The title of this post is taken from a nice article posted by Chatelaine magazine. There were good points to consider when thinking about the impact of intersectionality on the therapeutic alliance between therapist and client. Intersectionality commonly considers factors such as age, race, gender, sexual orientation, disability, native tongue, citizenship, religion, and social class in studying how a person's lived experiences, view of the world, and expectations for the future are created and shaped with time.

      While factors such as age, race, sex, physical disabilities, and sexual orientation tend to be visible, disabilities (learning and mental health), social class, citizenship and religion tend to be more hidden. I've observed that clients tend to gravitate to a therapist who shares visible factors in common with them, with age and race being most commonly sought out. Sometimes therapists will discuss on their websites the non-visible factors they experience or have experienced in the past in an effort to convey that they have a particular lived experience in common with their potential clients. Or perhaps they will disclose this if you discuss it in session. 

    The list of non visible shared experiences are endless but for example, being a first or second generation immigrant, having a parent who was a refugee or coming to the country as a refugee, having overcome an addiction, being a parent or single parent, miscarriage or issues with pregnancy, divorce or separation, marital difficulties, being in an interracial relationship, holding precarious jobs or other issues with career, being bullied, experiencing trauma, experiencing sexual assault, going back to school in mid-life, growing up in a particular country, parents divorced when young, learning English as a second language, experiencing challenges with mental health or having a learning disability, and experiencing difficulty with household income as a child.

     When you are in a school, are a client at a community centre or are accessing a therapist through a EAP, there may be just a handful of therapists to select from and you feel they may not be a good fit for you. It is important to invest in your mental health and put a great deal of care in selecting the right therapist for you. It is a crucial investment because your thoughts and feelings shape your destiny. The right therapist can be a huge catalyst for change in your life. Many therapists in private practice offer a sliding scale (even if it isn't advertised) and are willing to work with you to make therapy accessible. 

    When seeking therapy, it is natural for clients to want to seek out a psychotherapist who shares at least a few of these features of intersectionality in common as it suggests they may have had some similar experiences and therefore have a better understanding of what the client is going through. Lived experiences are powerful builders of empathy, because if I remember going through something, or am going through it  myself, and you are now going through the same thing, my understanding comes from the heart and not just the mind. You may be able to convince me out of believing in a theory but not out of my lived experiences. When we share lived experiences, I can see and understand you in ways that other people may not. You are free to speak your personal truth. Taking the risk of being raw in session, and then feeling truly seen, heard and validated in a caring, genuine way is the power of a strong therapeutic alliance. 

     The therapeutic alliance is the single best predictor of meaningful client outccomes. The strength and quality of the therapeutic alliance has been shown to be associated with: positive changes in attachment style in clients (Messer & Gurman, 2011, p. 95), clients being able to access and express their emotions faster and more in-depth while in therapy (Greenberg, 2014) and more profound, long-term behavioural changes after termination (Ardito & Rabellino, 2011; Leszcz, Pain, Hunter, Maunder & Ravitz, 2015). Leszcz et al (2015) state that the therapist’s ability to: convey genuineness and empathy to a client, collaborate on goals, quickly and effectively repair ruptures, and understand the client’s beliefs and worldviews make for a stronger therapeutic alliance. In turn, this helps to create an atmosphere where clients can heal, regardless of the therapeutic style employed (Leszcz, 2018).

     Every therapeutic model has research that demonstrates the effectiveness of its individual techniques on client progress. Examples would be the thought record and exposure therapy in CBT and empty chair and self-critical split techniques in EFT (Josefowitz & Myran, 2017; Elliott, Watson, Goldman & Greenberg, 2004). However, two therapists using the same technique on the same client may have significantly different results, depending on the therapist’s personal characteristics and the quality of the therapeutic alliance they have established with the client (Greenberg, 2018). 

     In emotion focused therapy, the therapist’s presence in creating a safe space for expression of emotions that may have never been made conscious or expressed to others is associated with a high-quality therapeutic alliance (Greenberg, 2014). While the technique used can make a difference, the therapeutic alliance is more important (Greenberg, 2014; Greenberg, 2018). In other words, technical mastery is not enough for meaningful change unless it is accompanied by a high-quality therapeutic relationship. Sensitivity to issues of diversity (Big 7 identities) and equalizing the power helps to cultivate the therapeutic alliance (Moodley, 2011).

