Beginner’s Mind #11: On Wanting to Be a Good Therapist for Black Patients

I awaited Henrietta, knowing that I wanted nothing to do with her today. We had only started seeing each other the week of Labor Day, and our work had started calmly enough. In our first hour together, she told me she was seeking therapy to help her find new ways of dealing with problems in her life that needed urgent attention, like helping her widowed grandfather find a better nursing care facility and aiding her brother in building a professional life for himself following his lengthy incarceration. She was clear from the outset that she didn’t want to work on “deeper things,” which was shorthand for all of the emotional issues and traumatic experiences that her previous therapists had wanted her to focus on: as she put it, “I just don’t see the value in therapy if it’s only going to focus on things that are so unproductive.”

Had I known beforehand what Henrietta was looking for in therapy— or more to the point, what she was hoping to avoid—I might never have started working with her. I am neither good at nor interested in problemsolving forms of therapy that bypass any exploration of the deeper forces that influence how minds work and how people grow across time. But, ultimately, I chose to work with Henrietta, and the primary reason I did so was because she was black. I have seen only a small handful of black patients in my practice over the years and felt very motivated to do so now, having been stirred so painfully and deeply by our nation’s collective conversation about race in the wake of George Floyd’s murder and the subsequent protests. I want to be the kind of therapist that black people want to work with, I told myself, and Henrietta provided me a real opportunity to develop that aspect of my clinical work. We started seeing each other once a week on Fridays over Zoom.

Our first meetings felt tense and disjointed, but not altogether different from the initial sessions I have had with other patients. I was immediately struck by the way Henrietta presented herself to me: She spoke in a very deliberate way, appearing to make a concerted effort to use words that made her sound intellectual, sophisticated, and highly familiar with the jargon of psychotherapy (as when she once observed, “I hear you attempting to build therapeutic rapport with me via supportive mirroring reflections and transference interpretations”).

Despite my initial efforts to get a better sense of her life and upbringing, Henrietta only spoke of her previous experience in the most abstract and indecipherable of terms, and at times flatly refused to share certain parts of her life with me, as when she told me that discussing her marriage was “off limits” because “my marriage is important to me and I don’t want any therapist to get inside my head and change how I feel about it.” This would become a frequent refrain of hers in our brief time together—that therapists like me had the power to invade her mind and alter the way she perceived and made sense of her life and self. Henrietta wore all black clothing and wore a black mask for each of our sessions, despite the fact that she always called me from a sheltered area in her back yard. I never once had the opportunity to see her full face.

In our third session, I noted to Henrietta that her way of speaking and presenting herself seemed very intentional, as though it was meant to present an image of herself to the world that she wanted others to see, perhaps to the exclusion of other parts she wanted to keep hidden and protected. She shot back: “Well, that’s only because there are real forces in the world that seek to subjugate black people, and especially black women, and strip them of their rights and autonomy and intentionality if they show even a hint of weakness. When I call a white male therapist who works in a fancy office building in Madison Park, I don’t assume I am on safe ground at all and I need to protect myself accordingly.” The hostility in Henrietta’s tone blindsided me, and I felt it was completely unwarranted and hurtful. Her implication—that I, as a white man, was an agent of systemic racism with every intention of dominating and humiliating her, a black woman— rankled me.

Things between Henrietta and I deteriorated from that point on. For the next two months, every one of our sessions almost immediately devolved into a brutal bombardment, with Henrietta accusing me of being an awful therapist with neither the ability nor the willingness to give her what she was “really looking for.” Any attempt I made to try to emotionally connect with her was either met with intellectualized dismissal (as with her aforementioned comment about “building therapeutic rapport”) or outright attack. “You are an absolutely terrible listener,” she told me early on, a comment that gave me the distinct impression that she was saying the things she felt were most likely to wound me. It is painful to admit now that they did wound me: Every session left me feeling utterly incompetent, guilty, and profoundly ashamed of myself for ever having thought that I could be her therapist.

In the first moments of our second to last session, Henrietta told me that we were “not a good fit” for one another and that she was more than likely going to be quitting therapy soon. Thank goodness, I responded inside, relieved at the thought of being rid of her and embarrassed by it all at once. “What you say to me makes no sense,” she said. “‘Object relations,’ ‘psychoanalysis,’ ‘attachment theory’—these modes of therapy only focus on pathology, trauma, when what I really need is a therapist who is going to recognize my strengths and give me support that will actually help me with what I want to deal with.” She paused, then concluded: “not the things that some privileged therapist wants me to focus on.” I never once mentioned object relations or any other therapeutic modality to her in our sessions and figured she had read my biography on my website and had researched those terms herself. Whatever those terms may have meant to me, they seemed to mean something completely different to Henrietta; a heap of useless psychobabble that could not have been a bigger waste of her time.

