“An Unspoken Level of Comfort”

Abstract

This study examined 36 Black therapists’ experiences working with Black clients in hospital, school, college, and community counseling settings. Findings of this interpretative phenomenological analysis suggest these therapists most often feel a distinct sense of solidarity with their Black clients, as evidenced by having a better understanding of the context of Black clients’ lives, creating easier and faster therapeutic connections with Black clients, and feeling especially committed to these clients’ well-being. Participants also acknowledged the potential pitfalls and having insufficient boundaries and acknowledged the limitations of their formal training in learning to work with Black clients. How participant responses differed according to years of experience, practice setting, and gender are also explored. This study also suggests implications to increase the quality of training provided to therapist trainees of African descent.

Keywords

psychotherapy Blacks therapist characteristics same-race dyads

Black clients frequently prefer working with mental health providers of African descent (Cabral& Smith, 2011; Townes, Chavez-Korell, &Cunningham, 2009), though explanations for this phenomenon vary. Whether this preference is construed as the manifestation of an innate connection between all Black people (Montgomery, Fine, & James-Myers, 1990; Resnicow, Soler, Braithwaite, Selassie, & Smith, 1999), the result of cultural mistrust embedded within African American identity (Terrell, Taylor, Menzise, & Barrett, 2009), evidence of clients’ advanced racial identity statuses (Constantine, Reddington, & Graham, 2009), or myriad other factors depends on one’s cultural, philosophical, and epistemological paradigm. Regardless of how one explains the origin or maintenance of this connection, a robust theoretical and empirical literature exists suggesting that Black clients tend to strongly prefer working with Black psychotherapists (Cabral & Smith, 2011).

Empirical research examining and explaining how Black psychologists and other mental health practitioners experience working with Black clients is less well developed. Theoretical literature from the past four decades has provided a solid foundation for the exploration of Black therapists’ experiences in same-race therapeutic dyads. Several challenges may emerge when Black therapists work with Black clients, including the denial of identification with the client (Calnek, 1970), overidentification with the client (Boyd-Franklin, 2003; Calnek, 1970; Jackson, 1973), judgment or rejection by the client (Ablack, 2000; Ayonrinde, 1999; Boyd-Franklin, 2003), and managing therapist and client reactions to perceived differences in socioeconomic status (SES; Ayonrinde, 1999; Boyd-Franklin, 2003; Calnek, 1970; Ferguson & King, 1997; Jackson, 1973). Conversely, Black therapists may experience unique benefits from practicing in these dyads, including the ability to serve as a sage or a role model (Banks, 1975; S. Kelly & Boyd-Franklin, 2005), connecting more easily and quickly (Boyd-Franklin, 2003) and being able to intervene in more culturally congruent ways because of their more nuanced understanding of Black communities (Bell-Tolliver, Burgess, & Brock, 2009; Boyd-Franklin, 2003; S. Kelly & Boyd-Franklin, 2005; Queener & Martin, 2001). Recent literature also suggests that Black therapists may be more likely to feel personally invested in their Black clients as well (Goode-Cross & Speight, 2014; Speight, 2012). In short, Black therapists are likely to experience distinct joys and challenges when working with Black clients (Boyd-Franklin, 2003; Goode-Cross, 2011a, 2011b).

Beyond Black therapists’ feelings about their work in same-race dyads, the nature of that work will likely differ because of the shared racial identity between the therapist and the client. Black liberation psychology proponents assert that for people of African descent located in oppressive and discriminatory environments such as the United States, being mentally healthy requires they recognize and fight the forces that inhibit their lives (Thompson & Alfred, 2009). Speight and her colleagues elucidated mental health for Black people within the United States similarly: “First, . . . mentally healthy African Americans know who they are. Second, . . . mentally healthy African Americans know where they are and how to deal with their environment” (Speight, Blackmon, Odugu, & Steele, 2009, p. 370). Not surprisingly, Black therapists often include racial socialization messages in their work with Black clients (Brown, Blackmon, Schumacher, & Urbanski, 2013) that may serve to inoculate these clients from the deleterious effects of racism. Black therapists may also self-disclose more with Black clients, both because they feel more comfortable and because they wish to normalize the experiences of their Black clients (Boyd-Franklin, 2003). In these ways, Black therapists are likely to experience their therapy with Black clients as unlike their work with clients of other racial and ethnic backgrounds.

Black therapists are not monolithic, and neither are their experiences. For instance, a 20-something Black lesbian social worker in a college counseling center will have different experiences working with Black clients than a straight, Black male psychologist in his mid-50s who works in a psychiatric hospital because of differences in their life experience, how clients respond to them based, and where they see clients. In her critique of the sometimes-essentialist discourse she observed among Black psychological scholars, Williams (2005) noted, “Afro-centric theory is laden with language that generalizes to all African Americans traits that are assumed to be inherently and essentially African without regard to gender differences” (279). Experiences of same-race dyads may vary according to the demographic characteristics of the therapist and client (Boyd-Franklin, 2003; Goode-Cross & Speight, 2014). For example, Black female therapists have written about the distinctive joys and challenges in relating to other Black women as clients (Ablack, 2000; Ferguson & King, 1997; S. Kelly & Boyd-Franklin, 2005; J. F. Kelly & Greene, 2010). How differences in demographic variables affect relationships between Black therapists and clients has not been fully explored in the existing literature. Therapist variables, including practice setting, experience level, and therapist gender are important to understand within Black therapist-Black client dyads. Hence, the current study seeks to deepen our understanding of the nuances of these relationships by empirically examining how Black therapists experience working in same-race dyads and comparing how these experiences differ based on the therapists’ demographic variables and setting-related differences.

