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Clients often relay to me after we begin our sessions how difficult it was to begin the therapeutic process. The Psychology Today Therapy Directory is a great resource to look for a mental health professional. However, my clients still may cite anxiety, fear, and even confusion in not knowing how to select the right fit for them because of the numerous options. In my initial consultation, I discuss how I work, what brings clients to therapy, and what their expectations are for engaging in therapy. I ask clients what their experience has been in the past and what aspects of therapy they did or did not like. I also ask the client about what type of communication style they would prefer.
Whatever attributes of a therapist that clients disclose are important to them provide me with a foundation to begin therapy. I am happy to honor my client's communication preferences to lessen the power dynamics in therapy. As a Black male therapist, working with clients of color especially, it is important to me that my clients feel a semblance of how my identity relates to them within our community. To address lessening stigma and power dynamics in therapy, I recommend that clients and therapists address the following areas of their therapeutic work.
Address Stigma Head On
Engaging in therapy can be so intimidating. Clients are literally telling us their truth: the good, the bad, and the not so cute parts of themselves they wish to work on as clients. It is important to address with our clients that therapy is a tool that can help them to develop skills to help with their issues. In addition, I inform my clients that I am not here to change them in the therapy process. I see my role as a collaborator working in tandem with clients to empower them to live the life they wish to live. I acknowledge and thank my clients for disclosing aspects of their lives that are difficult to speak about or for being brave enough to be open and vulnerable with me. I also address the stigma or perception of me being the one with solutions in therapy by asking periodically for feedback from my clients about our work.
If a client informs me that they have a mental health diagnosis prior to being in my care, I take time to explore with them how they see the validity of this diagnosis in their life and what it means to them. Sometimes clients reveal to me that they have not had enough psychoeducation about their diagnosis or that they have never felt that their diagnosis fits them.
Encourage Clients to Be Inquisitive
I want my clients to see me as a human being first and then a therapist. Understanding that they are curious about my life and who I am, I welcome questions about my identity within the context of their therapy goals. There is never a question asked of me that I can’t answer and turn into an exploration of how to process their thoughts and ideas and align them with their therapeutic goals. This requires that I be comfortable with leaning into discomfort and disarming my own defense mechanisms in session as well. This also means that I must be careful about emotionally triggering my client or myself (to some degree) to cause a break in our therapeutic foundation. Being open with your clients about ensuring they feel safe in session can deepen the therapeutic relationship.
Money, Money, Money
I was not sure when I began my private cash pay practice how feasible it would be to maintain a consistent revenue stream. A part of my anxiety about this was because I was anxious about how to discuss finances with clients, especially if I was going to set a feasible sliding pay scale that would sustain my business. However, I failed to realize the ways in which my clients placed a value on their time and money and the quality of care they are provided in therapy. I developed scripts for conversations to have with clients to discuss payment based upon their salary (only for those clients comfortable with disclosing this information) to decide what fee would meet their financial needs.
I have found that framing a financial discussion around self-care has been instrumental in having a conversation about payment. I often inform my clients that I want them to select a sliding scale rate that allows them to engage in self-care knowing that each year my rates will increase. I also inform clients that I am willing to work with them if any unforeseen issues with money arise. I have not had any issues with clients paying me on time, etc. I attribute this to having an open and direct conversation about finances that allows us both to honor our time and commitment to each other in session.
Building a therapeutic foundation between therapist and client is an ongoing process. Within this process, it is important to always de-stigmatize any stereotypes of how a client's culture, community influences, etc. can negatively impact how a client views our therapeutic relationship. It is also important to note that a client's cultural and environmental influences are interwoven into their identity, and it is our job (both therapist and client) to find a balance of how to utilize these aspects of identity and lived experiences in session.
To find a therapist, visit the Psychology Today Therapy Directory.
