The People's Therapist

Towards the end of a session a while back, one of my patients, who was African-American, laughed out loud, like he was sharing a personal joke.

“What’s so funny?” I asked.

“Oh, I don’t know.  I still can’t get over the fact that my therapist is a white guy.”

I shrugged and smiled – there wasn’t much else I could do.

But I was pleased.  I admit it.  I liked being his therapist.  And that patient has referred a bunch of people to me since, mostly African-Americans.  That felt good, too.

I wish I had a simple, clear answer to the question posed by the title of this posting.  But like so much else in psychotherapy and human life in general – it’s complicated.

On the one hand, a strong case could be made that a person’s background, and his experiences, should shape who he is, and his ability to connect with someone who has had a similar or different background or experiences.  By that logic, an African-American should be better off with an African-American therapist.

But it doesn’t always work out that way.  For one thing, the patient I was working with was gay – so did he have to find a gay African-American therapist, or was a gay white therapist okay, or a heterosexual African-American therapist?  And what about the fact that I’m Jewish?

I think one of the reasons I worked so well with that patient was that I studied African-American history and literature in college, and am a connoisseur of jazz and other African-American music.  It might also have helped that, as the Program Coordinator for a counseling program at a large urban hospital for a few years, I assigned myself lots of African-American patients, partly because I was interested in learning more about their culture and experiences, and partly from necessity.  We had a small, mostly-white staff, and the other full-time counselor spoke Spanish and Portuguese, so he was occupied with immigrant patients.  I became a sort of resident African-American expert.

Maybe that’s why I did so well with this patient.  Or maybe we just clicked.  He was an elegant, educated man, and a jazz fan, and, well, we liked each other.

Choosing a therapist is a bit like choosing a Supreme Court justice.  You collect all the information you can – and then you take your best guess.  An African-American jurist ought to have a better understanding of the issues affecting African-Americans – right?  But then, sometimes you get Thurgood Marshall – and sometimes you get Clarence Thomas.

Many therapist list their “specialties” on their websites, or even their business cards.  I don’t, because I find it limiting.  I don’t see why, if a patient with a new issue comes into my office – whether it’s bulimia or childhood sexual abuse or crystal meth addiction – I shouldn’t be able to get some books, talk to colleagues, and do whatever it takes to get myself up to speed. That goes with human diversity as well.  I’ve treated Kazakhs, Navahos, Cameroonians, Indonesians, Peruvians and Dubaians, among others.  They all taught me something about who they were and where they came from.  That’s part of my job – a fun and necessary part.

I once commented to a transsexual psychotherapist that it must be great to help others within her community.  She let out a rueful sigh.  Sure, she admitted.  But the real issue was that she worked within a ghetto.  She wanted to treat all sorts of people, not just transgendered patients.  Being seen as someone who worked only with other transsexuals limited her practice, and her ability to grow as a clinician.  I realized I was losing something, too, when transsexuals went to see her instead of bringing their unique diversity to my practice.

Seeking out the “logical” therapist for you can have drawbacks for the patient as well.  I once did a session with a deaf woman who was dealing with a domestic violence situation.  We worked with a sign-language translator, but afterward I discovered the hospital had a limited budget for translation services.  An administrator recommended I refer this patient to an American Sign Language-fluent psychotherapist.  I found two names, and gave them to the patient.  She only rolled her eyes.  She didn’t want to see a psychotherapist who worked with the deaf – those two therapists were already seeing all her friends in the deaf community, and she didn’t feel comfortable opening up to them.  She said she would much rather work with me, through a translator.  I was surprised – but I got her point.  I wanted to work with her, too – but I couldn’t find an ASL-translator, so we didn’t have that option, which was heart-breaking.

I ran into a similar situation with a Japanese patient.  His English wasn’t very good, but he could communicate.  I suggested he might be more comfortable working in Japanese instead of English, and proposed two Japanese-speaking therapists.  The problem, he confessed, was that he was gay, and working on coming out to his friends and family.  Of the two Japanese therapists, one was straight, and the other knew all the other gay Japanese people living in New York City.  He wanted a gay therapist to work on gay issues, which are sensitive in Japanese society – but he didn’t want someone who knew his friends.  He decided to stay with me.  Yes, he sometimes had to repeat things two or three times so I could understand him, but we did okay.  He’d come to America, he said, to live like an American – and he liked having an American therapist.

It’s worth pointing out that therapists spend most of their time listening, not talking.  When I do talk, I’m usually asking questions or taking a guess at interpreting something I’ve heard.  My job is to listen, and try to understand.  Theoretically, I should be able to listen to anyone – anyone – and understand him, whether he’s black, white or purple.

I take pride in showing off my bits of cultural competence.  I enjoyed greeting a Chinese patient from Hong Kong the other day with “Please come in!” in Cantonese.  Last month I shared a laugh with a Dominican patient when we realized we both have little half-Dominican nieces who call us “Tio.”

These touches might help make a patient feel more at ease.  But in the big picture, they’re minor details.

What really matters isn’t whether your therapist looks like you, or acts like you – it’s whether he understands you.  Just like a Supreme Court Justice – his competency depends not only on his background or experience, but how well he does his job.

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