Imagine having to over-explain your experiences of discrimination to a therapist, just to have that very same experience invalidated. It’s as though what you’ve just shared did not happen. You’re left confused, feeling misunderstood, and questioning your reality. Perhaps feeling worse than before meeting your therapist, why would you even continue?  

This surprisingly common experience highlights the importance of cultural competence—the understanding and acceptance of norms other than your own. This requires more than simply following a checklist; it requires the ability to openly embrace different ways of being, which at times, you may disagree with. In Canada, there is a clear—and striking—underrepresentation of ethnic and sexual minorities in the mental health profession. What are, if any, the practical consequences of this, one may ask? 

The Ontario Health Study tells us that mental health services are consistently underutilized in minority communities. Interview-based research gives us some insight as to why. A common thread in these studies is that many individuals encounter varying forms of discrimination (i.e., both “microaggressions” and overt discrimination) from professionals and begin to feel like “therapy is not for them”.

Mental health does not discriminate—and as unfortunate as this is, the data suggests that your care provider may. While there is an active effort to understand and teach the ability to perceive and appreciate subtle differences in the cultural experiences of any given client, at times there simply may be no substitute for shared experience. 

Demographic factors are not the only thing to take into consideration when selecting a therapist, but clients should not be made to feel ashamed if they choose to do so. By and large, most clinicians offer free consultations. Meet with them. See what they are like. Be explicit with your concerns and ultimately, you make the decision if you feel understood—whether the therapist looks like you or not.

Ola Kuforiji, M.A., is a registered psychotherapist (qualifying) at the Centre for Interpersonal Relationships. He provides therapy with for individuals and couples (with a special interest in ethnocultural and sexual minorities) under the supervision of Dr. Lila Z. Hakim, C.Psych.

By: Dr. Sela Kleiman, C.Psych

Within a few minutes of their first conversation, a White individual inquisitively asks a racialized minority a seemingly innocuous question they have likely been asked numerous times previously, “So, where are you from?” Now, imagine the above scenario but with the actors’ roles reversed (i.e., the racialized minority asks the White individual the same question). Which event is more common? Many people who live in Canada and the U.S would intuitively respond that the first scenario is more likely. The reason for this difference requires a contextual understanding of race relations; that is, knowing which social groups are dominant and as a consequence of this, who defines those that are normal from those that deviate from the norm. In our society, both historically and presently, White folks hold a disproportionate amount of power in society to institute and promulgate these definitions. Perhaps it is not surprising then, that as a result, White people receive messages daily which serve to confirm their sense of being normal. Contrarily, racial minorities often receive messages that convey the opposite sentiment. Given these realities, the question, “So, where are you from?” becomes rife with meaning. Indeed, what comes across as innocent curiosity may be read by those receiving it as reinforcement of a sense of un-belonging, especially given the frequency with which this event may occur. Inter-racial interactions between dominant and non-dominant group members are never just an isolated event; instead, they are historically and contextually grounded within the broader social systems that one lives.

The above incident highlights one of many examples of racial microaggressions which are subtle slights, jabs, and insults which convey demeaning messages to racialized minorities by dominant group members. Perpetrators of racial microaggressions are often well-meaning White folks, mostly unaware of the effect of their actions. This manifestation of racism, of course, stands in contradistinction to the overt, consciously directed racism more typical of a bygone era. And though most can agree that a dramatic decrease in “old-fashioned racism” is a good thing, one consequence has been that contemporary racism falls below the radar of most. Indeed, its subtle and insidious nature makes modern-day racism appear virtually non-existent to those who perpetuate it. Unfortunately, a consequence of this is that racism is referenced as a problem “over there” or “back then” and as such not given the warranted attention. 

Research on racial microaggressions has exploded in recent years (read Derald Wing Sue as a starting point), and various empirical studies have documented their varied manifestations. Moreover, researchers have documented its adverse psychological and physiological effects. As a starting point, it is critical for clinicians working with clients to be aware of current racial dynamics so that discussions of race and racism are not minimized or ignored in therapy. By ignoring these critical issues, therapists unwittingly disempower their clients by locating the root of mental health issues associated with racism within the individual rather than due to prevailing social forces. Clinicians who convey this message risk perpetuating the very thing that may in part be responsible for their client’s mental health issues.

by: Dr. Sela Kleiman, C.Psych.

Throughout life, especially during early life, we internalize messages sent to us by caregivers, siblings, extended family, peers, and larger social and cultural institutions. Growing up, if caregivers are attuned to our emotional needs and respond in a warm and empathic way, we are more likely to internalize, or have an unconscious felt sense, that we are a person worthy of being loved. If, on the other hand, caregivers respond to our emotional bids for affection with rebuke, derision, anger, and so forth, we instead may internalize a felt sense that we are unlovable in some way.

The messages we receive about ourselves from others profoundly impact how we feel about ourselves and how we relate to others. 

Messages sent from the cultural and social milieu in which one lives can greatly influence how we feel about our own worth. Growing up in North America where racism is prevalent, for instance, folks of colour are subject to many recurrent and demeaning messages about their racial identities. These messages often are subtle. For example, they may be revealed in television shows and movies where people of colour represented stereotypically and cast in a narrow range of roles. Additionally, these messages are found in schools. For instance, some children who have to pass through security guards checkpoints every morning before class undoubtedly receive the message that they are dangerous and not to be trusted. Unkempt school grounds and poorly supplied classrooms are a consistent reminder to some students that their education is not as important as those who live in more affluent neighborhoods. Consistently receiving these messages takes its toll on an individual; one result may be internalized racism. 

Internalized racism is a phenomenon whereby people of colour constantly exposed to demeaning messages that imply their inherent badness or lower worth may unconsciously start to feel this way about themselves. One of the most disturbing yet illuminating examples of this was the doll experiments conducted by Clark and Clark in the late 1930s/ early 1940s in which they asked children to rank Black and White dolls (everything the same except for their skin colour) on various characteristics. They showed that both Black and White children typically preferred White dolls over Black dolls in terms of appearance, niceness, and so forth. To Clark and Clark, Black children preferring White dolls for these reasons was an example of internalized racism. 

Aside from cultural and social shifts needed to combat internalized racism, a more intimate domain to work through this issue is in therapy. For this to happen, psychologists, psychotherapists, and other helping professionals must be multiculturally-competent practitioners. Indeed, they must be well-versed in psychological and emotional manifestations of discrimination and be able to engage in meaningful dialogue with clients as these issues arise. Ignoring internalized discrimination and placing the locus of responsibility solely within the client risks reinforcing oppressive patterns responsible for internalized racism. Using therapy as a space to explore themes of badness, worthiness, and so on through a culturally sensitive lens can empower clients to gain a better understanding of their pathogenic beliefs and, through deep and meaningful processing of these themes, detoxify these negative feelings about the self.