturally-competent clinical skills. This is one of many resources you can use to examine your beliefs and biases. This is necessary work to begin and advance anti-racism in psychotherapy practice.
Black Lives Matter
Violent crimes are harming Black Americans daily from Minneapolis to Louisville to New York. They are often caught on camera by body cameras, bistanders, and the victims themselves.
As I write this, Louisvillians are in the streets protesting on the heels of an abhorrent murder of an innocent woman in her own home. It’s unconscionably horrible that Breonna Taylor was killed the hands of Louisville Metro Police Department as the result of a bungled no-knock warrant. (Notably, no-knock warrants have been made illegal in Kentucky as a result of protest activity and pressure put on local officials.)
Still, it took three months for the officer who killed Breonna — a vibrant 27 year old Black woman — to be fired. Adding salt to the wound, the Louisville mayor appears to have intentionally withheld the decision and announcement of the officer’s termination for Juneteenth. The ex-officer is also yet to be charged and his colleagues remain on the force, undisciplined.
As tension surges across the US due to yet another cluster of threats and murders of Black men and women caught on camera, protesters in the big-little city of Louisville were recently shot for protesting.
These events are stirring racial trauma most therapists are simply not equipped to competently handle.
Cultural competence in psychotherapy
As Black Americans and allies pour into the streets to demand justice and equality, trauma in the Black community is surging.
Here lies the problem. Race-based trauma is an experience most white psychotherapists do not understand or appreciate, yet we make up a disproportionate majority of mental health providers.
This places us at the epicenter of risk for perpetuating harm inadvertently to against our clients. It is especially critical that we ask ourselves — now — how we “show up in the room” with our Black clients.
This is a call to action for Psychologists, Psychological Associates, Marriage and Family Therapists, Licensed Professional Counselors or Licensed Clinical Professional Counselors, and others mental health providers.
Racism can happen in psychotherapy because it can and does happen everywhere. How can my client trust me if I don’t even believe their experience as Black man or womxn is valid?
Avoidance prioritizes white comfort
The default behavior of white psychotherapy supervisors and students is to avoid this topic to whatever extent possible.
I lost count of the times I heard in my Supervision classes from peers that “unless a client brings up race, it must not be relevant.” This is a fundamental failure to unpack racial power and client-therapist power dynamics.
White Americans are socialized to avoid — not discuss — race. Discomfort is not a valid reason for avoiding uncomfortable conversations, nor is ignorance.
Because courses on cultural competence are compulsory, we have all had exposure to the concepts of bias in psychotherapy and working with clients of many cultures. However, that does not mean they are taught thoughtfully or thoroughly.
NAMI has voiced concern about the critical need for more culturally-competent therapists as a function of access to psychotherapy services.
Even where instructors are excellent, the breadth of issues is too overwhelming to dissect in one course.
Consequently, multicultural classes frequently take the form of awkward, box-checking exercises. They are built more around white comfort than an earnest effort to investigate the ways race, ethnicity, culture, and bias show up in our field’s history, theoretic evolution, empirical research, and current treatment models. Worse, where departments lack informed allies and view marginalized colleagues as the ones responsible for caring about diversity, Black and other minority faculty are frequently expected to teach them —without discussion.
White therapist, Black client
My second therapy client ever was a Black man in his 40s who requested to be paired with a Black therapist. But, I was a young white woman. This was a huge opportunity for disaster if I wasn’t trained adequately.
How can my client trust me if I don’t even believe their experience as Black man or womxn is valid?
And this is a common scenario people of color face when — or if — they seek out psychotherapy. The number of Black therapists to Black clients is also disproportionate. (Although, even if the field were equipped for access on a 1:1 basis, research suggests racially-matched client-therapist pairings can have its own blind spots.)
Thank God my supervising Clinical Psychologist taught me what to say so it wouldn’t be a disaster.
I was clueless. I’d been studying in the Center for Mental Health Disparities on campus where she was the Director. She researched mental health outcomes, trauma, and systemic mental health disparities and access barriers for Black clients.
What I learned was somewhat counter-intuitive to me as a young, white woman. But there are starting points white allies can use in uncomfortable conversations. Discomfort is not a valid reason for avoiding uncomfortable conversations, nor is ignorance.
