How to Find a Multiculturally Competent Psychotherapist

A young person of color on the phone at desk in front of computer July is National Minority Mental Health Awareness Month, the time of year when mental health advocacy organizations expand their efforts to increase public awareness of the mental health needs of ethnic minorities and the challenges of seeking and receiving culturally appropriate treatments.

While there may not be significant racial/ethnic differences in the incidence of mental health conditions, ethnic minorities are less likely to seek psychotherapy and are more likely to drop out after the initial session. The higher drop-out rates are likely due to the experience of microaggressions, according to psychologist Christina Capodilupo, author of Microaggressions in Counseling and Psychotherapy in the book Counseling the Culturally Diverse: Theory and Practice. These often subtle, insulting, or invalidating comments or behaviors directed at individuals or groups marginalized based on race, ethnicity, age, gender identity, sexual orientation, gender, religion, color, and/or socioeconomic status (SES) are not always intentional. Still, they reflect unconscious bias, insensitivity, and/or hostility toward the already marginalized person.

The ongoing experience of microaggressions, particularly those that occur in daily living based on skin color alone, can have a negative impact on overall psychological well-being. The negative psychological effects of microaggressions may be compounded if the individual is also female, transgender, impoverished, bisexual, homosexual, or non-religious. Experiencing microaggressions in a therapeutic setting can be even more harmful. Anytime an individual seeks the assistance of a psychotherapist, they are feeling some degree of emotional unrest or vulnerability. It takes courage to move past the stigma of reaching out for help, particularly for many racial and ethnic minorities. A person should never be made to feel unsafe, unworthy, or shamed because of a psychotherapist’s intentional or unintentional expression of prejudice or bias.

All people in psychotherapy need to have reason to trust that their therapist understands, respects, and accepts them unconditionally. This is the foundation of a therapeutic relationship and needs to be established in the early phase of treatment. Further, the therapeutic relationship has been shown to be the most important factor in the success of treatment, according to a meta-analysis of more than 190 related studies that was published in the March 2011 issue of Psychotherapy. In recognition of this, many professional mental health organizations have well-established definitions of and ethical guidelines for multicultural competence for educators and practitioners.

The first and most important step in becoming a multiculturally competent practitioner involves an increased awareness of oneself as a multicultural being based on one’s own race, ethnicity, sexual orientation, religion, gender, SES, and gender identity. Further, practitioners must develop an awareness of how their life experiences, particularly those involving privilege and/or marginalization based on their multicultural identities, have shaped their attitudes and beliefs or worldviews. This requires understanding how the socialization process conditions attitudes and beliefs that perpetuate privilege and marginalization on an institutional or systemic level. Practitioners are also expected to develop an awareness and appreciation of the same in the people they work with in therapy and understand the impact diverse worldviews may have on the therapeutic relationship and other aspects of the psychotherapy process.

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However, mental health professionals are a microcosm of society at large. Based on the socialization process, we all have unconscious biases and prejudices. The unconscious nature of the biases and prejudices is what makes it so difficult to deal with issues of privilege and marginalization, particularly as it relates to race and ethnicity.

For all psychotherapists, multicultural competence requires an ongoing process of deep self-reflection, letting go of maladaptive thinking, and shifting their worldviews in ways that benefit not only the people they help, but themselves as well. It is essentially practicing what they preach or doing what they are in business to help people do.

Many white Americans have difficulty recognizing the privilege and power they have based solely on skin color. Gaining an awareness of their privilege and the ways in which they have unknowingly participated in the perpetuation of marginalization of people of color can lead to feelings of guilt and anger and defensive behaviors. A common reaction is to adopt a colorblind ideology: “Race and ethnicity don’t matter; everyone is just the same.” While well-intended, white psychotherapists who believe this may deny or minimize experiences of marginalization by people in therapy based on race and ethnicity. The lack of awareness of privilege and its impact may invite the perception that people of color are “being overly sensitive” when they respond to this or other types of microaggressions.

Due to their own experiences, psychotherapists of color often have an awareness of marginalization based on skin color and ethnicity. However, these experiences alone do not provide insight into the impact they have had on their attitudes and beliefs about themselves, others within their own racial and ethnicity groups, other ethnic minorities, and white Americans. It is common for racial and ethnic minorities to internalize biases and prejudices learned from the larger society about their own and other racial and ethnic groups. This lack of awareness can lead to microaggressions toward people of color in therapeutic settings.

For all psychotherapists, multicultural competence requires an ongoing process of deep self-reflection, letting go of maladaptive thinking, and shifting their worldviews in ways that benefit not only the people they help, but themselves as well. It is essentially practicing what they preach or doing what they are in business to help people do.

