A new client came to me, a black therapist, at her first appointment and very pointedly said, “Whew, I am so glad that they didn’t assign me one of those white girl therapists out there. I don’t want to tell them all of my business and they won’t understand me anyway.”
Many clients have questions just like this when they are selecting a therapist about their cultural identifiers and whether it is important that they “match” their therapist in some way. And whether it is race, skin color, sexual orientation, gender marker, or some other trait, clients consistently seem to want someone that will have shared their experiences.
This perception that you must identify with your therapist to get any real work done seems to be on everyone’s mind. But is it a valid concern? Well, yes and no.
As a black, gay, male therapist, my clients fit within several demographics that do not match mine. But our differences show when a client recounts an experience that I am not familiar with. For the therapist, there is an immediate attention paid to the demographic differences when the client walks in the door.
We are taught to recognize our biases and immediately dispel them or deal with them in our own consultation. For many, if not most therapists, the quality of care is not affected and, in fact, is enhanced when the therapist can recognize and attend to their thoughts and feelings towards a client. And for a very small majority, this is difficult and could impact care.
One side of the argument says that it is very important for the client to feel like they identify with their counselors as it may be perceived that the therapist will know exactly what the client is going through and therefore they will not have to explain as much.
However, the other side of the argument, backed by research, says that it does not matter what the therapist looks like rather how they connect to the client in terms of being in a place of empathy, understanding, and true deference to the difference in the room.
For example, a white male therapist can work well with a young black female if he is self-aware and displays appropriate empathy, according to a meta-analysis of research published in the Journal of Counseling Psychology.
These same authors also reported that people who identify with a higher level of racial identity tend to fare better with those therapists that match their identity, but it is not needed to be successful.
Generally, what it comes down to is the level of cultural awareness that the therapist has and their propensity to understand that they are not going to always see clients that are similar to them. This includes attending cultural trainings, learning different language nuances, doing the “work” that we all have to do to understand and start to fix inherent biases, and not being afraid to call out differences in a room that a client may or may not even be thinking about.
As the client, it is important that you challenge yourself in terms of who you think you should be seeing. It is important to note that while you may share one or more identities with your therapist, it should not be assumed that they have had similar life experiences to yours.
And while it may come out during the session that this is true, do not count on this or dismiss this issue when selecting a therapist.
Now back to that client that I mentioned to you earlier. She and I have the best relationship that a therapist and client can have, but guess what? I have that same relationship with my young, black clients, middle-aged white clients, and adult Latino clients.
As a therapist, I fully understand the clinical implications in either direction, but it is fully understandable from the client perspective why this is important and why they make the choice they do.
The core of the issue here is the continued conversation about mental health in communities where it is seen as taboo or has seen less than optimal outcomes. Whether we address it or not, diagnoses such as anxiety, depression, and bipolar disorder will continue to ravage communities without the help to identify and treat these disorders. We will also continue to see increased suicidality related to those diagnoses if those individuals do not feel as though they have an empathic ear.
So, in so many words, should it matter? Nope. Can you build a good relationship with a therapist that looks different than you? Absolutely. Does it matter to some? Yes, but I’ll let you in on a little bit of a trade secret here.
Even if I do understand an experience that you as a client may have, I am still going to “pretend” as though I don’t so that you have to explain how you felt about it and what you went through.
Because…welcome to therapy.