Psychotherapy Bulletin

Psychotherapy Bulletin

As the family play therapy session drew to a close, my young patient, Madison*, began to begrudgingly return the dollhouse to its usual orderly state and place the simplistic wooden figures back into their bedrooms with care.  I remember smiling and playfully nudging Madison to action while patiently listening to a brief, but passionate, protest to the end of the session. My focus then turned to the patient’s parents as we began the mundane task of discussing the logistics of the next session, including the introduction of my patient’s sibling, Morgan, into the therapeutic dyad.  At the time of this appointment, we had worked together for several weeks on the goal of improving the family’s communication and conflict resolution strategies in the midst of raising a child with cognitive and developmental concerns.  As a unit, we had experienced much together in our brief therapeutic relationship; we had laughed together when the patient told us jokes and we cried together when the patient’s parents painfully reflected about how no classmates had accepted their child’s birthday party invitation.  In the midst of my brain attempting to juggle retaining the recently completed therapeutic work, planning ahead for the next session, and trying to negotiate my upcoming commitments for the following week in order to schedule our next appointment, it happened.

“…And don’t worry, I warned Morgan that you were Black.”

The words rolled out of my patient’s parent’s mouth with such ease, but pierced my ears with such unavoidable force as she left the office with a loving wave and smile.  And there I was, left with those words in my head and a stunned look on my face as the door slowly closed and I was left in the empty play therapy room with only my thoughts and my fears.  Upon reflection on that moment, I always wished that I had some witty retort to give, something like that of a sitcom where my comeback would have been followed by audience applause and hollering of solidarity.  But no witty retort was uttered from my mouth and instead I was left in stunned silence while coming to terms with the deafening truth:  Becoming a psychologist would not guard against or camouflage me from the stereotypes associated with my Blackness and, as soon as therapy ended, I would be, to some, just another potentially “dangerous” Black male.

As in many therapeutic interactions, both similarities and differences in culture can cause themes of power and privilege to surface within the therapeutic space.  For Black clinicians specifically, maintaining authenticity and staving off assimilation are main concerns for therapists given the psychological community’s often-homogenized demographics (Minsky et al., 2006).  When I look back upon the moment retold above, the strongest feeling I felt was a feeling of banishment from the therapeutic space.  With her comment, I felt violently thrown into a position where I had gone from being so closely knit with this family to occupying the role of the “other” in the room.  Whereas before it was “us against the world,” I now felt like my every move was being analyzed to either support or disprove stereotypes of people I have never met, but who look like me.  This would inevitably hamper the therapeutic work if it were not addressed in an appropriate and swift manner.  Thankfully, via the support of both my school and my individual supervisor, I was able to process this incident in a space where I felt supported and heard.

A key aspect of this particular clinical situation was how to address this comment with the family given the way in which it elicited such a visceral reaction in the moment.  The goal of this eventual conversation with the family would be to acknowledge the comment, but do so in a way to promote further discussion, not limit it.  Although race, ethnicity, and culture may not be spoken about in therapy, these constructs are always present in therapy given the seen and unseen cultural affiliations and biases of both the clinician and the patient.  In situations involving a cross-cultural therapeutic relationship, there exists a conscious and subconscious expectation regarding the course of therapy for both the patient and the clinician (Minsky et al., 2006) and this reality cannot be ignored.  My supervisor did an amazing job of both recognizing and validating my initial anger, but encouraging me to look deeper into the context of the comment to better understand the motives and meaning behind the statement.  Through deeper analysis of the context of the situation and through the eventual conversation with the parent, I was able to honor my humanity by recounting my initial shock and also honestly listen to her reasons for making the comment.  Although the work eventually continued and the patient and his family were able to make great progress in treatment, I never truly could cast aside her words and the feeling of forever being an outsider to this well-functioning unit I had helped create.

I felt especially concerned about what this particular family thought of me due to the realization that, in the world of clinical psychology, my presence and the presence of men who look like me is unexpected and uncommon.  Although it is commonly understood and appreciated that African American and Caucasian clinicians have similar training and capabilities as therapeutic supports for children (Abrams et al., 2006), there are an underwhelming number of African Americans in the field of psychology and psychiatry.  This demographic imbalance can be related to several key factors, including psychology’s regrettable history of mistreating minorities, especially African Americans (Richards, 2012), as well as other factors that many draw African American candidates towards fields other than psychology.

Based upon the 2011 article of Michalski and Kohout, it was estimated that only 2.7% of American psychologists are African American, compared to Caucasian psychologists occupying 87.5% of the workforce.  When these numbers are examined further, the number of African American male psychologists is even lower, reflecting the historic discrepancy between Black male and female academic achievement and the general low number of males in the field of psychology (Willyard, 2011).  This not only impacts the field as a whole but it also impacts the general expectations of patients when they enter the office to meet with “Dr. Jonathan Jenkins,” a name that gives no hint of culture, racial affiliation, or skin tone hue.

This harsh reality was one of the driving forces behind me writing an illustrated children’s book called Wednesday Afternoons with Dr. J (Jenkins, 2014).  This book was created as my Doctoral Project at the University of Denver Graduate School of Professional Psychology. In doing so, I sought to provide children with a fictional narrative in which the main character, Ari, engaged in psychotherapy with a safe, successful, warm, and engaging professional Black male psychologist named Dr. J.

The main reason for the creation of the book was to have the narrative address several misconceptions that youth frequently have about psychology, including confusing the roles of psychiatrists and psychologists, whether they will “get in trouble” for talking about certain emotions, what confidentiality means in psychotherapy, and what a clinician may due to keep a child safe.  Due to the amount of evidence to support the importance of parental psychoeducation in child psychotherapy outcomes (Mendenhall, Fristad, and Early, 2009), the psychological community has produced numerous resources explaining child psychotherapy to adults.  Although this is a helpful addition to the literature, the main target audience of the child patient is lacking in resources and acknowledgement.  For me, it was important to explain key aspects of therapy directly to children in order to empower them to be more engaged in psychotherapy and to help them advocate for their mental healthcare needs when necessary.