Method

The current study is a phenomenological examination of Black psychotherapists practicing in same-race therapeutic dyads, supervisory dyads, or both. Although the study was initially targeted at exploring the experiences of Black doctoral-level psychologists practicing in college counseling centers with American Psychological Association (APA)–accredited predoctoral internships, the scope was later expanded to include Black therapists licensed at the master’s level, those working in community, hospital, and school settings, and those without supervisory experience. For the purposes of this study, the term “Black” is used to denote people of African descent, including African Americans as well as people from Africa, the Caribbean, and other parts of the African Diaspora.

Because scant empirical literature exists about therapists of color working within their racial and ethnic groups, phenomenological inquiry was selected to fully explore the experiences of Black therapists working in same-race therapeutic and supervisory dyads. The idiographic nature of phenomenology is perfectly suited to examine how Black therapists experience the relational complexities of therapy and supervision in same-race dyads (Cresswell, Hanson, Plano Clark, & Morales, 2007).

Participating Therapists

Purposive sampling was initially used to recruit doctoral-level Black psychotherapists practicing in college counseling centers with APA-accredited predoctoral internship programs using U.S. Census data (McKinnon, 2001) in concert with the Association of Psychology Postdoctoral and Internship Centers directory (Lese-Fowler, 2009) to identify APA-accredited predoctoral internship sites in the states where most Blacks in the United States lived (see Goode-Cross, 2011a) for more information about initial recruitment procedures). Additionally, participants were recruited through the electronic mailing lists of APA Divisions 17 and 45, and local chapters of the Association of Black Psychologists.

Doctoral-level Black therapists in college counseling centers were initially targeted for two reasons. The first was to increase the likelihood of finding therapists with the requisite supervisory experience with Black therapist trainees. The second was to increase the probability of perceived similarity between the therapists and their clients by decreasing potential differences in SES between them. From nearly the beginning of the study, Black therapists without doctoral degrees, those working outside of college counseling centers, and those with no supervisory experience were referred to the project by other participants, responded to the calls for participation, or simply expressed interest in the study. The data collection team decided to interview these therapists and expand the initial scope of the study. A total of 38 therapists practicing in various settings, including college counseling centers, hospitals, and community mental health centers in 11 states and Washington, D.C. were interviewed between December 2009 and March 2012. Interviews of two therapists completing their graduate training were later excluded, leaving 36 interviews from participants practicing in California, Georgia, Kentucky, Maryland, New Jersey, North Carolina, Ohio, Pennsylvania, Texas, Virginia, and the District of Columbia to be transcribed and analyzed. The 26 women and 10 men ranged from 4 to 40 years of clinical experience and with 0 to 32 years of supervisory experience. Twenty-four participants were psychologists (12 counseling, 10 clinical, 1 clinical community, and 1 school), five were counselors, four were social workers, and three were psychiatrists. See Table 1 for more information.

Table 1.

Summary of Participant Characteristics.

Participant	Gender	Degree	Field/Discipline	Practice setting	Years of clinical experience	Years licensed as a therapist
1	Female	PhD	Counseling psychology	College counseling center	16	4
2	Male	PhD	Clinical psychology	Community mental health center	40	30
3	Male	PhD	Counseling psychology	College counseling center	30	26
4	Male	PhD	Clinical psychology	College counseling center	20	11
5	Female	PhD	Counselor education	College counseling center	18	3
6	Female	PhD	Clinical-community psychology	College counseling center	21	18
7	Female	PhD	Counseling psychology	College counseling center	8	0
8	Male	PhD	Counseling psychology	College counseling center	10	0
9	Female	PhD	Human development	College counseling center	15	13
10	Female	PhD	Clinical psychology	College counseling center	25	23
11	Female	PhD	Counseling psychology	College counseling center	26	19
12	Female	PsyD	Clinical psychology	College counseling center	6	1
13	Female	PhD	Counseling psychology	College counseling center	13	1
14	Female	PhD	Counseling psychology	College counseling center	22	11
15	Female	PhD	Counseling psychology	College counseling center	8	3
16	Female	PhD	Counseling psychology	College counseling center	11	1
17	Female	PhD	Clinical psychology	College counseling center	24	18
18	Male	MSW	Social work	Community mental health center	15	15
19	Female	MA	Community counseling	Community mental health center	8	6
20	Female	PhD	Counseling psychology	Community mental health center	4	0
22	Female	PsyD	Clinical psychology	College counseling center	17	10
23	Female	PsyD	Clinical psychology	College counseling center	7.5	0
24	Female	PhD	Clinical psychology	College counseling center	15	7
25	Male	PsyD	Clinical psychology	College counseling center	7	0
26	Female	PsyD	Clinical psychology	College counseling center	10	0
27	Female	MSW	Social work	State social services department	24	13
28	Male	PhD	Counseling psychology	College counseling center	20	11
29	Male	MA	Counseling	Community mental health center	5	2.5
30	Female	MS	Clinical-community counseling	Community mental health center	11	1
31	Male	MS	Clinical psychology	Community mental health center	5	2
32	Female	MSW	Social work	Community mental health center	21	19
34	Female	PhD	Counseling psychology	Hospital	15	0
35	Female	PsyS	School psychology	Public schools	9	3.5
36	Male	MD/PhD	Medicine/ psychology	Medical school/hospital	30	23
37	Female	MD	Medicine	Medical school/hospital	6.5	2
38	Female	MD	Medicine	Medical school/hospital	5	1