If you are a person of color interested in psychotherapy, it is crucial that you choose a multiculturally competent psychotherapist who also has expertise in your specific area of concern (depression, posttraumatic stress, etc.). The following recommendations may guide you in your search.

1. Learn More About Multicultural Competence

The Multicultural and Social Justice Competencies outlined on the Association for Multicultural Counseling and Development website (see references below) is an excellent starting point. Learning more about multicultural competence will help you formulate questions you would like to ask a potential psychotherapist to get a sense of whether they have some degree of multicultural competence.

2. Explore Online Mental Health Directories

There are many online mental health directories, including GoodTherapy.org, to assist you in selecting a psychotherapist. When searching for a therapist on GoodTherapy.org, after entering your city you can narrow your search using the “Common Specialties” field. Psychotherapists have the option of including “multicultural concerns” as something within their scope of practice; if selected, “multicultural concerns” will appear in the “Practice Details” section of any profile maintained by a therapist who selects it as an area of focus. Some psychotherapists will also mention multicultural competence in the “My Approach to Helping” section of their profile. It’s so a good idea to explore any links to their websites and professional social media to see if themes related to diversity are present.

3. Do Not Limit Your Search to Psychotherapists of Your Race and Ethnicity

Many people who pursue therapy prefer a psychotherapist who is of the same racial and ethnic background. Keep in mind, however, that not every psychotherapist of color is multiculturally competent. If you are unable to find a multiculturally competent psychotherapist of the same race and ethnicity who also has expertise in your area of concern, consider expanding your search. A multiculturally competent psychotherapist of any race or ethnicity, with the appropriate expertise, should be able to offer you culturally appropriate treatment.

4. Consider Online Psychotherapy Sessions to Expand the Selection Pool

Recent studies have found online psychotherapy (also known as distance therapy) to be as effective as face-to-face counseling sessions for certain conditions and concerns. If you live in a small town or city that is not especially diverse, you may have a greater chance of finding a multiculturally competent psychotherapist in a neighboring city or county. Be sure to choose a psychotherapist who is a licensed mental health professional in your state. It is also important that the psychotherapist uses HIPAA-compliant video conferencing software (not Skype, iPhone FaceTime, or mobile phone apps) to ensure privacy and confidentiality. On GoodTherapy.org, you can find psychotherapists who offer online counseling under the “Type of Service” category.

5. Contact Psychotherapists Who Offer a Free Phone Consultation

Free phone consultations give people an opportunity to learn more about psychotherapists of interest and ask questions to get a sense of whether the therapist is someone they may feel comfortable working with. It is also a chance to obtain an initial sense of whether the therapist has some degree of multicultural competence. Those who do will honor and invite your questions on this topic.

6. Remember: The Selection Process Is Only the Beginning

Even after selecting a qualified psychotherapist, building a therapeutic relationship is a process that requires a commitment from both of you and takes time to develop. Try to keep an open mind and give the benefit of doubt.

References:

  1. Capodilupo, C. M. (2016). Microaggressions in Counseling and Psychotherapy. In D.W. Sue & D. Sue (Eds.), Counseling the Culturally Diverse: Theory and Practice (pp. 179-212). Hoboken, New Jersey: John Wiley and Sons, Inc.
  2. Duan, C., & Brown, C. (2016). Becoming a Multiculturally Competent Counselor. Los Angeles, CA: Sage.
  3. Horvath, A. O., Del Re, A. C., Fluckiger, C., & Symonds, D. (2011). Alliance in Individual Psychotherapy. Psychotherapy, 48, 9-16. Retrieved from http://dx.doi.org/10.1037/a0022186
  4. Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2015). Multicultural and Social Justice Counseling Competencies. Retrieved from http://www.multiculturalcounseling.org/index.php?option=com_content&view=article&id=205:amcd-endorses-multicultural-and-social-justice-counseling-competencies&catid=1:latest&Itemid=123

© Copyright 2016 GoodTherapy.org. All rights reserved. Permission to publish granted by Sonya Lott, PhD, therapist in Philadelphia, Pennsylvania

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 16 comments
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  • Carter

    July 27th, 2016 at 8:31 AM

    I guess I just assumed that is someone is smart enough to get the appropriate medical training then they are going to be competent in this area.

  • Sonya Lott Ph.D.

    July 27th, 2016 at 11:24 AM

    Thank you for your comment Carter. I know that many others also assume that education or training would automatically lead to multicultural competence. But it requires so much more than formal education. That’s why I really wanted to share this information with others.

  • Robert

    July 27th, 2016 at 1:49 PM

    I think that you could do all the research in the world but you will never know if this is going to be a good fit for you until you sit down and have a session or a meet and greet with one another.

    Just because someone looks good on paper and sounds like they are a fit for you over the phone, until you work with this person one on one you may not have all the answers that you are probably looking for.