     Sometimes you have to try a session or two before you can gauge whether the outcome is likely to be fruitful if you continue to invest the time and effort. Pay attention to how you feel after the session and trust in your intuition to guide you to someone who is the right fit for you.


References

Ardito, R. B. & Rabellino, D. (2011). Therapeutic Alliance and Outcome of Psychotherapy:  Historical Excursus, Measurements, and Prospects for Research. Retrieved from      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198542/

Elliott, R., Watson, J. C., Goldman, R. & Greenberg, L.S. (2003).  Learning emotionally focused therapy: The process experiential approach to change. Washington D.C.: APA Books.
    
Greenberg, R. (2018). Essential ingredients for successful psychotherapy. In M. J Dewan., B. N. Steenbarger & R.P. Greenberg (Eds.), The art and science of brief  psychotherapies, 3rd edition. (pp. 17-28). Arlington, VA: American Psychiatric Association Publishing
     
Greenberg, L. (2014). The therapeutic relationship in emotion-focused therapy. Retrieved from
http://www.waburkhartphd.com/uploads/1/0/4/5/104505891/
/therapy_relationship_emotion-focus.pdf

Josefowitz, N. & Myran, D. (2017). CBT made simple: A clinician’s guide to practicing cognitive behavioral therapy. Oakland, CA: New Harbinger
 
Leszcz, M., Pain, C., Hunter, J., Maunder, R., & Ravitz, P. (2015). Psychotherapy essentials to go: achieving psychotherapy effectiveness. New York, NY: W.W Norton & Company

Messer, S. B., & Gurman, A. S. (2011). Essential psychotherapies: Theory and practice (3rd ed.). New York, NY: Guilford Press.

Moodley, R. (2011). Outside the sentence. Toronto, ON: Centre for diversity in counselling and psychotherapy


 
 
 

       Remember that the greatest gift you can give the world is your presence. Working on the energy you emit to other people and to the world elevates the consciousness of humanity. More helpful than doing good deeds, is being a genuinely good person. I've always been fascinated with Dr. David Hawkins map of consciousness levels and how just a handful of people at the higher levels (500 and up) counterbalance the energy so that the world as a whole stays above 200 which is the critical difference between power and force. 

      The next time you are doubting the impact you have on the world, or if your efforts make a difference, remember you have people in your life who you influence, those people have people in their life that they influence and the cycle continues, with your words, ideas, and behaviour influencing people you will never meet or know you have impacted. You don't need to be well-known or have tons of social media followers to be a change-maker. The biggest legacy you can leave is in increasing your own consciousness level. Create a sacred time to replenish yourself, to breathe deeply, to experience feelings of awe and to listen to inspiring stories and words of wisdom. Be aware of your words, knowing that it can take a second to say them but people may be thinking about them years later. What do you want your influence to be? Someone who uplifts or someone who denigrates? When people think of spending time with you, how do you want them to feel?

       I love being a psychotherapist because my client's transformation leads to transformation in their families and close friends. Your changed behaviour will lead to different relationship dynamics which will improve the quality of life for everyone. A new empowering story gets created which draws different experiences to you and allows you to break out of the stagnant energy patterns that have been holding you back.

      Do something today to uplift your energy, even if it's just a 5 minute practice. Trust that you do make a difference.

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    I think that when you work with people from disadvantaged groups and offer them a reduced rate (or are aware they were offered a reduced rate through your organization), you do have a moral obligation to honestly examine whether you are interacting with them in the same way you would if they were able to pay the full rate. This does not just apply to those with White privilege, it is true even when you are a member of a disadvantaged group. Don't assume that because you have the same group membership that you automatically understand what someone went through or is experiencing now. Don't undervalue their experience because you haven't had the experience. Be mindful of the words you are using and how they may shape other people's opinions, especially if you are publishing your opinions publicly. For instance, I've heard multiple racialized people say that racism doesn't exist and proceed to blame and shame the victim.

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   Keep in mind the role of intersectionality and how that ensures that no two people from the same group have the same experiences. Your clients are already vulnerable due to factors beyond their control. They are dealing with systemic forms of discrimination in society. You do not want to inflict more harm. Solicit feedback and create a safe space for people to respond honestly to you.
 
Ask yourself the following:

    Do you have sympathy or empathy for this client? If it is sympathy, what can you do to become more empathetic? Sympathy usually results in a patronizing attitude while empathy creates trust and a feeling of being heard.

"Empathy fuels connection. Sympathy drives disconnection"
– Dr. Brené Brown

Are you putting the same level of time and effort in?  