Procedures

As suggested for studies employing interpretive phenomenological analysis (IPA; Smith & Eatough, 2012; Smith & Osborn, 2003, 2008), a semistructured interview schedule was used for the interviews. The first author, in concert with other members of the data collection team, developed the interview schedule based on theoretical and empirical literature on same-race dyads (i.e., Ayonrinde, 1999; Comas-Diaz & Jacobsen, 1991; S. Kelly & Boyd-Franklin, 2005; Maki, 1999; Tummala-Narra, 2004). After receiving approval from the university’s institutional review board, the interview schedule was piloted with a Black male counselor practicing in a community mental health setting. Based on this interview, the data collection team made minor revisions. A copy of the schedule is available from the first author. Participation was voluntary and uncompensated. The data collection team conducted all the interviews via telephone or in person. The 36 interviews lasted between 12 and 70 minutes. After each interview was transcribed and stripped of personally identifying information, the transcripts were given to the data analysts.

IPA is intensely rigorous and thus perfectly suited for understanding the experiences of Black therapists working with Black clients, supervisees, or both, and how those experiences may be affected by therapist gender and practice setting. IPA involves two parallel meaning-making processes: participants making meaning of their own experiences and the researcher making sense of the participants’ description of their experiences (Smith & Osborn, 2008). Because of the copious labor required, IPA is generally recommended for studies with small and relatively homogenous samples (Smith & Eatough, 2012). Thus, the analytical process was modified to ensure sufficient time and energy was devoted to each of the 36 transcripts. The 36 interview transcripts were first divided into three groups according to years of experience (less than 10 years, 10-19 years, and 20 or more years), with 12 participants in each group. These categories were developed to correspond roughly with the stages of therapist development described by Rønnestad and Skovholt (2003). The categories served to increase the similarity within the groupings while simultaneously helping to make the workload of the individual analysts manageable.

Research Team

The research staff for this project was divided into two groups, each having unique roles. Lyons and Bike (2009) asserted that racial and ethnic and racial similarities between researchers and participants can provide intimate access to participants by making participants feel more comfortable. For that reason, the author and two doctoral students in counseling psychology—two Black men and one Black woman—served as the data collection team, with at least one team member conducting every interview. Prior to the first interview, each member of the data collection team wrote statements elucidating their experiences with and expectations of same-race dyads in therapy and supervision among Black therapists (see Goode-Cross, 2011a). Having diversity among the research team can also safeguard against faulty assumptions in the data analysis process (Lyons & Bike, 2009; Lyons, Bike, Johnson, & Bethea, 2012). For this reason, three counseling psychology masters’ students (two Black women and one White man) served with the authors as the data analysis team. Because researcher reflexivity is necessary to enhance trustworthiness in qualitative research (Lyons & Bike, 2009; Morrow, 2005), the analysts kept journals containing their cognitive and emotional reactions to the data during the analytical process.

Analysis

Prior to analysis, three analysts were each assigned to one of the three groups of participants. During the first step, the analyst read each transcript several times, noting emergent themes in participants’ descriptions of their experiences and connections among them. These themes were continually refined as each analyst read all 12 transcripts, and the emergent themes were finally classified into different domains. In the next phase, the analysts repeated the process of identifying emerging themes, this time noting how participants’ responses seemed to be influenced by each therapist’s gender. This process was again repeated, this time with attention focused on how the therapists’ practice setting and client population appeared to affect participants’ experiences. Each analyst drafted a final, comprehensive analysis that identified common themes among participants’ experiences of same-race dyads, as well as the analyst’s observations of how gender and practice setting appeared to affect these experiences. Next, the first author conducted the cross analysis. He first immersed himself in the data by reading the 12 transcripts and corresponding analysis for each of the three experience groups. Subsequently, the first author reread the three individual analyses, synthesized common themes, and identified patterns of responses related to therapist gender and practice setting. The outcomes of this cross analysis for the three experience groups are reported below.

