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Balancing the Power Dynamic in the Therapeutic Relationship

Section 24
Culturally Responsive

Question 24 | Test | Table of Contents


A key variable in a discussion of expectations pertaining to racial identity is superiority. The values and attitudes that emanate from the superiority belief in American society support a cultural norm in which there is a lower opinion of blacks and a level of hostility and unacceptance of them as peers. Moreover, these values and attitudes provide challenges for whites and blacks who seek to respect diversity and enhance self-awareness.

White therapists who exhibit enculturated values of superiority over blacks are often unaware of it. These therapists manifest their feelings of superiority in therapy, in case conferences, and in supervision. They tend to make statements about their surprise at the complexity of the personality of a black welfare mother, or at the range of social interests and skills possessed by a black colleague. They may attempt to create a false convergence by expressing a value or behavior that is not truly part of their repertoire in an attempt to connect on a personal level. For example, a therapist may use slang words or phrases because the therapist has assumed that the black client has a limited range of emotions and verbal skills around which to relate to the therapist.

A white therapist may also exhibit superiority through paternalistic attitudes and behaviors by, for example, assuming that the black client is unable to learn to negotiate systems and the therapist must do it for him or her. A counselor who negotiated with the school around a black child’s behavior and never included the mother, explaining that the mother felt overwhelmed and was unable to communicate effectively with the school or with her son, was being a “good master” and was unaware of it. He assumed that this mother could not learn to negotiate with systems or to advocate for her family, even though for 12 years she had negotiated with work settings and with social service agencies to obtain support and services.

A third way in which superiority is manifested is in some of the expectations that therapists have of their clients. For example, the white therapist may expect compliance and acceptance on the part of the black client and interpret the client’s challenge as a problem of the client rather than as an indication of the client’s ability to think about his or her therapy and the client’s investment in the therapeutic process. On the other hand, the therapist may experience fear. The challenge of the black client may bring forth enculturated attitudes that blacks are dangerous.

In contrast, white therapists may also be sensitive to the dangers of replaying the master/slave relationship in the therapy setting. By acknowledging the history of white/black relations in this culture and by understanding that they are not immune to their culture’s impact, they are able to learn from their black clients about themselves and about others. Moreover, they are able to use their socialized feelings as only one of the bases from which they assist the client in constructing an understanding of their self/world relations.

Like white therapists, black clients vary as to their belief in the superiority of one race over another, and their perspectives also significantly contribute to the nature of the therapeutic relationship. The black client who feels that whites are superior to blacks may enter therapy expecting to be helped or “cured” because the therapist is white and, therefore, take a passive stance. In contrast, clients who feel that blacks are superior to whites may not readily share their hostility, anger, or dissatisfaction with having a white therapist. They may choose to withdraw or to participate in a perfunctory way, which inadvertently results in their abdication of responsibility for their lives and a replay of the imbalance of power to which they may be reacting.

This nonevaluative trust or distrust on the part of clients puts therapists in a position of power and yet impedes them in their task of assisting clients to transcend such limited notions of themselves. In these situations, exploring the racial psychohistory of clients and therapists plus discussing the race differences of the dyad, with its strengths and limitations, seem particularly essential. For these clients, examining their enculturated limitations so that they can begin to transcend them in the therapeutic context is vital to improving the quality of their lives.

Expectations Pertaining to Culture
Most therapists recognize that individuals from different places have different customs, traditions, and ways of relating; they may, however, have difficulty discerning cultural differences among individuals born in their own country. Thus, white therapists may find it difficult to discern in what ways African traditions have been preserved in American language, food, and dress. They do not distinguish cultural differences from socioeconomic differences and what are considered to be genetic differences inherent in the makeup of black people. Culture is seen as being the same for both blacks and whites, and differences are seen as stemming from economic differences and different historical statuses.

For these therapists, convergence of standards and values with respect to self/world relationships and psychosocial realities is expected. There is some truth to this assumption. Nevertheless, it is limiting in that it ignores the various cultural and ethnic legacies of blacks and whites.

