Addressing Racial Bias in the Therapeutic Dyad
“Racial oppression is a traumatic form of interpersonal violence which can lacerate the spirit, scar the soul, and puncture the psyche”.
Kenneth V. Hardy
“The individual achieves a sense of inner pride regarding his or her Black identity and develops a sense of security with respect to his or her cultural heritage”
Robert T. Carter
In my work as a psychotherapist, I am consistently confronted with racial bias or expressions of racism/White supremacy articulated by the White patients I treat. Some White patients have asked me questions such as how I do my hair, what my racial background is, or what level of education I have. Other White patients have expressed being afraid of me or have accused me of being “too aggressive” when I have redirected them in session. A few White patients have asked to be switched to a different therapist when they discover I am African American. Merely being in the presence of White patients can feel like a microaggression. Some of the remarks made by the White patients I treat include calling Black people the N-word, stating that Black people are bad or trouble, or indicating that Black people want too much and should be satisfied with what they have. Additionally, I have experienced White patients verbalize outright hatred and hostility towards Blacks while in session. As an African American it is challenging to hear such remarks, even in my capacity as a psychotherapist, and remain empathic. The inclination to ignore such comments stem from countertransference responses such as fear, shock, or habit of survival, and can interfere with the ability to be empathic. This is problematic because empathy is essential to the therapeutic process. The task then is to address the racism/White supremacy expressed by White patients while remaining empathic.
Addressing race in the cross-racial therapeutic dyad is challenging, especially when the therapist is African American or non-White and the patient is White. This issue is directly the result of the historic relationship between Whites and non-Whites, especially African Americans, and absolutely impacts the therapeutic relationship. In his book, The Influence of Race and Racial Identity in Psychotherapy: Toward a Racially Inclusive Model, Carter (1995) speaks to the influence of race on Black and White people:
“Racial identity attitudes toward Blackness are negative, and White culture and society are seen as the ideal. Race is not a salient aspect of one’s identity” (p. 141).
Carter articulates a very important phenomenon in American society, which is that the concept of race is not important or a noticeable issue for White people, but race directly impacts the lives of Blacks. Hence, issues involving race are vitally important to Blacks and essentially a non-issue for Whites. Knox et al. (2003) point out the significance of the "lived experience of race versus the academic learning about race" of African American therapists as compared to White therapists. (p. 478). Essentially, African American therapists have the experience of living as Black people. Additionally, African American therapists consistently have regular cross-racial encounters and have more experience working with diverse groups of people. Conversely, White therapists have limited experience with Black and other non-White people and generally obtain information about diverse populations through educational pursuits, which are extremely limited in availability and scope. Thus, the varied experiences of African American therapists and White therapists can influence if race is addressed in treatment at all.
The lived experience of African American therapists versus the lived experience of White therapists is instructive in that it demonstrates the impact of the historical relationship between Blacks and Whites that undoubtedly is present in therapy. For example, when a White patient expresses microaggressions they may not be aware of their behavior or the impact on the therapeutic relationship. Another example is when a White patient makes explicit expressions of racism/White supremacy and retreats into the abyss of White fragility when confronted by the African American therapist. These types of responses can stymie the attempts of the African American therapist to demonstrate empathy due to countertransference reactions.
In African American and European American Therapists’ Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads authors Knox, Buckard, Johnson, Suzuki, & Ponterotto articulate the idea that addressing race in the therapeutic dyad can have a beneficial effect on treatment. Knox et al. (2003) argue that acknowledging the patient’s race and racial content can create a positive therapeutic relationship in the cross-racial therapeutic dyad. Knox et al. (2003) discuss the effect experienced in the cross-racial relationship when African American therapists addressed race in treatment:
“ All African American therapists reported that this incident had a positive effect on the therapy, whether in the form of increasing rapport, client comfort, or validation of client feelings. More specifically, these therapists also typically reported that such discussions increased the trust and security of the therapy relationship. One therapist, for example, stated that after the discussion, her client was more open and trusting, and the therapy moved to a ‘deeper level’” (p. 475).
