How to avoid the trap of therapy that ignores your truth.
I used to love my white therapist. An experienced psychologist and straight woman, she listened to all my problems with empathetic nods. It was 2018 and I talked to her about my experiences growing up in suburban Texas and how I was often the only Asian person in the room. I was honest about how I came to hate everything about my appearance — my wider nose, my monolids, the spikiness of my hair. I opened up about still struggling with how I looked, especially after a university classmate asked me flippantly if we had met before because “she couldn’t tell Asians apart.”
One day, that therapist came into our session with some papers and a diagnosis: I had body dysmorphic disorder. I left her office bewildered and worried about what it would mean to live with this strange affliction. I knew of body dysmorphia only through popular medical shows, which characterized those who had it as deeply delusional. For those who don’t know, body dysmorphia is when your perception of your appearance is distorted and you hate it so much that “it gets in the way of your ability to live normally,” according to John Hopkins. It’s a very real and misunderstood condition that affects 1 out of every 50 Americans, I was told. I blindly accepted her diagnosis and we talked about ways I could stop fixating on my appearance, but she never once brought up race again.
In the years since, I’ve found a community of other queer people of color and realized that many of us who grew up in predominantly white places have a similar story: At some point, we all hated the way we looked. Many of us had longed for some physical semblance of whiteness, which we tried to achieve by wearing color contacts, exclusively dating white people, or considering plastic surgery. But being around people who no longer see whiteness as the epitome of beauty has helped me actually love the way I look.
I now think back to my time with my white therapist and the diagnosis she gave me with more skepticism.
What if instead of diagnosed dysmorphia, the reactions to my own appearance were deemed perfectly natural, given that I grew up in a deeply racist environment? How many other people of color are being misdiagnosed by their white therapists? It’s incredibly frustrating to have our reactions towards a system of white supremacy chalked up to a disordered behavior, all the while ignoring the conditions that have led us here.
It’s hard to know where to even begin to explain this phenomenon of therapists explaining away racial trauma or dismissing it altogether. A part of it is the historic lack of inclusivity training, the fact that therapy as we know it now was created by and for white men and the lack of diversity in the mental health field. A staggering 85% of psychologists in the U.S. are white.
As more people of color seek therapy and understand the importance of dealing with our trauma, a lot of us will inevitably end up with therapists who don’t share our identities. I spoke with some therapists of color to get their perspective on how we can better navigate the overwhelmingly Caucasian world of mental health services and how therapists of every race can better acknowledge racial trauma in a nuanced, compassionate way. Here’s what I came away with.
Search for an informed therapist
Let’s get something out of the way: Having the same identities as your therapist can definitely help you connect with them, but it doesn’t automatically mean they’ll be more helpful to you.
For a long time, I regretted not going out of my way to find a queer or immigrant therapist who would really “get” me. But our identities are not monolithic, so just because your therapist is Mexican like you, their upbringing and worldview could still be wildly different. By the same token, not all white therapists will “psychologize” or pathologize your racial experiences.
Unfortunately, the entire mental health care system is still very white, so even a therapist of color might not have been taught how to consider racial trauma in their sessions.
Ask about a potential counselor’s specific qualifications, their clinical interests, and their experience working with patients of your background. “What makes the big difference is forming a relationship with a therapist who can openly talk about racialized experiences and how that impacts your mental health,” Anna Flores Locke, a New Jersey-based fertility expert who provides counseling for women of color, tells me. Focus on their training first and their identity second.
Approach new diagnoses with curiosity, not as a given
If I could have done anything differently, I would have reached out to more people of color after I got my body dysmorphia diagnosis. Instead, I kept it to myself like some shameful secret, which prevented me from seeing the situation more objectively and from leaning on a supportive community who’d have my back.
It turns out that having racial experiences pathologized is more common than we might think. “As a Black mental health professional, I often see how BIPOC communities are misdiagnosed with severe mental illnesses because culture, religion, and lifestyle weren’t taken into consideration,” Patrice N. Douglas, a California-based BIPOC mental health counselor, tells me.
There are behaviors among some of our communities that conventional, Western therapy sees as a sign of mental illness when in reality there may be many complicated cultural factors at play.
For example, my Chinese mother taught me to value modesty, so “speaking up” was not a desirable quality in my household. This might be deemed anxiety in a culture that rewards extroverts and those who constantly express their opinions. There are a thousand versions of this type of mistranslation.
“Especially among the Black community, religion and spirituality are important. I have had clients that were diagnosed with schizophrenia because they say they talk to God,” Douglas tells me. “I have seen Black men diagnosed with bipolar disorder because they expressed anger when they really had depression disorder. It is quite concerning that BIPOC communities are constantly misdiagnosed by non BIPOC [therapists] because it can lead to inappropriate medications.” Put plainly, being a racial minority makes navigating textbook diagnoses trickier.
There are, of course, times when a diagnosis provides relief and can help us work towards addressing a real problem. But if a diagnosis doesn’t feel entirely right to you or you don’t understand it, there’s nothing wrong with seeking support from people you trust. Also, pushing back and explaining why — to your therapist or a new, more informed one, is always an option.
“I noticed the psychologization of cultural identities even more than racial experiences,” Dulce Orozco, a Latina therapist based in Massachusetts who works with immigrant clients, tells me. “Clients often talked about how their former white therapist struggled to understand why it is so hard to set boundaries within Latinx families. This can lead to psychologizing the experience of being part of a Latinx family with Dependent Personality Disorder or something similar.”
Therapists should seek resources on how to better treat clients of color
So what can all therapists do to better serve their patients of color? The first step is to seek out resources and commit to learning about how race, culture and mental health intersect. “It’s a lifelong endeavor that should not be viewed as something that they can check off of their list of to-dos,” Dior Vargas, a New York City-based queer Latina feminist mental health activist, tells me.
But it’s also about being honest about why talking about race is so damn uncomfortable, for both patients and therapists. “Our bodies hold this trauma and react, without us actively knowing, to the topic [of race] as if it means danger.” Anna Locke, the fertility expert, tells me. “When therapists can openly engage with their bodily sensations that occur when race is discussed, then they will be able to talk about it and become allies.” In other words, bringing up race can trigger a trauma response and we should treat it like any other trauma response in the context of therapy — acknowledge that the feeling is there and try to move past it.
Shané Petite, an L.A.-based wellness coach and psychotherapist, tells me that at the end of the day when patients are dealing with racism, they are dealing with pretty basic emotions. “The most difficult fact we must all understand is that racism is in fact built and sustained by hatred, fear, anger, and many other emotions that lead to inhumane experiences,” she tells me. “So if you want to acknowledge, address, and clean out the mess, we all must get a little dirty.”
Racism is a scary word and can be challenging to discuss, even in a safe space like therapy. But when we move past that term, we can see what’s underneath all of it more clearly: We’re all wired to want to belong and be loved. Sometimes, our inability to feel get there can be caused by a disorder. Other times, it’s because we’re humans with unique experiences who live in an imperfect world. And therapists should meet us where we are.