There are therapists who do recognize cultural differences in American racial groups. Among them are some white therapists and black clients who view those cultural differences as severing any possibility of forming relationships or of understanding the other person’s world view. To them the idea of differences obstructs growth rather than providing a context for exploring each other’s humanness and approaching differences from an EVM perspective. To others, differences can be transcended. It is this latter expectation that provides a basis for working together in a therapeutic context to share their respective perspectives in a way that provides therapeutic gains for the client.

Expectations Pertaining to Coping Skills
Within a master/slave context, a white therapist who has little awareness of his or her racial self and of cultural differences can be expected to have great difficulty viewing an unfamiliar coping strategy of a black client as adaptive or creative. Instead, such an unfamiliar coping strategy is more likely to be viewed as pathological. Likewise, a black client who has little insight pertaining to his or her racial self and little appreciation of cultural differences may have great difficulty understanding why coping strategies developed from only the white therapist’s perspective make any sense, and whether these strategies are working or not.

A major barrier to overcoming these insensitivities is maintaining distance between themselves and thus remaining unaware of their different life experiences. This distance between therapist and client, which is most harmful therapeutically in its ignoring of the client’s humanness, is manifested in several ways. It can be observed in the desire of therapists who work with black clients for prescriptions for understanding black culture. These therapists tend to appreciate workshops that delineate how blacks differ from whites, and that offer in a cookbook fashion how to diagnose and treat black clients fairly and effectively. These individuals do not want to feel the “mess” of racial tension or deal with their bigotry and/or lack of knowledge. Furthermore, in understanding how to treat blacks, these therapists are not willing to struggle with the nuances of the ranges of social competencies that are needed to live effectively as a black person in America. To do so would require that they tackle their racial psychohistory, their white identity, and their prejudices. For them, those tasks feel unnecessary or irrelevant.

Second, the issue of humanness also arises in the philosophies and assumptions that some white therapists have about what it means to be black in America and about how blacks should cope with and approach their social status. A common one, the thick-skinned assumption, is based on the premise that in the process of living in America black people should, as a part of their development, form a tough emotional exterior, one that has been numbed to the more covert acts of racism. No one would question that all human beings struggle with unkindness, discriminatory behavior, and insensitivity from others. However, the thick-skinned assumption permits the therapist to avoid experiencing the client’s reality and the emotional wounds (or joys) that are by-products of that reality. The therapist is denying the client’s range of emotion, feeling, and humanness. Another assumption, that of assimilation, is based on the premise that for blacks to be “okay,” they need to adopt white cultural norms and coping styles. These two assumptions often lead to therapeutic relationships riddled with conflict or marked by premature termination.

There are, of course, therapists who are genuine in their desire to get to know how the black person sees himself or herself culturally and psychosocially. They acknowledge the client’s humanness by acknowledging the client’s ability to know and to communicate who he or she is to the therapist. These therapists need not be knowledgeable of black culture, but willing to expose their lack of knowledge about the shared values, philosophy, legacies, rituals, and relationship patterns of many blacks, and to use the information provided by their clients to achieve the agreed-upon therapeutic outcome. In a somewhat similar fashion, black clients who are willing to take the risk of exposing their biases and limited knowledge about white culture can work with white therapists and gain therapeutically in doing so.

Expectations Pertaining to Self/World Relationships
For this dyad, the manner in which the therapist and client perceive their own and each other’s relationships to the world and the people around them is crucial to the formation and maintenance of the relationship. Given their historical legacies and ethnic roots, each has an organizing framework that involves a set of expectations about trusting or being wary of others, particularly others who are on the other side of the black/white racial barrier. They also have expectations about the extent to which the friendliness or hostility of the environment is individually or collectively oriented. For example, from the client’s perspective and world view, it may be quite reasonable to feel a sense of responsibility toward black classmates when responding to questions posed in class, in spite of the stress this perspective brings, because of the feeling that the trustworthiness of the environment is going to be the same for all blacks. However, it may seem very unreasonable from the perspective of the white therapist for anyone to view himself or herself as a representative and agent of others. Each of these perspectives about self/world relations is legitimate, and each has its costs as well as its benefits. The degree to which the therapist and the client can work together depends in part on the degree to which they can together explore each one’s sense of what perspectives are most congruent with the client’s world view and realities.

