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Some therapists say things that signal so much otherness or a sense of superiority to people of different cultural backgrounds, or with different sexual orientations, from themselves that they should be avoided. But there are many therapists of many backgrounds competent to treat cross-cultural patients.
The greater problem is finding a therapist who is competent. Therapists tend to have a single theoretical orientation, which is great when the patient has the sort of problem best treated from that perspective, but it is otherwise a liability. Therapists, for philosophical and financial reasons, tend to think of life problems as conducive to treatment, when many of them need some other solution. For example, I treated a man from a marginalized group with anxiety. It took some time for us to determine if he needed therapy (for personality change) or if he needed friends (for emotional support), but I already knew that if he needed a friend, it shouldn’t be me. I think some therapists unfortunately feel fine about selling what amounts to friendship.
Once a therapist and patient become friendly, they occasion all the social tact that keeps people from taking off their masks with each other. My main concern about seeing a therapist who looks like you is that a misalliance may arise. A misalliance is a positive relationship organized around something other than the work of therapy. Specifically, I worry that a winking coalition will emerge that wards off the particular meaning of the patient’s symptoms. This might happen between men who complain about women or between white people who can’t explore the privileges in the therapy room because they are so used to ignoring privilege. Also, just as I worry that therapists will be too quick to assume that personality underlies the problems of patients of color, I worry that therapists of color (and overly woke therapists) may be too quick to attribute the life problems of patients to cultural and situational issues. People of all backgrounds have normal problems—like exorbitant expectations of themselves, intolerance of certain emotions, and difficulties with intimacy—that need normal therapy.
Another problem is that you don’t want to have to explain too many things to your therapist. I think it’s fine if your therapist doesn’t know who your favorite musician is, but if you’re making a point about a microaggression, you don’t want your therapist staring at you blankly. Still, a lot of good comes in therapy from having to explain how your family works, and a lot of obstacles in therapy derive from your therapist thinking he or she already knows. Most of us assume we already know much more frequently when the patient looks like us.
Here’s another problem I’ve noticed. A patient tells her therapist about a microaggression—for example, about being eyed suspiciously while shopping. I worry that some therapists will think she is overreacting or that some will roll their eyes in an implicit indictment of people from other groups. I worry that neither one of them will wonder whether they have been suspicious of her in a way that reminded her of this incident. For example, either of them might be accepting payment at the beginning of sessions and utilizing their therapist privilege—the privilege of not noticing what things are like for patients because of the power to define the situation—to avoid examining what it says about trust to take payment upfront. Feelings of otherness or of sameness can impair the exploration of what is going on in the dyad.
One good question might be to ask yourself whether your preference says something about you that could use some exploration. Another might be to ask yourself what your therapist would have to look like for you to tell him or her your deepest secrets. Part of the process has to be authorizing yourself to fire your therapist if you don’t feel like revealing your secret thoughts and feelings, even though you might feel kind of relieved to find that you are not tempted to do so.
You should certainly fire your therapist if they don’t handle your differences well at the outset or if they emphasize similarities to the exclusion of your uniqueness. Still, it’s often more important to find a therapist who can discuss their minor mistakes than one who doesn’t make them (everyone makes them). A black woman told me about her white therapist whose bookcases were full of books about black people. That therapist did not lose the black patient because of the books but because she could not talk about what she was trying to communicate with all the books. She would only say that she was very interested in the black experience. I’m a fan of Pat Parker’s poem, "For the White Person Who Wants to Know How to Be My Friend," which starts with two simple rules: “The first thing you do is to forget that I'm Black. Second, you must never forget that I'm Black.” The bookcases suggested the therapist would follow only the second rule and never forget.
