The Importance of Conversations About Race in Clinical Practice

When it comes to race, saying nothing is saying something.

Race, racism, and inequality penetrate every facet of our society, so ignoring them is sidelining issues that shape many people’s identities and lives.

Today, the nation is involved in a contentious discussion about equity, policing, and institutional racism. Yet some behavioral health professionals are reluctant to bring up race with clients.

When and where is it okay to talk about race? 

And how do behavioral health professionals approach race and racism in treatment spaces?

Open the Door to Discussion

In this Psychology Today article, Naomi Torres-Mackie EdM, PhD, writes: “Many therapists never ask, ‘What is it like to be Black?’ ‘To be white?’ ‘To be biracial?’ or ‘What prejudice have you experienced (or not experienced) because of your race?’”

She shares a story of treating a cisgender Black woman and waiting three months before exploring her race‑based experiences. The client thought her experiences were off limits, or the therapist didn’t care about them—which meant she didn’t care about her, because race is central to her experience of living in this world.

“When therapists are supposed to be curious about the entirety of their clients’ lived experience, leaving this topic out is a failure to fully understand the lived reality of their clients,” says Torres‑Mackie.

One of her top suggestions is to bring up race in the very first session with clients. Ask them about their racial identity when you are getting to know them. That way they understand that talking about race is not off limits: it is welcomed and encouraged as part of the healing process.

The Myth of Colorblindness

Have you heard people say the phrase, “I don’t see race”? 

That’s a harmful misconception, and one that was cultivated in elementary schools around the country in a misguided attempt to wish away our country’s painful history of racism.

In the Connecticut Women’s Consortium training, Racism and the Myth of “Colorblindness,” Mara Gottlieb, PhD, LMSW, provides some context and valuable insights for behavioral health professionals seeking to understand more about the ways that race affects our day‑to‑day lives. 

The course explores the history of race and racism and how this history has shaped our identities, power structures, and institutions, including the criminal justice system.

When we learn to identify bias in ourselves, in our culture, and in our society, we become more effective clinicians, and better human beings. 

Facing Racism

As the late great author James Baldwin wrote, “Not everything that is faced can

be changed, but nothing can be changed until it is faced.”

When it comes to racism, we have a lot to face and a lot to change. 

There are many paths to becoming educated about race, oppression, and privilege. When we have a shared understanding of the kinds of barriers, challenges, and injustices that people of color have faced in this country, we can better understand the types of racialized trauma that Black and Brown people experience.

Anti‑racism, cultural humility, and diversity, equity, and inclusion (DEI) workshops offer a chance for people to demystify, understand, and begin to dismantle racism. 

What Is Racism? 

In Racism and the Myth of “Colorblindness,” Dr. Gottlieb begins with a basic explanation of what race is and what it isn’t.

• It is the differentiation or categorization of people based on skin color, hair texture, or the shape of someone’s eyes, nose, or mouth. 

• It is historically constructed, and the definitions of race have shifted over time.

• No racially specific genetic markers exist; there is greater variation within racial groups than between them.

• Racism is race prejudice + power. 

A History of Racism

American history is full of examples of how power has been wielded to create a violent and unjust society. The following are just a few examples:

• The massacre of more than 13 million Native Americans and theft of their land.

• The trans‑Atlantic slave trade, where colonists from Spain, England, Denmark, and other European countries brought enslaved Africans to labor on American plantations.

• The accumulation of wealth based on the free labor of Africans.

• The building of railroads by low‑paid Chinese workers.

• Institutionalized barriers to people of color owning land such as the Homestead Act of 1862

• Housing practices such as “red lining” that confined Black residents to certain neighborhoods.

• The 13th Amendment to the US Constitution that allows prison labor.

When we look at the way privilege and racism have shaped our world, we can more clearly see the reality for many of our clients—and the impact of growing up internalizing messages of inequality and hate.

Race in Therapy

Because so many people have experienced the traumatic effects of racism, many antiracist educators believe that a first step for clinicians is to approach our lives and our trauma-informed practices with a sense of cultural humility. 

That starts with listening to our clients’ stories and experiences—and honoring the strength and wisdom they already possess.

It also means understanding that their relationships with the behavioral health community have often been damaged by racism. Too many harmful stereotypes have made their way into treatment practices because of implicit bias. Disparities in the mental health system mean that people of color are less likely to seek out and receive high-quality mental health care.

If cultural humility is a first step, where do we go from there?

6 Tips for Conversations about Race

Torres-Mackie offers some practical tips for getting off on the right foot when it comes to discussing race with clients.

1. Ask about a client’s racial identity during the first session when you are getting to know them.

2. Make it clear that you ask these questions of all clients because you understand the importance of group identities.

3. Indicate that it is fine to not answer the question.

4. If they do answer, ask follow‑up questions like, “How did adults in your early life help you think about racial differences?”

5. Even if clients are white‑passing, ask questions because you can’t assume what their experience is, and racial identity affects us all.

6. If you are a white therapist, seek out training and education to understand your own privilege and how it affects your life and practice.

Necessary Discomfort

Because race and racism have sometimes been taboo topics, it might feel uncomfortable to bring them up at first. 

Some clients won’t be ready to talk about race. 

However, if we approach these conversations with cultural humility and genuine curiosity about this important topic, we move one step closer to dismantling the toxic force that has harmed so many lives.