Findings

Several interrelated themes emerged in data analysis that were consistent for the therapists in this study—regardless of their years of experience, gender, or practice setting. The five interrelated themes in participant responses are: understanding the context of work with Black clients, easier and faster therapeutic connections, greater commitment to Black clients, the perils of insufficient boundaries, and learning to work with Black clients. These themes were common across all experience groups and will this be reported first. Subsequently, differences in participants’ experiences based on the participants’ years of experience, gender, and practice setting will be discussed.

Common Themes

Understanding the Cultural Context of Working With Black Clients

Early-, mid-, and late-career participants nearly unanimously reported that their work with Black clients was made more fulfilling because they well understood the challenges Black clients faced. Many therapists identified the challenges of coping with both racial discrimination on a larger, societal level and with microaggressions that most often occur within the context of interpersonal relationships as major life stressors that often negatively affected their Black clients. Participants described working with clients to ameliorate or even mitigate the effects of these stresses using terms such as “meaningful” and “interesting”, and they appeared to relish working with Black clients for these opportunities. For example, one clinical psychologist practicing in a college counseling center described how being African American afforded him an understanding of the issues his clients may face: “I think with a African American or Black [client], because I am African American, Black, I don’t have to go to the literature, it’s like I know these experiences, I’ve had these experiences” (Interview 25). Similarly, a school psychologist described how her knowledge of the challenges Black students often face informed her attitudes toward her work: “[I feel] a heightened sensibility to the challenges that Black youth and families face when the family system is existing in impoverished communities, encountering high rates of community violence and some of those social predictors of risks” (Interview 35).

Participants also reported understanding the prevalence of mental health stigma and its manifestations within Black communities. Most participants described believing that Black clients often must traverse systemic challenges and cultural taboos to seek therapy. The therapists perceived of a paucity of culturally competent providers in the profession—not to mention the relative scarcity of culturally competent Black therapists—to deliver appropriate services to Black clients. These factors also seemed to affect how the participants understood and valued their work with Black clients. As described below, therapists across disciplines and experience groups discussed their understanding of stigma and its effect on their work with Black clients. For example, one psychologist practicing in a college counseling center described her experiences of this phenomenon:

When I work with African American clients we also talk about help seeking. We talk about mental health concerns that go undiagnosed in our families. We talk about the nuances of our historical legacy. What it means to be strong and redefining that in a way that’s more functional because a lot of times, the definition of strength that’s given is that we’re supposed to endure everything, be everything to everybody. And this is particularly for women, but for some men as well in terms of traditional gender role stuff. So we interrogate that a little bit more than I do with other clients (Interview 1).

One social worker in a community mental health setting made similar observations:

A lot of my work with Black clients [has been with] people who have been relatively new to the therapeutic relationship or having therapy at all. So a part of our work has had to deal with what they may perceive as a stigma to receiving services. Their belief that working with a therapist is going to be helpful at all (Interview 32).

Participants reported that being Black provided them with a nuanced understanding of the issues their clients face, which in turn enhanced their ability to work effectively with Black clients.

Easier and Faster Therapeutic Connections

Participants indicated that having a shared understanding of Black communities enhanced their therapeutic connection to Black clients. Across all groups of experience, nearly every participant reported frequently establishing easier and faster therapeutic connections with Black clients than with non-Black clients. These connections were far more likely when differences in SES and racial identity between the client and the therapists were minimal. One psychologist practicing in a forensic hospital, described both being more comfortable and perceiving clients as being more comfortable in same-race therapeutic dyads: “I think with, and this is overall with Black clients, there’s a familiarity . . . sometimes an unspoken level of comfort that comes into play that isn’t always there with cross-cultural dyads” (Interview 34).

Specifically, participants identified feeling more comfortable with Black clients and feeling more able to communicate in more culturally congruent and often direct ways in comparison with their work with other clients. The use of cultural idioms and a shared vernacular was helpful for both participants and their clients in communicating effectively. For example, one psychologist observed a difference in the tone of her sessions with many Black clients: “I think there’s a different use of humor in the room. With talking about things that most of the time, they get my references, which are more culturally based” (Interview 24). Another psychologist spoke about understanding vernacular common in Black communities, which enabled the participant and his clients to communicate more comfortably:

The whole thing with code switching, it’s just easy to do with Black clients. That’s part of that starting with some common ground. On some common ground. Just being able to code-switch with them . . . ’Cause they probably appreciate that, and I appreciate being able to speak with them that way (Interview 4).

Better communication with Black clients most often led to participants feeling a greater connection to them. Generally speaking, participants did not describe their relationships with Black clients solely in terms of transference and countertransference. While some used those terms, many participants used words like “family” to describe these relationships as exemplified by the counseling center psychologists’ comments below:

I think all my clients elicit this, but maybe it’s a little bit more with Black clients. I think the parent in me comes out. I think the big brother in me comes out more, maybe more, with African American clients (Interview 4).

