Ever wonder what makes someone disclose the intimate details of their life to a relative stranger… and feel comfortable doing so? If you are a therapist, or an individual who one day might work with a clinical social worker, psychologist or family therapist you should care. A host of evidence demonstrates that the perceived level of trust and empathy a therapist has towards clients directly impacts whether clients drop out of therapy, disclose information relevant to treatment, and report a high level of satisfaction with treatment. This relationship is referred to as the therapeutic alliance. Challenges exist to establish a strong therapeutic alliance with any client. The obstacles only increase when a White therapist works with a client of color. If therapists receive the same training and utilize the same skills to establish empathy and trust with all clients, why do differences exist in the therapeutic alliance between racial and ethnic groups? Even more important, how do we address this differential?
Today non-Hispanic Whites make up approximately 90% of all mental healthcare providers in the United States, while racial and ethnic minorities are projected to make up 40% of the U.S. population by 2025 (Annapolis Coalition Report, 2007). Understanding what facilitates a strong therapeutic alliance between White therapists and clients of color, as well as what impedes this relationship can increase the amount and effectiveness of mental health services for underserved racial and ethnic minorities. Having a strong belief that racism and discrimination does not exist in the United States can have a negative impact on establishing a strong therapeutic alliance between a White mental health provider and a racial/ethnic minority client.
Someone who proscribes to the idea that racism and discrimination does not exist in the U.S. might believe that if an individual does not gain admissions into a university they must not deserve to go. It would not matter if the rejected student only had access to very poor secondary schools and did not have help with homework growing up because parents only spoke Spanish. The person who denies the existence of racism and discrimination would argue that the rejected student competed on an equal playing field with a student that went to an elite private school, or very good public school, had access to tutors and help from mom and dad with school work. Now if that same rejected student sought out counseling for symptoms of depression and low-self worth surrounding the university rejection from a White counselor who does not believe that racism and discrimination exist in the United States a serious problem will arise. This therapist would not acknowledge and validate the client’s belief that he/she had not had equal opportunities. The client in turn would likely not feel understood by the therapist and have difficulty establishing trust. In situations like this one, where the therapist does not empathize and validate the client’s perspective, clients typically drop out of treatment prematurely and report low satisfaction with the therapeutic experience.
This problem is not irresolvable. Many training programs do not integrate exploration of attitudes regarding race, class and personal bias/discrimination into curriculum. If future therapists had to examine and confront their views regarding racism and discrimination early on in their training, and reflect on evidence about how such attitudes impact the development of the therapeutic alliance and client outcomes, training programs might generate practitioners more in tune with the realities and perspectives of minority clients. Initiatives to make training programs more accessible to non-White populations and increase diversity within the mental health field can provide a long term solution to facilitating dialogue about techniques to best establish trust and understanding between therapists and clients from different racial and ethnic backgrounds.
Gushue, G., & Constantine, M. (2007). Color-blind racial attitudes and white racial identity attitudes in psychology trainees. Professional Psychology: Research and Practice, 38 (3), 321-328 DOI: 10.1037/0735-7028.38.3.321
Neville H, Spanierman L, & Doan BT (2006). Exploring the association between color-blind racial ideology and multicultural counseling competencies. Cultural diversity & ethnic minority psychology, 12 (2), 275-90 PMID: 16719577