Expectations Pertaining to Personal Power and Control
The expectations pertaining to personal power and control are difficult to distinguish from those pertaining to superiority and humanness. The white therapist’s and black client’s perspectives on superiority and acceptance of the other person’s humanness shape their visions. They will see the range of personal power and control that they have over their lives and that they expect to influence each other’s lives in the context of those visions. Moreover, their expectations shape their ability to see and recognize the multiple systems that influence how each other experiences autonomy and control. They will be able to work together more effectively if they can break through those limiting barriers.

Black Therapist/White Client Dyad: Expectations Pertaining to Racial Identity
The members of this dyad face many of the same issues faced by the white therapist/black client dyad, but their roles are reversed. The person who held the historical role as master and the most powerful is the person in need of help and is the least powerful one. For both members to work effectively with one another, they must address this historical role reversal.

The issue of inferiority/superiority remains a vehicle through which racial identity awareness is manifested. If black therapists have not successfully come to terms with their reality, then they will continue to struggle with inferiority issues. These therapists may look to their white clients for affirmation of their acceptance as part of the white norm and as an accepted participant of the majority culture. For these therapists, issues of convergence may have additional significance in that they represent affirmation of their understanding of the ecology of whiteness. On the other hand, these therapists run the risk of having their fears of inferiority affirmed when they confront divergence or conflict in therapy. As a result of their need for validation from the client, they abdicate their role and responsibilities as expert and give it to the white client, who is there seeking assistance from the therapist. These therapists may also expect to be perceived as less competent than a white therapist, never fully trust the client’s acceptance of their expertise, and become impotent at fully examining the dynamics presented in the therapeutic ecosystem.

Another expectation is that of the perpetual test, in which the therapist expects to have to prove himself or herself repeatedly to be competent. If this expectation goes unnoticed by the therapist, then the therapist may become angry with the client and act out that anger in the therapy relationship. Also, if the therapist feels that this is a typical consequence of black/white interactions and that this expectation is the norm, then the therapist limits the degree to which trust will be established in the dyad.

Expectations Pertaining to Culture
Both the therapist and client may enter this dyad with expectations that both affirm and challenge. The expectations of affirmation are of two types. Both the therapist and client may expect to have their knowledge about the other person’s group affirmed through processes of convergence and divergence. That is, they expect to confirm both cultural similarities and differences in relation to each other. They may also expect conflicts due to their cultural differences to interfere with their ability to form a relationship and work effectively with each other.

Racial identity issues. Each of these expectations is to some extent a function of the degree to which the therapist and the client have worked through their racial identity issues and have grappled with enculturated values stemming from the master/slave legacy. A key issue in these expectations is the degree to which both the client and the therapist perceive their respective cultures as compatible. It is also important for the therapist to be aware of how he or she and the client react to outward signs of cultural identity (e.g., the therapist wearing braids, type of music played in the waiting area, style of interaction, and office decor). Culture is experienced on many levels, and it may be that the client can accept cultural differences if they are not part of the therapeutic ecosystem but find them difficult to accept when they are visible.

Expectations Pertaining to Self/World Relationships
The issues related to self/world relationships for this dyad are similar to those of the white therapist/black client dyad. In this pairing though, it is the black therapist who needs to be particularly sensitive to the differences in expectations about the trustworthiness of the world and of blacks as experienced by his or her white clients. The therapist, given his or her world view and perspective, can help clients to modify their perspectives about themselves in the world. In turn, the therapist can learn from the client a different pattern of expectations about interpersonal relations.