   Do you try to evade their phone calls, emails or reduce the number of times meeting with them?

   Do you answer their lengthy queries with brief or vague responses? Short responses give an impression of not wanting to spend the time to look into any given point, question or concern. 

Do you respond to all of their concerns or ignore some of them?

    How do you feel when interacting with them? How may it come across in your tone and nonverbal body language? While people can not read your thoughts, your thoughts and feelings do influence your energy.

    Is boosting your professional reputation a bigger motivation for offering the reduced rate than helping people? If you are a vocal advocate for the rights of a disadvantaged group, this can make you more of a target for criticism as people can feel when actions are taken due to self-serving motives.

    Are you as considerate of their feelings and speak to them with the same level of respect as you do others? This is a tougher one to look at because most people will act in a way that they believe is respectful. However, to the other person it does not come across that way.

    Are you trying to find other ways to get more money from them because you feel the rate you originally offered was not reflective of the work you put in or will have to put in the future? This is especially true if you are in a high-paying profession and don't need the money as much as the client, if not having it would result in you not having a luxury in comparison to them not being able to afford a necessity. 

​    If they don't agree to pay you more, are you still as motivated to do the work or do you try to finish as quickly as possible and/or end the client relationship as soon as you can? Don't penalize the client for your miscalculation. If you are truly interested in social justice, try to obtain the best results for them instead of encouraging them to settle for less than you know they can get.

    Do you follow through on promises you made even if the client can not hold you accountable if you don't? It is better to not promise anything rather than state you can help with something that you don't really intend to help with later. This puts the client in a position of waiting for you to help them rather than looking into other avenues to help with the issue. And then feeling hurt when you don't help them in the way you said you would.

    Have you done the IAT (implicit association test) to assess the extent of your unconscious biases?

    Have you done inner work to reduce your own unconscious biases about oppressed groups? I have detailed some ways we can do this in my last blog post about implicit bias.
 
    Having a desire to help disadvantaged groups isn't enough. If you aren't able to offer a reduced rate without being able to treat these clients the same way as others who can pay your regular rate, you should not offer the reduced rate at all because it harms more than it helps. People know when they are not being treated equally and it is very hurtful and negatively impacts self-esteem.
 
     As a service provider, people rely on you to help them and it is a serious responsibility. Your words and actions can be just as damaging as the incident they hired you to help with in the first place. Be mindful and do the inner work necessary to help rather than harm.

       Meghan Markle and her family were forced to leave the royal family because despite being beautiful, successful, independently wealthy, eloquent and charitable, the U. K. was not ready to accept a biracial or Black person into such a powerful position. She did not fit the image they had in their minds of who would be a suitable match for Prince Harry. She would never be good enough. The royal family refused to defend her from the constant abuse, although they defended Kate Middleton even when the level of abuse she receives was of less frequency and intensity. I believe Meghan was seen as 'the other' from the beginning and treated in ways that dehumanized her. She wasn't seen as worthy of protection. People refused to consider that race may be even one factor in the discrimination she was facing. The lack of empathy and compassion was probably also because she was now in one of the richest and most powerful families in the world, being partially funded by the tax payer. The expectation was that the abuse and increased scrutiny was the price she was expected to pay. All sorts of things were said to portray her as a villain in the media, when her only crime was being half Black. The U. K. as a whole will probably take a long time to admit that as they continue to vilify her for stealing Prince Harry (when it was really him who decided to move out of the U. K.). However, what happened to her did cause important conversations to come to the forefront all over the world. I hope that her lawsuit against the British media, regardless of whether it is successful in court, will be a force for change.

      When I first saw the video circulating of the police officer kneeling on George Floyd's neck on facebook, my first thought was how is this still able to occur in 2020? After so many incidents like it in the past on recording, you would think that systems would have changed so that this could not happen again. Nevertheless, it happened with 3 other officers present in broad daylight on a busy street in front of numerous witnesses in a first world country. Why? People generally don't do things like this so brazenly unless they think the consequences they will face will be insignificant, or perhaps they think they will get away with it entirely. We have seen this happen before, particularly with White officers and Black civilians. The police have power because of their position in society. Power with an absence of proper checks and accountability lead to the abuse of that power. Targets are typically oppressed groups, particularly minorities, and especially Black people in the United States.