    And most therapists will want to do this too just to see if the skills that they have to offer to you are actually what you need at this time.

  • Sonya Lott Ph.D.

    July 27th, 2016 at 8:33 PM

    Hi Robert. I agree that you can’t know for sure if a client and psychotherapist are good fit for one another until they have had some time to work together. That’s why I included a reminder at the end of the article about the selection process is only the beginning. A trusting relationship develops over time. But the recommended selection process can be very effective in identifying some psychotherapists who are not multiculturally competent.

  • Nan

    July 27th, 2016 at 5:00 PM

    Thanks for the tips on how to increase the number of options that we have! Just because there isn’t someone in your city that you feel comfortable with there are always online options and I had not even thought about looking into that until you listed that option here.

  • Sonya Lott Ph.D.

    July 27th, 2016 at 8:36 PM

    You are welcome Nan. The availability of online counseling has increased significantly in recent years. Many clients appreciate the increased privacy and the time saved from not having to travel to and from an office location.

  • Yolanda

    July 28th, 2016 at 7:09 AM

    Very timely piece especially given that we are in a very racially charged moment in our country. I think that it could actually be a great healer to teach others how we are worthy no matter the color of our skin but it is the point of living together and working together to come together as one nation.

  • Sonya Lott Ph.D.

    July 28th, 2016 at 7:34 AM

    Good Morning Yolanda. I appreciate your comment. I agree that we are in a very racially charged period in our country. The key is really connecting to the Truth that is already within us that we are worthy no matter the color of our skin or anything else. Once we know this about ourselves then we can celebrate this with others. This is why it is so important for all psychotherapists to become aware of who they are first as multicultural beings independent of race and ethnicity. It allows us to help others find that Truth within themselves as well-no matter what external conditions appear to be.

  • steve

    July 29th, 2016 at 7:46 AM

    It isn’t like someone is going to have an asterisk beside their name in the phone book noting if they are aware of multicultural issues or not

  • Sonya Lott Ph.D.

    July 29th, 2016 at 2:02 PM

    Hello Steve. Thank you for your comment. Actually, multiculturally competent psychotherapists are more like to note this in ways that I have described in the blog post, because we realize the important of making potential clients aware that we offer culturally appropriate treatment.

  • Rhett

    July 30th, 2016 at 11:14 AM

    I hope that people will read this and understand that there is more to therapy then simply being depressed. It could mean needing some help because you feel like you are being pout down or discriminated against because of what you appear like on the outside, and it is sometimes a good thing to have someone who knows these feelings all too well and who can help you come to terms with the fact of loving yourself. Because most of the time behavior like this makes you question who you are and a good therapist will just reaffirm that you are strong and powerful no matter what someone else might think of you.

  • Sonya Lott Ph.D.

    July 30th, 2016 at 7:02 PM

    Hi Rhett. It’s true-depression is just one of many reasons you can benefit from seeing a psychotherapist. Experiences of discrimination and marginalization can be a significant source of stress and having a multiculturally aware psychotherapist to reaffirm the truth about who you really in despite of this can be very healing.

  • karenn

    July 31st, 2016 at 9:02 AM

    You could always ask friends that you know see a therapist who they use and if they think that this is a person who would be sensitive to their needs.
    Word of mouth is often the best endorsement that one can get.

  • Sonya Lott Ph.D.

    August 1st, 2016 at 12:08 PM

    Hi Karen. Thank you for the suggestion. Asking a friend of color who has had a positive experience with a psychotherapist is an excellent idea!

  • Portia

    July 31st, 2016 at 4:17 PM

    Dear Dr. Sonya, What if my therapist is not religious? Should I ask questions about their religious beliefs? And what if they don’t believe in gay rights? Is this important in choosing a therapist?

  • Sonya Lott Ph.D.

    August 4th, 2016 at 12:47 PM

    Hi Portia. Thank you for your questions. While this article focuses on race and ethnicity, multicultural competence includes awareness, knowledge, and skill about race, ethnicity, gender identity, religion, gender, sexual orientation and socioeconomic status (SES). You can ask the psychotherapist about their beliefs about religion and gay rights, but it won’t necessarily let you know if they are multiculturally competent. What is more important is that they have an awareness of their own biases and prejudices and the influence of priviledge and marginalization in their own lives based on their multicultural identities as well as the influence of the same on others and a willingness to maintain this awareness and let go of as much of their biased perceptions as possible. This is what allows them to be able to work with clients who have different religious beliefs. Also a psychotherapist may believe in “gay rights” but still have very stereotypic ideals about sexual orientation and not really know about the prejudice and discrimination individuals who do not identity as heterosexual experience and the impact it can have.

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