Knox et al. (2003) suggest that addressing race in the therapeutic dyad can increase the strength of the union between the therapist and patient and foster greater understanding and trust, which undoubtedly supports the demonstration of empathy. This point of view is ideal and would undoubtedly improve therapeutic outcomes.
In Broaching the Subjects of Race, Ethnicity, and Culture During the Counseling Process, authors Day-Vines, Wood, Grothaus, Craigen, Holman, Dotson-Blake & Douglass (2007) posit when race is addressed in the therapeutic dyad, positive treatment results occur. Thus, addressing race and linking the discussion of race to the patient’s presenting problem can create meaningful dialogue and growth. When the therapist is able to recognize and address the meaning of race and its relationship to the treatment material, as well as to the problems in the patient’s life, the patient feels more equipped to handle his or her life, the therapeutic relationship becomes stronger, and the patient improves.
In spite of the challenges inherent addressing racial bias in the racialized therapeutic dyad, its importance cannot be understated. The ability to do so takes courage and commitment. Addressing race is an important aspect of the cross-racial treatment relationship because it increases the therapeutic bond, helps the patient feel comfortable sharing, and improves treatment outcomes.
From my own experience and from a review of the literature, resistances to empathy can be mitigated when transference, countertransference, and White fragility are addressed in treatment. Additionally, addressing racial bias in the racialized therapeutic dyad can create positive treatment outcomes. I recommend the following ways for therapists to effectively manage transference, countertransference, and White fragility, as well as to address racial bias in the therapeutic dyad.
Reasonable Guidelines for Managing Transference, Countertransference, and White Fragility, as well as Addressing Racial Bias in the Cross-Racial Therapeutic Dyad:
1. Recognize and Accept: Recognize and accept the patient's racial bias, transference material, and expressions of White fragility as it
occurs.
2. Promote comfort: Help the patient feel comfortable in expressing his or
her views on race. Help the patient normalize his or her feelings.
3. Identify and Explore: Identify the patient's racial bias, transference and expressions of White fragility. Explore the patient's beliefs, thoughts, and feelings about race from the standpoint of interest, sensitivity, and understanding. Question the patient’s racist views and explore how those views might impact the patient’s problems.
4. Increase Awareness/Self-Development: Recognize and accept
countertransference reactions. Engage in self-reflection regarding thoughts and feelings about the patient, race, and the impact on treatment. African American and other non-White therapists are encouraged to increase his or her awareness of the historical and sociopolitical relationship between Blacks and other non-Whites, and Whites in order to develop an understanding of the racialized material expressed in treatment. African American and other non-White therapists are encouraged to develop a secure cultural and racial identity in order that they may be psychologically equipped to endure and to address racial bias.
5. Seek Supervision: Discuss treatment in supervision to develop increased self-awareness, to obtain support, and to refine skills necessary to work effectively with patients who express racial bias.
References
Carter, R. (1995). The Influence of Race and Racial identity in Psychotherapy: Toward a Racially Inclusive Model. John Wiley & Sons, Inc.
This book discusses the impact of the race and racial identity in psychotherapy.
Day-Vines, N. L., Wood, S. M., Grothaus, T., Craigen, L., Holman, A., Dotson-Blake, K., & Douglass, M. J. (2007). Broaching the Subjects of Race, Ethnicity, and Culture During the Counseling Process. Journal of Counseling and Development, 85(4), 401-409.
This article encourages therapists to take into account how social and political factors, such as race, influence the presenting problems of the client.
Hardy, V. K. (2013). Healing the Hidden Wounds of Racial Trauma. Reclaiming Children and Youth, 22(1), 24-28.
This article discusses the impact of racial trauma on non-White children and youth.
Knox, S., Buckward, A, W., Johnson, A. J., Suzuki, L. A., & Ponterotto, J. G. (2003). African American and European American Therapists' Experiences of Addressing Race in Cross-Racial Psychotherapy Dyads. Journal of Counseling Psychology, 50(4), 466-481.
This articles examines the experiences of both Black and White therapists who addressed race in psychotherapy.