How to Practice Therapy Inclusively

What does it mean to be an inclusive therapist and how can you get there?

 Illustrated by Marcy Gooberman

Illustrated by Marcy Gooberman

Many therapy skills can be learned once and then implemented. A therapist can learn to fill out insurance paperwork. They can learn the rules about being a mandated reporter. They can learn about specific interventions to use in sessions. Inclusivity, however, is not a one-and-done skill. Being a truly inclusive therapist requires continuous engagement with principles of social justice and intersectionality.

Here are some thoughts on how therapists can practice inclusivity in an authentic, integrated way.

Understand The History of Oppression in Psychotherapy

A therapist who is truly inclusive will work to acknowledge and deconstruct oppressive therapy practices that have harmed marginalized identities for as long as the field has existed. Because our understanding of psychology is culturally and socially situated, therapy has always inherently mirrored the patriarchal, racist, sexist, ableist, transphobic, etc. power structures of our larger society.

For example, over the decades, sexism has resulted in mothers being blamed for causing autism and schizophrenia in their children. Similarly, sex-negative cultural values caused healthy sexualities to be pathologized. Women who masturbated or were too sexually active could historically be committed to mental institutions. Homosexuality was an official mental health disorder until 1987.

Oppression in psychotherapy continues in the present day. Currently, women are diagnosed with Borderline Personality Disorder three times more often than men. Clients who attempt to discuss racism or racial justice with clinicians are often dismissed as being oversensitive or as misinterpreting events. Trans and gender non-conforming folks often have to rely on a therapist’s official recommendation before pursuing gender confirmation surgeries. These are just a few ways in which modern therapy continues to pathologize and maltreat marginalized individuals.

Any therapist that advertises themselves as working with a particular community should have a thorough understanding of how psychotherapy has impacted this identity through history.

Be Aware of Personal Limitations

A truly inclusive therapist will also need to understand that they won’t be talented at treating every single type of individual. Of course, a therapist and client do not necessarily need to share an identity to accomplish meaningful work together, but therapists need to be aware of strong biases (because we all have them) and understand when these biases might prevent them from working effectively with a client.

If a therapist truly believes that there is something bad or ethically wrong about a client’s worldview or way of life, this is a pretty good indicator that the therapist may not be able to work effectively with that client. This impasse could show up in a lot of ways. It could mean that a devoutly Christian therapist finds it impossible to work with a queer client, or perhaps a young, female therapist could find it impossible to work with sex offenders or men who have physically abused others.

Similarly, a clinician may want to consider referring a client to another therapist if they simply do not have the knowledge needed to treat the client robustly and cannot easily gain access to that knowledge through a professional training. For example, a therapist may have no issue with a client who is polyamorous, but that therapist may not feel they have adequate relationship knowledge or experience to be able to guide this client confidently.

Respect the Agency of the Client to Self-Identify

An inclusive therapist will also trust and validate the client’s understanding of their own identity. During the course of therapy, clinicians will often challenge clients to think about issues from a new perspective. However, only a client can define their own identity and share how that identity has impacted their experience of daily life. An inclusive clinician will truly listen and honor a client’s experience of identity.

Furthermore, an inclusive clinician should be actively curious about a client’s central identities and ask questions or offer perspective that helps the client more deeply connect with these identities and use them as a source of positive self-expression. Each clinician will have a different way of doing this, but the client should feel supported for who they are. A client should not feel a need to constantly defend or explain why a certain aspect of their identity such as race, gender, faith, religion, etc. is important or relevant to their treatment.

Know How to Take Feedback Professionally

An inclusive therapist will know how to authentically respond to feedback from clients. The client always has the right to ask for what they need in therapy and to request adjustments in treatment. After all, the client is paying for therapy!

It can be really scary for clients to bring up an issue with their therapist. A good therapist will be able to receive constructive comments professionally. This means that if the client raises a concern, the therapist will give the client the space to fully express themself. Ideally, the therapist will reflect the concern back to the client to make sure he, she, or they has understood the feedback properly. If this happens, hopefully, the client and the therapist can discuss what functional changes need to be made in the therapy relationship. The client should then observe in the next few sessions whether the therapist was capable of making the changes the client needed.

Educate Yourself

Finally, an inclusive therapist will understand that marginalized individuals often bear the burden of educating others about oppression. Many clients may find it helpful to discuss the impact of oppression such as racism, sexism, or homophobia on their lives. However, it can be unfair to ask clients to use their time in therapy to teach or explain these concepts to the therapist.

If a therapist is completely unfamiliar with a term or some aspect of identity that their client brings up, the therapist should check out resources written or produced by individuals who share that identity. Though there is no guarantee a client will have the same feelings or experiences that show up in the literature, this can help guide the clinician in asking questions that will be meaningful to help the client understand themself rather than resulting in the therapist asking the client unhelpful questions that are common knowledge to their community.

Keep Reflecting and Practicing Self Compassion

Our culture’s understanding of power, oppression, and identity continues to morph and change very rapidly. It is an impossible feat for any therapist to possess a deep knowledge about all marginalized groups. For this reason, it is incredibly important for any therapist to have reflected on their own position in society, their privileges, and their oppressions and to give themselves time to understand how this impacts their approach to therapy.

Again, this process is a lifelong journey that takes attention and intention. Committing to inclusivity in the practice of therapy is incredibly rewarding as it deepens your connection to humanity in all its forms. The work is not always easy. Therapists will find themselves in situations that make them feel uncomfortable, out of their depth, and challenged. If you are a therapist aiming to become more inclusive, remember to practice self-compassion and remind yourself that you have put yourself in this position so that you may grow and provide more effectively for clients in the future.

 

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Louise is an associate marriage and family therapist who writes about sex and relationships. Want more juicy facts about sex from a feminist, research-based, perspective? Check out more of her writing and follow her on Instagram @swoon.sex.ed.