There are some 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
7 Comments
Cherise Tan
9/10/2020 06:12:35 pm
I've wondered why there aren't more racialized therapists given the diversity of the GTA. It's been a struggle to find someone who I really connect with, I think it's like dating too! I've tried 3 so far and none of them really clicked. I haven't given up because I know there's got to be someone who is the right fit. At my school, all the therapists are middle aged white women, and I tried therapy with two of them but neither understood what life is really like for young Asian Canadian women. They were nice enough, just that I felt they didn't really understand the culture or cultural expectations related to family and relationships.
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Samantha Samuels
9/11/2020 08:53:53 am
I encourage you to keep trying Cherise, there is someone out there that would be a good match for you. Psychology Today is the largest directory for therapists in private practice. I grew up in Mississauga and as I remember from elementary school to graduate school, the vast majority of teachers, principals and counsellors were White. Many of them didn't make any real effort to convey that they understood the cultures their students came from. I think the onus is on people hiring to make tangible efforts to diversify staff so that students will see themselves more represented.
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Radhika C.
9/14/2020 11:09:43 pm
I've been a therapist for over 35 years. When I was seeking therapy in my late 20s, I had trouble finding someone who looked like me and could relate to my experiences (I'm South Asian). I had just had an arranged marriage and was dealing with depression, anxiety and moving to a foreign country with no family present. Though I tried therapy, the white therapists who I saw had little undertsanding of Indian culture, and they just didn't care enough to learn. My experiences were not validated and left me feeling more alone.
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Samantha Samuels
9/15/2020 09:18:23 am
I appreciate that so much Radhika and thank you for sharing your experiences. Representation is everything. I am hopeful that more South Asian men and women become psychotherapists especially as South Asians are the largest minority group in Ontario
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Richard Turner
10/6/2020 08:25:02 pm
The cultural connection made a huge difference for me. In retrospect I realize how as a young Black man in the 80s, how lucky it was to have a Black male therapist who could relate to me. I saw him weekly for just over a year. Was at a crossroads in my life and he helped me make decisions that I am grateful I made to this day.
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Samantha Samuels
1/30/2021 10:39:07 pm
There is a lack of ethnic male psychotherapists even today Richard, and I imagine there were even less back in the 80s! You were very lucky to have someone who you had a strong therapeutic alliance with, who was able to challenge you in the right ways that were necessary for you to get to the next breakthrough in your life.
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