“Can I really tell my therapist this??” Building trust with BIPOC clients.
When you begin therapy, you will notice that there will be several questions asked about your history. Some of the questions included in the process touch on the topics of past psychiatric history, cultural background, and family history. History taking is an essential part of therapy, regardless if you are a BIPOC (Black, Indigenous, People of Color) client or not. But if you are a BIPOC client, I make sure I know as much about your culture/ethnic background as I can both by educating myself but also by listening to your story. I believe knowing your cultural history is crucial because, from my own personal experiences and what I’ve seen in clients, culture has a big impact on how we show up and navigate this world.
As a BIPOC woman myself, I am acutely aware of the cultural differences that have impacted my life and how they, in turn, have affected how I present myself to others. There are several common themes that I see when I work with BIPOC clients. Usually, at the beginning of their therapeutic journey, “code-switching” is quite prevalent, even when sitting across from someone BIPOC themselves! Code-switching was originally intended to mean alternating between languages while conversing with others, but it has shifted to include changes in behaviors and voice tones in order to fit the majority (See the link below). For example, many BIPOC individuals have a “phone voice.” This is where individuals will shift their tone and/or way of speaking to avoid being stereotyped or looked down upon. During the first few sessions, I will notice individuals code-switching, trying their best to say the “right” things in the “right” way to avoid being judged. I know this because I notice a shift in their behavior and demeanor the more sessions we have, and I’ve done it myself in what would be considered “professional settings.” Code-switching may lead to feelings of not being safe and eventually inauthenticity. Feelings of “ I can’t be me.”
Something I also have noticed with BIPOC clients is the tendency to avoid discussing specific topics about themselves or their history during sessions. After further analysis, this is usually because they feel they may be judged or misunderstood or may not perceive the topic as necessary. The being misunderstood piece is what is crucial. Specific topics are viewed differently depending on the culture. For some cultures, something may be considered “wrong” or “traumatic,” while for other cultures, it may be considered “the norm” or “respectful.” For example, in some cultures holding a parent’s opinion in high regard is typical, while others may firmly push for autonomy and setting your own standards. For this, as a therapist, it is important for me to understand the importance of family status for my clients and how that influences their lives—not trying to push boundaries that go completely against their cultural views or beliefs.
TIPS:
What should you look out for in a culturally thoughtful therapist? See if they are inquiring and speaking openly about culture and race. Not only about yourself, but when warranted, acknowledging what is currently occurring in society that may be influencing you personally. Also, be aware if they are making an effort to be inclusive. This may include a therapist asking direct questions about yourself instead of assuming your experience is similar to other BIPOC individuals. Also take notice if they are normalizing any resistance you may have during sessions. This is not associated with BIPOC individuals exclusively, but it is more apparent given the history of stigma for BIPOC individuals seeking mental health services. Lastly, when your therapist is in the process of using psycho-education, see if they are including subjects specific to BIPOC individuals. This can be informative in letting you know of their knowledge and awareness of systemic disparities and any other cultural stigmas. So what should a client who is BIPOC do? Be completely honest with yourself and your therapist. Don’t question if your words and/or tone are “correct” or “proper.” Try your best to get past the impulsive desire to change your mannerisms just because of what society has deemed “acceptable.” If you feel hesitant to touch on a specific topic because of fear of judgment or being misunderstood, take small steps to express it. We’re not here to judge, and there’s no rush. There have been times when I've shared personal, cultural experiences to help clients understand that I, too, am human and have experienced things that are normal to my Hispanic culture but not other cultures.
Don’t question, “Can I really tell my therapist this?” You can! I always aim to provide clients with a space to be themselves and feel safe and comfortable. If you want to crack a joke, do it! If you want to speak your native language, speak it! I personally speak Spanish, but if you speak another language, I would love to hear it! Even in different languages, a deeper understanding can be found.
Code-Switching at Work: What It Is and Why You Need to Understand It. (n.d.-b). https://www.betterup.com/blog/code-switching
