The Elephant in the Room: Racism in the Therapy Space

By Renée Burwell

PACT Level 1 Therapist

There is an elephant in the room. It is big, it is smelly, it is old, and it doesn’t seem to want to go away. Money won’t move it. Ignoring it doesn’t change it. Some choose to dress it with niceties to make it appear more tolerable, but its harm still remains.

This elephant takes many shapes, making it hard for some to recognize when it’s right in your way. It can be subtle, overt, passive, abrupt, implicit, covert, and even micro. Until we are able to address the elephant in all its forms directly by name, it will continue to fester and transform, creating havoc in all spaces, even in those as esteemed as the therapy space.

Its name is racism, and some would say it is as old as humanity. It is the foundational economic structure for the United States and many other parts of the world. Although structures such as American slavery and Jim Crow laws are no longer in existence, the residual impact and trauma of oppressing racial groups for the benefit of economic gain are still in full effect. Racism is sprinkled in every social and economic system in America. Although many would like to believe otherwise, the mental health system is not immune or excused from its embedded harm.

People of color have a lot of mistrust of the mental health system, and this mistrust is not without cause. Black Americans, specifically, are often misdiagnosed, exploited, and criminalized for mental health issues in comparison to their White counterparts. 

A history of barriers for Black, Indigenous, and people of color (BIPOC) to access networks, trainings, and education to become mental health providers is evident. Micro and macro-aggressions based in colorblindness and political correctness have created atmospheres for both professionals and clients from minority groups to feel disenfranchised by the same systems created to see the person as a whole — and see that they heal. According to the American Psychological Association (2020), BIPOC psychologists represent only 17 percent of all psychologists (Latinx representing 7 percent; Asian, 4 percent; Black, 3 percent; and Other, 2 percent).

Psychotherapy has been a broken system for minority groups. The premise being to help people find peace and security. However, the concept of peace and security is often framed from the perspective of racism and those holding power; teaching people who do not fit within mainstream standards to assimilate within systems designed to penalize and oppress them. Many in our field, including industry associations like the APA, see that the mainstream guidelines of those holding power need an active and rigorous overhaul. Our work as therapists is to look beyond the surface of objectivity, but how can we truly see a person if we don’t acknowledge the systems already in place that objectify and prevent a Black, Indigenous, or person of color from being seen fully as a person? 

We have to begin to fully acknowledge and name the elephant in the room. We have to acknowledge the depths of pain racism inflicts — not only to those directly targeted, but on humanity as a whole. We have to accept that no matter how much work we do or knowledge we provide in this area, racism is still in the room. As providers who are partnering in someone’s journey to create peace and security, we have to embrace cultural humility. Regardless of what we may know based on education or experience, we always have room to grow. We all have biases. The therapy room and the therapist are not excluded from the harms of racism, and we all have to do our part to repair the trauma inflicted on Black, Indigenous, and other people of color. 

If you are a therapist reading this, I ask you to really reflect on the following questions (BIPOC clinicians are not excluded from these reflections):

• How many Black, Indigenous, and other people of color clinicians do you work alongside, staff cases with, or refer to?
• How do you view your Black and Brown counterparts?
• Do you pay for supervision or obtain training from Black and Brown professionals?
• If you have clinicians that you work with, how do you choose which cases you refer their way or which trainings you attend?
• Are most of your referrals or trainings by people of color based on race and/or diversity and inclusion?
• How many people of color do you see on your caseload? Specifically, how many Black and Brown people do you have on your caseload?
• Is it proportionate with the greater population or only the population that you identify with?
• How welcoming are your marketing materials to people of color?
• How often do you hold the seat as a minority in the room?
• How often do you receive services from a provider of color?
• How are you creating access to those with barriers both clients and clinicians of color?

Question yourself: are you accessible? Are you competent and aware? Are you willing to learn and be a continuous student?

As we do this work of moving the elephant out of our therapeutic space, remember to give yourself and those around you room to make mistakes.

Allow for vulnerability and transparency that challenge you and the people around you to grow. Ask for help. Pay for education to become more culturally aware. Put yourself in situations where you might be uncomfortable.

We may not have control over the damage of racism’s legacy, but we do have the power to call racism by its name and do the work to create more healing versus harm in the therapy room.