When Vanessa Jackson was a young black professional looking for a therapist to help her battle depression, she knew just what she wanted: “An African-American woman who was a feminist.”
A therapist who didn’t think that racial identity and racism were important issues in treating black patients would do no good and, in fact, would do harm, said Jackson, now 36 and living in Atlanta. “It would be to me the equivalent of being Jewish and having someone come in and say they think the Holocaust isn’t relevant to your day-to-day life.”
Many African-American patients share Jackson’s view, as do many other minorities, from Asian-Americans to Hispanics, who might prefer a therapist from their own culture, and gay and lesbian patients who wouldn’t feel comfortable seeing a heterosexual therapist.
But for African-Americans, the problem is compounded by a long history of slavery, racial discrimination and mistrust of whites. And a scarcity of minority therapists–less than 1 percent of the nation’s psychologists and psychiatrists are black–means that black patients don’t always have a choice about whom they’ll see.
Among therapists themselves, the racial issues are often less clear-cut. And because psychotherapy is becoming more accessible for African-Americans and less stigmatized, practitioners and patients are grappling with how much they must have in common for counseling to be successful.
The American Psychological Association and the American Psychiatric Association have no official positions on the race question. But the psychological association publishes guidelines stressing the importance of understanding and being sensitive to the diverse cultures of patients. The psychiatric association supports both increasing the number of minority therapists and including cultural sensitivity courses in the training of therapists, something that more university programs are doing.
Therapists themselves come down on both sides of the issue.
Cassandra Landry, 32, a black mental health clinician, said her experience as a patient being treated for depression and anxiety convinced her that a racial match between therapist and patient can lead to more effective treatment.
“I have had white [therapists] before, and as for the rapport building, it wasn’t there,” Landry said. “I really didn’t get very far. My issues were not resolved.”
But she added that black patients have told her they have done well with white therapists who have a spiritual, very religious background.
Dr. Peery Grant, president of the Atlanta Psychoanalytic Foundation and a training and supervising analyst on the faculty of the Emory University School of Medicine, said he fears that an emphasis on matching up patients and therapists based on race revives a racist notion once held by many in the psychoanalytic field: that a white therapist cannot analyze a black patient and a black therapist cannot analyze a white patient.
“At the time I was being taught that, there were some very outspoken people at Columbia University who were fighting against that,” Grant said. “They were able to … demonstrate that it wasn’t true. It really was a prejudicial idea that was wrong.”
He believes that a cultural difference between patient and therapist can be a factor but doesn’t see it as “a massive one. It’s there, but … it can be dealt with, is my point.”
Dr. Richard Mouzon, an African-American psychologist with a practice in southwest Atlanta who has been in therapy himself and has treated white patients, believes the obstacles that a white therapist must overcome in treating black patients are more formidable than those faced by a black therapist treating white patients.
African-Americans “were really raised not to trust the white man, not to trust him with everything about us,” Mouzon said. “When you’ve got to give up to a therapist your core issues, that’s hard to do. It’s almost impossible to do with a white therapist.”
Mouzon said he was treated by four white therapists — all of whom he respected — but didn’t make progress until he went to a black therapist.
Other therapists acknowledge that racial and cultural differences can be barriers to effective treatment but say they don’t have to be.
Dr. Carl Bell, a professor of psychiatry at the University of Illinois and president and chief executive officer of the Community Mental Health Council in Chicago, has written about race and mental health treatment. He stresses that the quality of the therapy is what’s important — a bad therapist is a bad therapist, even if he’s treating a patient from his own culture. Interracial therapy can be effective, Bell said, but the therapist must be sensitive to even the most subtle cultural issues.
“If you’re a white therapist and you’re treating black patients, do you have African art in your office?” Bell asked. “Or do you have only Eurocentric art? If you do, black patients may not feel comfortable. They may not feel welcomed.”
Dr. Michelle Clark, a San Francisco psychiatrist and founder of the University of San Francisco’s Black Focus Program, which does research and tries to meet the special needs of black mental health patients, is a leading advocate of acknowledging and addressing cultural differences between therapists and their patients during therapy.
Treatment involving different races or cultures, Clark said, “is very challenging, and that’s putting the positive spin on it.” She believes that such differences can lead to misinterpretations of language and demeanor that can render treatment ineffective.
Dr. Patrice Harris, past president of the Atlanta chapter of the Black Psychiatrists of America, said patients and therapists can’t remain silent about the matter. “If the two people are of different races,” Harris said, “if the issue doesn’t come up in the first two or three sessions, it should be brought up.”
Dr. Quentin Ted Smith, a professor of clinical psychiatry at Atlanta’s Morehouse School of Medicine, said being of the same race or culture doesn’t guarantee successful therapy.
“There is some information out that sometimes people that have similar cultural and racial backgrounds seem to match up better as far as therapy is concerned,” Smith said, citing articles in professional journals on the subject in recent years. “But, at least in my experience, if you have a therapist from the same culture — let’s say you’re black and looking for a black therapist, or you’re white and you’re looking for a white therapist — the matchup in race or culture does not guarantee that the therapist is going to be understanding and empathetic. They may be of the same racial background and the same culture, but their experience may be quite different from yours, and it may be difficult for them to understand your life experiences.”
And because of the shortage of African-American therapists, a black patient who insists on a black clinician may discover that it’s difficult to find one.
Vanessa Jackson, for example, couldn’t find a black therapist who met all her criteria. She eventually was treated by a white lesbian feminist therapist. That worked out fine, she said.
