Of all the professions associated with racism, therapy probably isn’t what first comes to mind. Therapy is a healing profession that self-selects for compassionate people who have a deep interest in illuminating rather than suppressing uncomfortable truths. But what happens if mental health practitioners aren't aware of their own discomfort with the topic of race? We’re supposed to be the profession where nothing gets swept under the rug, but are we complicit in doing just that?
I am white, and when I was in graduate school, professors spoke openly to students about the fact that most therapists are white, and that white therapists needed to examine the assumptions they carry as white people — say, white culture’s focus on individualism and separating from family in young adulthood vs. another culture’s valuing community and multigenerational households. We talked about the shame that certain cultures feel when deciding to see a therapist and learned about systemic factors that disproportionately affect mental-health-care access. We discussed the ways in which race, gender, age, sexual orientation, religion and socioeconomic status subject people to discrimination — and, in turn, depression, anxiety and trauma.
But here’s what we didn’t talk about: the racism that might take place inside the supposedly “safe space” of our therapy rooms — our patients’ racism and our own.
An example: A white patient is telling me a story about being afraid while walking to her car on a deserted street because there was “a black man” standing nearby. She had been raped two years earlier on a deserted street — by a white man. I wonder why this man’s skin color matters, and I want to say something like, “Tell me why you mentioned that he was black.” But I don’t, and I justify it to myself by thinking that I shouldn’t interrupt her story while she’s crying, or that my saying this might sound judgmental. But I also know that if I were a therapist committed to racial equity, I would have asked.
Another example: I’m seeing a black patient, a woman who looks a lot like me on paper — we’re both professionals, we went to the same college, we’re moms of kids about the same ages. And because of our similarities — and also my unstated reluctance to go there — we tacitly collude in pretending that she isn’t black and I’m not white. Until one day she tells me about an incident at her company, where she is one of the few black executives: Her white boss chose a white woman for a promotion that she had fully expected to earn, and my patient would have been the first black executive to be promoted to this level. The white woman was not nearly as experienced or qualified, my patient tells me. And she says this is the story of her life — a story she hadn’t told me about until that day.
We may have a lot in common, but unlike her, I had never walked into a classroom at our college and wondered if I had to prove myself worthy of being there; I hadn’t sat in the dining hall and overheard someone talking about “affirmative-action” students who got into the school more easily; I never stepped foot in a job interview and watched someone try to cover her surprise because, based on my résumé, she had expected my skin to be lighter. I wasn’t treated differently in restaurants, assumed to be the caterer at a party at which I was a guest or a maid at a hotel where I was staying, or questioned about whether I belonged in business class on an airplane because of the color of my skin. There were differences between this patient and me, and I chose to be willfully colorblind, thinking that I was being inclusive and “not a racist” when I was really denying my patient’s experience of being discounted and minimized and humiliated — the trauma of being black in America.
Racism has a significant impact on mental health. There’s a world of difference between the so-called cultural competence that we were taught in graduate school and cultural humility, which is a deep curiosity about our patients’ experiences, an ability to bear witness to the truth of their lives and a keen awareness that we have work to do if we want to be therapists who are part of the change that our patients — and society — so desperately needs.
As a therapist, I am used to providing people with guidance. Now, though, I am committing myself to asking the questions. I hope that my asking them aloud, instead of hiding behind my shame, will encourage others in the mental health field to do the same.