“What would a White doctor know about my problems?” “They’ll call me crazy and lock me up!” “The pastor has been helping me,” and “Where would I even find a good Black counselor?” Although the Black community shares the same concerns and mental health issues as others and with even greater stressors due to discrimination and economic inequities, many shy away from psychotherapy. This is due to many factors such as feeling unable to find a therapist they feel can truly help them, being distrustful of White people, the belief that seeking help makes you weak and also the idea that therapy is for “crazy” people.
African Americans have a greater distrust of the medical establishment in general, and many feel that medical institutions hold racist attitudes. This goes back to historical abuses of slaves by White doctors for medical experimentation; Blacks could neither consent or refuse to participate because of their low social status and were often victimized, even to the point of being used as examples of surgical techniques for medical students.
Cultural mistrust is partially responsible for the under use of mental health services, leaving many without needed care. Black people may fear mistreatment, being hospitalized involuntarily, or being used as research “guinea pigs.” Black people who regularly encounter prejudice often develop “healthy paranoia” — a cultural response style based on experiences of racism and oppression in White society. Worries about being judged or wrongly diagnosed may lead many African Americans to exercise caution or avoidance of mental health care. This reaction has lead some clinicians to over diagnose paranoia in Black clients, which then leads to greater mistrust on the part of the client.
White therapists often don’t understand why Black clients are cautious. Unfortunately ethnic and racial stereotypes often affect therapeutic relationship. The therapist’s reaction to the client can be complicated by unacknowledged prejudice, stereotypes, and feelings of guilt. An honest discussion of ethnic and racial factors in the therapeutic relationship can increase trust and mutual understanding. However, many therapists are unsure how to approach racial differences, and may prefer a “colorblind” approach.
Colorblindness Is Not the Answer
A colorblind approach only relieves the therapist of his or her obligation to address racial differences and difficulties. Being colorblind allows the denial of uncomfortable racial and cultural differences. Being colorblind ignores the experience of being stigmatized by society and represents a failure on the part of the therapist.
The Black Client and White Therapist
In my work as a therapist working primarily with Black clients, I have had many clients tell me about difficulties they’ve had with White therapists. Many clients felt there were subjects they couldn’t discuss with their therapist because they felt the therapist couldn’t possibly understand due to cultural and racial differences. I have also had clients say that they have discussed racism they’ve experienced and felt that their therapist felt that they were making a “big deal” out of something. These situations led to clients being distrustful of their therapists.
Choosing a Therapist
It’s important when choosing a therapist to choose someone who you feel understands you and will be empathetic and non judgmental towards you. Sometimes it takes going to different therapists to find the right one for you. Finding a culturally competent therapist can be especially difficult but not impossible. Remember no matter what race or ethnic background your therapist is, the most important thing is that you feel heard, understood and safe to express yourself in therapy.