It’s probably maternal, maternal or sisterly, or it’s very family [in] spirit. Like looking out, helping out that next generation the way that I was helped. That whole process of reaching back and pulling forward. Wanting to do that, feeling like it’s a part of what you’re here to do. Like this is, someone helped you, so you help someone else (Interview 23).

Though participants often spoke in language connoting familial relationships and feelings toward their clients, they rarely described their connections to many Black clients as problematic or as unchecked countertransference. For these therapists, being connected to their Black clients was viewed as an extra component of the relationship that often positively affected their perceptions of the work.

Greater Commitment to Black Clients

Not surprisingly, the therapists in the study noted that the nature of their work with Black clients could differ based on the differences in the therapeutic relationship. Specifically, participants often reported going beyond the traditionally defined role of a therapist with Black clients, and often served as mentors and role models for their clients. One psychologist in private practice described his experience of having lunch with his client as an exemplar of how his work with Black clients can differ:

For example, there’s a kid that I’m currently seeing . . . and this is a kid, for all intents and purposes, that’s been sort of abandoned in a way by many people in his family. And so, he’s just hungry. Emotionally, he’s hungry . . . but every time he comes, I have lunch, and we eat. Because he needs to be fed. And, while I think it complicates rapport and the therapeutic alliance, at the same time I think it meets a need. Now, I’ve never done that with any client. I’m not sure if I would or wouldn’t do that with a White client. I’ve never exactly run into a White adolescent with the same kind of needs this kid has. But I think there’s something about him being Black and having so much promise. And I don’t want to see that promise missed (Interview 2).

Having a commitment to Black clients often prompted therapists to behave in ways to level the figurative playing field for those Black clients, who they perceived as having fewer advantages because of their race. Participants often described teaching clients to navigate predominately White spaces and live in a society that often devalued their existence. Other participants, like the social worker practicing in a college counseling center quoted below, described feeling invested in making sure Black clients could be successful in systems that may not be designed for their success: “I’m really invested in making them successful. And also, they’ll come in with—they might come in and I help them understand the system. How to survive the system; how to be successful” (Interview 9).

Potential Perils of Working With Black Clients

Participants also reported that dual relationships were more likely in same-race dyads, as the therapists were more likely to share the same social space. Whether at church or at a sorority mixer, participants indicated having to negotiate different boundaries, because of the increased chance that they would encounter a client outside of the therapeutic setting. One psychologist discussed this dynamic in light of living in a small town and seeing his clients at events within the Black community:

I think one of the difficulties with Black clients in a town this small and where there are not so many of us, I often see clients outside of here at other functions. So if there’s a sorority or fraternity function, I’m gonna see clients there, Black clients there. If it’s an MLK celebration, I’m going to see Black clients there. You know, so anywhere we’re in numbers, I’m going to see somebody that I see in therapy, so I think that’s difficult at being able to manage those dual relationships (Interview 4).

Participants described being more likely to encounter their Black clients in social gatherings and spiritual communities and concomitantly needing to negotiate social spaces and therapeutic relationships differently.

Just as the potential for sharing social spaces with clients forced many participants to examine their relationships with Black clients critically, having clients relate to them in more familiar ways was also a challenge that most participants faced. Therapists described Black clients as wanting to have closer, more personal relationships with them. Some participants like the counseling center psychologist quoted below described feeling pulled to use more self-disclosure in sessions, which required diligent monitoring in order to maintain appropriate professional boundaries:

I think the boundary setting is really important and to be aware again of what, if we are speaking about clients, what a client’s needs are first and foremost because some of them need the motherly connection, some of them don’t. Whether or not I’m thinking about it, I think you always have to be aware of your reason for doing things. So it is that self-awareness on that part of me as a therapist and giving the client what I think that they need (Interview 11).

Participants also described the possible perils of overidentification with Black clients. While these participants did not use the words “transference” and “countertransference” solely when describing their relationships with Black clients, they did suggest having learned to be vigilant to avoid emotional enmeshment with their clients. Participants in their mid- and late-careers, particularly, reported having more difficulty maintaining appropriate emotional boundaries with Black clients during the earlier stages of their careers. For example, one later career psychologist described his earlier experiences working with Black clients:

Sometimes when I had Black clients, I identified with them and invested in them so much that I might not have pushed them in the way they needed to be pushed. Or I might not have helped them develop something they may have needed to develop. Because I was so busy caring about . . . being helpful (Interview 28).

While acknowledging the potential rewards of working with Black clients, participants also recognized how being the same race as their clients could lead to complications for themselves and their clients. Having to negotiate boundaries in ways that both acknowledged a shared sense of culture as well as the line of professionalism necessitated by therapy was a challenge nearly all participants reported experiencing.

Learning to Work With Black Clients

With rare exception, participants endorsed receiving inadequate training in graduate school about working with Black clients. Most early- and mid-career practitioners reported having a class in multicultural counseling—particularly those not trained as psychiatrists—though most of these participants perceived themselves as having not been prepared for the complexities of working in same-race dyads.

In my graduate training we did have I think one or two courses on working with African Americans, not African Americans, I’m sorry, working with minority students in general . . . I know for sure I had Multicultural Counseling. And then I think we got to, I took an elective, but it had nothing to do with counseling but it was just about psychology of racism and stereotypes. You don’t get that many electives in counseling psych programs (Interview 7).

In the absence of adequate training, many participants learned by doing therapy with Black clients. A mid-career psychologist practicing in a college counseling center described her first experience working with a Black woman client as being instructive about her expectations of Black clients and the dynamics that may occur within same-race dyads:

I found, particularly with the first African American client I worked with . . . I was so pumped. And I was like, “Ooo, a Black woman!” And I had all these thoughts in mind of what working with her would be like. And she was more Pre-Encounter in terms of her racial identity. So it was more challenging than I thought, and actually I was her positive encounter with Blackness that helped her, helped her to shift. And I didn’t realize that until after the fact. So I think early on I had expectations, and because that was my first experience, it helped me to shift and see, “Okay, we might look alike but there’s some very different dynamics that can take place, just identity-wise” (Interview 1).

Attending continuing education workshops, often presented by professional organizations with predominately Black memberships (e.g., Association of Black Psychologists), was another often-reported mechanism that participants learned about the nuances of working in same-race dyads:

When I was in graduate school, there were no courses in diversity. So the training that I’ve had has come about through continuing education, so to speak. Going to conferences and, doing workshops, and that kind of stuff…APA, Association of Black Psychologists, National Council School of Professional Psychology, American Orthopsychiatric Association, Black Social Workers (Interview 2).

Some participants also indicated that being mentored by more experienced (and most often, Black) therapists was another valuable mechanism for learning to work most effectively with Black clients. Though this method of learning was less common, participants, like the early-career psychologist quoted below, who had mentors with whom they could discuss their experiences in same-race therapeutic dyads were enriched by that experience:

The two supervisors that I feel the most comfortable with and that I can be very vulnerable and open with, I look back and I have to be quite honest and say that they both are supervisors of color. And not to say that my other supervision that I received was just not as valuable; it was just as valuable. But when I think about again how vulnerable I was able to be, how comfortable I was with them, and even sometimes discussing issues of race and culture, I think it was always easier for me to do that with a supervisor of color (Participant 12).

Differences Based on Therapist Practice Setting, Gender, and Years of Experience

Therapist Work Setting

More than any other variable, practice setting seemed to dictate how participants experienced their work with Black clients. Black therapists practicing in counseling centers, schools, and hospitals more frequently reported that Black clients were relatively few and far between, which contributed to the therapists experiencing their work with Black clients as unique and more interesting. Paucity of Black clients was not the only contributing factor, as even participants practicing in these settings who had predominately Black clients were more likely to report experiencing their work with Black clients as more interesting and fulfilling. These therapists were also substantially more likely to report feeling more connected to and having different expectations of Black clients. Participants in these settings were also more likely to discuss feeling more invested in client success in contrast to participants working in community mental health settings.

While many participants discussed the impact of SES on their work with Black clients, these issues appeared to be more salient for participants in community settings. For these therapists, differences in SES seemed to be a point of contention and disconnection with many of their Black clients and often contributed to clients distrusting them. This may have been exacerbated by the fact that participants in community settings often described having nonvoluntary clients, which was far less likely in therapeutic other settings. Other factors may have contributed to this distinction, as the overwhelming majority of participants practicing in community setting were therapists licensed at the master’s level, whereas participants practicing in college counseling centers, community hospitals, and schools were overwhelmingly educated beyond the master’s degree. Beyond educational differences, participants practicing in community settings tended to work with adults, whereas as participants in other settings worked most often with young adults and children.

Therapist Gender

Among all 36 interviews, participants’ gender did not seem to significantly affect how they experienced same-race dyads. Within each of the three experience groups there were other, slight differences that emerged between the responses of men and women but these differences were not consistent across groups of experience. The sole difference related to gender across the three experience groups was that female participants tended to elaborate more in their responses than did male participants. Consequently, interviews of female participants tended to be slightly longer than those with male participants, though the interview content did not vary significantly between female and male therapists.

Therapists’ Years of Experience

As previously stated, the overwhelming majority of participants in each experience group endorsed the themes reported earlier. However, there were subtle patterns that separated the responses from therapists in each group. Early-career participants were more likely to report feeling caught off guard when their relationships with Black clients were not characterized by mutual affinity for one another. These therapists seemed to expect to establish closer relationships with Black clients and were sometimes surprised when such relationships did not develop. In contrast, participants in their later careers often described struggles of maintaining appropriate boundaries with Black clients that happened earlier in their careers as mental health providers. These therapists tended to discuss the challenges associated with same-race dyads using the past tense, suggesting that they no longer experienced navigating these therapeutic relationships as being problematic.

Two distinct patterns emerged among the mid-career participants’ responses. The first was that these therapists described the increased use of self-disclosure as a common intervention strategy when working with Black clients. Second, mid-career participants more often described their connections to Black clients using language that characterized their feelings as parental. Such language was far less common among the early or later career participants. The participants’ work setting may be a factor, as 10 of 12 mid-career participants had current or previous experience practicing in college counseling centers—the highest proportion of college counseling center practitioners by far. Additionally, one final pattern emerged when looking at participants’ description of how they learned to work in same-race dyads. In contrast with early- and mid-career participants, late-career therapists were considerably less likely to endorse receiving formal training related to working with Black clients or issues of cultural diversity. An overwhelming majority of the early- and mid-career participants reported having such exposure as a part of their professional training. Beyond the differences described above, little variance in participant responses emerged based on years of experience.

Discussion

This study sought to better understand Black therapists’ experience in same-race therapeutic dyads. The current findings suggest Black therapists experience their work with Black clients as distinct from their work with other clients. They often find working with Black clients as rewarding—though the setting in which they work with clients may significantly affect their perceptions of experiences with Black clients. More broadly, regardless of their theoretical orientations to therapy, these findings support the assertion that Black therapists use their identities, experiences, and knowledge of the Black community to inform how they related to Black clients.

As reported by other research (e.g., Bell-Tolliver, Burgess, & Brock, 2009; Speight, 2012), racial solidarity was a key factor influencing participants’ work with their Black clients. This sense of connection to the experiences of other Black people enabled participants to understand issues within and outside of Black communities that could affect their Black clients as well as relate to their clients on a more personal level. While fostering a strong emotional connection between therapist and client is often conceptualized as transference and countertransference (Hayes et al., 2011), the current study highlights another level of identification between disengagement and enmeshment within same-race therapeutic dyads. This identification appears to foster a deeper connection from the therapist and a more rewarding therapeutic encounter. This identification between client and therapist may in part explain why Black clients often prefer working with Black therapists (Cabral & Smith, 2011; Townes et al., 2009): Black therapists feel connected and committed to Black clients and find working with them enjoyable. A logical assertion, therefore, is that feeling fulfilled positively affects the relationships Black therapists build with their Black clients.

Despite the fact that Black therapists often enjoy working with Black clients, the current findings suggest there may be some caveats. As a popular adage in Black communities warns, “Your skin folk ain’t always your kinfolk.” Participants’ feelings of connection to Black clients were qualified by myriad factors, including client SES, practice setting, and possibly therapists’ educational level. Black clients’ perceptions of perceptions of privilege and racial identity (i.e., is the therapist “Black enough”) often negatively affect how they relate to Black therapists (Ayonrinde, 1999; Boyd-Franklin, 2003; Ferguson & King, 1997). Participants practicing in community settings may have been more likely to experience negative evaluation from their Black clients because of differences in SES, and thus were less able to connect with some Black clients. Indeed, participants who practiced in community settings were less likely to endorse a universal feeling of connection to their Black clients. Coincidentally, these therapists were also more likely to be educated at the master’s level. Whether educational attainment affects same-race dyads among Black therapists was not the focus of the current study, though future researchers may wish to examine how this variable may affect Black therapists’ experiences of same-race dyads.

The length of participants’ career was a variable examined in the current study, and indirectly, the effects of participants’ ages. Though participants were not asked to disclose their ages, their years of practice may provide information that may be useful in interpreting the data. In general, the data suggest that working with younger clients tended to elicit feelings of connection and often protection. For mid-career practitioners who tended to have more experience in college counseling center settings, age may be an important factor in their experience of the relationships with Black clients. By virtue of having 10 to 19 years of experience, one may extrapolate that these practitioners are close to the parents of the college students they see. This dynamic may explain why this group of participants, more than any other, tended to use language that connoted a parent-like relationship.

Implications

The most obvious implication of the current study is the need for better training on working within same-race dyads among Black trainees. Regardless of when they entered the profession, participants’ responses suggested that their academic training insufficiently prepared them for the nuances of working with other Black people as clients. The participants had little to no training about issues that arise within same-race therapeutic dyads. While therapist educators may assume Black therapists intuitively possess the requisite skills to work with Black clients based on their life experiences, this study suggests this assumption is erroneous. Scholarship on this topic is still in its nascent stages; however, changes at the programmatic, institutional, and disciplinary level can improve the training of Black therapists in the interim.

Accrediting bodies must begin to interrogate how courses define therapeutic relationships and recognize how such definitions may tacitly discourage therapists-in-training from feeling a sense of solidarity with their clients. In cautioning trainees against emotional enmeshment with their clients, educators may inadvertently teach students to restrain their therapeutic relationships to disallow for feelings of mutual solidarity. Therapist educators must instead teach trainees to avoid having dual relationships that may obfuscate clinical issues while simultaneously acknowledging that therapeutic relationships—like all human relationships—are nuanced and complex. Adopting a broader approach to therapeutic methods courses may also help Black trainees intervene with their clients in ways that feel more culturally congruent. Infused in the cultures of people of African descent are often traditional African notions of spirituality, human connectedness, and the union of mind, body, and soul (Graham, 2005; Parham & Parham, 2002). Teaching traditional African healing methods in therapeutic interventions courses would be one way to incorporate such values in therapist training, though that would likely be difficult given the paucity of educators versed in such techniques. An alternate, more practical strategy would be to expose students to the practice of mindfulness, which also teaches ideas of the fundamental goodness of human nature, the interconnectedness of all beings, and awareness of mind and bodily sensations. Mindfulness has been shown to facilitate therapist self-reflection and meta-cognition (Shapiro & Carlson, 2009), which scholars have recently advocated for in the training of psychotherapists (Jones-Smith, 2012; Ridley, Kelly, & Mollen, 2011). Implementing such changes would likely strengthen the preparation of not only Black students, but all therapist trainees as well.