Given how children are often strongly encouraged or “forced” to attend therapy by the adult caregivers in their lives, it is important to provide them with appropriate acknowledgement of their unique perspective as the patient who is without total control over the course of treatment, or even confidentiality.  Additionally, children are just as capable as adults of harboring misconceptions about therapy or prejudices regarding emotions, and their concerns need to be addressed with the same attention and nuance as adult patients.

Another goal of the book was to utilize it as an arena to foster dialogue about topics such as race.  By having two characters of different ethnic and racial backgrounds interact in the narrative, the audience has the opportunity to discuss this dynamic and the various ways in which culture or identity might influence the relationship between the patient, the family, and the clinician.  As a child, I grew up devoid of many examples of people who looked like me in children’s books, cartoons (Klein & Shiffman, 2009), and television.  In addition to the lack of viable role models, the expectations for people with brown skin were, and continue to be, somewhat limited, given how many in our community view people with darker skin tones as either primarily athletes or prone to criminal behavior (Eberhardt, Goff, Purdie, and Davies, 2004).  This lack of fictional and actual role models who occupied professions that I was interested in as a child had a tremendous impact on me and made me feel like there were several professions unavailable and unobtainable with Black skin, with the most salient childhood example being President of the United States.

The power of narratives with main characters of various skin tones was first highlighted in Ezra Jack Keats’ 1962 beloved and award-winning story The Snowy Day, which was the first story to chronicle an African American child in a normal and undistorted narrative where the child was effortlessly integrated into the story instead of unduly highlighted for her or his race.  During the 50th anniversary of the story, an NPR segment highlighted how Keats purposefully wanted to craft a holistic narrative with a minority child, which he saw as an especially important endeavor during the 1960s with the Civil Rights Movement and segregation at the forefront of the nation’s collective consciousness.  The success with which Keats was able to accomplish this task is best observed in the remarks from a teacher who wrote to the author after using his book in her classroom with her young students: “The kids in my class, for the first time, are using brown crayons to draw themselves.  These are African American children.  Before this, they drew themselves with pink crayons.  But now, they can see themselves” (NPR, 2012).  For me, the creation of Wednesday Afternoons with Dr. J (Jenkins, 2014) was so that both Black children AND Black male psychologists could see themselves.  As much as I wish that my book provides motivation for young minority children to explore a career in psychology, I am also conscious of how the book can provide solace and support to those already in the profession as they look down at the cover and see themselves looking back at them.

Upon reflection, that moment in the empty play therapy space, born from such a confusing and painful moment in my life, birthed a meaningful and beautiful retort: a book that will advocate for the mental healthcare needs of ALL children, while also speaking to the talents of ALL psychologists in the community.  In the end, the book is a love letter from me to both my brown skin and my profession, both of which I have learned to love more dearly since that day in the empty play therapy room.  Cue the studio audience applause and hollering of solidarity.

*All identifying information has been disguised to protect client confidentiality.

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Cite This Article

Jenkins, J. (2015). That day in the empty play therapy room. Psychotherapy Bulletin, 50(2), 7 – 10.

References

Abrams, L., Post, P., Algozzine, B., Miller, T., Ryan, S., Gomory, T., & Cooper, J. B. (2006). Clinical experiences of play therapists: Does race/ethnicity matter? International Journal Of Play Therapy, 15(2), 11-34. doi:10.1037/h0088913

Eberhardt, J. L., Goff, P. A., Purdie, V. J., & Davies, P. G. (2004). Seeing Black: Race, crime, and visual processing. Journal of Personality and Social Psychology, 87(6), 876-893. doi:10.1037/0022-3514.87.6.876

Jenkins, J. (2014). Wednesday afternoons with Dr. J. Charleston, SC: CreateSpace Publishing.

Keats, E. J. (1962). The snowy day. New York, NY: Viking Press.

Klein, H., & Shiffman, K. S. (2009). Underrepresentation and symbolic annihilation of socially disenfranchised groups (“out groups”) in animated cartoons. Howard Journal of Communications, 20(1), 55-72. doi: 10.1080/10646170802665208

Mendenhall, A. N., Fristad, M. A., & Early, T. J. (2009). Factors influencing service utilization and mood symptom severity in children with mood disorders: Effects of multifamily psychoeducation groups (MFPGs). Journal of Consulting and Clinical Psychology, 77(3), 463-473. doi:10.1037/a0014527

Michalski, D. S., & Kohout, J. L. (2011). The state of the psychology health service provider workforce. American Psychologist, 66(9), 825-834. doi:10.1037/a0026200

Minsky, S., Petti, T., Gara, M., Vega, W., Lu, W., & Kiely, G. (2006). Ethnicity and clinical psychiatric diagnosis in childhood. Administration and Policy in Mental Health and Mental Health Services Research, 33(5), 558-567. doi:10.1007/s10488-006-0069-8

National Public Radio (NPR) Staff. (January 28, 2012). “The Snowy Day”: Breaking color barriers, quietly.  Retrieved from http://www.npr.org/2012/01/28/145052896/the-snowy-day-breaking-color-barriers-quietly

Richards, G. (2012). Race, racism and psychology: Towards a reflexive history (2nd ed.). New York, NY: Routledge/Taylor & Francis.

Willyard, C. (2011).  Men: a growing minority.  GradPSYCH, 9(1). Retrieved from http://www.apa.org/gradpsych/2011/01/cover-men.aspx

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