Mental Health, Uncategorized

Intersectionality and Psychotherapy

Pride Month (Pride Week in Kitchener-Waterloo just wrapped) often gets me thinking about intersectionality:

Intersectionality is a concept often used in critical theories to describe the ways in which oppressive institutions (racism, sexism, homophobia, transphobia, ableism, xenophobia, classism, etc.) are interconnected and cannot be examined separately from one another.

Intersectionality is a concept that has developed from feminist theory (specifically exploring the lived experiences of women of colour), but now provides a lens through which to look at the power dynamics inherent to, but often invisible within, ANY kind of relational system. “The personal becomes the political” when we amalgamate those individual lived experiences into a narrative that can then influence–hopefully for the better, though the road is long–both cultural thought on the broad spectrum, and political agendas that often interfere with movement towards balance and equality.

Intersectionality also gives us a framework for exploring all of the many factors exerting influence on our day-to-day relationships with ourselves, partners, family, coworkers. It’s the language of systems theory, shifted a little to consider the oppressive nature of some, often many, of these factors. Family Systems looks at the function of the family actors and values on the individual; intersectionality gives us a broader perspective in which to observe and change the oppressive impacts of racism, ableism, patriarchy, classism, etc. on the individual within those relationships. In short, the personal became the political… became the personal again, providing us with better tools to re-examine the relational from clearer perspectives.

Many psychotherapists, and certainly anyone operating from a feminist-informed perspective, has likely already been working from some degree of intersectional understanding. This is a perspective that goes beyond the therapist speak of having “an eclectic practice”, which usually means we draw from any number of intervention strategies or therapeutic modalities to help alleviate client issues. This gets into the heart of truly seeing the vast array of impacting factors on any one individual trying to function in a relationship… and doubling or trebling that with every other relational partner we add in the room.

Depending on the kind of practice we work in, we’re somewhat hampered by a variety of cultural blindspots:

  • Access to psychotherapy is often a privilege tied to income, making it a very classist resource; agencies that can offer sliding-scale fees are often hamstrung by funding to limited, severely-short-termed services. Private practitioners who can offer scaled fees, especially geared to those on low- or welfare-based income levels, are few and far between.
  • The overwhelming majority of our clients are white, even in a plausibly-multicultural urban environment, introducing a (sometimes only subtle) degree of implicit racial bias, whether we are aware of, or admit to it, or not.
  • “Middle-class black women and men were about 30% and 60% less likely, respectively, than their white middle-class counterparts to hear back from a therapist agreeing to see them. Working-class individuals fared even worse: Women and men, regardless of race, were about 70% and 80% less likely, respectively, to get an appointment, compared with white middle-class individuals.
    “Psychotherapists are not immune to the same stereotypes that we all have, and I think they could become even more relevant for psychotherapists than for other professions [both medical and nonmedical], because they are embarking on this intimate, potentially long-term relationship with these [clients],” said Heather Kugelmass, a doctoral student in sociology at Princeton University. Kugelmass is the author of the study (PDF), which was published Wednesday in the Journal of Health and Social Behavior.” — “Therapists often discriminate against black and poor patients, study finds”, Carina Storr for CNN

  • Not every office space is handicap accessible for a variety of reasons–creating a very ableist environment even when we don’t mean to. (Point of disclosure: both my home office space and the Bliss office space uptown can only be accessed by means of stairs, and for a variety of reasons, not all of us can/will offer video sessions as a means of alternate access.)

Part of the ethical training to become a therapist deals with uncovering what we can about our own internal biases, but often we can only see where those biases reside by looking at what we’re NOT doing, those areas of the population we can see we’re NOT adequately addressing. Gender bias and transphobia, xenophobia and racism–some aspects of a therapist’s personal aversion may become clear during their training. It becomes the work of the training institute and supervisors to ensure that potential therapists explore those aversions and biases, pushing comfort boundaries where they can, but at the very least working to assure the therapist will Do No Harm to clientele out in the field.

The dark side of working to identify our own blind spots is the unfortunate side effect of being equally blind to how these factors potentially impact our clients, not just in terms of the therapeutic relationship (though this can become a strong tool in session; more on this in a minute) but in the broader systemic perspective. Becoming aware of therapeutic blind spot can then lead to some interesting conversations with the client about their experience of these biases on the micro and the macro levels; if the therapeutic relationship is deemed “safe enough” by the client for the conversation to happen, it opens up a level of insight to the therapist and client alike about how classism, racism, ableism, etc., impacts their ability to function in their relational contexts, their narratives about themselves, their values, their perception of their roles, their expectations for themselves and others.

Most white therapists I’ve known over the past decade don’t willingly bring these questions into the therapeutic conversation unless the client introduces the topics first. I don’t know how often I’ve heard a white therapist trot out the phrase, “I don’t see colour,” when speaking with or about clients of colour, but if racism is a system factor impacting the clients in question, then the therapist may be at fault for not being open to that discussion as it potentially affects the client. I still encounter therapists who refuse to work with queer or trans clients, or the well-meaning ones who claim that orientation or gender are no issue for THEM, and don’t know what to do with clients for whom orientation or gender identity clearly *IS* an issue.

Trans clients are often my best example of complex intersectionality; it’s never going to be “just a simple case” of depression or anxiety. The endemic issues of workplace or school bullying transfolk experience, for example, speaks to the trans/xenophobic and sexist issues that have enormous impact on self-esteem and self-image; they may not feel they can safely access support networks and services, even when those service are financially accessible to them. The entire transitional experience can be hugely impactful on a client’s social, familial, relational structures; it can threaten their employability, introducing the classism issues:

“The 2011 National Transgender Discrimination Survey found that trans people are four times more likely than the general population to have an annual income of less than $10,000.” — Lara Rutherford-Morrison, “8 Statistics That Prove Why Transgender Day Of Visibility Is So Crucial”, citing National Transgender Discrimination Survey: Full Report, SEPTEMBER 11, 2012

Women, especially women of colour, experience many similar intersectional issues; many struggle against gender roles projected by a male-dominated cultural narrative. They battle in the workplace against glass ceilings imposed by traditional male-biased evaluation systems (up to and including being outright penalized for things like mat leaves), limiting their upward mobility and earning potential. Working in the bromance-laden High Tech industry, for example, introduces some significant challenges for women. Single women, and single mothers in particular, face strongly-biased class/financial and racial stigmas, even in the 21st century.

These are NOT ISOLATED FACTORS that bear zero impact on the clients and the issues they bring into therapy. It’s therefore a huge disservice for therapists to be blind, however inadvertently, to the unknown impact of these systemic influences. Practicing intersectionality doesn’t mean we turn therapy into discussions ABOUT those issues, but it does mean we really need to learn to be fearless in asking about the client’s own experiences in these areas as potentially affecting the challenges they ARE bringing into the counselling room. Our job as therapists is to check our own biases, including our own well-intended willful attempts at non-bias, at the door.

One Comment

  1. Kate

    I’ve also been noticing how internalized sexism plays out in my personal (hetero) relationship (with a man). Even though he is pretty woke for a straight, white dude, I notice his reactions to my “nagging,” his penchant for responding with “but you didn’t ask [me to help],” and the frequency with which he’ll embrace ideas he reads in a book (usually written by a white dude) that I tried to introduce years before from my own readings, and which he dismissed at the time. Our relationship is largely peaceful, and these instances are infrequent, but I notice them and he’s starting to too now.

    Reply

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