How do we address racism in therapy?

As a psychological wellbeing practitioner, I have engaged with various discussions around discrimination and therapy recently. Broadly speaking, one of the key aims of any therapy setting is to build therapeutic alliance with a client. This can be achieved in various ways, including empathic statements, showing positive regard for the client and letting the client feel heard. This year, the BLM movement has rightfully asked us to address racism in its various insidious forms. Within my service, this has raised discussions around how we deal with racism in the therapeutic space and has highlighted a tension that emerges in therapy. This tension raises the question, how do we balance the need to build therapeutic alliance whilst addressing discriminatory comments from clients?

In recent group supervision sessions addressing discrimination and racism in particular has been discussed in detail. As a white British cis-gendered heterosexual male I have yet to be discriminated against directly by a client, but I have been privy to racist or discriminatory comments from clients which has left me uncomfortable and uncertain about how to respond. This could be a derogatory comment about the BAME community or a sexist comment about women. Our group supervision sessions proved insightful and upsetting about how often BAME colleagues have experienced direct and indirect racist comments from clients. These horrible experiences are nothing new to these practitioners but up until recently it seems as though there hasn't been a focus or specific guidance to help therapists through these situations.

When addressing these issues as a group, one point of discussion that came up was the role of the therapist. Are we there to educate people or improve mental health conditions? The consensus appeared to lean towards the latter; we are not teachers and cannot consistently spend sessions educating clients around racism. This is especially relevant in the time limited sessions that psychological wellbeing practitioners have. Despite the consensus we should not necessarily educate people, there was still a feeling that discriminatory comments by clients need to be addressed.

When dealing with implicit or explicit statements, our discussion suggested a graded scale of how a therapist or practitioner could deal with racism in the therapeutic space.

1. If there is a one off implicit or explicit racist remark, a definitive statement could be agreed across a service. This could be stated to set boundaries and then further funnelling around an unrelated comment could be made to continue with the session. For example, 'we do not encourage or tolerate discrimination within our service. You mentioned that you feel upset by how you are being treated at…'
2. If there are repeated implicit or explicit remarks, the therapist feels particularly uncomfortable with a remark or they have been directly discriminated against, we discussed that a therapist can challenge this comment. Previous experience of this has suggested that it can lead to changed viewpoint from the client or no further mention of it in the future. This challenge could be, 'You mentioned… Can I ask what makes you think this way?' or 'what evidence do you have to suggest this is true?
3. If there are repeated comments or the therapist no longer wants to engage with the client, this can be discussed in supervision and/or raised with senior leadership. The therapist can remove the client from their caseload, be spoken to by senior staff or even barred from the service.

This is my understanding of how we respond, based on suggestions from colleagues, and is by no means a definitive set of rules. Various questions still remain. What role do therapists have in combatting racism and other forms of discrimination? How do we best deal with discrimination in therapy? Can we create a universal guidance?

Jonathan Dawson
[email protected]