A well trained therapist should be able to support any client, regardless of their identity.” Recently, I have come across several comments similar to this in online therapist spaces. Most often these comments are in response to someone requesting a therapist who holds a specific identity that matches that of the person they’d be supporting. Folks make the argument that in the medical community you should be able to work with anyone and be trained to put your bias aside. I agree with that statement in theory. I shouldn’t need to worry about my dental hygienist, xray technician, or internal medicine doctor treating me differently from other patients they see because of my identity, but I am not sure that the principle works the same way in therapy.
Why the Therapeutic Connection Matters
We know that one of the main factors that impacts whether or not therapy is effective is the relationship folks have with the person they are working with. For that relationship to be strong and healthy, therapists need to be able to respond to folks needs and preferences, they also need to recognize if they were misattuned or out of sync with someone and repair, recognizing when their own emotions or experience are showing up in a way that could negatively impact the person they are supporting.
Unconscious Bias and Systems of Power in Therapy
If anyone has gone through the work needed to start to deconstruct the impact that systems of power and oppression like racism, sexism, and religion (to name a few) have had on them, they know that the roots of these systems run deep, and are often integrated into the way we have learned to make sense of the world in way that we are not always conscious of.
Here’s an example from my own experience:
Through the somatic work I have done as part of my own journey, I have realized that growing up I learned to respond to differences between myself and others with some fear. On some level this makes sense, we have a need for belonging, and often similarity can contribute to belonging; however, when the differences I am responding to are racial, or socio-economic, or cultural, as a white person, my response of fear can cause harm because I hold power through my identity. If I was not aware of the ways I have internalized racism in these ways, what would happen when that fear response shows up in my work?
It is easy to see how quickly a white therapist could have a reaction and then rationalize it in a way that allows them to avoid any discomfort on their part. This can cause pathologizing, labelling of clients, and all sorts of problems, simply because we have not done our own work. Systems of oppression are insidious and infiltrate our lives in a variety of ways. Without active participation in deconstructing them, we would be perpetuating harmful narratives in our work, often without even realizing it. From this perspective, it is easy to see why folks would feel safer with someone whose identity overlaps theirs, particularly the parts of their identity where they feel the most vulnerable.
Why Early Dropout Happens When Therapists Miss the Mark
A recent article by ‘Mad in America’ highlights that most clients would need between 30 to 50 sessions of therapy to truly see the shifts they are hoping for. The writers state that many folks drop out of therapy sooner, not because they are not engaged, but because the therapist they were working with was not able to truly meet them where they were at.
The Limitations of Standard Clinical Training
Having the majority of therapists hold a white identity is problematic in a variety of ways. Whiteness tends to come with some fragility, and a patriarchal sense of knowledge that is limited to what is able to be analyzed and reasoned. Many therapists feel most comfortable working within models that are prescriptive and even rigid in some cases. This allows them to feel more competent and comfortable, but may be doing the folks they support a disservice.
We know that being able to genuinely relate, listen, ask open-ended questions, and stay emotionally responsive has a positive impact on the therapeutic relationship, and the level of safety folks experience in their therapy journey; however, these are often not the skills that are taught in grad schools. Staying emotionally responsive requires a stance that allows for flexibility and not knowing where things will go. In my experience, being in this state can cause therapists to feel anxious, reaching out for interventions or techniques instead of learning the grounding skills they need to truly stay with whatever is happening in the session. It is easy to imagine that having to sit with identities they are unfamiliar with could bring up that same anxiety around ‘not knowing’, causing the therapist to become the unintentional block to healing because they are not willing or able to go with the experience that is unfolding due to their own fear or need for control. My supervisor often says to me, I need to be brave so that the person I am supporting can feel safe enough.
Next Steps for Therapists and Therapy Seekers
If you are a therapist reading this and want to know what you can do to start working through some of this for yourself, I highly recommend Resmaa Menakem’s work and the book ‘My Grandmother’s Hands’. If you’re looking for a therapist, and intuitively noticing yourself wanting someone who’s experience of the world mirrors your own in the ways that feel important to you, that makes sense! At the Collective we hold a variety of intersecting identities and if one of our therapists feels like a good fit we would love to chat with you. If not, we would love to help you connect with someone who does.