Elephant in the room
It was powerful how a few simple phrases invited openness with my client. It was an emotional exchange. Saying what I did (and how I did) seemed to be disarming because it addressed the elephant in the room — race. White Americans are socialized to avoid — not discuss — race, but acknowledging it was imperative to our work.
What mattered most in that moment was building trust with my client. The conversation demanded raw and thoughtful vulnerability and humility.
Sample statements
- “I know I won’t be able to fully appreciate or understand your experience as a person of color in the USA.”
- “It is my commitment to you that I will try. When I don’t, I will educate myself rather than put the burden of explaining oppression on you.”
- “Some times I will mess up. I hope you will tell me when I do, so I can do better.”
- “Within our safe and validating relationship, you can always trust that I will believe you when you say you’ve experienced racism, bias, or discrimination.”
- “I acknowledge I benefit from privilege I have not earned.”
- “Your experience as a parent is influenced by the reality that you must teach your child to guard their physical safety solely due to the color of their skin.” Racial and ethnic socialization “specifically includes the direct, explicit messages children receive about the existence of racism and the meaning of race, as well as related indirect or implicit messages.”
Resources
What not to do
Do not expect your Black colleagues, mentors, friends, or family to explain the history of racism and institutionalized bias to you. This is known as emotional labor because it puts an exhausting burden on an already oppressed group. Put in the effort to educate yourself.
With that in mind, let’s look at a few additional resources to augment those inline above.
Use psychotherapy professional resources
- Association for Behavior and Cognitive Therapies (ABCT)
- Association for Contextual Behavioral Science (ACBS)
- American Association for Marriage and Family Therapy (AAMFT)
- American Counseling Association (ACA)
Read books by Black authors
Learn local history
In examining my own biases lately, I have realized my network remained overwhelmingly white. I’m working on expanding the voices I listen to online and within my Louisville metro community, which remains among the most segregated cities in the US due to the legacy of racist redlining practices.
Learn why colorblindness is harmful
Learn about microaggressions
Some examples of microaggressions against Black clients (and other Black, Indigenous, and people of color [BIPOC]):
- Ascription of Intelligence
- Color Blindness
- Criminality/Assumption of Criminal Status
- Denial of Individual Racism
- Myth of Meritocracy
- Pathologizing Cultural Values/Communication Styles
- Second-Class Citizen
- Sexual Objectification
- Assumption of Abnormality
Reflection
I began learning cultural competence in spite of — not because of — the system that trained me.
unpack racial power and client-therapist power dynamics
I am very thankful I had awesome grad school peers. They’ve all been awarded their Ph.D.s and credentialed as Clinical Psychologists. Beginning to learn how to be an ally thankfully was part of my educational environment. This is an exception, not a rule, for most therapists, however; it only happened because I was aggressively seeking research experience outside my own department!
You’ll need to work at overcoming the shortcomings of your own education and training, too. But make no mistake, that responsibility to learn is now on you — the licensed practitioner.
Lori Gottlieb, a fellow psychotherapist, reflects on her journey for another point of view.
Being a white, cis, straight woman in the Clinical Psychology research lab I referenced was the learning environment of a lifetime. I had the pleasure of working alongside talented peers representing Black, LatinX, womxn, queer, Asian, middle eastern, and immigrant identities.
These are the environments we learn in. It made me uncomfortable at times, I’ll admit. When I proofread a PhD student’s research article draft, I remember being shocked and embarrassed I had no idea how huge the access and outcome gap is in mental healthcare for Black adults.
It’s possible I never would have learned that if I wasn’t involved in the Center for Mental Health Disparities. And it’s possible I would have alienated my Black client if I had no idea how to say, “I know I’ll screw up.”
Through both, I learned cultural humility and vulnerability are habits that move the needle.
Mental health technology
I now have the opportunity to use what I have and will learn to build an inclusive and validating SaaS product and company at Enriched Couples.
We recently applied for an NIH grant to validate our platform is helpful for same-sex couples, for example. We are working on where our early-stage product can be improved to be more inclusive of the Black community and issues unique to Black and interracial couples.
Psychotherapy is not inclusive nor culturally affirming by default. Neither are mental health technologies. We have to put in the work examining our own beliefs and subtle biases if we’re to help our clients heal.
Annette Miller is the Cofounder and CEO of Enriched Couples, a financial therapy platform that uses psychology to guide couples through unifying their values, financial priorities, and future goals.
