Addressing Race in Therapy

As a social justice-focused psychologist, I am always surprised when I learn of therapists who never talk about race in a meaningful way with their clients. We ask our clients questions about themselves all the time, but many therapists never ask, “What is it like to be Black?” “To be white?” “To be biracial?” or “What prejudice have you experienced (or not experienced) because of your race?”

Talking about race can be difficult, and many in the mental health field are not adequately trained to do so in the clinical setting. This reflects larger societal norms, and it is a major gap in our field (Carter 2003; Sue, 2015).

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Ignoring racial identity in therapy conveys indifference to clients. When, for example, three months into treatment I began exploring the race-based experiences of a client who identifies as a cisgender Black woman, she let me know that because I had not brought it up earlier in our treatment, she had thought she was “not supposed” to talk about her race-based experiences in therapy, or that I did not care about them. The underlying concern was that I did not care about her, because race is a major part of how she moves through the world. The same is true for all of us, regardless of how aware we are of our own race. When therapists are supposed to be curious about the entirety of their clients’ lived experience, leaving this topic out is a failure to fully understand the lived reality of their clients.

An easy way to address this? Have conversations about race. During your first session with a client, ask about their racial identity. In the midst of all of the other getting-to-know-you questions typically asked in the first session, let your client know that because you recognize the importance of social group identities, you like to ask all of your clients about their reference groups. Let them also know that it is perfectly fine if they would prefer not to answer, but at least you have opened the door and they know that if it becomes important at any point in treatment, it will be welcome. After asking “How do you identify in terms of race?” get curious. Ask things like, “What messages did you get as a child about being Asian?” “How are your interpersonal interactions affected by the fact that you are Latin American?” “How did adults in your early life help you think about racial differences?” And so on.

Before doing this, however, it is important to take an active effort in educating yourself on systems of oppression and engage in conversations in your own life that help you deeply understand your own unconscious biases and racial identity. It is impossible to adeptly do this work without having first done it yourself (Sue, 2015). These conversations can be difficult, but they are crucial to well-rounded therapy and the full healing of those with whom we work.

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As you begin to address race-based experiences in therapy, explore not just cross-culturally (learning about a culture different from yours) but multiculturally (learning about systems of power, privilege, and oppression and their impact related to social group identity). This will also be important to do for all of your clients’ reference group identities such as ethnicity, gender, sexual orientation, social class, immigration status, veteran status, religion, and other identities that might be important to that individual.

It is also crucial to address race-based experiences in therapy regardless of a client’s perceived racial identity. Notice if you find yourself shying away from these conversations with clients who are white or white-passing, and ask yourself why this is. To assume that racial identity only holds significance to people of color is false (Sue, 2015). Racial identity is important no matter your racial background because, for one thing, it dictates how you are treated in the world.

For white therapists, blindness to your own racial identity is harmful because it means you are unaware (and therefore unable to address) the ways in which your racial identity carries a great deal of unearned privilege. Blindness in this area leaves a gap in self-understanding, as to not understand yourself as a racial being is to not understand yourself. Some of the most well-known researchers in the field of multiculturalism have asserted that if you are unaware of the impact your whiteness has, then you remain part of the system that upholds an unjust racial hierarchy (Carter, 2003; DiAngelo, 2018; Sue, 2015).

Since white individuals in the United States are largely brought up to not think about their race (DiAngelo, 2018) and therefore have difficulty thinking of themselves as racialized beings, it is all the more important that white therapists open up this conversation with their clients. Otherwise, it is entirely likely that when a client meets her white clinician who does not discuss race, the client will may feel not fully seen by the clinician, and the client may therefore keep those parts of her lived experience out of the therapy room. As a white clinician, I have seen this happen, and the only way I have found to resolve it is to be transparent about my genuine interest in my clients’ race-based experiences and to continue to show curiosity and empathy after this door is opened. I also make clear that my goal is not for my clients to teach me about race (I continually do that work on my own time), but to provide a space where they feel comfortable bringing their whole selves into the room.

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For too long, the mental health field has not proclaimed loudly enough that we value our BIPOC clients’ experiences and that we are equipped to help them heal from race-based stress, while acknowledging that racial trauma is an ongoing experience. We have also neglected to adequately show white clients that understanding race is a major part of understanding themselves and the world in which they live. With these conversations, therapy can go so much further.