Expectations Pertaining to Coping Skills and Range of Personal Power and Control
Many blacks and whites in this country have struggled to develop relationships among themselves that are not bound by the shackles of the master/slave relationship paradigm. That struggle arises in a particular form in a black therapist/white client relationship. To develop such a relationship, both parties must move beyond their social and historical legacies to an area of convergence that defines their humanness, their power, and their patterns of coping in other terms. The therapist must move beyond his or her enculturated expectation that the white client’s relationship to him or her is to exploit or oppress him or her in some fashion. The client must move beyond his enculturated value of superiority. Otherwise, the possibility of their working together in a therapeutic relationship is quite limited.

Summary
We have highlighted the importance of race, separate from ethnicity, in discussing psychotherapy relationships. The point is that racial membership provides a separate and unique piece of information about who we are, how we are seen by others, and our position in society. This information interacts with our ethnicity and personal life history to create our psychosocial perspective and way of viewing the world.

We have used the black/white dyadic combinations to highlight the intricacies of racial membership and psychotherapeutic process. There are other racial groups and unique issues that arise, but we have chosen the black/white dyad as an exemplar for several reasons. First, it is a dyad that epitomizes, in the master/slave relationship, the role of history in shaping the ecology and world view of individuals ascribed one status versus another.

Second, the black/white relationship exemplifies the nature of the struggle to achieve balance or equality in relationships for a number of groups. It highlights and parallels the various struggles about diversity in a number of dyads, including those involving gender as well as cross-ethnic and other cross-racial pairings.

Finally, black/white relations provide the broadest available empirical base from which to analyze the issues involved. Conceptually, this racial dyad has provided a framework to entertain how we think about differences. For example, it was in the context of black/white differences that the concern about using whites as a normative sample arose. Consequently, at this juncture, other racial groups have a precedent upon which to advocate for a multiracial and cultural framework. It has now been fairly well established that white America is not the standard for assessing the behavior of other groups. Nevertheless, it continues to be the norm whose nature defines psychotherapy and the participants in it, unless we provide more compelling alternatives.

In summary, race in addition to, but separate from, ethnicity plays a significant role in the formulation of our ecology and psychosocial competence. It defines our sense of ourselves as well as our status on the power hierarchy, brings with it a set of coping skills, and fosters a particular world view. These factors are part of the therapeutic process.

Tyler, F. B., Brome, D. R., & Williams, J. E. (1991). Ethnic validity, ecology, and psychotherapy: A psychosocial competence model. Plenum Press.

Update
Culturally Responsive
Cognitive Behavioral Therapy
for Ethnically Diverse Populations

Huey, S. J., Jr, Park, A. L., Galán, C. A., & Wang, C. X. (2023). Culturally Responsive Cognitive Behavioral Therapy for Ethnically Diverse Populations. Annual review of clinical psychology, 19, 51–78.


Peer-Reviewed Journal Article References:
Cordes, C. C. (2021). Culturally responsive refugee and migrant health. Families, Systems, & Health, 39(4), 670–673.

Ellis, D. M., Guastello, A. D., Anderson, P. L., & McNamara, J. P. H. (2019). How racially concordant therapists and culturally responsive online profiles impact treatment-seeking among Black and White Americans. Practice Innovations, 4(2), 75–87. 

Katz, A. D., & Hoyt, W. T. (2014). The influence of multicultural counseling competence and anti-Black prejudice on therapists’ outcome expectancies. Journal of Counseling Psychology, 61(2), 299–305. 

Roberts, S. O., Ho, A. K., Kteily, N., & Gelman, S. A. (2021). Beyond Black and White: Conceptualizing and essentializing Black–White identity. Cultural Diversity and Ethnic Minority Psychology. Advance online publication.

QUESTION 24
What behavior on the part of clients puts therapists in a position of power and yet impedes the therapist in his or her task of assisting clients to transcend their limited notions of themselves? To select and enter your answer go to Test.

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