Hearing this, I tried my best to communicate that I understood where she was coming from, and I genuinely thought that I did. I could imagine how many well-intentioned (and likely white) therapists she had seen, each of whom was fundamentally misattuned to Henrietta’s needs, choosing to overemphasize the pathological impact of her early traumatic life on her current functioning, without paying any attention to the strengths Henrietta could build upon to tackle the real problems in her life. Whatever I may have said about this, however, clearly made no difference in how she felt: “You’re not listening,” she commented tearfully. Hard as it was for me to hear her say this, Henrietta’s tears gave me a glimpse of the depth of the sadness and isolation within her. In that moment I felt real empathy for her for the first time.

When Henrietta arrived to her session on the first Friday in December, she dismissively told me that this would be our last session and that she was “done” with devoting time to a therapeutic cause that “only makes me feel worse every time I take part in it.” After a brief pause, I simply replied to her that I had heard what she said and this would be our last hour together. This seemed to touch something in her, and for nearly the rest of the session she wept from behind her black face mask. She looked for all the world like she was fighting back an ocean of tears that threatened to wash her away. I sat there, listening silently. I knew the therapy was over and decided to simply listen and to feel the weight of her sadness as thoroughly and deeply as I could feel it. At some point near the end of our time, I commented about the sadness I could feel in her tears and how hard she seemed to be trying to hold them back. A moment of silence passed, and then Henrietta shook her head, looked into the camera, replied, “I gotta go,” and abruptly ended the call.

***

Two weeks ago, as I was reading a chapter from a book entitled The AfricanAmerican Experience: Psychoanalytic Perspectives (Akhtar, 2014), I encountered the following passage: “Patients in the African American community are rightfully opposed to being pathologized, because from their vantage point it makes them the problem as opposed to reaching an understanding of how those problems emerged with concomitant strategies to resolve them” (Powell in Akhtar, 2014, p. 67)

Reading this passage made me think of Henrietta. Looking back on our first meetings together, I believed I tried with genuine good intent to help her in the way that I know how to be helpful; by listening, validating, and empathetically offering my thoughts about how her current problems could most meaningfully be understood by placing them in the context of the entirety of her life. That was what I knew I could offer, what I wanted to provide her, and yet reading this paragraph made me realize how little any of that had to do with what Henrietta might actually need from me. It was not understanding and insight she was asking for; it was concrete help with real problems faced by her and so many people like her in this systemically biased country of ours. Perhaps Henrietta would have been better served not by a well-meaning white male therapist interested in using his black patient to develop his credibility as a white-therapist-whodoes-good-work-with-black-people.

That is not to say that Henrietta would not have benefitted at some point from the kind of empathic insightoriented object relations therapy I might have one day provided her. In fact, I think she could have benefitted from it immensely. And I hold in mind the very real possibility that any therapist might have had a hard time with a patient as rigidly defended as Henrietta was, a woman who may have been prone to an almost psychotic kind of negative transference with any therapist she worked with. But in addition to all that, I now believe there was no way that I could do good work with Henrietta, given what I wanted from her and what she was looking for from me. If nothing else, I am grateful to Henrietta for teaching me something that I have learned and forgotten many times in my work; that if there is to be any hope of good work being done in therapy, it will be due in large part to the therapist meeting the patient where she is and who she is in the present moment. It is a lesson I will continue to learn over and over, and hopefully forget less and less.

References

Powell, D. (2014). Psychoanalysis and African Americans: Past, present, and future. In S. Akhtar (Ed.), The African American experience: Psychoanalytic perspectives (pp. 59- 84). Lanham, MD: Rowman & Littlefield.

Jeff Grant, PhD, received his MA in existential psychology from Seattle University and his PhD in clinical psychology from Pacifica Graduate Institute. His dissertation was entitled “A Psychoanalytic Exploration of Father Death and its Impact on the Adolescent Ego-Ideal.” He is currently a board member at COR and maintains a private practice with adults and adolescents in Madison Park.

Categories: Beginner's MindPublished On: January 21st, 2021Tags: