The origins of modern psychotherapy date back to Sigmund Freud in Vienna in the late 19th century. At that time, patients visited Dr. Freud several days a week to lie down on his couch and say anything that came to mind. During treatment for mysterious emotional or behavioral difficulties, Dr. Freud, who didn’t say much during the session, was the ultimate authority: interpreting, diagnosing, and prescribing treatment.
Psychotherapy, in its original form, though helpful, wasn’t without its problems. It could be a judgmental environment where someone didn’t know what it was like to be his patient (most were women), and it made determinations about the source of their problems and describing them as defensive if they disagreed.
The development of the technique mostly centered on wealthy women of European descent, so it’s easy to see that many of us were excluded from that equation.
Why the Community Might Forego Treatment
Although Sigmund Freud left this Earth 82 years ago, he’s who many of us picture when thinking of the early days of therapy. Combine that with the legacy of the Tuskegee experiments and the result is People of Color, particularly Black people, often believe therapy isn’t for them. Many Black people don’t think they’ll be comfortable telling a complete stranger about themselves and there is also the sense that therapy wasn’t designed with them in mind. These are major hurdles to overcome.
The Effects of Systemic Racism
Due to the challenges caused by systemic racism (e.g., the effects of approved treatments not having been validated among People of Color, having cultural factors misunderstood, devaluing the fact that people from different cultural backgrounds often live a different experience from “mainstream culture” which, in turn, impacts their health) many communities of Color have opted to take care of themselves in an insulated fashion.
Some examples of keeping concerns “in the family” are seeking advice and support from the community, speaking with clergy, and, as a last resort, looking for the ever-elusive Black therapist. It seems as though these are efforts to make sure values, culture, and identity are understood and appreciated before showing the soft underbelly of vulnerability.
How Therapy Has Changed Since its Inception
The truth is therapy has come a long way and isn’t just for white people. Sometimes we encounter challenges that require the expertise of a mental health professional. In the 100+ years since psychoanalysis came on the scene, new theories, ways of understanding people, and ways of providing help have been created.
For example, there are many approaches in which the therapist and client take on roles as co-collaborators. Something I often say to clients is, “You’re the expert on you.”
This is because it’s true.
Therapy today is much less about the therapist being the judgmental expert and the client is at the mercy of their interpretation. Therapy can be a place of profound healing where someone who has your best interests in mind walks beside you and helps you through the work. Another very important change is that more individuals from a wide variety of experiences and backgrounds have entered the field. This has profoundly changed how we understand the work we do, the types of services that are offered, and the progress that the field now knows it needs to make.
What Does This Mean for You?
What does that mean for you, the Black person wondering if you can take a chance on therapy? Well, it means a few things: first, while finding a mental health professional from a similar racial/ethnic background may be simpler than it was 50 years ago, you need not have a therapist who looks like you in order to make a connection and be profoundly understood. That said, you do want to establish the type of relationship in which you can discuss your differences and how that impacts your therapeutic relationship and your life in general.
Second, there are many different perspectives and techniques used by therapists. You might not yet know your preference, but it’s worth asking a potential therapist how they work with clients.
And third, if you have someone in your community you trust (a physician, pastor, or friend), you might ask them to whom they typically refer. Sometimes knowing that someone you already trust feels good about a mental health professional can help us along on the road to therapy.