The current study also suggests that having mentors of color can significantly and positively affect Black therapists’ development of competencies working in same-race dyads. At the institutional level, this means that more educators of color are needed to serve as mentors, instructors, and supervisors to Black therapist trainees. Participants in this study indicated that working with supervisors who understood the nuances of Black identity and its possible manifestations in therapy was important in their skill development. With tightening hiring budgets and a paucity of people of color serving as teachers and supervisors within the profession, it would be difficult for therapist training programs to hire Black faculty en masse. Programs may instead be able to cull Black therapists who are willing to mentor Black students from their clinical and adjunct faculty ranks. Programs can leverage their connections to practitioners in their communities in order to match Black students with mentor-therapists. Additionally, organizations such as the Association of Black Psychologists, the National Association of Black Social Workers, and the Association of Black Psychiatrists may be useful in helping locate Black therapists. Programs may also supplement this mentoring by sponsoring trainings by experts on this matter for their students. In these ways, training programs may bolster Black students’ exposure to senior Black therapists even if no Black therapists serve as full-time faculty members.

In the absence of such professionals, all therapist educators must become acquainted with issues of solidarity, racial identity, multiple identities, and systemic and internalized racism in order to effectively educate Black therapists-in-training to work in culturally competent ways in their communities. These educators must be prepared to help Black trainees manage the emotional valance that often accompanies working with Black clients and help them discern between feelings of solidarity and ineffective emotional boundaries. Doing so requires a more nuanced understanding of such issues rather than simply labeling trainees’ emotional reactions as countertransference or overidentification. Myers, Young, Obasi, and Speight (2003) asserted that therapists must know the history and current manifestations of oppression along with the unique cultural worldview to effectively conceptualize or treat the mental health problems of people of African descent. Hence, one can glean that therapist educators must be aware of the same issues to understand the plight of their Black students.

Limitations and Future Directions

The current study provides a unique look at the experiences of Black therapists’ experience with Black clients. Issues inherent in qualitative research and the design of the study suggest researchers must take care in the interpretation of these data. Participants in this study were voluntary and uncompensated. Hence, this self-selected group of therapists may have been drawn to participate in the study (and perhaps to their work with Black clients) because of their belief in the salience of same-race dyads as well as their affinity for Black people. Furthermore, some demographic factors may limit generalizability of these results to the population of Black therapists as a whole. First, male participants were outnumbered by more than two-to-one in this sample. Second, because of the original intent of the study, two thirds of this sample was composed of psychologists, and the majority of participants practiced in college counseling centers. Because of the rigorous analytical method employed, we are confident that the current findings would be replicated with a different group of Black therapists, though it is possible that these results are idiosyncratic to this sample. Beyond sampling, this study did not directly assess how the age of participants may have affected their experiences within same-race dyads. The authors argue that the use of years of experience serves as a proxy for age, though they acknowledge that participants’ ages have not been explicitly factored into the findings.

Several research questions for future inquiry emerged from this study. The first is how therapists’ level of education (i.e., master’s vs. doctoral degrees) and client population (i.e., children, adolescents, or adults) affect therapists’ sense of connection to Black clients. The current data suggest the possibility that educational attainment and client age affect therapists’ experiences within same-race dyads, and further study could either substantiate or disconfirm that hypothesis. Similarly, whether Black therapists use of self-disclosure is related to their years of experience could also be clarified in further studies. Future researchers may also explore the dynamics of same-race dyads within supervision. Given the clear implications for the importance of having mentors and educators of color for Black therapists, it would be useful to examine more clearly how sharing the same race of one’s supervisor may enhance or complicate these relationships. A handful of scholars (e.g., Kelly & Boyd-Franklin, 2005; Goode-Cross, 2011b; Jernigan, Green, Helms, Perez-Gualdron, & Henze, 2010) have examined supervisory dyads with two people of color, though both studies looked at relatively small samples and only one exclusively examined these dyads among Black therapists. Future research may help psychologist educators better under the limits and pitfalls inherent in supervisory same-race dyads. The current study examined Black therapists’ distinct experiences of working within same-race therapeutic dyads as experienced by Black therapists. Future researchers may wish to explore this phenomenon among Black therapists throughout the African Diaspora.

Footnotes

Acknowledgements

The authors wish to thank the therapists in this study for their participation and support. They are also thankful to Denisha M. Gingles, Donald Georgette, and Dalya Y. Hassan for their diligent work as data analysts.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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