A good relationship between client and practitioner is salient to effective treatment. It helps clients connect with therapy fully, and encourages them to remain in it as well.
As a reminder, I decided to speak to some Londoners between the ages of 18-24 years old who’ve accessed or attempted to access mental health services here. Combining personal anecdotes, testimonials, opinions, and research, I’ll highlight their experiences. For their own privacy, participants will remain anonymous.
While the chemistry between a client and their practitioner can depend on differing personality traits and characteristics, one factor that can also be a make-or-break for many minority-identifying clients is whether their practitioner shares those identities. “It can be useful for people who […] identify certain ways to have access to counsellors who also identify that way” a participant explained. This idea was echoed by other interviewees as well. Why is this?
Minority Stress and Perceived Discrimination
To understand this factor, we must address the unique impacts on mental health that only minority groups face. The unfortunate truth is that our society was built on the oppression of certain people. Many groups face oppression and discrimination in multiple facets of their lives, on top of regular hardships that don’t pertain to their identities.
To give a broad example: racism can manifest as having your resume thrown out because you have a foreign name. Job interviews can be hard for everyone. They can be even more challenging for a racialized person applying to a predominantly white workplace. Marginalized folks might grow up feeling alienated, even in supposedly “welcoming” places like schools, which only adds on to school-related stressors. Running errands is tiring, but it can also be daunting if you belong to a population at risk of hate crimes. The list could go on, but the takeaway is that there exists unique, inescapable compounded hardships and stressors for marginalized groups of people.
Next, we have to understand how these additional adversities impact mental health. I’m East Asian and queer. Both of those aspects of my identity have influenced my life immensely because they affect how I’m perceived and treated by others, and thus, how I view myself. Marginalized identities aren’t easy cards to be dealt with, and many of my interviewees brought up similar points: that navigating the intersections of your identity can be strange and difficult, and knowing how the world views you because of your race, sexuality, or gender, is heavy to hold.
What I’ve just described is called minority stress. Minority stress theory proposes that marginalized individuals are predisposed to greater stress levels than their non-marginalized counterparts because of prejudice and discrimination in society. It’s important to note that this is not only about individual experiences, but also about how prejudice and discrimination exist in institutions, structures, and social processes. Minority stress explains that greater stress levels in marginalized people negatively impacts their mental and physical health. Another element that feeds into minority stress is perceived discrimination, which heightens your stress response, as illustrated in the diagram below.
Cultural Competency and Cognitive Distortions
Numerous interviewees also mentioned the lack of and necessity for cultural competency. That is, understanding the importance of culture and having the skill to adapt interventions to meet culturally-specific needs. There is a lack of adequate services in cities (this article speaks specifically to Hamilton, but could be applied elsewhere), including at educational institutions. One participant even cited her institution’s total lack of racialized counsellors. So, where does this leave racial minority adolescents and students?
Several participants revealed this answer as they discussed the increased stigmas and barriers facing racial minorities, including people from migrant families. Many cultures don’t approach mental health the way “Western” society does. An East Asian participant mentioned how uncommon it is for East Asians to seek help for mental health or neurodevelopmental disorders, such as autism. A South Asian woman lamented that counsellors at her university lacked cultural and religious understanding. They would judge her when she tried to explain how values in her culture prevented her from following particular advice.
For those who have accessed cognitive-behavioural therapy (CBT) before, cognitive distortion may be a painfully familiar term. Simply put, it’s an inaccurate pattern of thinking that convinces people of things that aren’t true. Examples include making overgeneralizations or focusing only on negatives while discounting positives. Unfortunately, the attempt to correct cognitive distortions can become a way to gaslight or invalidate minorities’ real experiences when used by practitioners who lack cultural competency. A participant I spoke with shared some of her racialized therapist’s insight, that “therapists [who] aren’t minorities won’t go the extra step to talk about how the world at large is imbuing cognitive distortions within us.” Systemic racism is the issue.
One participant acknowledged she would feel more comfortable with a non-white counsellor because they would understand how it feels to experience racism. Another shared her experience having to explain how race affected her life to a white therapist, adding that switching to a racialized therapist was beneficial. To racialized individuals’ detriment, there is a deficit of racialized practitioners, especially within our educational institutions’ counselling systems, the most convenient and accessible resource for many students.
Misunderstanding of LGBTQ+ Identity
In contrast, some 2SLGBTQ+ participants believed that their therapists over-emphasized the importance of their queerness. When they went to therapy for help with mood or stress, but also mentioned that they were 2SLGBTQ+, their therapist would focus on the latter, even if it meant dismissing the issues the participant needed help with. One participant recalled a psychiatrist listing “transgender” as one of his problems, even after he explained that being trans wasn’t the reason he’d reached out for help.
Others explained that they were more comfortable being vulnerable with queer practitioners. Some were particularly uncomfortable sharing their experiences with cisgender (meaning not transgender) and heterosexual practitioners. One interviewee commented that there’s “a huge difference between a therapist with lived experience versus one who’s just an ally.” They shared that whenever they brought up being queer, their practitioner would react with surprise.
There’s also the risk of having a practitioner who is homophobic. A lesbian participant opened up about a time her university doctor referred her to a psychiatrist with known homophobia allegations. When she brought it up to her doctor, he insisted there was no hard proof the psychiatrist was homophobic. Another participant addressed homophobia within their school’s administration. They felt that having to walk past their campus’ ministry chapel to get to counselling services reiterated to them how unwelcome they are, despite the school’s insistence on its inclusivity.
What Does This All Mean?
In an ideal world, there would be no systems of oppression. In a less ideal world, institutions would hire a diverse range of mental health staff and work to remove barriers for minority students wanting to become mental health professionals. For our current situation, the first step is bringing awareness to the issue, which is what I hope this article can do. Londoners need to be aware of the added barriers minority students and adults face within the mental health system and acknowledge that they deserve better. As stated by one participant, at the very least, “people should have the opportunity to see their identities reflected in their therapist.”
Feature photo by Jessica Ticozzelli.
This is Part Three of a series by Teigan Elliott exploring the mental health system in London, Ontario. Part One and Part Two cover the failings and suggested improvements of the mental health system.