How unconscious bias plays a pivotal role in therapy’s effectiveness
Her office was always draped in heavy, dark curtains. The air was musty, perhaps because the emotional support dog frequently napped in the corner.
Where I come from, animals aren’t kept indoors, so the scent of wet dog clinging to the linens was new. The room, however, felt familiar. Maybe because it was filled with antiques, like British West Indian homes in the ’90s which were outfitted with Syrian rugs and Chinese porcelain figurines. Unfamiliar were the European-esque paintings, reminiscent of my therapist’s upbringing. The only thing missing was a painting of White Jesus, but she struck me as more of an atheist anyway.
She sat opposite me in a wide-armed chair. Her pale, friendly face was slim and sunken. She was fit despite her age, or at least I thought she was. I could have simply equated thin with fit, or White and thin with fit. I always imagined her jogging at 7 a.m. with her phone strapped to her arm, her straight blonde hair pulled back into a ponytail, swinging from side to side like a pendulum, just like on television.
Perhaps I’d begun to judge her too quickly. It had only been a few weeks ago after all. But how could I not; I was about to divulge my deepest secrets to a stranger. About to voice concerns about the systems I took issue with created by people who look like her.
She sat cross-legged with her palms clasped together resting on her lap. She jerked her chin and brows upward, expectantly, as if to ask, “Well, what are we talking about today?”
This was how most sessions began. No words, just expressions. Maybe this was her method, but I didn’t know what else to say.
We’d covered most everything: my religious upbringing, my relationships, the complications in changing careers and the magnitude of anxiety those things brought me.
There was an ongoing disconnect between us. I couldn’t describe it, and I couldn’t shake it. But the unease I felt in that office was overshadowed by the unease I felt in the real world. So I stayed and struggled in each session to help her help me.
She seemed to think that I could just abandon the spaces I occupied, and I think that’s what many White people assume Blacks can do. That if we don’t like our situation we just snap our fingers and change it. The privilege their skin affords them — and, for some, their class, status, and economic standing — means they can do as they please with limited consequences. It was difficult to relay to her that I needed help navigating the systems I was a part of that affected my mental health. It was a delicate balance she seemed unfamiliar with and was blatantly dismissive of. I envied her freedom.
Eventually our sessions ended. They didn’t taper off; they just sort of stopped abruptly, with a “there’s nothing more I can really offer you, but you’ll be fine” conclusion.
I smiled graciously on our last day, and thanked her, like I’d been raised to.
I had no clue what I was thanking her for.
That was four years ago.
Since then I learned to self-soothe in unorthodox ways while searching for a long-term therapist. This time I chose not to search blindly. I innocently thought that color didn’t matter when it came to health care, specifically mental health care. I felt the same about age and gender too. I quickly learned otherwise when I started courting an older male psychologist. In our first session, barely five minutes in, he squawked, “And don’t expect me to prescribe you meds either!”
I never asked to be prescribed meds.
That was our first session, and it was our last.
Without due process, he diagnosed me. I can only assume as another fragile millennial snowflake who needed to suck it up. He had the testicular fortitude to judge me by my appearance and demeanor, not after a full session or two, but after five minutes.
Proponents of inclusivity and activists for fairness in taboo spaces teach Black women that we deserve to be offered equality and equity. But no one teaches us how shallow and performative it can be. No one explains we should consider rejecting services and products that present as beneficial but are simultaneously harmful because of who offers them.
Even in spaces of conglomerate, universal trust — the church, hospitals, universities — we see more and more how one class benefits more than others, and how the rest are left wanting. We continue to court these systems and are used as poster children when convenient. Yet we are continuously sidelined, taken advantage of, and muted.
In health care, there are numerous stories of BIPOC whose symptoms are ignored and made light of because no one believes us. Near-death experiences run the gamut. Serena Williams’ story of asking for medical attention to treat a blood clot no one believed she was suffering from after giving birth immediately comes to mind.
My personal experience with a White gynecologist was nowhere near fatal, but it was traumatizing. She did not do her due diligence. She did not listen to what I had to say. One day I will tell that story, but for now we only have to Google in order to find a glossary of misdiagnosed and untreated Black patients.
My ex-therapist was detached and out of touch. But for someone else she may have been amazing and the absolute best.
Why? Because of intersectionality.
Intersectionality is worth paying attention to when selecting your health professionals. Meaning: someone who checks several boxes which run parallel to the way you identify may or may not provide the level of professional services you deserve.
I didn’t need someone who shared my thought process. I didn’t need a sympathizer or yes-man or enabler. But I did need a professional cognizant of the layers of being a dark-skinned, West Indian immigrant with locs raised conservatively and living radically.
I thought that what tied my ex-therapist and I together — our gender — would help the fluidity of our communication. It did not. She is European; I am Caribbean. She is White; I am Black. I am a millennial; she is 60-plus. Her upbringing and life experiences shape how she relates to me, but more importantly, it shapes how I relate to her. If the majority of the session is spent explaining Ebonics, culture, and context, then we lose valuable time. Time that would be better spent focused on my healing.
Therapy wasn’t the place for me to conduct a case study on race and therapy, and I was foolish to think that this relationship would go unaffected by who we were as individuals. I needed to be comfortable in order to be vulnerable.
After years of searching I found a compatible therapist. We are not the same, yet we are similar. Our vernacular, heritage, race, gender, and age mesh so well that I have processed more in our virtual sessions than the in-person therapy I attended with my ex-therapist years ago. Imagine that.
I didn’t need someone who shared my thought process. I didn’t need a sympathizer or yes-man or enabler. But I did need a professional cognizant of the layers of being a dark-skinned, West Indian immigrant with locs raised conservatively and living radically.
I’ve finally found her.
I understand the push for visibility of BIPOC and professionals from marginalized communities in every space, not just health care. Where there is art, there should be diverse voices. Where there is science, there should be diversity. Where there is politics, there should be an army of Stacey Abramses and Stacey Plasketts front and center, instead of simply holding up the rear. Where there is cinema, colorism, featurism, and racism should be eliminated. But most importantly, all these spaces need Black women as voices because our stories are unique yet oddly all-encompassing.
When it comes to therapy, we as Black women are already greatly disenfranchised. Therapy is not always accessible or affordable. In media, it’s painted as “something White people do.” The thought that therapy is for weak or crazy people is what limits us from engaging in it at all. The truth is that therapy helps us to unravel self-inflicted limitations and universally held beliefs perpetuated by societal, religious, and economic systems. Meanwhile, these oppressive systems weigh on us daily, and Black women juggle it all while simultaneously striving to dismantle them.
We don’t always know how to, and because we play into the strong Black woman trope, we don’t often admit we can’t. We don’t know how to take progressive action to grant ourselves reprieve.
But what I am learning is that Black women are deserving. Period.
We are deserving of good things, not just luxury items. Self-care has been so commoditized that it has lost its true meaning. It is not always glamorous. Therapy requires copious amounts of guided self-work. It means understanding that Black women — the disrupters and troublemakers — are deserving of something we aren’t typically equated to: peace. It’s a forgery. A myth. A blatant and continuous lie told to balance the “softness” of White femininity. Our fight for peace has painted us the anti-Christ of peace and nothing can be furthest from the truth.
We deserve peace even as we battle what robs us of peace.
We are tired and deserve a space to rest. A good first step is acknowledging that we are deserving of therapy and that we are deserving of therapists who look like us.
This post originally appeared in The Medium and was re-posted with permission on the Althea Therapy blog.
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