Jeff Guenther on May 05, 2019
Well it depends, right? Sometimes yes. Sometimes no. But it’s important to figure it out. So let’s figure it out together.
Full disclosure, I’m a white, straight, cisgender, monogamous, male therapist. And I interviewed Alana, a woman who is self-described as black, femme, poly, and fat on this week’s episode of Say More About That. We talked about her journey trying to find a competent therapist who would be a good match. If you’re like me, a white, straight therapist, you should give it a listen.
Listen to this week's episode of Say More About That. Alana, a self-described fat, black femme in her 30’s talks about her search for a competent therapist. Click play below or listen on Apple Podcast or Spotify.
After I ended my interview with Alana, I kept thinking about our conversation. I think as therapists we first weed out clients that wouldn’t be a good match for us based on their presenting problem or mental health issue. If a client is coming to see me for addiction or recovery, I’m not your guy. That’s not something I specialize in or am competent treating so I provide a referral to one of my many talented colleagues. I have absolutely no problem admitting that and I am very clear about it with myself and others.
But what if a client comes to me who is poly? Well I’m hip. And I’m young(ish). And I know a bunch of poly terms. Do you know what a metamour is? Cause I do. (A metamour is your partner’s partner). And what if a black client wanted to see me? Well I’m obviously not racist. So I’m good there, right? And a fat client? I’m a skinny guy but I don’t fat shame! And queer? I mean, just like Weezer famously sang, “everyone’s a little queer,” so I’m sure I can relate at some level.
I hope the above paragraph read as tongue-in-cheek. However, in my experience, many therapists can say those things to themselves and really believe it. How come as therapists we can be so clear when it comes to what mental health issues we can or can’t competently treat, but so unaware about cultural and systemic issues we may have no business talking about?
So keeping with this client example, if a black person wanted to come in to see me, then it’s my responsibility to educate myself about what it is like to be a black person in this country. I need to be reading books and articles and going to classes about it — I might want to find an anti-racist coach or supervisor who I can consult with. And I need to talk to the client openly about where I am in my education so they can make an informed decision. I need to be upfront about my limitations as a white therapist.
If my client wants to talk about poly relationships, then I need to understand how my monogamy lens has impacted how I view relationships. Poly relationships came up exactly zero times when I got my degree back in 2005 at USC. I never learned how healthy open and non-monogamous relationships work. How are they different from monogamous relationships? What if a client wanted to bring their metamour into a session and work out how they can get a long better? Could I actually navigate that? If I want to treat poly clients, I should read some books, go to trainings and get some help around these things.
And yes, I have some queer friends but really I have no idea what it’s like to be queer in our modern world. I don’t experience discrimination based on my sexual identity. I can’t truly empathize with that. I’ve never come out to my family. Coming out is an incredibly impactful and important experience and I probably know very little about what that’s like. I could process that experience with a client, but I imagine there would be a lot of subtle things I’d miss.
And what if my client describes themself as fat? I agree with the term “health at every size” and I’m “body positive.” But what the hell do I really know about it? Our culture is so fucked up when it comes to blatantly and subtly shaming people that are not skinny. What kind of effect can that really have on someone’s psyche? I don’t have personal experience so I don’t know. And is there a part of me that might wonder why a fat person just doesn’t lose the weight? I hope not. But maybe there is something inside of me because of how I was raised that really believes that. Everyone in my family believes that. So I wouldn’t be surprised if it was knocking around in my subconscious. And how might that effect my connection or empathy with a fat person?
All therapists should ask these questions, right? But I think the majority of us don’t. When a fat client comes into your office, do you even think about what it’s like to be fat in America? Should you? How do you feel about even saying the word “fat”? Does it seem like a bad word?
Getting back to my point, if a client comes in with OCD symptoms and I’m not fully trained in treating them, then I’ll tell them that. If they decide to stick around, I’ll get a book on OCD and call up my supervisor and get some training on it. I’ll confer with colleagues with expertise in that area. But if a client comes in that is a different race, body size, sexual identity or relationship style, I might not really blink an eye. And even worse, I might pathologize something about them that I really shouldn’t. I might not even know that I’m doing that. And I might do some real damage to the client if I shame them or tell them they are wrong and unhealthy about something.
So answering my original question, can a white, straight, monogamous, male, cisgender therapist competently treat a black, femme, queer, poly, fat client? Yes, but only if they do the work. And if you’re not doing the work, then you should refer them to someone who is.
Jeff Guenther, LPC, is a therapist in Portland, OR. He has been in private practice since 2005. Jeff is the creator and owner of Portland Therapy Center, a highly ranked therapist directory. Jeff, and his team, have launched a new progressive therapist directory, TherapyDen.