Therapy in Black and White

My shrink said the strangest thing to me in therapy once. She said she was sorry she’d monopolized so much of our previous session asking me questions about “race.” She felt it was inappropriate, selfish even, for her to squander our limited time on tangential, if interesting, discussions about our different ethnic backgrounds. We were there to talk about my problems, she insisted, not to satisfy her own sociological curiosity.

True. We WERE on the clock and sessions weren’t cheap. Even with insurance, I had a $20 co-pay that was squeezing a girl’s already hurting pocketbook. But, being my typically neurotic, compulsively eager-to-please self, I told her that it was OK, that not only did I not mind talking about race, but I thought it was a necessary part of our getting to know one another. After all, we’d only had a handful of these little psychological pow-wows so far and, superficially, we didn’t have a helluva lot in common. There was a generation gap to start, and, well let me just put it all out there: My shrink was a white lady, married with children and a couple grandchildren, and I’m a happily single, young-ish, African American woman without a crumb snatcher to my name. With such different lives, how could she possibly begin to help me without knowing where I was coming from, and how could she ever know if she were afraid to ask some taboo questions? I think my reassurances put her at ease, at least I hope so. But, to tell the truth, her peculiar revelation got me thinking….just how much does race really matter when choosing a therapist?

The Office of Minority Health reports that “African Americans are 30% more likely to report having serious psychological distress than non-hispanic whites”, largely due to socio-economic factors. Although poverty levels and lack of access to mental health services continues to be a hindrance, more and more people of color are finding their way into psychotherapy and psychological counseling for the first time. Though the reasons for seeking treatment will range from the trivial to the alarming, each potential new patient will have to overcome the same obstacle…choosing their therapist.

Oh, like me, the searches will start out simple enough. With the same routine questions one would ask if looking for say, a good podiatrist. Questions like, “Is the office convenient?”, “Is this person qualified?”, “Licensed?” , “Do they come well recommended?” But once past the formalities, the unique challenge of picking the right therapist starts delving into decidedly grayer areas. You begin asking yourself more touchy-feely questions like, “Can I trust this person?” “Will they understand me?” “ Would I feel more comfortable opening up to a man or a woman.” “Someone younger or older?”

The thing is, if you’re a black person seeking therapy, and you’re lucky enough to get over that first huge cultural hurdle of black folk “don’t tell our bidnizz”, and get yourself into a therapist’s office for the help you may need, there’s still a whole pile of baggage to deal with. I can dance around the precise definition of what I mean here, coat it with oh, about two or three spoonfuls of sugar, but that won’t change the fact that I’m talking about racism, folks. Plain and simple. Mine, theirs, ours. Hey, we could get matching bath towel sets for it.

But truly, I’m not saying that there aren’t some amazing, empathetic people out there of caucasian, Asian and Latin descent who aren’t amazing at what they do. What I am saying is that, in my experience, people of other races are more likely to have preconceived notions about my income, about how many “baby daddies” I have or about whether or not I dig opera. And, all of that prejudging and stereotyping could mean a greater likelihood that I would be misdiagnosed.

On the other hand, I remember growing up and hearing horror stories about white folks who refused the treatment of black medical staff (my parents were both nurses in the 60s) and feeling outraged about that. I wonder if my hesitancy to embrace a white (or Asian or Latin) therapist doesn’t, in a way, make me guilty of the same thing? I could be wrong, in this day and age of cultural competency classes and diversity training, to assume that a therapist of another race doesn’t understand things like “generational trauma” in African American people and the “weathering effect” of racism. Add to that the fact that having a therapist who isn’t of one’s immediate community may have the added benefit of increased anonymity, so that it’s less likely that we have acquaintances in common. Definitely, the idea that I might have friends or family in common with my same-race therapist, that we might run into each other at The Roots concert on Friday, makes it a little more awkward to open up.

I guess what I’m saying, bottom line, is that I don’t know, but it’s at least worth talking about. Worth thinking about. We’ve got Obama and Michelle chillin’ in the White House, and I think it’s time we started having some of those taboo conversations with ourselves (why still so much stigma about seeking help for mental illness in the black community?) and with each other (hey, Mr. White therapist, I don’t know if you’ll really be able to understand me. You don’t even know what a “perm” is). It’s time we all just started conversing about it. So, let’s talk.