Is it better to see a therapist of your own race, gender or sexual orientation?

A friend of mine posted to Facebook the other day, seeking to see a therapist who was a woman and a person of color, like her. This stirred up the question in my mind: Is that a better outcome for someone?

In thinking about this question, I think the most important guideline here is obvious: It’s all about you. If you are more comfortable seeing someone whose demographics and experience match your own, then that needs to happen (although that can be a challenge). There is little more important to the ability to get real value out of therapy than the strength of the relationship between a patient and their therapist, and if having someone of your race and gender is important to you, than you should certainly do whatever you can to make that happen.

The good news, however, is that research indicates that having a therapist of your race or gender is not a requirement for positive outcomes, as long as you and your therapist are comfortable with any demographic differences.

In 2011, Brigham Young University conducted a meta analysis of studies (thanks to Joe El Caraballo for the catch). The meta analysis found:

  • There was a “moderately strong” preference for a therapist whose race/ethnicity matched the patients and a “tendency” for patients to view therapists of their own race/ethnicity more positively than other therapists.
  • However – and this is arguably more important – in terms of outcomes, the meta analysis found that there was “almost no benefit” when it comes to matching patients with therapists of the same race/ethnicity.

The analysis went on to note the importance of teaching cultural competency for all therapists, ensuring that they are able to appropriately treat patients from all walks of life. That was a theme in a Guardian article on the subject, which noted the importance of that competency. From the article:

Dior Vargas, a 28-year-old Latina mental health activist, recalls a therapist in college – her second one – who she stopped going to after realizing she was “culturally incompetent”.

“She wasn’t aware of how close-knit Latino families are. That they are a part of my decision-making process. My therapist didn’t understand that, she would say: ‘No, you need to stand up to your mother.’ That felt very disrespectful to me. Maybe sometimes you do, but the way she said it made me very defensive.”

The article also noted the challenges of gender from the perspective of an African-American male client and a white female therapist:

With one white female therapist, he says he felt his gender and race made her treat him like a threat that needed to be controlled. “She shut me down when I expressed anger. The response was you need to stop your anger, as opposed to “let’s work with that and figure out why you are angry,” which would have been a healthier therapeutic response, he says.

I think these two examples really cut to the heart of the issue. A “mirror match” isn’t necessary. Cultural competency and sensitivity is.

On a personal level, that’s been my experience. I’ve seen three therapists in my life who have really, truly made a positive difference, and all three were men. My counselor in college was gay, my first psychologist was a straight white Jewish male (so basically me), and my current psychologist is a straight Venezuelan immigrant. While these were characteristics which I obviously noticed, it’s never something that I felt made an impact in my therapeutic experience. That’s because they all understood my background.

In retrospect, I suppose that the Jewish therapist did understand some things about my upbringing and culture which would have been impossible for another therapist to truly understand, having not lived with it, but I never felt like this was a barrier. When I would explain things to them, they would fold that information into further conversations. They never judged, never questioned and never made me feel like I was wrong for feeling a certain way. While my upbringing wasn’t their experience, they never used their own experiences to color mine in a negative way.

As always, I’d love to hear what you have to say – what has been your experiences in this area? Positive? Negative? Let us know in the comments below!

An in-depth look at suicide statistics in the United States

Before you can truly solve a problem, you have to have a better idea of what that problem is.

In my policy-making career, I’ve taken a long look at suicide reduction.  I’ve come to the conclusion that there is no one-size fits all approach; different demographics require different solutions.  We know there are certain groups more likely to commit suicide, and those groups require different interventions.

First, here’s a look at what the American Foundation for Suicide Prevention has found.  The basic statistics are tragic:

  • Suicide is the 10th leading cause of death in the United States.
  • 44,193 Americans die by suicide.  That’s an increase of 25% since 1999.
  • For every completed suicide, there are 25 attempts (Note: Terminology matters – “committed” or “successful” suicide have negative connotations, and “completed” suicide is a much more appropriate term).

Now, this is a broad overview.  Let’s take a closer look at these numbers in-depth.

Gender

According to the CDC:

Males take their own lives at nearly four times the rate of females and represent 77.9% of all suicides.

One of the reasons for this: Men are more likely to attempt suicide via a firearm, which is much less survivable than other suicide methods.  This is also despite the fact that women attempt suicide three times as often as men.

Race

In most mental health related fields, it is members of the minority community who are on the wrong end of the statistics.  That being said, for race, the reverse is true: Whites have the highest suicide rates of any ethnicity, followed by American Indians.  African Americans, Hispanics and Asians are well behind.

More research certainly needs to be done in this realm, but at least one researcher suggests that, “White older men, however, may be less psychologically equipped to deal with the normal challenges of aging, likely because of their privilege up until late adulthood.”

Age

While suicides have been increasing across all age groups, those of middle age (45-64) have the highest rates of suicide, followed by those 85 or older.

What is particularly striking and tragic is where suicide falls in terms of leading causes of death.  It is the 3rd highest cause of death for those 10-14 and 2nd for those between the ages of 15-24 and 25-34.

Method – and gun ownership

49.8% of all completed suicides result from firearms, with suffocation (26.8%) and poisoning (18.4%) as the next most used method.  It is important to note that there is a strong link between gun ownership and suicides.  Suicide rates are higher in states where there are high levels of gun ownership, and lower where there are low rates of gun ownership:

The lesson? Many lives would likely be saved if people disposed of their firearms, kept them locked away, or stored them outside the home. Says HSPH Professor of Health Policy David Hemenway, the ICRC’s director: “Studies show that most attempters act on impulse, in moments of panic or despair. Once the acute feelings ease, 90 percent do not go on to die by suicide.”

But few can survive a gun blast. That’s why the ICRC’s Catherine Barber has launched Means Matter, a campaign that asks the public to help prevent suicide deaths by adopting practices and policies that keep guns out of the hands of vulnerable adults and children. For details, visit www.meansmatter.org.

As I hope this entry has demonstrated, “suicide” should not be viewed as a monolithic disease or condition.  It varies from person to person, group to group.  We have to treat is as such, and ensure that any treatment effort addresses the many various demographics that suffer from suicidal idealization or attempts.