Cultural Considerations in Choosing a Therapist

Is Shared Identity Important?

Cultures and subcultures are based on the shared identity, beliefs, customs and values of a particular group within a larger social context.

In the U.S. we tend to associate these most readily with race and socioeconomic status. In consideration for choosing a therapist, we often seek those with shared and identifiable commonalities. We do this with the expectation that those most similar to ourselves will most readily understand and support us.

The less a clinician is immediately identifiable as being a member of a subculture, the more problematic selection becomes. In the context of recovery from addiction, the subculture most often considered is whether the clinician is a person who is in recovery. In the context of a person who is gay, lesbian, transgendered, bi-sexual, or questioning, there may be significant concerns regarding the sexual identity and/or the respect a clinician has for this aspect of a person’s identity. In these circumstances, we tend to rely on reputations, recommendations made by people we see as being like ourselves, and self disclosures made publicly by clinicians to help us make our selections.

In the case of rural service settings and in other circumstances in which we are not able to locate a clinician that we identify with, we are left to choose from an available pool. If feasible (affordable), seeking a clinician through online therapy is a trade off of personal preference as we sacrifice the advantages of meeting in person for the opportunity to connect to a member of our own culture.

Whether or not you find someone from your own culture or subculture to work with, here are some tips on making sure you forge an effective therapeutic alliance:

Ensuring a Good Fit

The factors of a good working relationship between client and clinician tend to be intangibles that are not identifiable prior to meeting. I encourage folks to interview the clinician they seek to work with. Passive approaches to treatment tend to yield slow and often unsatisfying results. Better to ensure that the person we’ve chosen or been referred to is someone we can be confident will be accepting, supportive and able to challenge us.

Potential Interview Questions:

• What biases do you have clinically?
• What experience do you have in bridging gaps between cultures?
• What did your training and education teach you about how to relate to people of my culture? (Seeking preconceived or erroneous assumptions).
• Does your world view or belief system dictate anything about people of my culture?
• What do you believe about people who struggle as I do ( whether it’s addiction, sexual identity, poverty, discrimination, oppression, sexism, or other socially divisive identity/challenge).

We have a right to know about the ability a clinician has to understand to our experience. To a lesser extent we have a right to know their ability to relate.

• We who seek to overcome addiction have the right to know whether our clinicians are in recovery from addiction.
  
• Those of us seeking couples counseling have a right to know about their clinician’s relational history (why would we seek marriage counseling from a clinician with three divorces?)
  

A clinician who is not willing to share such pertinent truths about themselves is not a person I’d recommend working with.

If Not Relating, Understanding

A clinician who is healthy and secure is able to take the perspective of others and attempts to see the world as their client does. Challenging the beliefs and internal behaviors that define a person’s perspective allows development of greater clarity and a deeper understanding of self. A good clinician is able to point toward possible blinders on our worldview and self imposed limitations.

He or she understands that even if they experienced the same struggles as their client they were not necessarily impacted in the same ways. The LAST thing a clinician should ever say to a client is, “I know how you feel.” Assumptions limit us and take away our voice.

Trust Your Gut

As you come to the end of your first session with a new clinician, make eye contact and then take a moment to connect to your intuition. It’s the best tool we have, especially with limited information/experience. Ask yourself, “Does s/he seem like someone who can understand and help me?” If we are able to separate what we feel emotionally from what we sense, we will know if we’re heading in the right direction or if we need to seek another clinician.

Multiculturalism as Opportunity

Perhaps our greatest opportunity in celebrating diversity lies in our willingness to learn from those outside of our identified culture. As clients we have no responsibility or obligation to educate our clinicians beyond what we wish for them to understand about us personally. However old adages still ring true, “If you really want to learn something, teach it.” Sharing what we most value or most struggle with about our culture is an opportunity to reexamine and further integrate our individual selves with our collective identity.

The institutions, traditions, and resources of every culture are important strengths to be integrated into treatment. The more we seek to utilize cultural beliefs, values and practices to promote understanding, coping and needs fulfillment, the more readily we achieve catharsis and holistic health. A good therapist is always looking to put themselves out of a job. The more we work together in treatment to identify natural supports the less reliance on professional supports is perpetuated.