       With the rise of cell phones, these incidents are being recorded and the truth being exposed so that perpetrators can be held accountable.  Convenient excuses used in the past of officers taking innocent people's lives on the premise of defending themselves against aggressive Black men resisting arrest will no longer hold as the public outcry becomes louder, as society demands change. Change will not happen overnight but little victories add up and change on a micro level leads to change on a macro level. Every generation becomes better than the one that came before it.

     Overtly racist comments are rarely made in public discussion but the belief that minorities are more aggressive, particularly when standing up for their rights or bringing up systemic discrimination persist. Mistakes are blown out of proportion. Punishments are harsher. Expectations for achievement are lower. The benefit of the doubt is not given as much and there are fewer second chances. There is not as much room for error because judgements of  behaviour are immediate and attributed to inherent flaws rather than external changeable factors. Assumptions are made about profession, class and/or social status. 

    It is frustrating to observe that most people in upper management within organizations or in significant political or judicial decision making roles are White, upper middle class, straight, and with no disability. Racialized people who have been in the organization for years find it hard to get promoted over their White co-workers who have less education and experience. 

     Sadly, people with White privilege often make decisions about people whose lived reality they know (or care to know) very little about, though they may pay lip service to it. Or they may say they "don't see colour", or one is "playing the race card". Race is not a card to be played, it's a non-changeable factor that causes real disadvantages in many areas of life, as evidenced by research in many social contexts.  For example, the fact that there is a significant wage gap between Canadian born and educated minorities, and Canadian born and educated Caucasians despite the children of visible minority immigrant parents going to university at much higher rates than the rest of the population. Refusing to acknowledge race is a way for those with white privilege to ignore systemic inequalities, maintain their power and diffuse their responsibility in considering what factors contribute to discrimination and exclusion from the highest decision making positions. By pretending the issue does not exist, it is easier to maintain the status quo that is already in their favour and avoid any change that could upset the power balance. It is easier to silence dissenting voices by inflicting punishment, to teach others vicariously not to speak up.

    This lack of empathy for 'the other' dehumanizes the victim, inhibits one's ability to feel their pain, and as a result causes injustices to be swept under the rug or minimized to as great extent as possible. It frustrates me that when someone complains or files a lawsuit about racial discrimination, that the judge or person in charge of hearing the complaint is often someone with White privilege. People from this privileged group can at times lack the awareness and humility to truly understand (or to take the time to learn) the subtle nuances of racism and all the ways in which it has historically (through intergenerational trauma) affected and continues to affect racialized people. These people don't take the time to learn because there are no consequences for them for their ignorance. If you make an appeal, the higher and higher you go up the chain of command, almost all the decision makers are people with white privilege. 

   As one of my favourite authors Najwa Zebian notes, they often would like to believe something is wrong with you then something wrong happened to you.  You are written off as a troublemaker when you have the courage to advocate for your rights. This placing of people with White privilege in positions where they have to decide on whether racial discrimination happened, for example in regulatory bodies, organizations, courts and tribunals, shows a lack of sensitivity towards the complainant and most of the time risks re-traumatizing them in the process. There is usually no way for the complainant to bring up White privilege as a bias or demand that another person of colour investigate the case because it's up to the judge to decide whether they exhibit a bias and take themselves off the case. Bringing up potential bias could risk angering the judge before you start the case and puts you at a further disadvantage. 

     As a racialized person, I believe the only way to fight back against this is to keep speaking up, keep recording through audios and in journals the microaggressions and keep having the courage to bring up these issues publicly despite attempts that those with power and privilege will make to ruin your reputation. Know in your heart that you are not the labels they place on you. The more people who complain about this treatment, the harder it is for the same person or organization to keep treating people badly.

    Success is not to be judged just through the outcome. On the other hand, success comes from knowing you used your voice to fight the good fight and you can be proud of yourself for raising awareness and making it easier for the next person who finds themselves in the same situation that you did.   
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"We don't change the world when we whisper, we change it when we roar"
- Cleo Wade

     
      As Shakil Choudhury notes in Deep Diversity, minorities do generally have implicit racial bias towards other minorities.  There is an automatic preference for white people from most other people regardless of race because there are more  automatic positive associations for white people.

    For instance, studies show that with identical resumes, those with ethnic names receive far less calls for interviews than names that sound white.  The result is that some minorities feel compelled to engage in a process known as whitening the resume, which could include changing one's name, leaving out job experience or achievements which relate to ethnic organizations, and adding in interests that reflect those of western culture. 
   
         It's inaccurate to assume you don't have unconscious bias towards stigmatized groups because you have friends from those groups, are married or in a relationship with a person from those groups, that you have been nice to them or that you haven't done anything wrong towards them. The fact is that good people often hold unconscious racial and other types of bias. Holding these biases does not make you a bad person, you just need to recognize that you need to learn more about the nature of these biases and how to reduce them in order to grow as a socially responsible citizen.

       Growth comes from learning about different perspectives and experiences; for example watching films, reading stories or listening to audios/ videos from: women, minorities, immigrants, poor and working class, persons with disabilities, LGTBQ, or people with different religious and cultural backgrounds than your own.  These stories are being told and it is up to you to seek them out and listen with an open heart and mind. This process of reducing unconscious bias takes time, effort and a sincere willingness to change.

     After realizing to what extent the dominant narrative about these groups is shaped by people who are not a member of those groups, you will start to change your beliefs because your assumptions will be challenged.

     I watched the entire series of Little Fires Everywhere in just 3 days and highly recommend it for a thought-provoking look into race and class in America and how it shapes the choices available to us. Elena, an upper-middle class White woman, (who was born into wealth and is married to a lawyer, who is also White) tells Mia, a working-class, lesbian, Black woman who is a single mother, estranged from her parents and was recently homeless, "A good mother makes good choices" to which Mia responds, "You didn't make good choices, you had good choices".

    While people can be quick to judge the choices of others, very seldom do they adequately consider what factors led to them having to make that choice, or question if it was actually a choice at all? It is easy to blame others and assume you would do better if you were in their situation but since you lack that lived experience, there is no way to know for sure what you would have done. It does cause discomfort to realize that you may have done the exact same thing if you were them and had the same "choices" to make as they did.

       The power starts to re-balance when we have a collective shift in attitudes and expectations about different groups in society. Choosing to say something is better than saying nothing at all when it comes to speaking about injustice. We need people with privilege to advocate on the behalf of those who don't have it.

    When you change your beliefs towards and expectations of people, the way you unconsciously act towards them will change because you will develop more empathy and be less likely to view them as 'the other'.  This is making the unconscious conscious so that longstanding behavioural patterns change and we as a society progress in the right direction. I think that's something you can find peace in. 

Black Mental Health Resources

​1. The Most Nurtured https://www.themostnurtured.com/
2. Women’s Health in Women’s Hands http://www.whiwh.com/
3. Black Health Alliance http://blackhealthalliance.ca/
4. Black Youth Helpline https://blackyouth.ca/

Organizations to support Anti-Racism, Equity, and Legal Action 

1. Black Lives Matter https://blacklivesmatter.ca/
2. Black Legal Action Centre https://www.blacklegalactioncentre.ca/
3. Federation of Black Canadians https://fbcfcn.ca/
4. The Urban Alliance on Race Relations https://urbanalliance.ca/about-us/

​A list of anti-racism resources – including articles, books, and podcasts



     

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Pranayama practice has several benefits. These include increasing oxygen supply to the body, reduction of stress and tension, improved immunity and digestion, enhancement of the body's ability to eliminate toxins, as well as promoting balance in the mind and body. While it can be very challenging to control one's thoughts, it is much easier to control breath, which has a direct effect in calming the mind. Over time, deep breathing practices can lead to lengthening of the silent periods in between our repetitive thoughts.

      Kundalini pranayama is said to have a cleansing effect on the chakras. There are 7 chakras in the body: root, sacral, solar plexus, heart, throat, third eye and crown, each symbolizing different energies. For instance, the heart chakra relates to one's ability to be compassionate, empathetic, and to give and receive love. 

     When there is an energy blockage in a chakra, there may be ill effects on the mind and body connected to its domain. To illustrate, if the heart chakra is blocked, the person may be selfish, unaffected by other people's suffering, have difficulty being affectionate and loving, feel lonely, and value their happiness at the expense of others. On a physical level, it may manifest as lung diseases, high blood pressure, heart problems and chronic upper back pain.

    General signs of chakras being imbalanced include depression, fear, doubt, repression, vengeance, criticism, greed, and inability to engage in healthy, mutually satisfying relationships. Ways of balancing the chakras include pranayama, yoga postures specific to each chakra, mudras specific to a chakra, meditations focused on a specific chakra, sound healing, and yantras for each chakra.

    I find it helpful to use a variety of these techniques to balance the chakras at different times. Different people resonate with different techniques and teachers. I thought I would post some helpful resources that I have tried so you can see how it works for you.

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